Endemic and epidemic signatures of dengue were shown to be present in the PR VHA patient population. Furthermore, an average lag time of 7 days between the epidemic waves of inpatient and outpatient dengue cases was observed at the annual scale, not reported previously. In light of these observations, future studies will examine whether the dengue dynamics in the VHA patient population in PR, coupled with other data such as weather parameters, can be used to forecast dengue epidemics in VHA patients and perhaps inform dengue dynamics in the general population in the region. 