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Dengue in Laos

  • somtam2000

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    So our Laos update has ground to a halt with our man on the ground down with dengue fever -- unfortunately not the Cambodian musical variety.

    Never heard of dengue fever? You're far more likely to pick dengue fever up than malaria, but you can read about both via the links below. In summary, I don't recommend either.

    Malaria
    Dengue

    So, stress again, take adequate precautions regarding mosquitos and make sure your travel insurance is current.

    Safe travels.

    #1 Posted: 7/10/2012 - 06:09

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  • squaretheci-
    rcle

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    Do you have an idea of what part of Laos he caught the fever in?

    #2 Posted: 16/10/2012 - 11:32

  • daawgon

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    I believe the press is saying the far north is the problem area right now.

    #3 Posted: 16/10/2012 - 17:17

  • somtam2000

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    Adam had travelled Huay Xai to Xieng Kok to Muang Long to Muang Sing to Luang Nam Tha to Udomxai to Phongsali to Hat Sa to Muang Khua to Nong Khiaw when he gor ill -- so somewhere along that route.

    #4 Posted: 16/10/2012 - 20:38

  • MADMAC

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    Normally takes about 2 weeks from time of infection to when you get sick. It's much more common in populated areas (because the mosquito gets infected from humans who are infected and then pass it to other humans). My son and wife both got it. There isn't much you can do to treat it, just try and treat some symptoms and monitor the patient. Move fluids lost back into the patient where appropriate.

    FYI my son was treated at the local government hospital here in Mukdahan and I paid cash for that (his insurance policy was not yet activated) and it cost me just a touch over 5,000 baht because I put him in the VIP room.

    #5 Posted: 16/10/2012 - 23:00

  • sayadian

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    Madmac
    I'm curious to know the how they treat this in a hospital now. I realise you wouldn't want to take any chances with your child and you did the right thing taking him to hospital but I can't think what else they can do bar monitor him, saline/glucose drip maybe and parecetamol. Do they have other ways of treating it in Thailand now?
    I dread this illness.Having had it 20 years ago. I thought then you get immunity but apparently there are four strains.
    Am I right in thinking you get it off the big, slow tiger mosquitos that aren't usually found in towns but in the forests?

    On the subject of mosquitos. I left Bangkok three weeks ago and was there 2 weeks.It rained everyday but I only got bitten once, this is living in a fan room with no net. Does anyone know if they have a spraying programme now in Bangkok or am I getting some sort of immunity from eating gapi. :-)

    #6 Posted: 17/10/2012 - 02:59

  • somtam2000

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    @Sayadian, When I had it, I was hospitalised for two days at the end of it because my "score" (Sorry can't recall what it was they measure off the top of my head) had dropped below a certain threshold.

    They moved me to hospital for observation and faster treatment should matters go pear shaped (once the score drops). More or less though it was putting me on a drip (for fluids) and subjecting me to hospital food and Indo TV, so was a very mixed bag.

    #7 Posted: 17/10/2012 - 03:21

  • squaretheci-
    rcle

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    @somtam2000 - when and where (in Indo) was that? It seems the scoring and recommend treatment protocol come out of the southern part of Taiwan, probably since that's both a technologically advanced society and a place with a dengue fever problem.

    #8 Posted: 17/10/2012 - 03:29

  • MADMAC

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    Yep - it's the tiger mosquito. But it's a ubitquitos mosquito. Find right here in Mudahan. BUT, the mosquito only has it if he bit someone who has it. They fumagated my house (probably going to latter give me cancer, but hey, no dengue) and my street when my wife and son got it (within a day of each other). My daughter and I did not get it. I almost never get bit anyway. That's why once there's an outbreak, they move to erradicate any mosquitos and that's why you have outbreaks rather than just single incidents.

    They check platlate (Sp?) counts to monitor each case. That's because of the danger of hemoraging. If you hemorage, they have to replace blood loss. My sons numbers were in the danger zone for a while and he needed fluids, but no blood. He did not hemorage. He was in terrible pain but bore it stoically. My wife, though, she bore it poorly. She was howling for hours.

    #9 Posted: 17/10/2012 - 03:30

  • somtam2000

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    @squarethecircle was in Bali, coupla years ago - outlined here

    As Madmac says, the pain is considerable.

    I don't recommend it :)

    #10 Posted: 17/10/2012 - 03:39

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  • sayadian

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    Fumagation is one way to eradicate them but apparently if you go around outside your house, and it's important everyone in the village does this, putting a small drop of oil in all standing water it causes a film to form on the surface and the mosquito eggs can't hatch.They fall to the bottom and the hatching mozzies drown.I think they use this method in Singapore.
    Yes, the pain is what I remember.Being unable to keep still but all movement being agony.
    Does anyone know why this disease seems to be getting more prevalent in S.E.Asia?
    The platelet count must be a recent development since all I got from the doctor was paracetamol.
    I think it's much more dangerous for children so I understand Madmac's concern.
    A lot of questions on here about what to take to avoid malaria but unfortunately more travellers will get dengue than malaria.I have rarely seen a case of malaria but have seen plenty of dengue.

    #11 Posted: 18/10/2012 - 03:18

  • MADMAC

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    "Fumagation is one way to eradicate them but apparently if you go around outside your house, and it's important everyone in the village does this, putting a small drop of oil in all standing water it causes a film to form on the surface and the mosquito eggs can't hatch."

    I live in a city, right downtown. This method is also used, but we still have mosquitos. Some places are overlooked or not in plain sight.

    "Does anyone know why this disease seems to be getting more prevalent in S.E.Asia?"

    Same reason malaria made a strong comeback. DDT usage was terminated. When the moquitos came back, the dengue and malria came with them.

    "I think it's much more dangerous for children so I understand Madmac's concern."

    Absolutely. And I don't want my daughter to suffer either. So I keep a close eye on it and mosquito exposure.

    #12 Posted: 18/10/2012 - 08:34

  • sayadian

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    Madmac, it makes no difference if you live in a city or a village.if everyone took care of their own backyard with the method I outlined there would be less mosquitos hence less risk.Singapore is not a village.
    So if DDT is the only effective means of fumigation what 'ineffective' sprays are you using?
    We can't eradicate them all but we can sure dent the population.
    'Some places are overlooked''
    I think they actually inspect in Singapore and you are encouraged to look a bit harder by a series of punitive fines for allowing stagnant water.

    #13 Posted: 18/10/2012 - 11:06

  • somtam2000

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    Was in Singapore last week, talking to a local friend about dengue, they said they have "dengue checks" for stagnant water, where inspectors in particular check clothes hanging poles that may hold stagnant water. They uncap the end of the pole and if more than a teaspoon of water is found there is a $50 fine.

    Can'r see that happening anywhere else in Asia (or the world for that matter - Sg a bit special on these kind of things).

    I think one of the problems with fumigation is that if they miss a pod (say a bunch festering under your cupboard in the bedroom) it takes precious little time (like 24 hours) for them to "reinfect" the area.

    I think much comes down to where you live - when we lived in Sanur in Bali (an area that was a swamp before it was substantially developed early 1900s), the mozzies were nuts - and not surprisingly I got dengue. Now, we live on the other side of the island (near Seminyak) and while the area is predominantly ricefields, our house gets a stronger breeze to the sea daily and it is "less" (by Bali standards) urban. There are zero mozzies -- we sleep with the bedroom doors open and no longer use mosquito nets at all.

    From a traveller's POV, given asking the owner to fumigate your bedroom before you move in probably isn't going to fly, being in a daily system of burning coils, using repellant, using a net and dressing sensibly is the best threat minimisation approach...

    ... and stay in Umalas rather than Sanur when in Bali ;-)

    #14 Posted: 18/10/2012 - 17:19

  • DLuek

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    "Does anyone know if they have a spraying programme now in Bangkok or am I getting some sort of immunity from eating gapi."

    I agree -- I can't remember actually noticing being bitten once in the last year during several months in Bangkok. Back in 2007 though I recall getting eaten alive in some Khlong Toei neighborhood.

    In fact, the only occasion over the last year when the mosquitoes actually made me uncomfortable was on little Ko Chang in the Andaman Sea.

    My girlfriend complains about it fairly often though. Sayadian, maybe we're just not sweet enough for taste of Thai mosquitoes?

    #15 Posted: 18/10/2012 - 21:07

  • MADMAC

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    "So if DDT is the only effective means of fumigation what 'ineffective' sprays are you using?"

    I don't know what they're using now. Doubtless carcinogenic though.

    DDT is not the only effective means, but was the most effective means.

    And it was sprayed all over the place - including villages.

    Because of the nature of the transmission though, the denser the human population the higher the general risk. Of course in some places the environment has really impacted on Mosquito poplations. In that case, human population is irrelevent.

    #16 Posted: 19/10/2012 - 04:45

  • wanderingcat

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    what they used in Singapore some years ago were ovitraps. the design & how it works - no oil involved: http://www.nature.com/scitable/content/ovitrap-22404316
    they were placed like every 10 metres in residential areas, & at least in my neighbourhood (a dengue hotspot in Singapore) it was incredibly effective in reducing the mozzie population, unlike fumigation (where the mozzies just hide within homes & are protected cos everyone shuts all windows & doors during fumigation of common areas).

    for some reason the ovitraps disappeared a few years ago (perhaps it was just an experiment?), & the problem is back. the authorities here put up banners in hotspots stating the number of new dengue cases in the neighbourhood over the past week. a colleague just came down with it this month, Clementi is currently a hotspot.

    the female mosquito has to acquire the virus by feeding on the blood of an infected person. so the more humans there are, & the higher the population density, the higher the rate of transmission. that's why it's such a big problem in Singapore, we have a few hundred thousands less than the entire population of Laos squeezed onto an island. & as humans spread into previously unsettled areas, the area that can be affected increases.

    climate change is also a problem. average temperature here has increased, & the warmer times of the year are hotter than before. (1) the higher the temperature, the more rapidly the larvae develop, & the shorter the time it takes to become an adult. (2) when the temperature is 30'C or higher, more female than male mozzies are produced (just like how the incubation temperature of turtle eggs affects the sex ratio of the offspring that hatch), & female mozzies are the ones that bite to feed on blood in order to produce eggs (males live on plant sap). (3) the higher the temperature, the faster the dengue virus multiplies within the mosquito.


    #11:
    platelet count is not a new thing, it's the standard test for dengue when the disease is suspected, especially when there is concern that the infected person will develop dengue haemorrhagic fever (DHF).

    #17 Posted: 19/10/2012 - 21:56

  • sayadian

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    'platelet count is not a new thing, it's the standard test for dengue when the disease is suspected, especially when there is concern that the infected person will develop dengue haemorrhagic fever (DHF).'
    Tell that to the useless quack on Koh Samui who took my money and gave me paracetamol. I was on my own and if it hadn't been for the girl in the guesthouse bringing water probably would have died.I don't remember much except the pain and drifting in and out of consciousness.

    #18 Posted: 20/10/2012 - 02:15

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