Reply To: Surviving the Bangkok dengue fever outbreak

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Rainy season is now upon us and with that begins an increase in Dengue Fever. Every doctor will warn you that before heading to a tropical destination, there are a few mosquito borne illnesses that strike fear into people worldwide. These often include malaria, Japanese encephalitis and Dengue fever. According to the Public Health Ministry of Thailand, this year is expected to be the worst season in Thailand’s history for haemorrhage dengue fever, also know as “Break-Bone Fever.” Already this year, 39,029 people have been treated for dengue fever and 44 people have died. With those cases expected to peak during the rainy season, the Public Health Ministry expects more than 100,000 cases by the years end and more than 100 deaths. So the question remains, “How do I make it through this rainy season without getting dengue fever?”

What is Dengue Fever?

In order to avoid a week of misery, its best to first understand where dengue comes from. The simple answer is from a mosquito, specifically the Aedes mosquito. This small, daytime mosquito is distinctive by its black body with white stripes or spots. It often hangs out around clean, still water while looking for blood in order to get the necessary protein to lay eggs. When the mosquito bites a human with dengue fever, the virus incubates in the mosquito for a number of days and then reaches the mosquitoes salivary glands. This allows the virus to be easily transferred to the person who is next bitten by the mosquito.

How do I know if I have it?

The good news is that 80% of the cases of dengue fever are asymptomatic or the person only shows signs of a mild fever, which means you may never even know you have it and your body will naturally deal with it over the course of a couple weeks. However for approximately 5% of those infected, they will be in for a long week or two. The incubation time, or the time between exposure to the virus and the onset of symptoms can be anywhere from 3 days to as much as two weeks.

When symptoms do start, they will often feel very similar to an ordinary fever including raised body temperature, a stuffy nose as well as vomiting or diarrhea. While these symptoms are common and hard to distinguish from any old cold, there are a few tell tale signs that should throw up some warning flags and warrant a trip to the doctor. The first sign is severe headaches. We are talking I-can’t-think-because-my-head-might-explode headaches. The second sign is that you will feel like you have been hit by a truck. Expect joint and muscle pain rivaling that of a seventy year old man. If you think you have somehow thrown your back out while doing no labor harder than eating a bowl of rice, you may need to think about visiting your doctor. Another very common symptom is eye pain. If your eyes suddenly feel like they are three sizes too big for your eye sockets and every time you look left or right it exacerbates your headache, than that is another sign you may have dengue. Finally, if in conjunction with these symptoms you develop a body rash, you should immediately head to the hospital. Another rule of thumb is anytime you have a fever for three days, you should go see the doc for a check up.

Once arriving at the doctors it is normal to get the full check up and be questioned about your symptoms. However, if you are really worried about potentially having dengue, do not leave the office until you get a blood test because that is the only way to confirm whether or not you do indeed have dengue.

Crap, I have dengue, what can I expect now?

Quite simply, a long hospital visit. There is no medicine or vaccine for dengue fever, so once you have it, there is little that can actually be done. However, if the disease gets too advanced, it’s possible you can enter Dengue Shock Syndrome or haemorrhage blood from you intestinal tract. This can lead to other complication like liver failure and possibly death. So listen to your doctor. When he tells you to stay at the hospital a few nights, don’t fight him. You will be hooked up to an IV day and night and given paracetamol or acetaminophen, which is commonly sold as Tylenol. Do not take ibuprofen or aspirin as this can increase your chance of internal bleeding. If your doctor is trying to give you this, sit him down and have a serious conversation with him. I repeat, DO NOT TAKE IBUPROFEN OR ASPIRIN.

When the doctor tells you to stay in the hospital, expect to stay for a number of days. Five was my magic number and was corroborated by a few friends who have also had the disease. Every morning you will have blood drawn and a visit from your doctor to update your white blood cell count, blood platelet count and kidney functions. Nurses will check your temperature and blood pressure every four hours and you will eat horrible, horrible hospital food. Typically your doctor will allow you to go home when you have not had a fever for 24 hours and your blood counts are trending towards normal. Congratulations you made it.

That sounds horrible, how can I not get this?

It is horrible and there are a few things you can do to decrease your chances of acquiring it. The easiest thing to do is to coat your body in mosquito repellent 24/7. It is also important to understand that if the Aedes mosquito bites during the day and is attracted to still, clean water, then you should aim to stay away from those areas or prevent those environments from occurring.

There are a number of preventative measures you can take to make your home unattractive breeding grounds for the Aedes mosquito. The most obvious is to get rid of still water in your house or apartment. These mosquitoes love to hang around water holding containers such as water bottles, plant dishes and toilets. Make a concerted effort to throw water bottles away, or at the very least screw the caps on them. Plant dishes should be cleaned every other day and toilet seats should be shut. The idea is to not even let them breed as one of the reasons for this years outbreak is that the mosquitoes are breeding at hiring rates than ever. For more information on preventing Aedes mosquitoes from breeding and other information on dengue fever, check the Singapore National Environment Agency website.

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