Dengue vaccine

[Tofer]

I'm aware there is a vaccine for dengue fever, developed in the Philippines, and just wondered if anyone has come across it in Thailand and if they have tried it.

 

Also does it cover all 5 versions of the infection, as I understand malaria tablets / treatment (?) are species specific.

 

Just now nursing my second bout for the second year running, so getting a bit sick of it, no pun intended.

[Sheryl]

It is available in Thailand at some private hospitals and MedConsult Asia in Bangkok also has it.

It protects against 4 strains. It is not known if there will be any cross-over immunity to the 5th.

New data has shown it is not advisable for people who have never had dengue of any type before but in people who have had at least one strain it is beneficial.


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[Siam Bruce]

Thanks for the information you have given, More MEDICAL  info on this topic would be greatly appreciated.

[Sheryl]

Pretty much everything there is to know is covered here

 

http://www.who.int/immunization/diseases/dengue/q_and_a_dengue_vaccine_dengvaxia_use/en/

[Oxx]

In short, if you haven't had dengue already, don't get it - it makes a subsequent dengue attack worse and possibly fatal.

 

http://news.abs-cbn.com/news/02/26/18/fda-sanofi-knew-of-dengvaxia-risks-in-2015

 

It's also not licensed for use in people over 45.

 

http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005179

[Tofer]

16 hours ago, Sheryl said:

It is available in Thailand at some private hospitals and MedConsult Asia in Bangkok also has it.

It protects against 4 strains. It is not known if there will be any cross-over immunity to the 5th.

New data has shown it is not advisable for people who have never had dengue of any type before but in people who have had at least one strain it is beneficial.


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Many thanks sheryl for your concise and informative reply.

 

My first bout was hemorragic dengue, but I don't know what strain. Would the hospital have that info in the blood test results?

Edited April 13, 2018 by Tofer

[Sheryl]

42 minutes ago, Tofer said:

Many thanks sheryl for your concise and informative reply.

 

My first bout was hemorragic dengue, but I don't know what strain. Would the hospital have that info in the blood test results?

Probably not since it has no clinical value (doesn't change the care for an individual patient) to isolate the strain and involves costly tests.

 

It really doesn't matter - if you had hemprrghaic form that pretty well narrows it to dengue as opposed to i\similiar diseases like chikungunya.

 

Although the dengue vaccine contains antigens for only 4 of the 5 strains, some short-term cross over immunity is likely.

 

From what you say, probably worth getting the vaccine (once you are fully recovered).

 

Also very worth trying to identify why you keep getting it, especially if all infections occurred while living in the same place or frequenting the same places.

 

The dengue vector does not fly very far, and likes to hatch in stagnant water. Water collection jars, old tires, and any sort of stagnant puddles or shallow ponds are prime breeding grounds. So if there are anythings like that around your home, address it. Wet markets and anywhere with drainage ditches that collect water are also big risk areas, if you must walk near them use insect repellant. Remember, it is a day biting mosquito.

Dengue is far from the only mosquito-borne disease here so well worth trying to address this, with or without getting the dengue vaccine.

 

[Tofer]

8 hours ago, Oxx said:

In short, if you haven't had dengue already, don't get it - it makes a subsequent dengue attack worse and possibly fatal.

 

http://news.abs-cbn.com/news/02/26/18/fda-sanofi-knew-of-dengvaxia-risks-in-2015

 

It's also not licensed for use in people over 45.

 

http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005179

Thank you Oxx for your detailed reply. 

 

So that's me ruled out at 61. Drat!

[Sheryl]

The 45 year bit is because they have only tested it in people up that age, does not mean no benefit to immunizing older folk.

 

But you should prioritize trying to avoid daytime bites.

 

If you are in a rural area, given that you have now had dengue twice, I would definitely urge you to get the Japanese B encephalitis vaccine. It too is mosquito borne, but due to the need for a pig reservoir not a problem in urban areas.

[Oxx]

4 minutes ago, Sheryl said:

The 45 year bit is because they have only tested it in people up that age, does not mean no benefit to immunizing older folk.

 

Actually, there have been (to the best of my knowledge) no trials with people remotely approaching that age.  The phase three trials only included individuals aged from 2 to 16 years.  This is confirmed by the link to the WHO you posted in post #4.

 

However, the age limit is pretty arbitrary and you're right there's no reason to think there's no benefit in immunising older people (a) provided you've previously had dengue, and (b) you can find a physician willing to give it.  (Samitivej wouldn't give it to me based upon my age.)

[Tofer]

15 hours ago, Sheryl said:

The 45 year bit is because they have only tested it in people up that age, does not mean no benefit to immunizing older folk.

 

But you should prioritize trying to avoid daytime bites.

 

If you are in a rural area, given that you have now had dengue twice, I would definitely urge you to get the Japanese B encephalitis vaccine. It too is mosquito borne, but due to the need for a pig reservoir not a problem in urban areas.

When I spend the day on our building site I rarely get bitten unless I venture close to the adjacent jungle. We often joke about our neighbour 200m away who frequently recites his favourite mantra, "there's no mosquitos on my land". Of course there are, but with the sea breezes they don't tend to be very evident.

 

Unfortunately where we are renting temporarily overlooks some shabby seafront local residences. They have nearly all of the mosquito breeding environments you mentioned in a previous post, and there's little I can do about it. We are subjected to a constant barrage of mosquitos in this property, we have an electric zapper in every room, burn coils and use the plug in repellents, sit with fans trained on us, but still they persist. Our only respite is on strong windy days. We hope to be moving onto our site within the next couple of months or so, then hopefully the situation will improve.

 

We live on the East coast of Koh Lanta Yai, no pig breeding around here. I presume by pig reservoir you mean a water reservoir serving a pig farm.

 

Many thanks again for all your advice.

[Tofer]

15 hours ago, Oxx said:

 

Actually, there have been (to the best of my knowledge) no trials with people remotely approaching that age.  The phase three trials only included individuals aged from 2 to 16 years.  This is confirmed by the link to the WHO you posted in post #4.

 

However, the age limit is pretty arbitrary and you're right there's no reason to think there's no benefit in immunising older people (a) provided you've previously had dengue, and (b) you can find a physician willing to give it.  (Samitivej wouldn't give it to me based upon my age.)

Could I be rude and ask what age that is?

[Sheryl]

No, I meant pigs themselves - they serve as a resevoir for the virus. But as there are none, you're OK on that front.

 

Indeed try to move before the  rainy season if possible.

[Tofer]

5 minutes ago, Sheryl said:

No, I meant pigs themselves - they serve as a resevoir for the virus. But as there are none, you're OK on that front.

 

Indeed try to move before the  rainy season if possible.

We had planned to be there already, but we are still hanging out to find good tradesmen, an extremely uphill struggle.

 

It's impossible to plan / schedule in this country unless you are prepared to accept very poor quality construction.

 

It would help if I didn't keep getting debilitated by this horrible infection, but thankfully my wife is an angel, looks after me and manages the site works in my absence.

 

This current bout is far less unpleasant than the first, I'm feeling quite a bit better today, only 6 days since the start. I was surprised when I read on wiki that it lasts 2-7 days, as my first bout had me in hospital for 4 days and laid up for about a month.

[Oxx]

31 minutes ago, Tofer said:

Could I be rude and ask what age that is?

 

Early 50s.  They took the 45 years old limit seriously.

[Tofer]

6 minutes ago, Oxx said:

 

Early 50s.  They took the 45 years old limit seriously.

In that case I guess I would ruled out also.

 

[Tofer]

Just as a bit of an aside whilst you medical experts are on board, my wife is pumping fluids down me and likes to add the 'Neo-Lyte' electrolyte powder (Glucose-4.4 gram, sodium-4.0 mEq, chloride-3.1 mEq, citrate-1.3 mEq, potassium-0.5 mEq). What would you advise as a limit to the number of these to be consumed in a day?

[Swimman]

How much fluid is the "Neo Lyte" being dissolved in and how many litres of fluid are you drinking? Normally oral re-hydration salts are safe --IF the manufacturers' instructions are followed

[Sheryl]

Also depends on your fluid losses. Are you sweating much?

[Tofer]

1 hour ago, Swimman said:

How much fluid is the "Neo Lyte" being dissolved in and how many litres of fluid are you drinking? Normally oral re-hydration salts are safe --IF the manufacturers' instructions are followed

2 sachets in approx. 1 ltr of water.

 

I'm getting through about 4-5 litres a day whilst suffering the dengue. Usually I consume between 2-3 litres under normal circumstances.

Edited April 14, 2018 by Tofer

[Tofer]

50 minutes ago, Sheryl said:

Also depends on your fluid losses. Are you sweating much?

Not a great deal whilst house bound with this virus. Although I'm urinating nearly every hour or so with the excessive fluids I'm consuming, about 4-5 litres a day.

 

If I'm out on site I sweat a lot, all my work T shirts are discoloured form the salt / sweat staining. I usually only have one sachet in a glass of water (half litre) when I return in the evening, sometimes an extra one at lunchtime if I feel really drained.

[Sheryl]

From what you describe I would say 2 sachets a day maximum.

 

If you are peeing every hour you can probably reduce the fluid intake such that you pee more like every 2-3 hours, keeping the urine light in color (assuming your platlet count is holding).

 

Those sachets can be over-diluted with no harm (opposite is not true). So could put just 1 sachet in a liter, and that may also be more palatable.

[thaibeachlovers]

On ‎4‎/‎14‎/‎2018 at 11:45 AM, Tofer said:

When I spend the day on our building site I rarely get bitten unless I venture close to the adjacent jungle. We often joke about our neighbour 200m away who frequently recites his favourite mantra, "there's no mosquitos on my land". Of course there are, but with the sea breezes they don't tend to be very evident.

 

Unfortunately where we are renting temporarily overlooks some shabby seafront local residences. They have nearly all of the mosquito breeding environments you mentioned in a previous post, and there's little I can do about it. We are subjected to a constant barrage of mosquitos in this property, we have an electric zapper in every room, burn coils and use the plug in repellents, sit with fans trained on us, but still they persist. Our only respite is on strong windy days. We hope to be moving onto our site within the next couple of months or so, then hopefully the situation will improve.

 

We live on the East coast of Koh Lanta Yai, no pig breeding around here. I presume by pig reservoir you mean a water reservoir serving a pig farm.

 

Many thanks again for all your advice.

See if you can get the sort of zapper that used CO2. I found the electric ones useless.