LAUSR

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. Infections such as dengue, tuberculosis and malaria remain a bigger challenge for children in low/ middleincome countries (LMICs) but unlike infection with SARSCoV2 have not attracted global attention and continue to be neglected. More children died of dengue in the last 2 years than from COVID19. Vaccines and antiviral drugs for dengue have not taken off despite initial enthusiasm. Unlike the vaccine trials, welldesigned 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 COVID19 pandemic has helped illustrate the importance of interplay between host and viral factors in determining disease severity. A subset of patients with COVID19 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 COVID19. Dengue infection predominantly causes an asymptomatic or mild illness. However, ~25% of those infected can develop an illness with a febrile or viraemic phase, a critical phase that coincides with the peak of disease, and finally the recovery phase. Severe dengue can develop in ~5%. Previous infection with dengue increases the risk of developing severe disease, due to mechanisms such as antibodydependent enhancement that promote viral replication.