World Mosquito Day: How Can You Manage Dengue in Children?

(20 August is observed as World Mosquito Day. In light of it, FIT is republishing this article.)

Every year in the monsoon season, India prepares for a host of monsoon-related diseases like dengue, malaria and cholera. This year, there is COVID-19 in the midst as well, and fears of visiting a hospital are high.

“There is a lot of tension about coming in for a consult, parents are worried of a COVID-19 infection. But hospitals and doctors are taking every precaution to keep patients safe, and early diagnosis of the disease can help tremendously,” says Dr Dhiren Gupta, a senior paediatrician at Gangaram Hospital, New Delhi.

Dr Gupta adds that he has only seen 4-5 paediatric patients so far, but “we do usually see a spike in the month of September.”

Viral diseases can often be more devastating for children so FIT spoke to paediatricians to find out how to care for children with dengue.

Which Children Are Most At Risk of Dengue?

Children under the age of 1 are more at risk.

Dengue is a common mosquito-borne viral disease that occurs in tropical climates such as ours. While certain environmental factors like stagnant water which attracts mosquitoes or unclean surroundings can increase the risk of infection, is there any profile type that is more at risk?

“Babies who are less than 1 year, and those around 6 to 8 years who are obese  and are exposed to mosquitos are more prone to getting complicated dengue.”

Dr Dhiren Gupta

You can get infected with mild or severe dengue. “Most of the complications happen in second dengue - that means if one has suffered from dengue and is re-exposed to it,” says Dr Gupta.

So for less than 1-year-olds, if the mother has suffered from dengue, babies carry antibodies and if they get an acute infection, they then get complicated dengue. Even for the 6-8 age range, most of the complicated dengue cases are of second dengue.

“However, while paediatric dengue patients are more vulnerable to the disease and to complications, they generally tend to recover faster as compared to adults.”

Dr Dhiren Gupta

Why is Paediatric Dengue a Worry?

Second dengue is more worrisome.

“For most paediatric patients, first dengue is comparable to a normal viral infection. But in second dengue, there is a hyper-immune phase that starts after 4-5 days.”

Dr Dhiren Gupta

Hyper-immune response - sound familiar? Scientists and doctors around the world have noticed that COVID-19 often results in an inflammatory immune response or a cytokine storm. “The same immune dysregulation occurs in both COVID-19 and dengue,” confirms Dr Gupta.

The symptoms of dengue are:

1. Fever
2. Body-ache
3. Flu-like symptoms

This mostly settles in 4-5 days, but in “1 out of 100 patients land up in the hyper-immune phase of dengue,” adds Dr Gupta.

For these patients, when the fever is supposed to settle, they end up getting low-blood pressure and various organs get involved - including the liver, kidney and the brain (again, similar to how the cytokine storm of COVID-19 can lead to multi-organ failure.)

How Can We Prevent Paediatric Dengue?

There is no way to prevent dengue, except to prevent mosquito bites.

“There is no way to prevent dengue, except to prevent mosquito bites.”

For this, we should ensure kids are well-covered, we are using mosquito repellants and nets. Besides this, we need to ensure our environment is hygenic - there is no water accumulation as stagnant water attracts mosquitos. This is harder to do in the monsoon season, where often our localities infrastructure creates puddles and water-logging.

COVID-19 and Dengue

COVID-19 and dengue have similar presentations - fever, aches and flu-like symptoms.

Would staying indoors, avoiding exposure in schools and otherwise lessen the impact this year? However, environmental factors like waterlogging or reserves of water nearby can still cause the disease.

Besides, COVID-19 has thrown other illnesses for a loop. People are fearful of coming in for a consult, other illnesses are getting side-tracked, and dengue is also a fever-differentiated illness.

COVID-19 and dengue have similar presentations - fever, aches and flu-like symptoms.

In an earlier FIT article, Dr SP Kalantri, Medical Superintendent of Kasturba Hospital and MGIMS, Wardha, Maharashtra said, “Dengue and COVID can co-exist, as shown by recent reports. COVID-19 can masquerade as dengue.”

He added that acute undifferentiated fever illnesses cannot wait even for more than 24 hours. “If you are seriously ill with dengue and your platelets are falling, you need an ICU bed,” and so people need to be vigilant for the signs.

Dr Gupta added that people who have had COVID-19 may also be at risk of severe dengue.

“So don’t be hesitant to consult your doctor if you notice any symptoms in child,” he reminds us.