Dengue fever in Southeast Asia

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First published 6th November, 2010

For many first time visitors to Southeast Asia, a visit to a "travel doctor" is a part of the pre-departure planning. Invariably discussion revolves around nasties like rabies, hepatitis and malaria as there are preventative shots, pills and potions you can buy for all these. What gets discussed far less frequently, yet in all likelihood you're just as likely to pick up, is dengue fever.


One of the reasons dengue doesn't get brought up, is because there is no pill potion or shot for it — if you catch it, you just have to ride it out — but unfortunately, for too many people, dengue kills.

What is dengue fever?

Dengue fever is a virus which is caused by any one of four related viruses (DENV 1, DENV 2, DENV 3, or DENV 4). There is also the more serious Dengue Hemorrhagic Fever (DHF). Each of the viruses is slightly different, meaning that if you've already had one strain of dengue, you are not immune to the others — sequential infections put you at greater risk for dengue hemorraghic fever.

Dengue: Positif

The virus manifests itself via high fever, severe pain behind the eyeballs, in some cases a bad rash, and in most cases extreme pain in the bones and joints (especially in the lower body). This last symptom led to the virus also being known as "Breakbone Fever".

A typical "dengue experience" lasts around a week to ten days. It commences with loss of appetite, a high fever and aching joints. It is after the fever subsides that the changes in platelet count normally occur. This count needs to be closely monitored as treatment is determined by how low your platelets are. Left unmonitored and therefore untreated can lead to death.

There is no "cure" for dengue. Instead painkillers can be taken to bring down the fever. It is important to note that aspirin and non-steroidal anti-inflammatory drugs such as ibuprofen (otherwise known as brufen or nurofen) must be avoided as they 'thin' the blood and can worsen the situation. Muscle relaxants can be taken in an attempt to reduce the bone and joint pain. Once hospitalised, patients may be placed on a drip and have a blood test each day to monitor their platelet level. In cases where platelets drop too far a platelet transfusion may be given and in extreme (life threatening) situations a blood transfusion takes place.


Aedes aegypti
Aedes aegypti: shoot on sight. Photo by Marcos Teixeira de Freitas

How do you catch dengue fever?

The virus is spread primarily by two types of mosquito Aedes aegypti and Aedes albopictus. They tend to bite in the early morning and have white bands on their legs. They like to rest in cool, dark areas, like cupboards and under beds and are extremely resilient to control measures. The CDC (Centre for Disease Control) says "if we were to eliminate all larvae, pupae, and adult Aedes aegypti at once from a site, its population could recover two weeks later as a result of egg hatching following rainfall or the addition of water to containers harboring eggs."

Dengue fever can take up to four days after infection to begin displaying symptoms and it can take a number of blood tests to determine that an infection is present.

How to protect yourself from dengue fever

Unlike malaria there is no preventative medication for dengue and a vaccine is not currently available. The only way to exercise preventative care is to avoid being bitten by mosquitoes. There are a number of core practices that can help reduce the chance of you being bitten.

  • Wear repellent.
  • Where practical, use a mosquito net. Be sure to fix any holes in the net.
  • Burn mosquito coils, but make sure they are a safe distance from the net.
  • Dress sensibly 1: Avoid dark, heavy clothes.
  • Dress sensibly 2: Wear light cotton clothing with long sleeves and pants/dress.
  • If your accommodation has still water in it, keep the bathroom door closed.
  • Kill every single mosquito you see — regardless of if they have stripy legs or not.
  • Once infected, it is important to protect others around you by wearing repellant yourself and abiding by the other recommendations above to reduce potential for cross-infection.

How big a problem is dengue fever?

Unlike malaria, which is primarily found in rural areas, dengue is found both in rural and urban areas. This substantially increases the risk for casual tourists.

When I was being treated, the doctor said that last year (2009) there were around 4,000 dengue cases in Bali. This year, as of September, there had been 8,000. While generally a disease of the tropics, fatalities have been recorded in cooler climates from Perth to Paris as well. If you return to your home country and start to display symptoms, it is crucial that you explain to medical staff you have just come from a "dengue region" as they won't suspect it otherwise.

The CDC estimates that there are over 100 million cases of dengue, worldwide, each year while the World Health Organisation (WHO) estimates that there are 50 to 100 million infections annually, including 500,000 DHF cases and 22,000 deaths, most of which are children. In 2010, dengue fever outbreaks (not including countries where the virus is normally present) have been recorded in Australia, Pakistan, Puerto Rico and USA.

Personal experiences

Turns out you don't have to ask around much to find others who had dengue — here are three examples (from myself and two travellers) who all had dengue around the same time.

Yours truly

I came down with dengue in September 2010 and was bed ridden for a week, including a two night stay in hospital. I woke up feeling a little off and within a couple of hours had a 40 degree fever. By afternoon was suffering intense pain in hips and lower legs along with exhaustion. Couldn't walk without considerable pain. The pain in the eyeballs was intense and maddening. It was two days before dengue was confirmed (by blood test) and I went to hospital once my platelet level fell below 70,000 (on day five). Once in hospital, was put on a drip and kept under observation for two nights.

Kyle

I felt like I had the worst hangover that lasted days.  I had headaches, my eyes hurt when I would move them, and my fever was around 104F (40degC) for a couple of days. Of course, when your temperature is that high your body gets sweaty and you start getting the chills. After the fever passed, it felt like I had mono. I was tired all the time and didn't have an appetite to eat much. When I did eat, I wanted the blandest food possible, which is weird for me because I love spicy food. It took me a while to get my appetite back. I was lucky in that I had only mild bone pain.
Kyle blogs at "On Our Own Path", recently hit 1,000 days of straight travel and is currently hanging out in Chiang Mai.

Brianne

It started with flu-like symptoms... very achy and fatigued and just a general feeling of being sick. Then I got a horrible headache with pain behind my eyes, which worsened whenever I moved my eyes. It got so bad that I had to move my head whenever I wanted to look at something. Not moving your eyes at all is MUCH harder than you'd think! Around the same time as the headache started, I also started feeling very feverish- chills, sweating, etc. Over the next few days all of the symptoms got increasingly worse. My muscles and joints hurt so much I had to lay in bed all day, which actually worked out well since I was so tired, I slept all day every day. I actually had all of the symptoms of Malaria, so I went to the hospital to get tested for that. They told me that no, I didn't have malaria, but surprise! I had dengue! As the disease started to clear up towards the end, my fever was on and off. Once the fever had completely broken, my body was COVERED in an incredibly itchy rash. My hands and feet were unbearably itchy, and the rest of my body was covered in a hive-like rash, that ended up spreading so much that you couldn't see a single spot of "normal" skin on my arms, legs, or stomach.
Brianne blogs at Mai Ow Pet.

More about dengue fever

CDC
WHO
Naked Hungry Traveller

Thanks to our resident nurse, Susanne, for sorting out my medical hoo haa in the story. Thanks Sus!

And a very special thanks to my better half @babyexpat, who cancelled her holiday to Turkey to look after me, and an apology to @auntarnie her travel companion - I'll make it up to you both!


About the author:
Stuart McDonald co-founded Travelfish.org with Samantha Brown in 2004. He has lived in Thailand, Cambodia and Indonesia, where he worked as an under-paid, under-skilled language teacher, an embassy staffer, a newspaper web-site developer and various other stuff. His favourite read is The Art of Travel by Alain de Botton and he spends most of his time in Bali, Indonesia.


Read 23 comment(s)

  • Wow.... harrowing stuff. It must have been particularly scary up to the point where you were diagnosed, to feel such pain but not know what was going on. As one who hates wearing repellent, it's a sobering reminder of WHY I wear it when travelling.

    Posted by Lisa on 8th November, 2010

  • We had all the miserable symptoms..(key indicators were wild temperature swings and a very hot, painful neck n' headaches. Dengue was confirmed with a blood test at SOS ... TWICE in the last 10 yrs for both of us ! To live through the process, We found that lots of Guava juice and 'Pocari Sweat' (local gator aid)and, lots of water helped control fever and symptoms. Call me crazy. When my core temperature became unbearable, I dropped into the pool to cool off ...then back to bed. Both of us were back to normal after 10 days or so when the red rash faded.

    Hope you find this helpful ... Be well.. be safe... prevention is best.
    dick

    Posted by OmDick on 8th November, 2010

  • Hi Lisa,
    Within a few hours of waking up on the first day I was pretty sure I knew what I had! Friends here have had dengue and the symptoms are pretty clear. The first blood test came back negative (which isn't at all unusual) but by then I already knew exactly what I had!

    An added bonus of following the prevention methods I mention above is that you're also protecting yourself against other mosquito-borne viruses like malaria.

    Cheers!

    Posted by somtam2000 on 8th November, 2010

  • Fantastic report and update on Dengue. It is amazing how unaware people are and the risks they are prepared to take in the name of stupidity! One mosquito bite people - that's all it takes.
    I would also add to the not what to do - don't wear perfume or heavily scented products and mosquito plug in are excellent. Deet or tropical strength repellent is excellent. Roll on seems to work better than spray. Remember also - sunscreen first and repellent 2nd
    Regards
    Suzi

    Posted by swatral on 8th November, 2010

  • @OmDick,
    Ahh I forgot to mention the guava juice, I drank a lot of it and even if it didn't help, it tasted great! I can't stomach Pocari though. I was also given a local (Balinese) concoction made from squashed up papaya leaf that was, well, vile.

    Posted by somtam2000 on 8th November, 2010

  • I have one question for those of you who have had Dengue Fever. Many of you mentioned having platelet counts monitored or being treated/hospitalized. We will be traveling in Laos in a few weeks where I don't think monitoring/treatment will be available, so I'm not sure what we should do if one of us experiences symptoms characteristic of Dengue Fever. i.e., how hard should we try to evacuate to a larger city like Bankok if we become ill.

    Posted by Heidi on 8th November, 2010

  • Hi Heidi,
    Outside of severe cases, hospital treatment is basically getting stuck on a drip and the nurses checking blood pressure etc through the day/night. Dengue is common in Laos and the hospitals in Luang Prabang and Vientiane should be able to treat as they're doing it all the time for locals. In severe cases (and depending on where you are in Laos) perhaps you'd be evacuated over to the Thai town of Udon Thani which has quite good care - from there it is about another ten hours to Bangkok (and World Class care).

    Posted by somtam2000 on 8th November, 2010

  • My partner was confirmed with Dengue Hemorragic Fever in Bali on 24 September. He spent a week in hospital on a drip and experienced all the documented symptoms including one frightening episode when he lost an awful lot of blood. Six weeks later he is still suffering extreme (break bone) pain in his neck, hips and left arm. The pain gets worse at night. Doctors here and people who have experienced the illness themselves assure him that this is not unusual and he could take up to 6 months to fully recover. Why doesn't the literature talk about the long recovery time and these extreme symptoms? Now he is terrified of being bitten again because he knows the next bite could be fatal.

    Posted by Diana on 8th November, 2010

  • I contracted dengue fever in India about 13 years ago. Am returning to Thailand for a bit in two weeks. The thought of contracting it again -- along with the hemorragic implications -- doesn't sit well.

    Posted by Daniel Noll | Uncornered Market on 8th November, 2010

  • Thanks for writing this. I wish I would have known this before hand and done the quick task of liberally peppering myself with bug repellent before I leave the house. I hope this can prevent someone else from contracting it, though.

    Posted by Kyle on 8th November, 2010

  • @ Diane - I didn't have DHF but it still took best part of a month before I felt like I was really back on deck, and then last weekend I had a relapse (primarily) with the pain behind the eyes, that laid me out again. A good friend who picked it up in Sri Lanka got over the initial bout only then to come down with Post-dengue arthritis that was totally debilitating. Sorry to hear about your partner's bout - you still in Bali?

    Posted by somtam2000 on 8th November, 2010

  • I appreciate you all sharing your experiences. It has made me a little nervous about my upcoming trip, but also helped me to realize the importance of avoiding mosquito bites. Thank you

    Posted by Heidi on 11th November, 2010

  • Hi,

    I have had Dengue once already and had an unknown virus last summer, which I contracted from hiking through the rainforest in Colombia. I am off to Vietnam in under a week. My friend has a mosquito net, which we can use and I have 30% DEET. I was also thinking that it would be best if I got that anti-mosquito soap. Do you know which one is the best to get? Thanks

    Jamie

    Posted by Jamie on 25th July, 2011

  • I had DHF in May 2010 and can tell you it was horrible. I woke up at about 4am and felt like a truck had gone through my bedroom. My head ached, my body ached and i was whimpering like a child.

    I couldnt drive, so i got a doctor to come to my house to check me out - i think he was Doogy Houser. Gave me an injection of some kind and went on his way.

    The next day, i went to the hospital to get checked. They told me that i had some sort of virus, but would not know what it was until the blood tests came through. I got a call in the afternoon to say that i had Dengue.

    My platelets were at about 130 at that stage, so i did not need to be hospitalised. They told me to come back on Sunday if i didnt feel better, or earlier if i felt worse.

    I went back the next morning as i was going downhill fast. My platelets were sitting at 75 then, which requires hospitalisation.

    So, off to hospital I went. I stayed in for week, with my platelets dropping down to about 33 before climbing up again.

    As a result of the Dengue, i also had fluid on one of my lungs, and an enlarged gallbladder, which sucked the big one.

    i didnt get a spotty rash - i was just bright red all over. thank goodness i didnt get the itch.

    I have had malaria 4 times now, but i can tell you that Dengue is far worse than that!

    SPRAY YOURSELF, SPRAY YOUR ROOM AND REMAIN BITE FREE is the best advice i can give anyone.

    Posted by Donna on 25th November, 2011

  • I contracted Dengue Fever after a Caribbean Cruise. Symptoms first started with painful bloodshot eyes and terrible neck and headache pain. Days later the weakness and muscle pain especially in my legs started.I was exhausted and very fatigued. I woke in the night with a high fever and extreme "bone breaking" pain. (Perfect for diagnosing!) I have never been in so much pain! Woke up the next day around 2:00pm and my hands and feet were swollen double in size and were extremely itchy. Because of the strange symptoms and the fact that I just returned from the Caribbean, I typed my symptoms on a medical web site and Dengue came up. Went to the Dr and he said he never would have tested me for Dengue had I not mentioned my suspicion. Test IGG and IGM confirmed.
    Six weeks later and I am still exhausted and experiencing symptoms. It is a horrible disease!

    Posted by Maureen on 2nd December, 2011

  • I must agree, dengue fever was undoubtedly the worst virus I've had in my life. I also experienced the textbook symptoms of: fever, aching bones, loss of appetite, swollen and itchy hands and feet, but also had the deep red/purple rash all over my body. As I got better, the rash went down my body in a straight horizontal line to the point where 3 weeks later I still had it around my feet and legs. I also experienced serious hair loss about 3 months afterwards from the entire ordeal.

    That was two years ago and I'm now planning another trip to South East Asia (I believe I contracted it in Koh Chang, Thailand). I'm quite nervous about the possibility of contracting dengue again and am wondering if mosquito repellent, nets, etc are enough for prevention?

    Also, I've heard mixed reviews on the chances of becoming seriously ill from getting the virus again. Some doctors have told me that my immunity has been completely hindered because of my first encounter and my body will not fight off the second dengue fever as well as it could. I have also heard, however, that I will be affected by it just like anyone else regardless of the fact that I've had it before. I'm just wondering what everyone else has heard on this matter?

    Posted by Marta on 26th January, 2012

  • Marta my understanding is if you have had it once it will be worse the second time but I am no doctor and really you should be seeking professional medical advice on this. As far as prevention goes you must ensure you prevent getting bitten - even by just one mosquito. Always have repellent on – we bought clothing patches and wrist bands in addition to spray a lot, don’t wear perfume, wear long sleeves, long pants where possible and if you can afford it sleep in air conditioning as they don't like the cold. Good luck!
    Regards
    Suzi

    Posted by swatral on 26th January, 2012

  • 6 months later after Dengue...still suffering from extreme fatigue. I also have had recurrent conjuntivitis and pain in my right eye. Seems like my eyesight has been permanently affected.(The very beginning of this horrible disease started with pain in the right eye) I have always been physically fit and active. Not since Dengue. My fatigue overcomes me some days. I have done much research on my own. Not much out there as far as outcome and long term health prognosis.I am eating healthy, walking and trying to get my immune system back to normal.. Dengue is debilitating for a long time! More research is needed!

    Posted by Maureen on 11th April, 2012

  • @ Maureen - i have heard that iodine tablets can assist in killing any bug that may be left in your body. that coupled with one clove of garlic swallowed whole every day will work together to get rid of bacteria. very simple solutions.

    I, too, was ill for up to a year afterwards, and I do hope that more research is done into this awful condition.

    I hope you feel better soon.

    Posted by Donna on 11th April, 2012

  • My top tips for Avoiding Mosquito Bites
    1.Wear mosquito repellent bands on wrists and ankles.
    2.Apply repellent to skin every 4 hours.
    3.Use plug-ins in your rooms.
    4.When going out in evening spray high and low with mosquito killer spray before you leave.
    5.take vitamin B (B1 thiamin) took every day and 2 weeks before visit.
    6.burn Mosquito coils outside near entrance
    7.Anti mosquito Plants (Liligundi)
    8.Avoid after shave and perfumes.Wear long slieve and leg, loose fitting clothes.
    9.sleep under a mosquito net.

    I worked in Pharaceutical industry for 14years and have been to bali 6 times.My wife is a mosquito magnet and would average 30-40per 2week holiday.We were not aware of Dengue fever in Bali until very recently and have a 2year old child
    we wanted to avoid deet on our child and used an Autan repellent which contains picaridin. In 16days I received 1 bite when I left one morning without repellent,mother and child received Zero bites.
    We stayed in a villa and asked the owners to plant the Liligundi a few weeks before we arrived.
    The mosquito which causes dengue fever bites during the day.A classic place to find them is in the footwell of a car.So if you are at the beach and need to catch a cab home put some repellent on first.

    Posted by john mccullough on 25th April, 2012

  • Hey guys,

    found this site and thought I would share my experience with dengue, since I was constantly online looking to see what kind of symptoms could arise from this disease during its course. Hopefully this may help a few, along with everyone else who has posted.

    It all started on Dec. 28th(merely 2,5 weeks ago) at Koh Phangan, Thailand. I was suppose to have a blast with my friends on the Full Moon party that night, but during lunchtime I woke up with a slight feeling of exhaustion. The one you get when you are about to get sick. For me this was EXTREMELY unusual since I haven't been sick for about 20 years(not even fever!). As the day progressed, I started sweating like MAD and everything started aching. It wasn't an intense pain as described with "break-bone" fever, but more like the one you get when you have a flu. I didn't check my fever until the day after, so I cannot tell how high it was the first day. I would assume it was close to 40C, maybe even higher, because it was 38,5C on second day and didn't feel as hot and as bad as the first day.

    Anyway, I took some painkillers the first day, it helped for a few hours, but then the effect wore off. I went home at about 23:30 hours and continued to sweat that night. Everything was soaked! Next day when I woke up my eyes were hurting badly! This was probably one of the worst things. I had trouble focusing and moving my eyes. Literally had to move my head instead. This kinda scared me! The pain was worst in the morning and subsided during mid-afternoon. Then I decided to go to the doctor to get a check-up. She did a check-up on me and said I most likely had a bronchitis, because I also had this cough every time I would breathe in. And that my throat was infected. She gave me some antibiotics. I took them for a day with no effect whatsoever. That being the case, and me feeling really bad, made me think that I had contracted malaria. So I went to the clinic and got my blood tested. Later that day, my blood test came back positive on dengue. My white blood cell count was down to 3200 and my platelet level was down to 137,000.

    At that point I was put on IV and monitored throughout the night. Got another blood test in the morning of 31st. The count was down to 85,000 and I was told I had to be transferred to Koh Samui for surveillance. Got admitted in hospital on New Years Eve. :/

    I would say I am probably one of those lucky ones that only contracted mild symptoms. The fever itself was by the book. It was at its peak the first night and dropping the next 3 days. On 4th and 5th day it was down at around 37. PS!(my normal body temperature can get as low as 35,8 and I forgot about this. Doctors thought my fever was gone at 37!) and then one more spike to 37,5 on the night of 5th day and to 38,5 on 6th day. During the evening of 6th day the fever was gone and my body temperature was down to 36,2 for the first time in a week!

    My blood platelet level was never lower than 85,000. It was mainly around 100,000 area the whole time before it spiked back to 180,000 on the morning of 7th day(January 4th). That morning my WBC had also recovered to 5200 after staying at around 3000-3500 the whole time.

    Other symptoms I had during my stay in hospital that I felt even while on medication:

    - Back pain that moved from lower back and up to upper back around the lungs. This lasted for about 2 days

    - Pressure on my lungs when breathing.

    - Didn't get any medication from doctor because he felt I was in a good shape when he discharged me. Ended up having heavy pain in my eyes for another 2 days!

    On the other hand:

    - Didn't experience any vomiting, diarrhea, rash and itching etc. I was eating normally.

    Today, 10 days after, I still feel a little bit weird in the mornings. I hate being idle and have trouble taking it easy. I missed the Full Moon party, I missed the New Years Eve and my birthday was on January 10th. Was about to miss that too. So I went out! Couldn't stand missing all 3 of them, especially my birthday. Well, to say the least. I felt bad for 3 days after that party. So, remember to take it easy after you've had dengue. Even though you feel fine, it just may be that your body is "just" above the level of being fine, but it will take nothing to bring it down again where you feel exhausted, fatigued or just sick.

    I think I have covered everything so far.

    Oh, one more thing! If you are travelling in Southeast-Asia, or any other area for that matter: TRAVEL INSURANCE!!! My stay at the hospital, which by the way was top-notch, ended up costing 162,500 bhat (About $5,500USD). That's for 6 nights and 7 days.

    Hope this helps. For more info on dengue fever you can find it here:
    http://en.wikipedia.org/wiki/Dengue_fever

    Posted by Sasha on 13th January, 2013

  • I contracted dengue fever on October 1st , 2013 on the island of Palawan and was discharged 6 days later.
    Compared to other patients in the ward I got off fairly lightly. I didn't get the bleeding or vomiting (DHF) and was able to eat and drink gallons of liquids while on IV.
    Now I went down hill whet I left hospital getting candida down the throat , massive fatigue and insomnia just to name a few.
    After a week I got myself back to Adelaide , South Australia and immediately started trying to juice my way to health. I mainly stuck to the green veggies like cabbage, brocoli and spinach with some carrot. Nystatin tablets got rid of my flush and I started to feel better.
    Staying off the sugar and junk food helped I think and within 4 weeks I started doing two 40 minute brisk walks a day.
    A few weeks a go I had a nasty bout of constipation for 4 days and I did some heavy straining on the toilet bowel. My BM returned to normal after taking some physilium husk and I felt this was doing me some good and it was cleaning me out internally.
    Still very exhausted.....anyone feel the same after 2 months
    e-mail: richards_nick(at)yahoo.com

    Nick from Adelaide

    Posted by Nick Richards on 26th November, 2013

  • Nick,

    I read your post. And since I was the last one who posted here I can tell you that I didn't recover properly until May this year! That is some 5 months later. But, that is also due the choices that I made.

    One month after I contracted dengue fever I also contracted some sort of a flue. For all I know it may have been swine flue. It was bad. And considering I haven't been sick for 20 years this was a major setback for me.

    This was my fault because I continued partying and having fun. Really bad mistake. I was completely destroyed. I also developed angular cheilitis, which are cracks in the corner of my mouth. A sign of weak immune system. I had to discontinue my travels and leave for home.

    I came back home to Norway early March. The first thing I did was to get to the doctors and test myself for everything, even STDs. Nothing came positive, it was all good. He couldn't tell me what the problem was and I didn't go into detail. Only that I had contracted dengue fever few months earlier and that I had something that seemed like severe flue a month later.

    Anyway, after eating and drinking properly for the next 2-3 months I finally recovered completely in the end of May. The cracks on my mouth disappeared and I actually felt much much better. From May and on I haven't had one setback. I've actually completely forgotten about it to be honest.

    Hope this helps bro.

    Have a nice Christmas time!

    Sasha

    Posted by Sasha on 29th November, 2013

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