What? Dengue fever again? Didn’t she write about this last year? And the year before? Yes she did, and she will do it again, every wet season until Dengue ceases to be a problem. Why? Because this is one of the most serious health threats that you are likely to encounter in the tropics. It claims hundreds of lives in Indonesia each year and the figures are rising. It is not a disease of the poor or malnourished. It cuts across every level of society, and no amount of money or know-how will spare you from its clutches. There is no vaccine and no cure, but some simple measures will minimize the chance of your family being exposed to this deadly disease.
Q. What is dengue?
A. Dengue is a disease caused by any one of four closely related viruses. The viruses are transmitted to humans by the bite of an infected mosquito. In Bali, the Aedes aegypti mosquito is the most important transmitter or vector of dengue viruses. It is estimated that there are over 100 million cases of dengue worldwide each year.
Q. What is dengue hemorrhagic fever (DHF)?
A. DHF is a more severe form of dengue. It can be fatal if unrecognized and not properly treated. DHF is caused by infection with the same viruses that cause dengue. With good medical management, mortality due to DHF can be less than 1%.
Q. How are dengue and dengue hemorrhagic fever (DHF) spread?
A. Dengue is transmitted to people by the bite of an Aedes mosquito that is infected with a dengue virus. The mosquito becomes infected with dengue virus when it bites a person who has dengue or DHF and after about a week can transmit the virus while biting a healthy person. Dengue cannot be spread directly from person to person. For this reason if a close member of the family or friend becomes infected you must protect the and others from further bites to avoid the spread of the disease. (This is why so many health care workers are affected by dengue).
Q. What does the A.E. mosquito look like?
A. The A.E. mosquito is nick-named the “tiger mosquito” as it has a characteristic black and white tail. It tends to live outdoors in heavy foliated wet areas although can venture into houses. It prefers to fly and feed at dawn and dusk.
Q. What are the symptoms of the disease?
A. The principal symptoms of dengue are high fever, severe headache, backache, joint pains, break bone fever, nausea and vomiting, eye pain, and rash. Generally, younger children have a milder illness than older children and adults.
Dengue hemorrhagic fever is characterized by a fever that lasts from 2 to 7 days, with general signs and symptoms that could occur with many other illnesses (e.g., nausea, vomiting, abdominal pain, and headache). This stage is followed by hemorrhagic manifestations, tendency to bruise easily or other types of skin hemorrhages, bleeding nose or gums, and possibly internal bleeding. The smallest blood vessels (capillaries) become excessively permeable (“leaky”), allowing the fluid component to escape from the blood vessels. This may lead to failure of the circulatory system and shock, followed by death, if circulatory failure is not corrected.
Note that the blood test performed for Dengue antibodies frequently does not turn positive until 3 – 10 days after symptoms are felt. e.g. a negative blood test does not mean you do not have the disease.
Q. What is the treatment for dengue?
A. There is no specific medication for treatment of a dengue infection. Persons who think they have dengue should use analgesics (pain relievers) with acetaminophen and avoid those containing aspirin. They should also rest, drink plenty of fluids, and consult a physician.
Q. Is there an effective treatment for dengue hemorrhagic fever (DHF)?
A. As with dengue, there is no specific medication for DHF. It can however be effectively treated by fluid replacement therapy if an early clinical diagnosis is made. Hospitalization is frequently required in order to adequately manage DHF.
Q. What can be done to reduce the risk of acquiring dengue?
A. There is no vaccine for preventing dengue. The best preventive measure for residents living in areas infested with Aedes aegypti is to eliminate the places where the mosquito lays her eggs, primarily artificial containers that hold water.
Items that collect rainwater or are used to store water (for example, plastic containers, 55-gallon drums, buckets, or used automobile tires) should be covered or properly discarded. Pet and animal watering containers and vases with fresh flowers should be emptied and scoured at least once a week. This will eliminate the mosquito eggs and larvae and reduce the number of mosquitoes present in these areas.
For travelers to areas with dengue, a well as people living in areas with dengue, the risk of being bitten by mosquitoes indoors is reduced by utilization of air conditioning or windows and doors that are screened. Proper application of mosquito repellents containing 20% to 30% DEET as the active ingredient on exposed skin and clothing decreases the risk of being bitten by mosquitoes.
Q. If I have had Dengue once do I have immunity to further exposure to the disease?
A. NO! Previous exposure to Dengue or DHF will not give you immunity to further episodes, in fact subsequent exposure to the disease can result in a more severe form of the disease.
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Kim Patra is a qualified Registered Nurse and Midwife that has been living and working in Bali for almost twenty years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info#chcbali.com”.
