The evolution of paediatric dengue management over the past three decades-a historical perspective

Over the past three decades, the recognition and management of dengue fever (DF) and severe dengue (SD) in children have undergone significant transformation. In the 1990s, limited understanding of dengue pathophysiology led to delayed recognition, with aggressive fluid resuscitation, invasive ventilation, and frequent blood product use, often resulting in adverse outcomes. The 1997 World Health Organisation (WHO) Guidelines introduced a structured classification and emphasized cautious fluid management, improving survival. Advances in diagnostics, particularly non-structural (NS) protein antigen testing, enabled earlier detection in the 2000s. The revised WHO 2009 classification and recognition of Expanded Dengue Syndrome (EDS) in 2012 broadened the understanding of severe organ involvement beyond plasma leakage. In the 2020s, improved intensive care unit (ICU) technologies enabled advanced organ support, and the coronavirus disease of 2019 (COVID-19) pandemic highlighted potential viral interactions. Ongoing controversy remains regarding the role of immunomodulation for dengue-associated hyperinflammation. Continued clinical research is essential to refine management strategies and optimize outcomes in severe dengue.