Dengue Fever

[p1p]

The Thai Government Health Service advise that there is a higher than normal incidence of Dengue Fever in Chiang Mai province this year.

Dengue is carried and transmitted by the Aedes aegypti mosquito, which commonly bites during the day, from 5 AM onwards with dawn showing the highest incidence of biting.

The Aedes Aegypti is a small mosquito and quite stealthy, you will often not see or hear them.

Incidence of dengue is normally relative to population density therefore the urban areas are most highly affected.

Take care, use Mosquito repellant containing deet and cover up exposed skin. Be particularly wary in the areas around Hot, it is currently a hot spot. (xcuse the bad pun).

The dengue in evidence this year is Type 1 and it displays a higher than normal incidence of haemmorhagic complication. (ie. it is more dangerous than normal.

You owe it to yourself to take prophylactic precautions, Dengue is a very nasty, sometimes fatal disease and you really do not want to catch it.

Further information on Dengue can be found at the United States Centre for Disease Control, CDC web site at http://www.cdc.gov/ncidod/dvbid/dengue/ or at the e-medicine web site on http://www.emedicine.com/emerg/topic124.htm .

If you read Thai, you can also access the Thai government web sites for Chiang Mai province.

[Whiplash]

I can vouch for its nastiness myself, I got it last year, spent 2 nights in hospital on IV and meds. :/

[cobra]

I heard that once exposed to Dengue you develop a resistance to the pathogen, making reinfection unlikely, any truth to this?

[dseawarrior]

Hi All,

This is my first post to this forum. Very well done from my perspective here in Berkeley, CA. Good job!

I am moving to CM in August to work and I am concerned about Dengue, too. It almost seems inevitable to get. I know about DEET and mosquito netting and good common sense, but what else to do?

I would even consider volunteering for the vaccine trials that I understand are being developed.

From my research, immunity to one of the 4 different strains does not convey immunity to the other 3 strains. And, I have heard that there is a cumulative effect. That is, the more times you get Dengue the worse your prognosis/ outcome becomes...

I have looked at those websites, but there is very little said about prevention -- aside from the obvious...

Any suggestions? Any experts out there?

[As an aside, I am looking for an apartment or small comfortable quiet house when I arrive after August 9th. Any suggestions or phone numbers? Please feel free to contact me separately.]

Many thanks! I think this is a great forum

Daniel

in Berkeley for the moment

[email protected]

[Maejo Man]

I heard that once exposed to Dengue you develop a resistance to the pathogen, making reinfection unlikely, any truth to this?

Not so. I was unlucky enough to pick up dengue some sixteen years ago, and thought I was going to die for about a week. Dehydration, halucinations, and extremely high fever, death seemed a preferable option.

Since then I have had small bouts of it, not unlike recurring bouts of malaria. You can take all the precautions under the sun, but you can also be just plain unlucky.

[chanchao]

> I am moving to CM in August to work and I am concerned

> about Dengue, too. It almost seems inevitable to get. I

> know about DEET and mosquito netting and good common

> sense, but what else to do?

Not saying that you won't catch it, as I've been here like 10 years without owning a mosquito net and very rarely using repellant. Last time I used repellant was when camping out near the Salween river on the Burmese border. Anyway, not saying that you should take this as any kind of advise, merely saying that it's hardly 'inevitable' that you get it.

Your house, hotel or guesthouse will have screened windows. You will not be sitting outside at times/areas where there are a lot of mosquitos anyway, or you will be using mosquito coils or some good old insecticide.

I really dislike DEET. It's horribly icky stuff and it eats plastic!

Cheers,

Chanchao

[p1p]

From my research, immunity to one of the 4 different strains does not convey immunity to the other 3 strains. And, I have heard that there is a cumulative effect. That is, the more times you get Dengue the worse your prognosis/ outcome becomes...

Daniel. (dseawarrior) Thank you for a most helpful first contribution to the forum. I hope we can see many more from you in the months/years to come.

As you state, Dengue has four strains and immunity to one gives you immunity to that strain only. Future bouts tend to be much worse and more likely to be life-threatening.

There is no cure and the vaccine on trial would convey immunity to only one strain, I believe No 4, although I may be wrong there. The only prophylaxis is to ensure you are not bitten in the first place.

Cover up, ensure you are behind screens or under mossie nets, or use repellant. I personally prefer to burn anti-mossie coils or incense sticks.

Note, you should take particular care if you are suffering from kidney or liver problems. A dengue attack could be particularly dangerous.

[dseawarrior]

Hi again,

Thanks for the extra info and extra welcome. Yeah, I hate mosquitoes but I love Thailand, so what to do? Being mindful of the critters and covering up seems the best option and to wish for good luck. Chok dee na krap! I don't currently have any chronic liver or kidney problems, but who wants to "stress test" the ol' bod that way?

I hope that I am as lucky as Chanchao -- luck is always very helpful.

If in a "worst case" scenario, you get bitten and then you get sick... What is the best course of treatment? How do you know when you are ready for the hospital or not? I worry because 3 dear friends of mine got it at different times. They all needed to be hospitalized for various amounts of time -- 2 of them (females) for about 10 days. I was apparently DEET-ly lucky for one of those times and "dodged" that bullet. Is it true that Dengue is "worse" for women in comparison to men? I understand it is rougher on kids, too.

I have read that Dengue is also fairly widely distributed in the Americas, too, and increasing in its range. I wonder if some of those skeeters at old grandma and grandpa's place had any nastiness like Dengue. Years ago in the same area (upstate NY, uSA) it was said that there was malaria -- and encephalitis is still relatively common there, too...

So, I get it that no place is perfectly safe. I just like to manage my health risks as much as I possibly can...

Thanks again for this forum. I think it is really cool. How does one get the fancy icon by your name?

D SeaWarrior

[chanchao]

> How do you know when you are ready for the hospital or not?

In Thailand you're always ready for the hospital.. Because you can show up without an appointment, get to see a doctor real soon and be out the door again (hopefully) with some medications in no time at all. Cost will be something like 200-500 baht in most cases. So when in doubt, go see a doctor!

> How does one get the fancy icon by your name?

At the top of the page it says 'my controls'. Click that link. Then from the list of options on the left, select 'Edit Avatar Options'. (The icon is called an avatar). Here you can upload an image or select one from a website. If you upload, the image needs to be exactly 64 x 64 pixels I think, so you'd have to use some graphics software to resize.

Cheers,

Chanchao

[BillW]

I rarely us insect repellant because, like Chanchao, I hate the stuff. When I do, I have always used 100% DEET “Jungle Juice”.

Reportedly, Health Canada has decided to ban concentrations of DEET greater that 30% due to risks of brain damage.

Here is a link: High concentrations of DEET considered harmful... that discussed the issue and cites some interesting studies.

Bill

[KevinN]

I think I have been very lucky,as I have spent a lot of time in SE ASIA and have had neither malaria or dengue,But the most mossie bites I have had were later at night,and today I saw some mossies come out of the box that I keep my skill saw in when I went to use it.

So I guess I will go over and notify the health dept and they will send the guy over with his noisy weed eater thingy and smoke the ###### outta the place under the carport and back porch.

Now about scorpions,went to put on my pants the other morning and the legs had been on the floor when my wife layed them out the night before,I kinds snapped then and a scorpion came out and was running across the floor,looked like a bark scorpion that they have in mexico and one of the more poison breeds,Guess I will have to get the exterminators back as one came in under the front door last week.

Had them here 2 years ago and since,have had no ants,sceeters or any bugs at all really.And had a 2 yr. guarantee and it has been 2 yrs. not bad for 4000 baht.

[expatwannabe]

Suggestions: If you go out at night, wear light-colored clothing. Mosquitos are attracted to dark spaces for camouflage, and also to dark-colored, moving objects because they look like prey. Also, wear long, loose-fitting clothing to cover as much skin as possible. Mosquitos are more prevalent at night and in town. However, disease-carrying mosquitos seem to be concentrated more outside of town. So avoid out-of-town stagnant bodies of water like lakes, if possible. At night, use mosquito netting over your bed/window/door. Mosquito repellent is a good idea. I've also heard Avon Skin-So-Soft and vitamin B-1 are good repellants.

[chanchao]

> Reportedly, Health Canada has decided to ban concentrations of DEET

> greater that 30% due to risks of brain damage.

Also, no increased repelling effect has been shown from increasing the DEET percentage; i.e. 30% works just as well as 80%

> vitamin B-1 are good repellants.

I think vitamin B has also been discredited as aiding to repell mosquitos

As for dark clothing, I wonder if it's the increased body-heat radiation that attracts mosquitos..? Mosquitos tend to bite on parts that aren't covered by clothing anyway, or low to the ground like near your feet. And they'd but straight through socks anyway. Keeping your feet off the ground would be good too in some particular environments/conditions.

Cheers,

Chanchao

Cheers,

Chanchao

[Pepe']

Hope this helps

Dengue Fever

Introduction

Cause and Pathogenesis

Symptoms and Signs

Investigations and Diagnosis

Treatment and Prognosis

Prevention

Introduction

Dengue fever is a disease caused by infection with a type of virus called Flavivirus. There are four different subtypes of this virus producing varying manifestations of the disease. The disease is spread through the bites of mosquitoes belonging to the Aedes egypti species. The disease is essentially a tropical one and is endemic in large parts of Latin and South America. Of late, its incidence has been on the increase in Asian countries such as India.

Cause and Pathogenesis

Dengue fever is transmitted to humans by the bite of the infected Aedes egypti mosquito. The Aedes mosquito breeds in relatively fresh water, lives close to human habitations and bites during the day. The incubation period between the bite and the onset of symptoms is usually two to seven days. The Aedes mosquito is also responsible for the spread of diseases such as yellow fever and Chikungunya virus fever.

Symptoms and Signs

A large number of infections may be sub-clinical, that is, the patients may not even be aware that they have had the disease. The infection usually manifests itself as fever with severe body pain or myalgia. There may be an associated rash over parts of the body. The body pain is so intense that this disease has been called break-bone fever. Quite often, the disease makes no further progress and the patients recover. However, some patients may develop involvement of either of the two dreaded syndromes in Dengue - bleeding (called DHF or Dengue Hemorraghic Fever) or involvement of the brain with altered consciousness (encephalitis). Fatalities are higher among patients in whom these complications are present. Joint pain is another symptom though there may not be true arthritis. Associated symptoms include severe headache, vomiting, and photophobia. Examination of the patient may reveal few findings such as a rash and pain on palpation of the muscles. These symptoms usually last for a period of two to five days and most patients who do not have complications recover completely.

The risk of complications appears to be greater in children, particularly the risk of bleeding and DHF with its high fatality rate. Some patients may also go into shock, a condition known as Dengue Shock Syndrome (DSS). This too carries a higher risk of mortality.

Investigations and Diagnosis

The diagnosis of dengue is based on the clinical presentation, knowledge of the area in which the person lives, and laboratory investigations. Blood tests may show a low white blood cell count, a low platelet count, and elevation of certain enzymes.

The definitive diagnosis is, however, made by isolating the virus in the blood of the individual during the acute phase of the disease or by detecting antibodies to the virus in the blood. Antigen detection is also possible. A rise in the antibody titre is a useful method of diagnosis. Investigations also need to be done to rule out other likely causes of fever such as malaria, and leptospirosis.

Treatment and Prognosis

Treatment is usually supportive and symptomatic. Analgesics, anti-pyretics, and broad-spectrum antibiotics are used during the acute phase to minimise the risk of secondary infection. In cases of bleeding, blood transfusions are required. Shock, if present, needs to be aggressively treated with fluids, oxygen, and close monitoring. Most patients will recover without any sequel. The overall mortality rate with effective treatment is close to 1% but this may be higher in children.

Prevention

Control and elimination of mosquito population is the best method of prevention. A vaccine is in the late stages of development but is still not available for commercial use on a large scale. Control of the mosquito population reduces the incidence of dengue, yellow fever, and certain other rare fevers that are also transmitted by the same species of mosquito.

Source

Dr. V.Ramasubramaniam MBBS, MD, MRCP.

Dr.V.Ramasubramaniam is an Assistant Professor of Medicine and heads the Division of Infectious Diseases at the Sri Ramachandra Medical College and Research Institute

[dseawarrior]

Hey Pepe!

Awesome. Thank you for sharing so very well!

d

[KevinN]

Well I notified the health dept. out here in the village about the mossies in my saw box yesterday,and they were here today with their noisy machine and smoked the houses here on our road,,fine people that work here.

[KevinN]

And I just found out that one of my wifes bro in laws who is a chicken farmer over on the otherside of our lake is in the hospital with Dengue Fever, Maybe thats why they are running around smoking everything with their leaf blower looking thingy.

[ThaiPauly]

I was in CM three weeks ago, got badly bitten, next day I was sweating so much I felt I was on fire, that passed, only to return whilst driving back to BK two days later half way through the journey, just had to press on, but went to hospital when I got back, they could not diagnose, wanted to keep me in put me in a bed and all but I discharged myself as I was due to fly to manilla the next day, my fever was still high so I could not make it, I have recovered and have not had a reocurance but don't and have not felt the same since I got back. I have absolutely NO energy.

Any medicine men want a guess, I'd be only to pleased to listen, and they can bite through socks, wow I never new that!!!

I am moving up for good in a month or so, so this post has been very informative for me, a big thank you to the brains who use this forum and use it constructively.

[ChiangMaiMike]

I've lived in C.M. about 3-4 years and so far have only talked to one person who has had Dengue Fever...

I spend my time worrying about motorcycle accidents....

m

[p1p]

I've lived in C.M. about 3-4 years and so far have only talked to one person who has had Dengue Fever...

I spend my time worrying about motorcycle accidents....

m

Never realised they were mutually exclusive...

[ThaiPauly]

I was in Home Pro the other day and saw this device on sale that mimics an animal and attracts mozzies and (get this word) "No See Ums"to the machine before they get to you. Costs range from 30,000 baht to 110,000 baht depending on the size of land you have.

Worth investigating a bit more I think when I have a bit more time.

[p1p]

Personally I prefer to keep fish and plant Takhai Hom, the scented Lemon Grass. 30 to 110K is just a bit steep for me at present.

[ThaiPauly]

Personally I prefer to keep fish and plant Takhai Hom, the scented Lemon Grass.

P1P does this work as a detterent then, I am very worried at the moment because the house I am buying is surrounded my rice feilds which are flooded at the moment (lots of standing still water). I have already been ill from mostiqto bites and dont want the same thing to happen again.

Meanwhile call me "the white Deet"

[Ice Treasure]

I got Dengue years ago at the Sixes at that expat clubby thing. Took me off work for 3 months.. dreadful business.

[p1p]

Personally I prefer to keep fish and plant Takhai Hom, the scented Lemon Grass.

P1P does this work as a detterent then, I am very worried at the moment because the house I am buying is surrounded my rice feilds which are flooded at the moment (lots of standing still water). I have already been ill from mostiqto bites and dont want the same thing to happen again.

Meanwhile call me "the white Deet"

My gardens are surrounded, on three sides, by a Klong filled year round with stagnant water. We also have a couple of ponds in the garden, one large & one small.

I have planted a fair amount of both culinary and scented lemon grass, especially around the ponds and keep fish. We have mosquitoes, but not too many!

I find the best thing is to be careful. Ensure your window and door mosquito screens fit and use these 45 or 90 day electric mosquito repeller/killers at night time.

(We also have a bat roost in our roof, which helps keep the blighters down!)

I find the most dangerous place to be in my car, especially if the window was mistakenly left ajar overnight. Damned machine fills with the little bighters.

(Sorry it took me a while to get back. Bl**dy computer's on the blink.

[ThaiPauly]

fit and use these 45 or 90 day electric mosquito repeller/killers at night time.

Hi P1P thanks for the info, where do you get the 90 day electic mostqito repeller from.?

[p1p]

fit and use these 45 or 90 day electric mosquito repeller/killers at night time.

Hi P1P thanks for the info, where do you get the 90 day electic mostqito repeller from.?

I have seen them in most of the supermarkets. I picked mine up from Lotus and Tops.

Make sure they are kept upright! My maid has a habit of knocking them over -0 thereby vastly shortening their useful lifespan...

[n7zrd]

I was recently incarcerated in the hospital for over 5 days with???????????????????

After a day of disorientation, fever, sweats, a temperature a bit over 103 degrees (41+) and kidney pains I taxied myself to a hospital. My 1st diagnosis was Dengue fever….at which the Doc. said, “Don’t worry Westerners usually don’t go into shock or die, they do pretty well comparatively.” In the end I left with no diagnosis, a virus or something. Anyhow….my lesson………if your Western immunized the odds are in your favor!

[Ajarn]

I heard that once exposed to Dengue you develop a resistance to the pathogen, making reinfection unlikely, any truth to this? 

I had a friend who was infected twice- in Chiang Mai.

Also, I haven't seen any posting here mentioning that Dengue mozzies tend to bite in the daytime, malarial types bite mostly at night....

[sbk]

Dengue Fever is also called bonebreak fever because one of the major symptoms is that your entire body aches, and I mean, really hurts. Also, when I had it years ago I found that food had no flavor, not bad, not good, just tasteless.

If the mosquito machine you are talking about is attached to an LPG bottle then what it does is produce C02 which attracts mosquitoes to the machine which then has a vacuum that sucks them in. My dad read in a Consumer Reports that it is actually the most effective way of removing mosquitoes from an area.