Epidemiological and clinical trends in pediatric dengue: A six-year retrospective hospital-based study on pre-vs pandemic patterns in Puducherry, India.

BACKGROUND

Dengue is a rapidly spreading mosquito-borne viral disease posing a significant public health challenge across tropical and subtropical regions, including India. While children are particularly vulnerable, age-specific clinical and epidemiological trends remain underexplored, especially in low-and middle-income country settings. This study describes the clinical and epidemiological trends of pediatric dengue in Puducherry from 2017 to 2022 and the impact of the COVID-19 pandemic on the disease trends.

METHODS

A retrospective review was conducted on 632 pediatric patients admitted with dengue fever to a woman and child speciality public sector tertiary care hospital in Puducherry between 2017 and 2022. Data on demographic, clinical, and laboratory parameters were extracted from inpatient records. Dengue severity was categorized using WHO 2009 criteria. Statistical analyses were performed to assess associations and identify risk factors.

RESULTS

Among the 632 patients, 54 % showed warning signs of dengue, and 3.5 % progressed to severe dengue. Fever (99.0 %), vomiting(51.3 %), and abdominal pain(37.3 %) were the common symptoms. Children under five years were significantly more likely to present with respiratory symptoms (cough: OR 1.85(1.27-2.70), p = 0.001; rhinitis: OR 1.67(1.13-2.46), p = 0.01), while gastrointestinal and musculoskeletal complaints were more common in the older children. The mean duration from symptom onset to diagnosis was 5.8 ± 2.8 days, with a significant prolongation in children aged 1-5 years (6.5 ± 3.6 days, p = 0.013). During the COVID-19 pandemic (2020-2022), time to diagnosis increased significantly (≥7 days in 27.2 % vs. 15.5 % pre-pandemic, OR 2.03, p < 0.001), although no significant differences in disease severity or demographic characteristics were noted.

CONCLUSIONS

This study highlights distinct age-related clinical patterns in pediatric dengue, with younger children tending to present more likely with respiratory symptoms and experience a longer time to diagnosis. Strengthening clinical recognition, adapting age-appropriate diagnostic protocols, and promoting early care-seeking are essential for timely detection and response to dengue in endemic regions.