Modelling estimates have shown that there are 390 million dengue virus infections annually, with 70% of the actual burden being in Asia, among which the vast majority are children. Since dengue and COVID-19 share several clinical and laboratory features, cases of misdiagnosis, serological cross-reactivity and co-infection have been reported, further complicating management. 

Dengue has been classified and described since 1997 and underwent many revisions thereafter, but they all failed to identify standard, quantifiable clinical endpoints which are needed to ensure reproducibility and comparability of research findings, thereby limiting its application in research studies, such as studies aiming to study the safety, efficacy and effectiveness of a dengue vaccine or therapeutic agent. Thus, an expert working group assembled in 2015 used the Delphi method of interactive consensus-driven guideline formulation to formulate dengue disease severity endpoints, optimal for use in clinical trials of dengue therapeutics and vaccine research. Consensus described most parameters including, moderate and severe plasma leakage, bleeding, and organ involvement (liver, heart and neurologic disease). The experts concluded that severe vascular leakage is an entity distinct from other severe manifestations such as bleeding or organ dysfunction thus can be used as a reliable endpoint for intervention research. The definitions for mild and severe dengue disease were established, while a clear definition of ‘moderate’ disease severity was considered as a need for conducting cross-validated research. 

Sreenivasan, et al. concluded that vascular leakage as manifested by clinical fluid accumulation, and hemoconcentration measured by hematocrit ≥40%, are important manifestations that are predictive of a shortened time towards progressing to severe dengue. These findings demand more surveillance and supplement other studies of clinical endpoints in dengue. The hallmark of severe dengue, especially in the younger age group, is vascular permeability causing plasma leakage, and subsequent circulatory shock and its consequences, can prove life-threatening. The authors also described the importance of other clinical manifestations like persistent vomiting and mucosal bleeding in predicting time to severe disease progression. Early recognition and close monitoring, along with the timely institution of appropriate management can lead to therapeutic success among children with dengue infection. 

The current pandemic situation has diverted the resources to address the devastating effects of COVID-19, but the toll of ongoing infections such as dengue must not be forgotten. The overlapping challenges of dengue and COVID-19 warrant an urgent action for continued disease surveillance, ongoing attention to clinical and environmental management and increased focus on research needs.

Source: Indian Pediatr. 2020 Oct 15;57(10):895-896. doi: 10.1007/s13312-020-1987-3. PMID: 33089802; PMCID: PMC7605470.