Impact of Recent SARS-CoV-2 Infection on the Course and Severity of Dengue in Children: A Prospective Observational Study from North India

Abstract

In 2020, a considerable overlap occurred between the COVID-19 pandemic and seasonal dengue transmission in India. This study aimed to evaluate the effects of acute or recent infection with SARS-CoV-2 on the course and outcomes of dengue fever in children. We prospectively enrolled 44 children with a clinical and laboratory diagnosis of dengue fever. Assessment of acute and recent SARS-CoV-2 infection was done using reverse transcription–polymerase chain reaction and IgG antibody through ELISA. Children were grouped based on evidence of SARS-CoV-2 exposure and clinical severity, and outcomes were compared. The median age of the study cohort was 96 months (interquartile range [IQR]: 69–129 months). Fever (98%), vomiting (78%), abdominal pain (68%), hepatomegaly (68%), and edema (32%) were the common features. About two-thirds (N = 30) had severe dengue; 20 (45%) had dengue shock. Liver dysfunction (58%) and acute kidney injury (25%) were other major organ dysfunctions. Nineteen (43%) children stayed in the pediatric intensive care unit for a median duration of 5 days (IQR: 2–11 days). None had acute SARS-CoV2 infection; however, IgG against SARS-CoV-2 was detected in 15 (34%) cases. Children with recent exposure to SARS-CoV-2 showed a trend toward a lower incidence of acute kidney injury, fewer organ dysfunctions, and a lower frequency of invasive ventilation. Four children (9%) died; none of the deaths were in the SARS-CoV-2–exposed group. The present study exposes preliminary evidence that dengue fever might follow a less severe course in children with recent exposure to SARS-CoV-2 infection. However, it is pertinent to understand the antigenic similarity and cross-protective antibody response between the two viruses and their clinical relevance.

COVID-19 serum can be cross-reactive and neutralizing against the dengue virus, as observed by the dengue virus neutralization test

“…It was found that previous exposure to SARS-CoV-2 had resulted in a less severe outcome with no death ( Ravikumar et al , 2021 ). These observations serve as further circumstantial/epidemiological evidence of our observations that SARS-CoV-2 serum samples can neutralize and protect against dengue.…”

Antibodies against the SARS-CoV-2 S1-RBD cross-react with dengue virus and hinder dengue pathogenesis

“…A recent study showed that previous SARS-CoV-2 infection may increase the risk of severe dengue ( 39 ). However, dengue fever might follow a less severe course, has also been found in children with recent SARS-CoV-2 infection ( 40 ). In these children, a trend toward a lower incidence of acute kidney injury and fewer organ dysfunctions has been reported.…”

Cross‐reactivity of SARS‐CoV‐2 with other pathogens, especially dengue virus: A historical perspective

“…Due to the cross‐reactivity of these Abs, when the same cohort is being exposed to SARS‐CoV‐2, partial neutralization seemed to occur and as a result the spread, as well as the severity of COVID‐19 in these people, appears to be reduced. Similarly, as observed in neutralization assays, there are reports stating reduced incidences of dengue in the post‐pandemic era or less severe dengue infection with a previous history of SARS‐CoV‐2 infection 71 …”