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Dengue in Children

Mosquito-borne fever now in season in Pakistan: the warning signs, the platelet myths, and what really helps

Dr. Sana Fatima Updated 8 November 2026 9 min read Draft · awaiting Dr. Sana's medical review

At a glance

  • Reported dengue cases worldwide rose from about 505,000 in 2000 to 14.6 million in 2024, with over 12,000 deaths that year 1.
  • 2026 is quieter so far: 2.2 million cases and over 1,100 deaths in 97 countries from January to August 2.
  • About 1 in 4 infections cause symptoms, and about 1 in 20 people who fall ill develop severe dengue 3.
  • Danger comes after the fever: warning signs usually appear 24–48 hours after it goes away 4.
  • In Pakistan, estimated cases rose from about 0.1 million in 2012 to 3.28 million in 2022 5.
  • WHO recommends the Qdenga vaccine only for ages 6–16 in high-transmission areas, as 2 doses at least 3 months apart 6.

What it is

Dengue is a virus spread by infected Aedes mosquitoes, which bite mostly in the daytime 11Dengue and severe dengue — WHO, 2025. who.int. There are four types. Catching one protects you from that type for life, but only briefly from the other three 33Clinical Features of Dengue — CDC, 2025. cdc.gov. A second infection with a different type carries a higher risk of severe dengue 1.

Symptoms

  • Febrile phase (fever usually lasts 2–7 days): high fever (up to 40°C), bad headache, pain behind the eyes, muscle and joint pain, vomiting, swollen glands, rash 13.
  • Critical phase (starts as the fever falls, about 24–48 hours): fluid can leak from blood vessels, and a child can get worse within hours 3.
  • Recovery phase: the fluid is reabsorbed and the child improves. Tiredness can last weeks 13.

See a doctor urgently if

Your child has any WHO warning sign 1:

  • severe tummy pain or repeated vomiting
  • fast breathing
  • bleeding gums or nose, or blood in vomit or stool
  • very sleepy, weak or restless
  • extreme thirst, or pale, cold skin

Who is most at risk

  • Children with a second infection by a different type 177Dengue (Paz-Bailey et al.) — The Lancet, 2024. pmc.ncbi.nlm.nih.gov.
  • Infants, who are one of the two age peaks for severe dengue. Young children also cope less well with fluid leakage 7.
  • Pregnancy and conditions such as diabetes or high blood pressure 88Combatting Dengue Epidemics: Bridging Gaps with Vaccine Innovation — Ann King Edward Med Univ, 2025. annalskemu.org.
  • High-burden areas. In Pakistan, Sindh has the highest estimated incidence 55Incidence of Dengue Fever in Pakistan — PLoS One, 2026. doi.org, and Kohat is a 2026 hotspot 99KP Reports Highest Single-Day Dengue Cases of 2026 — ProPakistani, 2026. propakistani.pk.

How it is diagnosed

  • Days 0–7: an NS1 antigen test (or PCR) plus an IgM test. NS1 is less sensitive in a second infection, and a negative NS1 does not rule out dengue 1010Testing for Dengue — CDC, 2025. cdc.gov7.
  • From about day 3–4: IgM appears and lasts about 3 months. A single IgG test cannot confirm a current infection 107.
  • Repeated blood counts: a rising haematocrit with a fast fall in platelets suggests fluid leakage 7.

Treatment

  • There is no anti-dengue medicine. Care is supportive 1.
  • Fluids: plenty of water and oral rehydration drinks 1111Treatment of Dengue — CDC, 2025. cdc.gov. Children with warning signs need hospital care and carefully measured IV fluids 7.
  • Fever: paracetamol only, at the dose your doctor sets for your child's weight 11.
  • Never give ibuprofen, aspirin or other NSAIDs. They raise the risk of bleeding 1. Check combined cough and pain products.
  • Go to hospital for any warning sign, or if your child cannot drink or keeps vomiting 44Signs and Symptoms of Dengue — CDC, 2026. cdc.gov7.
  • The platelet myth: platelets usually recover on their own. Transfusing platelets "to be safe" does not prevent bleeding and can overload the child with fluid 71212Platelet Transfusion in Dengue-Associated Thrombocytopenia — Rev Soc Bras Med Trop, 2026. doi.org. The doctor decides if a transfusion is needed.

Prevention

  • Home: each week, empty, scrub, cover or throw away anything that holds water (buckets, coolers, tyres, pots, toys) 11313Preventing Mosquito Bites — CDC, 2024. cdc.gov.
  • Repellents: DEET, picaridin or IR3535 1. An adult should rub repellent onto their own hands first, then onto the child's face. Never put it on a child's hands, eyes, mouth or cuts. Don't use lemon eucalyptus oil or PMD under age 3 13.
  • Nets and clothing: long sleeves, window screens, nets for daytime naps, and net covers on prams 113. Keep a sick child under a net, because mosquitoes can pick up the virus from them in the first week 11.
  • Vaccines:
  • Qdenga (TAK-003): WHO recommends it for ages 6–16 in high-transmission settings, but not under age 6 66Vaccines and immunization: Dengue — WHO, 2025. who.int.
  • Dengvaxia: only for people with lab-confirmed past dengue (CDC: ages 9–16, 3 doses). Its maker has discontinued it 1414Dengue Vaccines — CDC, 2026. cdc.gov.
  • Pakistan: Dengvaxia was approved, but not for mass use. Qdenga was not approved as of 2025 8, and we found no later approval. Neither is in the routine childhood schedule, so ask your paediatrician.

The situation now (2025–2026)

World: 2.2 million cases and over 1,100 deaths from January to August 2026. This is the lowest level since WHO's global surveillance began in 2024 (WHO, published 9 Oct 2026) 22Global dengue update (WER No 40) — WHO, 2026. who.int.

Pakistan, 2025 (official figures, which probably undercount):

  • Sindh: 20,502 cases and 33 deaths (reported 18 Jan 2026; the report is unclear whether the 33 includes malaria). Indus Hospital alone logged 8,883 cases and 40 deaths 1515103 people in Sindh lose battle against mosquito-borne diseases in 2025 — Dawn, 2026. dawn.com.
  • Punjab: 4,093 cases as of 24 Nov 2025 1616Three dengue deaths reported in Lahore as cases rise across Punjab — Aaj News, 2025. english.aaj.tv. Provincial deaths unconfirmed.
  • KP: about 6,000 cases and 4 deaths (reported 15 Mar 2026) 1717Health dept trains medics for dengue case management — Dawn, 2026. dawn.com.
  • Islamabad: no reliable full-year total found.

Pakistan, 2026 so far:

  • National: the NIH bulletin for week 41 (posted October 2026) recorded 1,728 suspected cases in one week: KP 1,408, Sindh 292, Islamabad 0. Punjab does not report to this system 1818Public Health Bulletin – Pakistan, Week 41, 2026 — NIH Pakistan, 2026. nih.org.pk.
  • KP: 4,091 cases as of 20 Oct 2026, including 2,567 in Kohat. One death was reported in that update 9.
  • Sindh: no official 2026 total found. Karachi's first 2026 death was reported in April 1919Karachi reports first dengue death of 2026 — Aaj News, 2026. english.aaj.tv. In week 41, public labs confirmed 177 of 2,384 samples 18.
  • Punjab: no provincial total found. Rawalpindi: 89 cases as of 7 Nov 2026 2020Dengue cases reach 139 in twin cities — Express Tribune, 2026. tribune.com.pk.
  • Islamabad: 50 cases as of 7 Nov 2026 20.

What the research says

  • Tricou V et al., Lancet Global Health 2024phase 3 placebo-controlled RCT, n = 20,099 children aged 4–16
    Over 4.5 years, TAK-003 cut confirmed dengue by 61.2% and hospital admissions by 84.1%. In children never infected before, no protection against type 3 was shown. Read the study
  • Carretta LTA et al., Rev Soc Bras Med Trop 2026meta-analysis, 9 studies, n = 3,377
    Preventive platelet transfusion was linked to more bleeding and more deaths, not fewer. Most of the studies were retrospective. Read the study
  • Aynekulu Mersha DG et al., Virulence 2025systematic review, 26 treatment trials
    Only three small trials (380 people) tested papaya leaf extract alone, with mixed platelet results. The evidence is too weak for firm conclusions. Read the study
  • Velez ID et al., PLoS Negl Trop Dis 2023interrupted time-series and case-control study, about 3.3 million people in Colombia
    Once Wolbachia mosquitoes were established, reported dengue fell 95–97%. Read the study
  • Childs ML et al., PNAS 2025modelling study, 21 countries
    About 18% of dengue in these Asian and American countries is attributable to human-caused warming, and cases could rise 49–76% by mid-century. Read the study
  • Nasim Z et al., PLoS One 2026retrospective study of three national lab networks, Pakistan 2012–2022
    Estimated cases rose from about 0.1 to 3.28 million, with Sindh worst affected. Read the study

Questions parents ask

Does papaya leaf juice raise platelets?

Some small trials found platelets rose a little faster, but others found no difference 21. There is no good evidence that it prevents severe dengue. It should never replace fluids or medical care.

Can my child get dengue twice?

Yes. One infection protects only against that one type of the virus 3. A second infection with a different type is more likely to be severe 1.

What platelet count is dangerous?

There is no single "danger number", and platelets fall in most cases. Doctors worry more when platelets drop fast while the haematocrit rises, or when warning signs appear 7. A low number alone is not a reason for a transfusion 12.

When is my child most at risk?

As the fever settles, often around days 4–6 7. Watch closely over the next 24–48 hours 4.

Can my child be treated at home?

Yes, if there are no warning signs and your child is drinking well, with daily check-ups 711. Go to hospital at once if a warning sign appears.

How long does recovery take?

Most children feel better in about a week 4. Tiredness can last a few weeks 1.

Myth vs fact

  • MythOnce the fever breaks, the danger is over.
    FactThe critical phase starts as the fever falls 3.
  • MythLow platelets always need a transfusion.
    FactPreventive transfusions were linked to more bleeding and deaths 12.
  • MythPapaya leaf juice cures dengue.
    FactThe evidence is weak and mixed. Fluids and monitoring save lives 21.

Sources

  1. 1.Dengue and severe dengue — WHO, 2025. https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue
  2. 2.Global dengue update (WER No 40) — WHO, 2026. https://www.who.int/publications/i/item/who-wer10140-285-289
  3. 3.Clinical Features of Dengue — CDC, 2025. https://www.cdc.gov/dengue/hcp/clinical-signs/index.html
  4. 4.Signs and Symptoms of Dengue — CDC, 2026. https://www.cdc.gov/dengue/signs-symptoms/index.html
  5. 5.Incidence of Dengue Fever in Pakistan — PLoS One, 2026. https://doi.org/10.1371/journal.pone.0352938
  6. 6.Vaccines and immunization: Dengue — WHO, 2025. https://www.who.int/news-room/questions-and-answers/item/dengue-vaccines
  7. 7.Dengue (Paz-Bailey et al.) — The Lancet, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC12372472/
  8. 8.Combatting Dengue Epidemics: Bridging Gaps with Vaccine Innovation — Ann King Edward Med Univ, 2025. https://www.annalskemu.org/journal/index.php/annals/article/download/6272/3428/26538
  9. 9.KP Reports Highest Single-Day Dengue Cases of 2026 — ProPakistani, 2026. https://propakistani.pk/2026/10/20/kp-reports-highest-single-day-dengue-cases-of-2026/
  10. 10.Testing for Dengue — CDC, 2025. https://www.cdc.gov/dengue/hcp/diagnosis-testing/index.html
  11. 11.Treatment of Dengue — CDC, 2025. https://www.cdc.gov/dengue/treatment/index.html
  12. 12.Platelet Transfusion in Dengue-Associated Thrombocytopenia — Rev Soc Bras Med Trop, 2026. https://doi.org/10.1590/0037-8682-0181-2025
  13. 13.Preventing Mosquito Bites — CDC, 2024. https://www.cdc.gov/mosquitoes/prevention/index.html
  14. 14.Dengue Vaccines — CDC, 2026. https://www.cdc.gov/dengue/hcp/vaccine/index.html
  15. 15.103 people in Sindh lose battle against mosquito-borne diseases in 2025 — Dawn, 2026. https://www.dawn.com/news/1967581
  16. 16.Three dengue deaths reported in Lahore as cases rise across Punjab — Aaj News, 2025. https://english.aaj.tv/news/330446305
  17. 17.Health dept trains medics for dengue case management — Dawn, 2026. https://www.dawn.com/news/1982151
  18. 18.Public Health Bulletin – Pakistan, Week 41, 2026 — NIH Pakistan, 2026. https://www.nih.org.pk/wp-content/uploads/2026/10/IDSRS%20Weekly%20Report-41-2026-NA.pdf
  19. 19.Karachi reports first dengue death of 2026 — Aaj News, 2026. https://english.aaj.tv/news/330456673
  20. 20.Dengue cases reach 139 in twin cities — Express Tribune, 2026. https://tribune.com.pk/story/2639052/dengue-cases-reach-139-in-twin-cities
  21. 21.Treatment of dengue infection: a systematic review — Virulence, 2025. https://doi.org/10.1080/21505594.2025.2587491

This page summarises published research for education. It is not a diagnosis or a treatment plan. Always speak to your child's doctor, and go to the nearest hospital in an emergency.

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