Dengue Viral Infection in Children: Epidemiological, Nutritional and Genomic Analysis

Abstract

Background: The epidemiology and genomic characteristics of dengue viral infection in children have been poorly explored in Bangladesh. The study aimed to delineate the epidemiological, nutritional, and genomic characteristics of the dengue viral infection in Bangladeshi children. Method: A cross-sectional study was carried out in the in-patient department of Bangladesh Shishu Hospital and Institute from June 2023 to May 2024. Children of age <18 years admitted with presumptive positive dengue infection and presumptive negative dengue infection (NS1 and/IgM negative) with features like dengue infection were enrolled in this study. A total of 722 presumptive dengue-positive children were included for epidemiological analysis, 349 children under the age of five for nutritional assessment; 104 dengue-positive children, and 50 dengue-negative children (from another group) for genomic analysis and concomitant viral infections respectively. MedCalc online tools and SPSS version 21 were used for genomic and statistical analysis. Results: Among 722 children, 600(83%) were from Dhaka City Corporation (494 and 106 were from North and South City Corporation respectively) and 122(17%) were from outside of Dhaka. The age group of <1 Year were 91(12%), 1- <5 Year 258(36%),5- <10 Year 238(33%) and > 10 Year 135(19%). Out of all, fever was the compulsory presenting complaint, and vomiting 355(49%), abdominal pain 192(27%), loose motion 135(19%), cough 49(7%), headache 30(4%), reluctant to feed 23(3%), bleeding 18(2%), convulsion 16(2%) were present. Among all 516(71%) presented with warning signs and 206(29%) without warning signs; 82(16%) children with warning signs and 23(11%) without warning signs were admitted to the intensive care unit. Reinfection was in 39(5.4%), a comorbid condition in 79(10%) and shock was the predominant complication. Among 349 under-five children, 7 (2%) were overweight, 178(51%) normal, 153(44%) moderately underweight, and 11(3%) severely underweight. Real-Time PCR results reveal that out of 104 positive cases, 96(92%) were true positive and 8(8%) were false positive. Among 50 negative cases 17(34%) were false negative and 33(66%) true negative. Real-time PCR of nasopharyngeal swabs reveals that 12(12%) had Flu or Respiratory Syncytial Virus (RSV) in true positive cases(n=103) and 5 (19%) in true negative cases(n=26). Circulating serotypes were DEN2 87% and DEN3 13%. Genomic footprint shows that DEN-2-2023 in Bangladesh was most similar to 2018 and DEN-3-2023 most similar to 2017. Conclusion: In children, DEN2 was the most predominant serotype in 2023 among children which might be responsible for more severe diseases. Concomitant viral infection could be an upcoming concern for the dengue outbreak. Authorities should prioritize the feasibility of using Real-time PCR for dengue screening in the coming years and a laboratory network system like COVID-19 should be considered.