Dengue In Children Research Articles

Study of clinical and laboratory predictive markers of dengue fever and severe dengue in children

Introduction: Dengue fever is the most rapidly spreading arboviral infection with major public health consequences. Leucopenia, thrombocytopenia, hematocrit, elevated aminotransferases, low CRP and prolonged APTT, are useful predictive markers for early diagnosis of dengue infection. Objectives of the study: To study the clinical presentation and laboratory predictive markers of dengue fever, dengue with warning signs and severe dengue. Materials and Methods: Prospective hospital based study of 100 patients who were classified as dengue (DF), dengue fever with warning signs (DWS) and severe dengue (SD). Lab investigations included WBC count, Platelet count, Hematocrit, SGOT, SGPT, PT, APTT, INR, CRP. Clinical and laboratory parameters in the 3 groups of dengue fever were compared in the study. Results: Study group included 100 cases of which DF was 36%, DWS 52% and SD 12%. Commonest presenting symptom was fever, nausea and vomiting. Pain abdomen, hepatomegaly, splenomegaly, bleeding, jaundice were seen in DWS and SD group. Lab parameters: Mean WBC count was low to normal in all 3 groups. Platelet count was low in all groups. Hematocrit, SGOT/SGPT, PT /APTT/INR was progressively found to be increased in the 3 groups. Low CRP was found in all 3 groups. Conclusion: Reliable diagnosis of dengue fever in endemic areas can be done by clinical parameters like presence of nausea, vomiting, pain abdomen and hepatomegaly. Ascites, pleural effusion, shock, liver dysfunction and hemorrhage are the markers for severe dengue. Monitoring platelet count, hematocrit and WBC count is very useful for management of dengue cases.

Laboratory profile in serologically proven dengue in children

Laboratory profile in serologically proven dengue in children

Clinicohaematological profile of dengue in children: a hospital based study

Background: Dengue fever is one of the most common arbo virus mediated outbreaks, being reported from different parts of the world. Now as the outbreaks are hitting different geographic locations, different clinical manifestations are being reported recently. The aim of this study is to document varied clinical manifestations and haematological parameters of dengue patients in a tertiary care centre.Methods: A total 130 cases of any of NS1 antigen, IgM card test positive or IgM ELISA positive dengue patients were included in this observational study. Clinical and haematological parameters were noted and analysed statistically.Results: Most common clinical feature was fever (100%) followed by headache (51.5%). Atypical features like seizures due to encephalitis was seen in a child with dengue. Seizure were present in 1.5% of cases, two children died due to severe dengue with shock and multi organ failure. In our study 26.92% of patients had thrombocytopenia. The mean Hb was 12.86 g/dl and platelet count was 104202/mm3.Conclusions: Fever and headache are the main features of dengue. However, one should be aware of different atypical presentations of dengue fever to diagnose and intervene timely. Early recognition of complication and timely intervention are required in the management of dengue cases.

Clinical and laboratory profile and outcome of dengue cases among children attending a tertiary care hospital of South India

Background: Dengue fever is an arboviral disease which is endemic in tropical countries and is of major concern with its morbidity and mortality. WHO classified dengue into three categories: undifferentiated fever, dengue fever (DF) and dengue haemorrhagic fever (DHF). Severe dengue is also regularly observed during primary infection of infants born to dengue-immune mothers. The objective of present study was to assess the clinical profile, laboratory profile and associated risk factors related to outcome of children less than 15 years of age. The outcome of the children and their management protocols were also assessed in the study.Methods: A prospective cross sectional study with 174 confirmed cases of dengue in children <15 years were enrolled and classified as per WHO guidelines. The demographic data, clinical history, laboratory parameters were noted in a separate questionnaire form. Hematological parameters were noted, chest x-ray, ultra-sonogram in required cases was done and observations noted. Cases were managed as per WHO protocol and risk factors were observed. The outcomes of the cases were noted as discharge or death of the case.Results: A total of 174 children with 149 non-severe dengue and 25 severe dengue cases with 95 males and 79 females were enrolled in the study. 6-10 years was the most common age group. The mean age of children admitted with severe dengue fever was 5.81yrs.and without severe dengue fever was 7yrs.The mean duration of hospitalization was 5.21 days in severe dengue and 3.4 days in non-severe dengue cases. Fever was the most common presenting symptom and hepatomegaly was the common clinical finding in the study. Bleeding manifestations were seen in cases of severe dengue with raised haematocrit levels, raised SGOT levels and severe thrombocytopenia. Pleural effusion and gall bladder wall thickening with ascites was seen in severe dengue cases. Management was by administration of colloids and crystalloids.Conclusions: Dengue is a dreadful fever among pediatric age group which needs to be considered with great caution in management. Understanding the risk factors helps in predicting the mortality which helps in management and better outcome of the fever.

Correlation of C-reactive protein and neutrophil counts as early indicators of severe dengue in children

Background: Dengue has broad clinical presentation with unpredictable clinical evolution and outcome while most patients recover following a self-limiting non-severe clinical course, a small proportion progress to severe disease. As early diagnosis of dengue infection remains a challenge around the world in areas of limited resources, laboratory parameters like CRP, Neutrophil counts may serve as predictive markers to promote early diagnosis. The objectives of this study were to stratify the levels of C-reactive protein and Neutrophil counts in children with dengue fever and to determine the correlation of C-reactive protein and Neutrophil counts with the severity of dengueMethods: This was an Observational chart based descriptive study done in all pediatric dengue children (aged 1-15 years) admitted at Father Muller medical college hospital, Mangalore during the period of June 2014 to 2016. Total sample size was 100. Data collection was done by using purposive sampling based on inclusion and exclusion criteria from case records. Controls (n = 20), children with diagnosis of viral fever were considered in the study.Results: Out of the 100 children studied, 16% were <5 years ,33% between 6-10 years and 51% above 10 years of age. Mean CRP levels in NS1, IgM and both are 6.2, 6.9, 6.3. CRP values >5 were considered as positive. Mean CRP values in dengue fever with warning signs (DF1), without warning signs (DF2) and Severe Dengue (DF3) were 6.3, 6.2, 11.4 respectively. Absolute Neutropenia was observed in 52% of the study population of dengue (DF1) of which severe neutropenia was observed in 19% and 15% OF DF2 (with no warning signs) also showed neutropenia. CRP values are significant in the study when compared to controls and absolute neutropenia was observed in 52% of dengue with warning signs. Hence CRP and neutropenia may be helpful as early predictors of severe dengue.Conclusions: Our study was an attempt to correlate CRP and neutropenia for early prediction of severe dengue. Mean CRP values in the population were significant statically but not as markedly elevated in other bacterial illness as the study population have no enrolled cases of severe dengue. But neutropenia (<1,500/cmm) and positive CRP (>5) may serve as predictive markers in a resource limited setting.

Dengue in children: Issues in critical care settings

Dengue infection is an important tropical infection that can be responsible for serious illness and intensive care admission in children. Dengue virus belongs to Flavivirus genus and is transmitted by Aedes aegypti and Aedes al- bopictus mosquito. New World Health Organisation classification for the disease into dengue with/ without warning signs and severe dengue better identifies patients requiring in-hospital treatment and classifies atypical cases with severe end organ system involvement (liver, brain, heart, etc.) without shock or bleeding diathesis. Point of care tests for Non-Structural Protein 1 antigen and IgM based immuno-assay are important adjuncts to early diagnosis in emergency wards. Capillary leak and bleeding are central mechanism of manifestations of severe dengue. Severe capillary leakage creates intravascular hypovolemia which needs correction with aggressive but not over-jealous fluid therapy with timely tapering of high fluid rates, to maintain a fine balance of adequate resuscitation and preventing fluid overload at the same time. Indication for use of colloids upfront especially in patients with evidence of severe plasma leakage needs further evaluation. Transfusion of fresh whole blood or fresh packed red cells is important in patients with suspected severe bleeding. In view of recent evidence, prophylactic transfusion of platelets is going out of favour and platelets should be transfused for severe bleeding irrespective of platelet counts. Echocardiography and central venous pressure based fluid status evaluation act as precious adjuncts to for better assessment of intravascular volume. Atypical manifestation like neurological manifestations, renal failure, abdominal compartment syndrome, hemophagocytic lymphohistiocytosis need further documentation for better management of critically ill patients. Outcomes worldwide are improving with structured protocol based management.

Características epidemiológicas del Dengue en niños menores de 15 años en el Paraguay. 2008 - 2013

Características epidemiológicas del Dengue en niños menores de 15 años en el Paraguay. 2008 - 2013

A prospective seroepidemiologic study on dengue in children in Southeastern Rajasthan, India

Background: In India, dengue epidemics are becoming more frequent (WHO, 2008). The majority of dengue viral infections are self-limiting, but complications may cause high morbidity and mortality. Objectives: To assess the clinical profile of the dengue infection in children less than 18 years of age and to evaluate the outcomes of dengue fever from July2015 to June 2016 at Pediatric Department of J.K. Lon Hospital, Government Medical College, Kota the largest tertiary care hospital of southeastern Rajasthan. Results: A total of 107 cases were classified into 81 (75.70%) nonsevere and 26(24.30%) severe dengue cases. The most common age of presentation was above 11 yrs. The mean age of admission was 8.9 yrs. The most common presenting symptom was fever seen in 100% cases and hepatomegaly (22.06%) was the most common physical finding. Elevation in aspartate transaminase (SGOT) was found in 28.03% and thrombocytopenia in 52.30%. The correlation between hepatomegaly and elevated SGOT was significant (value 0.0346). Case fatality rate (CFR) was 0 %. The mean duration of hospitalization was 5.2 days. Conclusion: In children, if symptoms like fever, pain, rashes, and vomiting are associated with hepatomegaly and elevated SGOT in context of low platelet count, a strong possibility of dengue fever is present, especially in an epidemic setting. Early suspicion and effective management can reduce the severity.

Clinical and laboratory signs associated to serious dengue disease in hospitalized children

ObjectiveTo evaluate the validity of clinical and laboratory signs to serious dengue disease in hospitalized children. MethodsRetrospective cohort of children (<18 years) hospitalized with dengue diagnosis (2007–2008). Serious dengue disease was defined as death or use of advanced life support therapy. Accuracy measures and area under the receiver operating characteristic curve were calculated. ResultsOf the total (n=145), 53.1% were female, 69% aged 2–11 years, and 15.9% evolved to the worse outcome. Lethargy had the best accuracy (positive likelihood ratio >19 and negative likelihood ratio <0.6). Pleural effusion and abdominal distension had higher sensitivity (82.6%). History of bleeding (epistaxis, gingival or gastrointestinal bleeding) and severe hemorrhage (pulmonary or gastrointestinal bleeding) in physical examination were more frequent in serious dengue disease (p<0.01), but with poor accuracy (positive likelihood ratio=1.89 and 3.89; negative likelihood ratio=0.53 and 0.60, respectively). Serum albumin was lower in serious dengue forms (p<0.01). Despite statistical significance (p<0.05), both groups presented thrombocytopenia. Platelets count, hematocrit, and hemoglobin parameters had area under the curve <0.5. ConclusionsLethargy, abdominal distension, pleural effusion, and hypoalbuminemia were the best clinical and laboratorial markers of serious dengue disease in hospitalized children, while bleeding, severe hemorrhage, hemoconcentration and thrombocytopenia did not reach adequate diagnostic accuracy. In pediatric referral hospitals, the absence of hemoconcentration does not imply absence of plasma leakage, particularly in children with previous fluid replacement. These findings may contribute to the clinical management of dengue in children at referral hospitals.

Incremento de la severidad del dengue en niños en epidemias sucesivas in Paraguay

Incremento de la severidad del dengue en niños en epidemias sucesivas in Paraguay

Clinical and laboratory signs associated to serious dengue disease in hospitalized children

ObjectiveTo evaluate the validity of clinical and laboratory signs to serious dengue disease in hospitalized children. MethodsRetrospective cohort of children (<18 years) hospitalized with dengue diagnosis (2007–2008). Serious dengue disease was defined as death or use of advanced life support therapy. Accuracy measures and area under the receiver operating characteristic curve were calculated. ResultsOf the total (n=145), 53.1% were female, 69% aged 2–11 years, and 15.9% evolved to the worse outcome. Lethargy had the best accuracy (positive likelihood ratio >19 and negative likelihood ratio <0.6). Pleural effusion and abdominal distension had higher sensitivity (82.6%). History of bleeding (epistaxis, gingival or gastrointestinal bleeding) and severe hemorrhage (pulmonary or gastrointestinal bleeding) in physical examination were more frequent in serious dengue disease (p<0.01), but with poor accuracy (positive likelihood ratio=1.89 and 3.89; negative likelihood ratio=0.53 and 0.60, respectively). Serum albumin was lower in serious dengue forms (p<0.01). Despite statistical significance (p<0.05), both groups presented thrombocytopenia. Platelets count, hematocrit, and hemoglobin parameters had area under the curve <0.5. ConclusionsLethargy, abdominal distension, pleural effusion, and hypoalbuminemia were the best clinical and laboratorial markers of serious dengue disease in hospitalized children, while bleeding, severe hemorrhage, hemoconcentration and thrombocytopenia did not reach adequate diagnostic accuracy. In pediatric referral hospitals, the absence of hemoconcentration does not imply absence of plasma leakage, particularly in children with previous fluid replacement. These findings may contribute to the clinical management of dengue in children at referral hospitals.

Symptomatic Dengue in Children in 10 Asian and Latin American Countries

BackgroundThe control groups in two phase 3 trials of dengue vaccine efficacy included two large regional cohorts that were followed up for dengue infection. These cohorts provided a sample for epidemiologic analyses of symptomatic dengue in children across 10 countries in Southeast Asia and Latin America in which dengue is endemic.MethodsWe monitored acute febrile illness and virologically confirmed dengue (VCD) in 3424 healthy children, 2 to 16 years of age, in Asia (Indonesia, Malaysia, the Philippines, Thailand, and Vietnam) from June 2011 through December 2013 and in 6939 children, 9 to 18 years of age, in Latin America (Brazil, Colombia, Honduras, Mexico, and Puerto Rico) from June 2011 through April 2014. Acute febrile episodes were determined to be VCD by means of a nonstructural protein 1 antigen immunoassay and reverse-transcriptase–polymerase-chain-reaction assays. Dengue hemorrhagic fever was defined according to 1997 World Health Organization criteria.ResultsApproximately 10% of the febrile episodes in each cohort were confirmed to be VCD, with 319 VCD episodes (4.6 episodes per 100 person-years) occurring in the Asian cohort and 389 VCD episodes (2.9 episodes per 100 person-years) occurring in the Latin American cohort; no trend according to age group was observed. The incidence of dengue hemorrhagic fever was less than 0.3 episodes per 100 person-years in each cohort. The percentage of VCD episodes requiring hospitalization was 19.1% in the Asian cohort and 11.1% in the Latin American cohort. In comparable age groups (9 to 12 years and 13 to 16 years), the burden of dengue was higher in Asia than in Latin America.ConclusionsThe burdens of dengue were substantial in the two regions and in all age groups. Burdens varied widely according to country, but the rates were generally higher and the disease more frequently severe in Asian countries than in Latin American countries. (Funded by Sanofi Pasteur; CYD14 and CYD15 ClinicalTrials.gov numbers, NCT01373281 and NCT01374516.)

Laboratory-confirmed Dengue in Children in Three Regional Hospitals in the Philippines in 2009-2010.

The burden of dengue is high in the Philippines but the prevalence of confirmed cases is unknown, and the disease is subject to underreporting because surveillance of suspected cases is passive. We conducted a prospective epidemiological study to estimate the proportion of laboratory-confirmed dengue among clinically suspected hospitalized cases in the pediatric wards of 3 regional hospitals in the Philippines and to describe the clinical and laboratory features, age distributions, case fatality rates and serotype distributions of these hospitalized cases. Patients ≤18 years and hospitalized for suspected dengue were included if they had an axillary temperature ≥38°C for 2-7 days and 2 or more dengue-associated symptoms. Dengue infection was confirmed in acute blood samples by serotype-specific reverse transcription-polymerase chain reaction and IgM immunoassay. We confirmed dengue infection in 1809 (86.1%) cases of 2103 suspected cases between November 2009 and November 2010. The 6- to 10-year-old age group had the highest proportion of cases overall (36.7%). Fever, anorexia, myalgia, abdominal pain and headache were the most common symptoms at admission. Hemorrhagic manifestations, signs of plasma leakage, thrombocytopenia and leucopenia were all significantly more common in confirmed than in nonconfirmed cases. Most cases (76.5%) developed dengue hemorrhagic fever or dengue shock syndrome, and the overall case fatality rate was 0.94%. Distributions of all 4 virus serotypes varied at each hospital. The clinical burden of pediatric dengue continues to be substantial in the Philippines. Most hospitalized cases of suspected pediatric dengue can be laboratory confirmed and most develop severe disease.

A prospective observational study of clinical predictors of outcome in dengue in children

In this Prospective Observational study during study period of one year, the incidence of severe dengue was 18% among children admitted with diagnosis of dengue fever. Nearly 40% children were of age 0-5 years. Case fatality rate in severe dengue was 5.5% .78% children responded either to crystalloids/colloids. Incidence of shock and bleeding at admission was significantly higher among children who died. Incidence of hepatic dysfunction and coagulopathy were higher and mean platelet count was lower in children who died compared to children who survived. Presence of shock, bleeding tendencies, coagulopathy at admission predict non response to fluids.

Dengue virus infection: Need for appropriate laboratory tests for diagnosis and management of the condition in children during an outbreak.

Outbreaks of dengue infection occur in several parts of India with clockwork precision closely related to changing seasons. Most recent outbreak in Puducherry occurred between October 2012 and January 2013, affected a sizable pediatric population. A prospective study was done to characterize the demographic, diagnostic and clinical profile of pediatric patients in a tertiary care center in Puducherry. Data of patients serologically positive for either dengue NS1 antigen or anti-dengue IgM antibodies were analyzed. Duration of fever, platelet count, complications, risk factors, morbidity and mortality were analyzed. Among pediatric cases with fever who were screened for NS1/IgM antibody during the recent outbreak, 161 (37.5%) tested positive. NS1 was detected in 85% while 5.5% tested positive for IgM and 3% for IgG. Few (4.9%) tested positive for both NS1 and IgM and 1.2% were positive for both NS1 and IgG. The mean age was 6 years of which 9% were <1-year, the youngest being 1-month old infant. Mean duration of fever was 4 days. Vomiting was associated in 42% of cases. Thrombocytopenia (51%) and hepatomegaly (41%) were two major observations. Among the NS1 positive cases, 49% had thrombocytopenia. IgM alone and NS1 with IgM were associated with thrombocytopenia in 67% and 78% respectively. 14 children had complications of dengue shock syndrome, and four had dengue hemorrhagic fever. Totally, 22 of the children had platelet transfusion. There was no mortality reported among any of these children. Combination of clinical findings and rapid NS1, IgM detection helped in confirming the diagnosis for appropriate management of dengue in children.

Dengue in children

Dengue is a mosquito-borne viral disease of expanding geographical range and increasing incidence. The vast majority of dengue cases are children less than 15 years of age. Dengue causes a spectrum of illness from mild fever to severe disease with plasma leakage and shock. Infants and children with secondary heterologous dengue infections are most at risk for severe dengue disease. Laboratory diagnosis of dengue can be established within five days of disease onset by direct detection of viral components in serum. After day five, serologic diagnosis provides indirect evidence of dengue. Currently, no effective antiviral agents are available to treat dengue infection. Therefore, treatment remains supportive, with emphasis on close hematological monitoring, recognition of warning signs of severe disease and fluid-replacement therapy and/or blood transfusions when required. Development of a dengue vaccine is considered a high public health priority. A safe and efficacious dengue vaccine would also be important for travelers. This review highlights the current understanding of dengue in children, including its clinical manifestations, pathogenesis, diagnostic tests, management and prevention.

Clinical efficacy and safety of a novel tetravalent dengue vaccine in healthy children in Asia: a phase 3, randomised, observer-masked, placebo-controlled trial

An estimated 100 million people have symptomatic dengue infection every year. This is the first report of a phase 3 vaccine efficacy trial of a candidate dengue vaccine. We aimed to assess the efficacy of the CYD dengue vaccine against symptomatic, virologically confirmed dengue in children. We did an observer-masked, randomised controlled, multicentre, phase 3 trial in five countries in the Asia-Pacific region. Between June 3, and Dec 1, 2011, healthy children aged 2-14 years were randomly assigned (2:1), by computer-generated permuted blocks of six with an interactive voice or web response system, to receive three injections of a recombinant, live, attenuated, tetravalent dengue vaccine (CYD-TDV), or placebo, at months 0, 6, and 12. Randomisation was stratified by age and site. Participants were followed up until month 25. Trial staff responsible for the preparation and administration of injections were unmasked to group allocation, but were not included in the follow-up of the participants; allocation was concealed from the study sponsor, investigators, and parents and guardians. Our primary objective was to assess protective efficacy against symptomatic, virologically confirmed dengue, irrespective of disease severity or serotype, that took place more than 28 days after the third injection. The primary endpoint was for the lower bound of the 95% CI of vaccine efficacy to be greater than 25%. Analysis was by intention to treat and per procotol. This trial is registered with ClinicalTrials.gov, number NCT01373281. We randomly assigned 10,275 children to receive either vaccine (n=6851) or placebo (n=3424), of whom 6710 (98%) and 3350 (98%), respectively, were included in the primary analysis. 250 cases of virologically confirmed dengue took place more than 28 days after the third injection (117 [47%] in the vaccine group and 133 [53%] in the control group). The primary endpoint was achieved with 56·5% (95% CI 43·8-66·4) efficacy. We recorded 647 serious adverse events (402 [62%] in the vaccine group and 245 [38%] in the control group). 54 (1%) children in the vaccine group and 33 (1%) of those in the control group had serious adverse events that happened within 28 days of vaccination. Serious adverse events were consistent with medical disorders in this age group and were mainly infections and injuries. Our findings show that dengue vaccine is efficacious when given as three injections at months 0, 6, and 12 to children aged 2-14 years in endemic areas in Asia, and has a good safety profile. Vaccination could reduce the incidence of symptomatic infection and hospital admission and has the potential to provide an important public health benefit. Sanofi Pasteur.

Hemophagocytic lymphohistiocytosis syndrome in Dengue hemorrhagic fever.

Hemophagocytic lymphohistiocytosis (HLH) is a life threatening florid activation of macrophages of the lymphoreticular system. It is reported to be associated with dengue in children in India and carries a high mortality. Patients present with high fever, worsening blood cell counts, splenomegaly, abnormal liver enzymes with features of liver failure, coagulopathy and neurological complications. The diagnosis is according to "Diagnostic Guidelines for HLH 2004", based on a triad of clinical, blood parameters and bone marrow cytology. In the present study, data of 212 children admitted with dengue were analyzed. Of 212 children, 31 children were classified as suspect HLH and advised bone marrow evaluation; of whom 23 children had marrow evidence of HLH. Worsening of blood cell counts were recorded in all children with a mean platelet count of 58,303.03 cells/cumm, low hematocrit in 95.65%, low mean hemoglobin level of 8.37g/dL, high erythrocyte sedimentation rate (ESR) and prolonged pro-thrombin time/international normalization ratio (PT/INR). Serum triglycerides, ferritin and transaminases were high. Of the 23 children, 19 patients received intravenous immunoglobulin (IVIG) and all of these children recovered. Dengue with multi-organ dysfunction is commonly concurrent to HLH in the marrow and hence, an early diagnosis based on clinical, laboratory and bone marrow evaluation is significant. A bone marrow evaluation confirms the diagnosis of HLH.

Diagnosis and management of dengue in children: Recommendations and IAP ID chapter plan of action

The epidemiology of dengue fever in the Indian subcontinent has been very complex. It is no longer restricted to urban centres, with outbreaks now occurring in rural India also. The mosquito vectors, Aedes aegypti and Aedes albopictus prefers to breed in artificial water. They are day biters and are most active just after sunrise and just before sunset. As per the new guidelines dengue is now classified into three categories, dengue, dengue with warning signs and severe dengue whereas the clinical course of the disease is divided in three phases – febrile, critical, and recovery. The diagnostic tests are NS1 antigen, which can be done by ELISA or rapid test, and serological tests by detection of viral antibodies IgG and IgM. Depending on the severity, treatment may be as outpatient, inpatient or emergency treatment. Shock and hemorrhage are the two most dreaded complications which require monitoring and intensive care management.

The association of cytokines with severe dengue in children.

Background: Dengue virus infection is a major public health problem. A hypothesis put forward for severe dengue is the cytokine storm, a sudden increase in cytokines that induces vascular permeability. Previous studies and our recent meta-analysis showed that IL-6, IL-8, IFNγ, TNFα, VEGF-A and VCAM-1 are associated with dengue shock syndrome. Therefore, in this study we aim to validate the association of these cytokines with severe dengue. Methods & Findings: In a hospital based-case control study in Vietnam, children with dengue fever, other febrile illness and healthy controls were recruited. Dengue virus infection was confirmed by several diagnostic tests. Multiplex immunoassay using Luminex technology was used to measure cytokines simultaneously. A positive association with dengue shock syndrome was found for VCAM-1, whereas a negative association was found for IFNγ. Furthermore, multivariate logistic analysis also showed that VCAM-1 and IFNγ were independently correlated with dengue shock syndrome. Conclusion: IFNγ and VCAM-1 were associated with dengue shock syndrome, although their role in the severe dengue pathogenesis remains unclear. Additional studies are required to shed further light on the function of these cytokines in severe dengue.