645 Original article https://doi.org/10.12980/apjtd.7.2017D7-176 ©2017 by the Asian Pacific Journal of Tropical Disease. All rights reserved. Effects of vitamin E supplementation on the clinical outcome of dengue fever and dengue haemorrhagic fever in children Panagoda Weththasinghage Prasad Chathurangana 1 , Dellabada Batawalage Dulani Lakmali Samaranayake 2 , Vinushiya Gunalini Quienters 1 , Vithanage Pujitha Wickramasinghe 3* 1 Professorial Paediatric Unit, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka 2 Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka 3 Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka Asian Pac J Trop Dis 2017; 7(11): 645-649 Asian Pacific Journal of Tropical Disease journal homepage: http://www.apjtcm.com *Corresponding author: Prof. Vithanage Pujitha Wickramasinghe, Department of Paediatrics, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo, Sri Lanka. Tel: +94 (011) 2688748, ext. 173 Fax: +94 (011) 2691581 E-mail: pujithaw@yahoo.com Ethical clearance was granted by the Ethics Review Committee of Faculty of Medicine, University of Colombo. The study was approved by the National Medicines Regulatory Authority of the Ministry of Health, Sri Lanka. The protocol was registered in Sri Lanka Clinical Trials Registry (SLCTR/2015/012). Informed written consent was obtained from parents of study participants. The journal implements double-blind peer review practiced by specially invited international editorial board members. 1. Introduction Dengue is one of the most important mosquito borne viral diseases, affecting approximately 50% of the world population[1]. Its incidence has increased dramatically over the last decade, and currently it is estimated to be 390 million dengue infections per year[1]. The virus has four serotypes (DEN-1, DEN-2, DEN-3 and DEN-4) and is transmitted by the mosquito species Aedes aegypti and Aedes albopictus. It causes diverse clinical manifestations which could range from asymptomatic infection to dengue haemorrhagic fever (DHF) with shock and can be complicated by bleeding, liver failure, encephalopathy and myocarditis[2]. Currently dengue is hyperendemic in Sri Lanka[3]. The pathogenesis of dengue infection is a complex interaction between the dengue virus, host genetic and host immune factors. Initial infection with a particular serotype (primary infection) is usually asymptomatic or results in mild disease. Subsequent infection with a different serotype (secondary infection) leads to a more severe disease or DHF due to the presence of cross- reactive non-neutralizing antibodies which enhance the infection ARTICLE INFO ABSTRACT Objective: To evaluate the effects of vitamin E supplementation on the clinical course of dengue fever (DF) and dengue haemorrhagic fever (DHF) in 5–12 years old Sri Lankan children. Methods: A triple blinded controlled interventional trial was conducted at a tertiary care hospital in Sri Lanka. Five to twelve-year-old children with clinically suspected dengue infection within 84 h of onset of fever were randomly allocated to receive an age-adjusted dose of vitamin E or placebo. Standard ward management for DF/DHF was provided for both groups. Clinical, biochemical [aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum albumin, serum cholesterol, serum calcium] and haematological [white blood count (WBC), platelets, packed cell volume (PCV)] parameters were monitored regularly throughout the course of the illness. Results: Data of 127 subjects (n = 61 in treatment group) were analysed after they were confirmed of dengue infection. Treatment and placebo groups both were similar. The temporal distribution patterns of WBC, platelets, serum albumin and serum cholesterol were higher, while PCV, serum AST and ALT levels were lower in the treatment group compared to placebo group. PCV on Day 3.5, WBC on Day 6, ALT on Days 4 and 5, AST on Days 3–5 and albumin on day 5 were significantly improved in the treatment group. There was no difference in the duration of hospital stay or occurrence of leaking. However, the duration of leaking was significantly lower in the treatment group. Conclusions: Treatment with vitamin E shows a significant improvement in clinical, haematological and biochemical parameters in children with DF and DHF. Article history: Received 24 Jul 2017 Received in revised form 28 Aug 2017 Accepted 11 Sep 2017 Available online 24 Oct 2017 Keywords: Vitamin E Dengue fever Dengue haemorrhagic fever Sri Lankan children