Abstract. Capture-recapture estimations compare the results of 2 or more independent surveillance systems for the same event, and by measuring the degree of overlap between them, provide an estimate of the total number of events, and therefore the completeness of ascertainment in each system. The Puerto Rico Department of Health and the Dengue Branch of the Centers for Disease Control and Prevention (CDC) monitor dengue activity in Puerto Rico through 2 distinct surveillance systems: diagnostic specimens from patients with suspected dengue and infection control nurses' reports on patients hospitalized for suspected dengue. The patient listings from these systems were used in a 2-sample, capture-recapture calculation to estimate the total number of persons with suspected dengue hospitalized from 1991 to 1995. The laboratory positivity rate for suspected dengue cases who submitted appropriately timed serum samples in those years ranged from 72.1% to 81.2%. The laboratory-based (diagnostic sample) surveillance system (routinely used to monitor hospitalizations for suspected dengue) detected an average of 1,197 hospitalized cases during non-epidemic years, and 4,329 cases during the epidemic year of 1994. The detection rate of this system averaged 42% of the numbers derived by the capture-recapture method. In non-epidemic years, an estimated average of 2,791 patients (range ϭ 1,553-3,481) was estimated to have been hospitalized with a clinical diagnosis of dengue, compared with 9,479 during 1994. These results demonstrate the under-detection inherent in passive surveillance systems for hospitalized cases of suspected dengue, and illustrate the value of capture-recapture techniques to better estimate the true incidence of hospitalizations for this disease.Dengue fever is an acute mosquito-transmitted viral disease of tropical and many subtropical areas. Its typical manifestations are fever, headache, eye pain, severe joint and muscle pain, and occasionally rash and mild hemorrhagic manifestations. Less frequently, infection may result in dengue hemorrhagic fever or dengue shock syndrome (DHF/ DSS). 1 Dengue shock syndrome may produce case fatality rates Ͼ 10%. 2 The dengue virus has four serotypes, and infection with one serotype does not fully protect against a subsequent infection with a different serotype; a second, heterotypic, infection increases the risk of more severe disease. 1,3 In the past 40 years, the geographic range, frequency, and severity of dengue epidemics have increased markedly. 4 Surveillance for the disease must therefore be able to detect such changes in incidence and clinical picture. Passive surveillance systems rely on health care providers to voluntarily report cases, and usually provide an undercount of cases. They may also reflect variable reporting over time and in different geographic locations; thus, it may be difficult to distinguish real changes in disease rates from artifacts of the reporting system. Capture-recapture calculations are increasingly being used to estimate the true siz...