Dengue Among Children: Early Detection Crucial To Prevent Severe Complications

KUALA LUMPUR, Feb 27 (Bernama) -- Dengue remains a significant public health concern in Malaysia, where the country is classified as an endemic zone with the virus widespread across all regions.

Among those most at risk are children, who are particularly vulnerable to severe dengue, a condition that can deteriorate rapidly and lead to life-threatening complications if not treated promptly.

Consultant Paediatrician and Paediatric Intensivist at Sunway Medical Centre, Sunway City, Dr Gan Chin Seng, said diagnosing dengue in children can be challenging as its symptoms often overlap with those of other viral infections.

“Common symptoms such as fever, headache, and vomiting are not unique to dengue, making it difficult for healthcare providers to pinpoint the virus without a high level of suspicion,” he told Bernama.

He emphasised that dengue should always be considered if a child has a persistent fever with no clear cause, particularly in areas where dengue cases have been reported.

“Blood tests are essential in confirming a diagnosis, with various tests available to detect the virus early. However, the challenge with dengue in children is that it can progress rapidly.

“While the fever may subside, this can be misleading as this signals the start of the dangerous plasma leakage phase. This phase can cause a drop in blood pressure and inadequate blood supply to vital organs, leading to shock and potentially multiorgan failure,” he said. 

Dr Gan said the classification of dengue has been updated in recent years to include “dengue with warning signs”, indicating that a child may be at higher risk of developing severe dengue.

“Warning signs include abdominal pain, persistent vomiting, fluid accumulation in the lungs or abdomen, bleeding symptoms such as gum bleeding, lethargy, liver enlargement and rapidly dropping platelet count with more concentrated blood.

“Children with warning signs will have a higher risk of progressing to severe dengue which may present with shock, severe bleeding or excessive fluid accumulation causing breathing difficulty. By identifying these warning signs, it will help the treating doctors in decision-making and the treatment of the condition,” he said.

Dr Gan also noted that severe dengue can affect the brain, leading to encephalitis (when the brain becomes inflamed), the heart, leading to myocarditis (when the heart becomes inflamed), and the liver, leading to hepatitis (when the liver becomes inflamed & congested) in dengue children with warning signs.

“Early recognition and prompt treatment are essential to prevent severe outcomes,” he stressed.

He said that multiple factors contribute to the risk of severe dengue, which can be categorised into patient-related and environmental factors.

“Patient-related risk factors include obesity, age of more than five years and above, a previous history of dengue infection, and pre-existing health conditions.

“Environment plays a significant role in dengue transmission, as areas with stagnant water serve as breeding grounds for Aedes mosquitoes that spread the virus. Living in such areas or having neighbours with dengue cases heightens the risk. Community efforts are also crucial in eliminating mosquito breeding sites,” he said.

According to Dr Gan, early diagnosis and intervention are critical in managing severe dengue.

As such, he advised parents and caregivers to be vigilant and seek medical attention if a child exhibits persistent fever, vomiting, abdominal pain, or difficulty drinking fluids.

“Early fluid management is the key to preventing kidney damage and other complications. If a child cannot drink fluids due to vomiting, they need to be hospitalised for intravenous hydration. After the fever subsides, continuous close monitoring is essential, as this period (critical phase) can be deceptively calm before more serious complications arise,” he explained.

The paediatrician and paediatric intensivist also noted that the appearance of a rash during the recovery phase is a positive sign, indicating that the child is improving.

“Besides treatment, family and public education play a crucial role in preventing severe dengue,” he said.

“Recognising the symptoms early, understanding when to seek medical help, and ensuring proper fluid intake are key messages that need to be conveyed to the public. Moreover, the introduction of the dengue vaccine has been a significant step forward in dengue prevention. The vaccine, which has been shown to reduce the severity of dengue by up to 90 per cent, is now available for children aged four and above,” he said.

However, despite the availability of the dengue vaccine, uptake in Malaysia has been relatively slow compared to neighbouring countries such as Thailand and Vietnam.

“To increase vaccination rates, public health campaigns are necessary to encourage parents to vaccinate their children, as the vaccine provides a vital layer of protection against severe dengue,” he added.

-- BERNAMA