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Immunomodulatory therapy in dengue: need for clinical trials and evidence base
  1. C S Bhat1,
  2. R Shetty2,
  3. Balasubramanian Sundaram3,
  4. A V Ramanan4
  1. 1 Paediatric Rheumatology Services, Rainbow Children’s Hospital, Bangalore, India
  2. 2 Paediatric Intensive Care Services, Rainbow Children’s Hospital, Bangalore, India
  3. 3 Department of Pediatrics, Kanchi Kamakoti CHILDS Trust Hospital, Nungambakkam, India
  4. 4 Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
  1. Correspondence to Professor A V Ramanan, Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol BS6 6BT, UK; a.ramanan{at}

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Dengue infection is a major public health problem especially in the Southeast Asian region (SEAR). The incidence of dengue is estimated at 390 million infections with a prevalence of 3.9 billion worldwide. Notably, the mortality due to severe dengue is 15.9 times higher in children under 14 years of age.1 Infections such as dengue, tuberculosis and malaria remain a bigger challenge for children in low/middle-income countries (LMICs) but unlike infection with SARS-CoV-2 have not attracted global attention and continue to be neglected. More children died of dengue in the last 2 years than from COVID-19.1 Vaccines and antiviral drugs for dengue have not taken off despite initial enthusiasm. Unlike the vaccine trials, well-designed randomised controlled trials for therapeutic strategies for dengue in both children and adults are currently lacking and hence treatment options beyond supportive care are minimal.

The recent COVID-19 pandemic has helped illustrate the importance of interplay between host and viral factors in determining disease severity. A subset of patients with COVID-19 have a stormy course due to an exaggerated immune response rather than the viraemia itself. Targeting host pathways that are exploited by viruses has emerged as the focus of newer therapies. This has resulted in a paradigm shift in the management of viral infections from supportive care and antivirals to immunomodulatory drugs. Corticosteroids, interleukin (IL)-6 receptor blockers and baricitinib are now strongly recommended by the WHO in management of severe and critical COVID-19.2

Dengue infection predominantly …

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  • Contributors AVR and SB conceptualised the idea. CSB drafted versions which were revised/amended by RS, AVR and SB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.