Dengue Fever Epidemic - S.E. Asia

[Bob]

This very important cautionary notice is directed to Cruisers in Indonesia; Malaysia; Thailand; Philippines; Burma and Northern Territory-Australia. (incl. the Cruising Rally leaving Darwin shortly for Langkawi - Malaysia via Indonesia and Singapore).

DENGUE FEVER EPIDEMIC
"The Health Authorities of South East Asian Countries are reporting serious outbreaks of Dengue Fever in epidemic proportions".

Full Details & important information.

Please propogate.

[btrayfors]

For those who may not know about Dengue Fever, I can tell you firsthand you absolutely DO NOT WANT TO GET IT!

When I was 17 and living in Indonesia with my Foreign Service parents, I contracted Dengue Fever. Although a healthy young man, I was bedridden and delirious for almost 3 days. Miserable stuff.

Bill

[delmarrey]

It's fairly common in Philippines. Three of my wife’s family has had it in the last two years.

You have to keep the mosquitos off of you at night by what ever means possible. Use fans in the hot season and nets in the cooler seasons. The tropics are a dangerous place (health wise) for humans and animals.

Chicken pox is next in line for common illnesses.

[DeepFrz]

Dengue Fever (breakbone fever, dengue hemorrhagic fever)

• "Dengue Fever" is also available in Portable Document Format (PDF, 48KB, 1pg.)
• Versión en español

What is dengue fever?

Dengue fever is a mosquito-borne disease caused by a virus. The disease is mainly tropical in origin but occasionally residents or visitors from other countries may arrive in this country with dengue fever. Although cases originating in the United States are virtually unknown, epidemic levels have recently been reported in parts of the Caribbean and Central America.
Who gets dengue fever?

Dengue fever may occur in people of all ages who are exposed to infected mosquitoes. The disease occurs mainly in tropical Asia and the Caribbean, usually during the rainy seasons in areas with high numbers of infected mosquitoes.
How is dengue fever spread?

Dengue fever is spread by the bite of infected Aedes mosquitoes.
What are the symptoms of dengue fever?

Dengue fever is characterized by the rapid development of a fever that may last from five to seven days with intense headache, joint and muscle pain and a rash. The rash develops on the feet or legs three to four days after the beginning of the fever. The hemorrhagic form of dengue fever is more severe and associated with loss of appetite, vomiting, high fever, headache and abdominal pain. Shock and circulatory failure may occur. Untreated hemorrhagic dengue results in death in up to 50 percent of cases.
How soon do symptoms appear?

Dengue fever may occur from three to 14 days after exposure to an infected mosquito, commonly within four to seven days.
Does past infection with dengue virus make a person immune?

Infection with one of the four strains of dengue virus usually produces immunity to that strain but does not provide protection against the other strains.
What is the treatment for dengue fever?

There is no specific treatment available. Intravenous fluids and oxygen therapy are often used for patients who experience shock during their illness.
What can be done to prevent the spread of dengue fever?

Since cases of dengue appearing in New York are imported, control measures are limited to advising travelers to affected areas to minimize exposure to infected mosquitoes. Use of mosquito netting and repellents may be helpful in minimizing exposure.

[CaptainK]

If anyone who plans to travel. Or live in Asia. I recommend anyone to visit these people. If they are in your area, in the US. I have used their services. And still am.

World Travel Health :: Providers of Quality Health Care

Also. Make sure that you bring with you. A xerox copy of your shot records with you. And keep them along close with your passport. Cause in some countries. They want to know if you have current innoculations.

Also bring with you. Or purchase any repellants that have Permethrin. Use that on your mosquito nets and clothes. And it is generally good for 3 weeks. And use a controlled release insect repellant that has 20% DEET.

I know about this. Cause I have consulted in person, with travel doctors. And they recommended these things to me. They even sell repellants. And they issue you shots and the records. For you to take with you, for your own records. And they even give you prescriptions for the medicine's Malarone & CIPRO for traveler's diarrhea & malaria.

For anybody planning to travel overseas to Asia. And I highly recommend anyone to do the same. Get innoculated!! To avoid a costly trip to a foreign hospital.

[Kuapa'a]

Aloha,

I have had dengue fever and also treated a number of patients with it over the years and can echo the sentiment "This is not a disease you want to fall ill with!".

What is dengue fever? What is dengue hemorrhagic fever?
Dengue fever is a flu-like illness spread by the bite of an infected mosquito.
Dengue hemorrhagic fever is a severe, often fatal, complication of dengue fever.

What exactly causes dengue fever?
Dengue and dengue hemorrhagic fever are caused by any of four dengue viruses. This is important because infection with one virus does not protect a person against infection from another.

How is dengue fever spread?
Dengue is spread by the bite of an Aedes mosquito. The mosquito transmits the disease by biting an infected person and then biting someone else.

Unlike the mosquitoes that cause malaria, dengue mosquitoes bite during the day.

Where is dengue found?
Dengue viruses occur in most tropical areas of the world. Dengue is common in Africa, Asia, the Pacific, Australia, and the Americas. It is widespread in the Caribbean basin. Dengue is most common in cities but can be found in rural areas. It is rarely found in mountainous areas above 4,000 feet.

What are the symptoms of dengue fever and dengue hemorrhagic fever?
Dengue fever usually starts suddenly with a high fever, rash, severe headache, pain behind the eyes, and muscle and joint pain. The severity of the joint pain has given dengue the name "breakbone fever." Nausea, vomiting, and loss of appetite are common. A rash usually appears 3 to 4 days after the start of the fever. The illness can last up to 10 days, but complete recovery can take as long as a month. Older children and adults are usually sicker than young children.
Most dengue infections result in relatively mild illness, but some can progress to dengue hemorrhagic fever. With dengue hemorrhagic fever, the blood vessels start to leak and cause bleeding from the nose, mouth, and gums. Bruising can be a sign of bleeding inside the body. Without prompt treatment, the blood vessels can collapse, causing shock (dengue shock syndrome). Dengue hemorrhagic fever is fatal in about 5 percent of cases, mostly among children and young adults.

How soon after exposure do symptoms appear?
The time between the bite of a mosquito carrying dengue virus and the start of symptoms averages 4 to 6 days, with a range of 3 to 14 days. An infected person cannot spread the infection to other persons.

Who is at risk for dengue?
Anyone who is bitten by an infected mosquito can get dengue fever. Risk factors for dengue hemorrhagic fever include a person's age and immune status, as well as the type of infecting virus. Persons who were previously infected with one or more types of dengue virus are thought to be at greater risk for developing dengue hemorrhagic fever if infected again.

What is the treatment for dengue and dengue hemorrhagic fever?
There is no specific treatment for dengue. Persons with dengue fever need rest and plenty of fluids. Dengue hemorrhagic fever is much more difficult to treat and may require blood transfusions, massive fluid replacement and diuresis to try and prevent kidney failure.

How common is dengue fever?
In tropical countries around the world, dengue is one of the most common viral diseases spread to humans by mosquitoes. Tens of millions of cases of dengue fever and up to hundreds of thousands of cases of dengue hemorrhagic fever occur each year.
In the United States, approximately 100 cases of dengue are reported each year in travelers returning from tropical areas. Many more cases probably go unreported.

Is dengue fever becoming an increasingly serious problem?
Yes. All types of dengue virus are re-emerging worldwide and causing larger and more frequent epidemics, especially in cities in the tropics. The emergence of dengue as a major public health problem has been most dramatic in the western hemisphere. Dengue fever has reached epidemic levels in Central America and is threatening the United States.
Several factors are contributing to the resurgence of dengue fever:

• No effective mosquito control efforts are underway in most countries with dengue.
• Public health systems to detect and control epidemics are deteriorating around the world.
• Rapid growth of cities in tropical countries has led to overcrowding, urban decay, and substandard sanitation, allowing more mosquitoes to live closer to more people.
• The increase in non-biodegradable plastic packaging and discarded tires is creating new breeding sites for mosquitoes.
• Increased jet air travel is helping people infected with dengue viruses to move easily from city to city.

Dengue hemorrhagic fever is also on the rise. Persons who have been infected with one or more forms of dengue virus are at greater risk for the more severe disease. With the increase in all types of virus, the occurrence of dengue hemorrhagic fever becomes more likely.

Can dengue fever be prevented?
There is no vaccine to prevent dengue. Prevention centers on avoiding mosquito bites.

• Use mosquito repellents (DEET) on skin and clothing.
• Use bednets if sleeping areas are not screened or air-conditioned.
• If you have symptoms of dengue, report your travel history to your doctor.

Parting thoughts.
This information is not intended to ignite an attitude of fear, but hopefully to simply provide some awareness about a potential danger for those of us who love the tropics. Yes you can die from this, but you can also die from Box and Irakanji jellyfish stings, or falling overboard and drowning because you weren't wearing a harness on deck. Like many other aspects of cruising, it's amazing how far a little common sense will go. So use some DEET when necessary and stay away from the mozzies!

All The Best,

John Kuapa'a, M.D.

[Boracay]

I grew up in the tropics, New Guinea.

I have spent some time in tropical North Queensland and the Philippines.

I have had malaria. Caught it in New Guinea. Massive infection count. Cured it in three days with locallly available medicine.

Lets count. One in Singapore, 14 in Thailand, 44 in Malaysia. A serious outbreak killed 25 in Singapore. In a population of how many?

Remember these are countries where public appearance can be more important than fact. Public health authorities could be very reluctant to report deaths that might reflect badly on them. If you can find the figures for deaths by malaria, road accident and food poisoning think about them.

The symptoms are sufficiently vague that they could easily be confused with other illness.

I would suggest that you are more likely to be killed crossing a road to see a doctor than by dengue.

And don't let the mossies get you. Stay inside screened areas at night. Wear loose light coloured clothes that cover most of your body. And stay out of areas with lots of mosquitos.

And keep off motor bikes.

[senormechanico]

In Mexico in the mid '90's, a cruiser friend of mine caught Dengue Fever. I'm not sure where he contacted it, but the path we took was more or less the same one that he and his wife cruised. We got bitten on our ankles by mosquitos anytime we were sitting on the beach with our feet in the shade, especially in San Blas!

At the time (and probably still) San Blas was the mosquito capital of Mexico. We heard the 411 from our local restaurant owner friends. They said the president of Mexico (at the time) saw Matachen Bay as the "New Acapulco". A stage was set up for a speech and all the locals and national officials gathered around for the big launch of the "Next Big Thing" for Mexico. The only problem was that the speech started around 2 o'clock in the afternoon, just about the time the "No Seeums" started to feed. The speech lasted about 5 minutes before everyone bailed. That was the end of the project.

The locals call the no seeums "Flying Teeth" with good reason.

Steve B.

[Whimsical]

Originally Posted by DeepFrz

"Dengue Fever" is also available in Portable Document Format (PDF, 48KB, 1pg.)

I know computer viruses were getting bad but never realised they have advanced this far.

Sorry all I just couldn't resist

Mike

[Kuapa'a]

Originally Posted by Boracay

I grew up in the tropics, New Guinea.

I have had malaria. Caught it in New Guinea. Massive infection count. Cured it in three days with locallly available medicine.

Lets count. One in Singapore, 14 in Thailand, 44 in Malaysia. A serious outbreak killed 25 in Singapore. In a population of how many?

I would suggest that you are more likely to be killed crossing a road to see a doctor than by dengue.

Aloha Boracay,

The fact that you grew up in the tropics and once had malaria has nothing to do with the fact that there is a 5% mortality rate from dengue hemorrhagic fever.
(So much for your suggestion about crossing the road to see a doctor).

Lots of us grew up in the tropics and have had malaria, dengue, typhus, Nile River fever and other nasties... multiple times and have been blessed to have survived. I'd suggest you get your "statistics" from the Centers for Disease Control (CDC) or the World Health Organization (WHO). The figures you report are ludicrous. You don't have to read in depth to find out that malaria kills millions each year in Africa alone.

John Kuapa'a, M.D.

[sneuman]

Originally Posted by Boracay

I grew up in the tropics, New Guinea.

I have spent some time in tropical North Queensland and the Philippines.

I have had malaria. Caught it in New Guinea. Massive infection count. Cured it in three days with locallly available medicine.

Lets count. One in Singapore, 14 in Thailand, 44 in Malaysia. A serious outbreak killed 25 in Singapore. In a population of how many?

Remember these are countries where public appearance can be more important than fact. Public health authorities could be very reluctant to report deaths that might reflect badly on them. If you can find the figures for deaths by malaria, road accident and food poisoning think about them.

The symptoms are sufficiently vague that they could easily be confused with other illness.

I would suggest that you are more likely to be killed crossing a road to see a doctor than by dengue.

And don't let the mossies get you. Stay inside screened areas at night. Wear loose light coloured clothes that cover most of your body. And stay out of areas with lots of mosquitos.

And keep off motor bikes.

I'm with you, there. I had dengue in India about 10 years ago. It is horrible, and curable. But many of the health and safety warnings nowadays have to be taken with a grain of salt. They are more often than not an exercise in bureaucratic CYA. Far more people get and die from Lyme Disease in the U.S.

Perspective, folks. It's never as bad as it looks on TV.

[Ex-Calif]

22 years in SEA and (knock, knock) so far no Dengue, Malaria or bird flu. Brother had Dengue. Sucks big time.

A couple of times a year the "Dengue Outbreak" stories hit the papers. Basically denying breeding grounds for mosquitoes is about the only thing that can be done. There are big campaigns here about reporting standing water and trying to keep drains and so on clear.

It's pretty much impossible. Lot's of Off or Deet. Mosquito coils, citrus candles etc. Long pants and shirts are usually not an option unless you are inside in the air conditioning and then what's the point?

In other news - Malaysia just found a "pod" (for want of a better name) of bird flu in the Klang valley - near Kuala Lumpur.

In asia get your poultry and eggs from reputable stores - Cook them very well and hope for the best.

[GordMay]

Malaria is a life-threatening parasitic disease, that is most commonly transmitted from person to person by mosquitoes. While malaria is easily prevented and curable, it still kills millions* of people every year.

Malaria can progress from an asymptomatic state to death in as little as 36 to 48 hours. Furthermore, the mortality of severe malaria is > 30%, even for previously healthy adults, managed in moderate intensive care units.

The World Health Organization has identified drug-resistant malaria as a re-emerging infectious disease and a threat to global health.

To prevent malaria deaths, cruisers need to be adequately informed about prevention of malaria using personal protection measures** and appropriate chemosuppression.

Chloroquine is no longer effective in preventing falciparum malaria for most of the malaria-endemic world, with the exception of Central America, the Caribbean, and a decreasing area of the Middle East.
Chloroquine and proguanil as combination chemosuppression are only 60 % to 70% efficacious in sub-Saharan Africa.
Weekly mefloquine or daily doxycycline continue to provide substantial protection against drug-resistant falciparum malaria in most malaria-endemic areas, except on the borders of Thailand with Myanmar (Burma) and Cambodia.

* Malaria is a leading cause of death and illness worldwide.
In Africa, south of the Sahara, between 13 and 23 million cases per year have been reported during 1985-1989. Based on the population exposed to malaria risk, and on the number of fever episodes (1 - 6) from which a person will be suffering every year, and of which about half are typically due to malaria, it has been estimated that between 270 and 480 million clinical malaria cases may occur every year. About 140 to 280 million of these clinical malaria attacks will occur in children less than 5 years old.
A 1987 study in the Gambia, concluded that malaria mortality may be as high as 6.3 per 1,000 per year in infants (4% of all infant deaths) and 10.7 per 1,000 per year in children 1 - 4 years old (one-quarter of deaths in that age group). Among children referred to hospitals with severe malaria, case- fatality rates of 10-30% have been noted, and in rural areas with little access to adequate treatment these rates might be even higher. Taking into account the above morbidity estimates one could expect malaria mortality to be in the order of 1.4 to 2.6 million annually, of which approximately 1 million deaths will occur in children below the age of 5 years (for some of the deaths malaria may not be the only cause).

** The World Health Organization has found insecticide-treated bed nets to be a safe and highly effective method of preventing malaria.

References:

Dengue and Dengue Haemorrhagic Fever ~ World Health Organization (WHO)
WHO | Dengue and dengue haemorrhagic fever

Dengue haemorrhagic fever: diagnosis, treatment, prevention and control ~ WHO
WHO | Dengue haemorrhagic fever: diagnosis, treatment, prevention and control. 2nd edition. Geneva : World Health Organization.

Recommendations for the Prevention and Treatment of Malaria Among International travelers ~ CCDR (Public Health Agency of Canada)
Canadian Recommendations for the Prevention and Treatment of Malaria Among International Travellers - Public Health Agency of Canada

Prescription Drugs for Malaria ~ CDC
Diseases: Malaria: Prescription Drugs, Public Info | CDC Travelers' Health

[Boracay]

Chapter 7 of Gord's second reference should be required reading for cruisers.

Gord's third reference discusses the risks involved. The infection rates they mention are much higher than I would have expected.

The risk does seem to be worse if accurate diagnosis and treatment is delayed.

When I was in New Guinea some long term residents did not take anti malarials and instead relied on getting a definative diagnosis using a blood test. They then used the medicine and dose that had been proven in their area.