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Hajialibeig A, Enayati A A, Hosseinzadeh F, Taji M, Rezai M S. An Outline of Dengue Fever in Iran, Focusing on Pediatric Manifestations and Case Management: A Narrative Review. J. Pediatr. Rev 2026; 14 (1) :37-52
URL: http://jpr.mazums.ac.ir/article-1-722-en.html

Background: Dengue fever is an emerging mosquito-borne viral disease caused by four dengue virus serotypes (DENV 1–4) and transmitted mainly by Aedes aegypti and Aedes albopictus. Given the distinct clinical course and higher risk of severe complications in children, understanding pediatric-specific manifestations, diagnosis, and management is critical for preparedness in Iran. This study reviews available global and regional evidence on dengue fever with a specific focus on pediatric populations. 
Methods: This is a narrative review. Data were synthesized from epidemiological reports, World Health Organization (WHO) guidelines, and published clinical studies addressing pediatric clinical presentation, diagnostic strategies, disease progression, and management approaches, with contextual relevance to Iran.
Results: In children, dengue fever frequently presents with nonspecific clinical features, including fever, gastrointestinal symptoms (vomiting, abdominal pain, diarrhea), rash, and lethargy, rather than the classic musculoskeletal pain commonly seen in adults. Pediatric patients are at higher risk of rapid disease progression to dengue hemorrhagic fever and dengue shock syndrome, primarily due to increased vascular permeability. Pleural effusion detected by ultrasound is the most common indicator of plasma leakage in children. Laboratory findings often include thrombocytopenia, hemoconcentration, and elevation of liver enzymes. Diagnosis relies on high clinical suspicion in endemic or affected areas and on confirmation by serological testing (IgM/IgG), NS1 antigen detection, or viral RNA detection. Management of pediatric dengue fever is primarily supportive, with timely, carefully monitored fluid therapy as the cornerstone of treatment. Early recognition of warning signs and meticulous fluid management are essential to prevent shock and organ failure. Recovery in children is typically rapid, occurring within 24-36 hours once the critical phase resolves.
Conclusions: Dengue fever in children differs significantly from that in adults in terms of clinical presentation, risk of severe complications, and management priorities. With the recent emergence of dengue fever in Iran, heightened awareness of pediatric-specific features, early diagnosis, and standardized supportive care are essential to reduce its morbidity and mortality. Strengthening surveillance systems, educating healthcare providers, and implementing vector control strategies are vital for national preparedness. As Iran is not yet hyperendemic, vaccination against dengue fever is not currently mandatory; however, continued monitoring and preventive strategies remain crucial, particularly for protecting the pediatric population.