Dengue Fever Spreading In Thailand's North And Northeast

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Dengue fever spreading in the North and Northeast

BANGKOK (NNT) -- Dengue fever is found to be spreading in many provinces, especially in the North and the Northeast, prompting public health officials to urgently destroy breeding sites of mosquitoes to prevent further spread of the disease.

Nakhon Ratchasima Public Health Office has dispatched officials to spray chemicals to kill mosquitoes in many community areas, notably at schools and temples. There have been 486 patients found thus far in the province, and an eight-year-old girl has recently died from the disease.

The situation in the northeastern province of Buri Ram was similar to Nakhon Ratchasima as the number of patients has rocketed to 360 people with one fatality reported, one fold higher than the same period of last year. Most of the patients were found to be children aged between 5 and 14.

Public Health offices in many provinces have sent out officials to spray suspected sources of mosquitoes and inform people on a door-to-door strategy on how to eradicate mosquito larva.

Anybody with high temperature is advised to wipe the body with towel to reduce the temperature and beware of convulsions, particularly in infants. Only paracetamol is recommended as medication to reduce body temperature while aspirin must not be used to avoid bleeding.

Patients must be sent to hospital immediately upon observation of any further severe conditions such as agitation or cold hands and feet.

-- NNT 2010-05-31

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[The Snark]

To clarify a few things about dengue.

It spreads primarily in densely populated areas where the mosquitoes can go from person to person multiple times. This means any urban and suburban area. The closer the residences are together, the greater likelihood of transmitting the disease. Dengue follows a pattern in Thailand. The majority of it at the start of the season comes from the densely populated areas around Bangkok then radiates out through the provinces.

The best way to protect yourself from dengue is avoiding dense population areas during the day and into the early evening or taking precautions. The culprit mosquito is a 'day biter'. It is relatively easy to notice if you are in an area where mosquitoes are out during the day. Mosquito repellents are only marginally effective. They don't repel but simply make you invisible. However, a lot of mosquito bites are from chance encounters where it just happens across you.

Do not underestimate the severity of dengue. In dengue areas if you come down with flu like symptoms, get checked out. Dengue can lay you flat on your back for up to a month or more and one type has up to a 15% mortality rate.

They are spraying the area where I live so I probably don't have to worry. Wrong. The most sprayed and mosquito vigilant country in the world, Singapore, has as much as admitted it is completely losing the battle against the pests. Vigilance and personal precautions are by far your best protection.

[davee58]

My "Niece" in Leyte, Philippines died due to Dengue Shock Syndrome just over a week ago.

She was only three years old!

On the Friday morning she was out playing with the other kids in the village, and on the Sunday evening she died in the local Hospital, there was nothing they could do to save her.

It was a nasty way to go, and a great tragedy for the whole family. May she rest in peace.

Denque is spreading rapidly in many areas of Asia, there is no effective treatment, and the problem is getting worse.

[orang37]

To clarify a few things about dengue. ...

Sawasdee Khrup, Khun Snark,

Good points made in your comments. Our human had Dengue once: it was a nightmare roller-coaster ride from feeling excellent to total disability in the space of thirty minutes (that rapid onset coming after the critter incubates in you a little while).

We were told at that time (ten years ago) that there were four strains of Dengue and that having one of the strains did not cross-immunize you from the other strains: don't know about the current status of that in the world of Dengue research: do you ?

By the way, the Lady is a Killer: it is the female of Aedes Aegyptus who carries Dengue.

best, ~o:37;

[Bosse137]

I have had the denguefever twice.From what I heard,the 4 strains a "paired" two and two when it comes to immunity,meaning that if you get one of the strins of one pair,you are immun to the other one in the same pair.Which,if true,should mean,that I now have total immunity.Don`t know if that information is correct,so I join "orang37" in asking,if somebody has the correct answer.

[Bottlerocket]

My "Niece" in Leyte, Philippines died due to Dengue Shock Syndrome just over a week ago.

She was only three years old!

On the Friday morning she was out playing with the other kids in the village, and on the Sunday evening she died in the local Hospital, there was nothing they could do to save her.

It was a nasty way to go, and a great tragedy for the whole family. May she rest in peace.

Denque is spreading rapidly in many areas of Asia, there is no effective treatment, and the problem is getting worse.

Sorry for your and your family's loss tragic loss, Davee.

[chevyinasia]

What makes dengue so dangerous is not the particular strain you get, but the fact that there are four (or more) strains. The strains are so similar that the immune system treats them as the same virus, yet different enough that antibodies for one are ineffective against any of the other three. If you were to catch two different strains within six months to a year of each other, you'd get full-blown hemorrhagic fever the second time around, as the virus is able to deliver its full payload at the same time that your immune system is carrying an all-out counterattack with the wrong weapon.

[welo]

Mosquito repellents are only marginally effective. They don't repel but simply make you invisible. However, a lot of mosquito bites are from chance encounters where it just happens across you.

You seem very knowledgeable and well-informed on that topic, but it seems that there is new information available about the mechanism of DEET (which is the main ingredient for many mosquito repellents).

Mechanism of action

DEET was historically believed to work by blocking insect olfactory receptors for 1-octen-3-ol,a volatile substance that is contained in human sweat and breath. The prevailing theory was that DEET effectively "blinds" the insect's senses so that the biting/feeding instinct is not triggered by humans or other animals which produce these chemicals. DEET does not appear to affect the insect's ability to smell carbon dioxide, as had been suspected earlier.

However, more recent evidence shows that DEET serves as a true repellent in that mosquitoes intensely dislike the smell of the chemical repellent.

A type of olfactory receptor neuron in special antennal sensilla of mosquitoes that is activated by DEET as well as other known insect repellents such as eucalyptol, linalool, and thujone has been identified. Moreover, in a behavioral test DEET had a strong repellent activity in the absence of body odor attractants such as 1-octen-3-ol, lactic acid, or carbon dioxide. Female and male mosquitoes showed the same response.

source: http://en.wikipedia.org/wiki/Deet

However, your main point was that repellents don't work 100% and this is probably true no matter how exactly they work

You are talking about precautions but then state that repellents are only 'marginally effective'. I don't have any extensive knowledge on that matter at all, but I wonder: besides avoiding densely populated areas like you pointed out, I guess protection against mosquito bites (clothing and repellent) is the only other option there is. I mean besides locking yourself up in the room or leaving Asia

My point is even though not 100% effective repellents are still a valid tool for protecting against Dengue. I guess your main point was that people should not completely rely on it.

On the matter of 'densely populated areas'. Are we talking about towns in general, or about a smaller scale like parties, pubs, etc. Not sure about the flight habits of the common Thai mosquito

welo

[bangon04]

How high can a Thai mosquito fly? Do they get tired after about the 10th floor and prefer to take the lift?

Apartments above 15th floor should be relatively safe, if you check for hitchhikers in the lift....

[The Snark]

Greetings. I will address a number of points here. I ask for some tolerance and forbearance in that I am a field health care worker and I find myself perforce having to simplify, dumb down, my instructions to people.

First, Davee58, my deepest sympathies on your loss. As you mentioned, Dengue can hit very fast with few indicators of having the infection.

Regarding DEET. It -may- have repellent qualities. That is, it does, but depends on the mosquitoes sensitivity. I have also noted camphor oil has demonstrated similar qualities. However, nothing will prevent a mosquito who hasn't read the manual and blunders onto your body by accident and decides to sample you in spite of the irritating odor. Body odor, presence of concentrations of CO2, and a number of other factors can also effectively defeat any mosquito repellent. The ideal mosquito attraction location is a room full of active people like at a party.

Dengue. Generally speaking without going into technical details.

There are 4 strains of Dengue. Catch any one strain then the next time you get it the body will gear up to fight that same strain. If the new infection is not the same strain as before, much of your immune system gets compromised, off fighting something with the wrong weapons so to speak. That infection is almost certain to be worse.

One of the 4 strains of Dengue causes hemorrhaging. A combination of things occur which cause blood vessels to rupture. Some of the bleeding may be visible in the form of hematomas, bruises under the skin, but a lot of the bleeding is usually internal. In the event of catching this strain of Dengue, there is a very real risk of the hemorrhagic shock syndrome and possible death.

The best way to avoid Dengue is to become a hermit. That is, avoiding contact with people in locations that are known to have the disease at the times the mosquitoes are known to be out. This is not all that practical however so there are some good rules you can follow. The commonest time the Aegyptii mosquito is out and biting in force is early morning and early evening. It usually heads for bed not long after sun down but lately it has been known to continue feeding up tp 11:00 at night in some locations. But as a general rule, you are much safer after 8:00 in the evening.

There are some locations that are prime for the spread of Dengue. Urban areas where people live in crowded together housing or apartments and there is lax vigilance. As example, student housing around some universities and few people using mosquito nets and repellents.

So the general rule is, if you expect to be in a densely populated location, wearing as much clothing as possible will help. (Long sleeve shirt and pants. Yes, mosquitoes can jab you right through a sweat shirt or jeans but clothing does slow them down and offers some protection.). Use repellent. I recommend one that has DEET and another like Tiger Balm together. Be vigilant. Pay attention to critters flying around. Playing mosquito tag with a partner is always a good idea. That is, you watch each other for a landing mosquito.

To sum up. If you live in an area where you suspect Dengue, take precautions like mosquito nets and repellent, have screens on windows, and burn incense. If it looks like a heavily mosquito infested party in the early evening at an open air bar, consider giving it a miss. Taking the time to trying to find the high Dengue incidence locations near you and avoiding those areas is always a good idea.

And as always, if you develop flu like or odd illness symptoms, when in doubt, get it checked out.

Aegyptii info. A 'ground flyer'. It stays down where the targets are, seldom flying more than 20 to 30 feet in the air. It is out from 4:00 AM to 8:00 PM, more or less. It is one of the 'tiger striped' mosquitoes and is relatively large. It does have very specific identifying marks if you wish to get into studying the head and back of everything flying around you. As with many other mosquitoes, it has been known to travel several kilometers in search of food but the majority of cases are believed to be where the mosquito has fed from multiple people in a relatively short period of time. It's favorite breeding locations are stagnant water including sewage. It is very cosmopolitan and highly adaptable.

Dengue. Children, the elderly, and people with compromised immune systems suffer the worst symptoms. (Compromised immune system can be caused by many factors such as recovering from some other illness like a cold or the flu.)

Edited June 2, 2010 by The Snark

[KunMatt]

By the way, the Lady is a Killer: it is the female of Aedes Aegyptus who carries Dengue.

I believe the only mosquitos that bite are pregnant females as they need the blood for their eggs, normally mosquitos feed on pollen.

One thing I don't understand is Dengue a human to human disease? i.e. does it spread by a mosquito biting one infected person and then bites another and then there is a very high chance of second person catching it?

Or is it something that comes from mosquitos regardless of who they have bitten before? And what are the chances of catching it from an infected mosquito?

[The Snark]

PS.

Only the female mosquito sucks blood. Dengue is a vector born virus. This is, it is carried by the mosquito from person to person.

If in the Chiang Mai area a visit to the insect museum off Huay Kaew Rd. is an excellent way to become familiar with our local critters. The proprietor and his wife are world renowned mosquito experts.

[Bosse137]

Many thanks to " The Snark";great info!

[greytown]

Is there no vaccine available against dengue?

[jayinoz]

Is there no vaccine available against dengue?

Yes I am concerned in regards for my infant son. As their does not seem to be ANY infant mossie repellant. So I put in screen doors and he often in Mossie net yet still gets bidden often. He is like a magnet for Mossies... No one else gets bidden much but he wakes up often with half a dozen bites. IT ANNOYING.

He is 8 months old and been vaccinated for nearly everything. As the village he stays in Lamphun often, there has been a lot of cases of Dengue + Chicken Pox.

I did find Johnsons Infant Mossie Repellant Formula once from Boots but now I cannot find it anywhere.

Anyone else know what works for infants???? Prevention better than him trying to beat the fever.

Also if you do catch it AND BEAT IT, are u Immune? A x gf caught it and she struggled with it for months, and it nearly took her. She thinks she is immune now- I say she is not. She had a compromised immune system as she struggled with Hep B, getting cancer of the liver from the disease. Infants, elderly and immune compromised people will struggle to fight this disease. I do not wish to go through that again. It is very serious.

So prevention better than cure (As there is no cure or even vaccine). If no vaccine I doubt you can become Immune, otherwise we would have a vaccine.

In Thailand many seem to take the Mai Pen Rai attitude to many high risk diseases- it baffles me..

[The Snark]

Is there a vaccine for Dengue? No. There are a number of technical reasons for this but the big answer is no, and none in sight for the immediate future. Think 'common cold'. One researcher described creating a vaccine for Dengue: Is it as if the virus plays hide and go seek'. It wears different clothing and changes how it acts and reacts much faster than a vaccine can be developed.

Children are the major problem in Dengue areas as they are very difficult to protect. You can use various mosquito repellents but none of the manufacturers are willing to tout their products as 'for children' due to liability issues. Children are very susceptible to developing rashes and other skin conditions that can be caused by repellents, or appear to be caused by them. However, you can usually use repellents on objects around the child as long as you avoid things that the child could get into it's mouth or have prolonged pressure exposure to.

One trick that has had some success is soaking cloth as clothing in a repellent solution. You will need to be creative and tailor this to your personal needs and tolerances. For example, there are DEET treatments for mosquito nets. One village has taken to imbuing cloths used as curtains with Tiger Balm or other camphor, eucalyptus or similar. When experimenting with chemicals, even supposed benign ones like camphor, it is always a good idea to test it before hand for reactions and sensitivities. The use of mosquito nets cut into curtains for windows and doors and periodically soaked in a repellent solution has proven to be quite effective while still permitting air circulation.

It is also much more difficult to be vigilant in regards to protecting children. Best bet is maintaining a protected area such as carefully closing off your home to the invaders. Use of pesticides are only marginally effective as the mosquitoes range over great areas. Also, be aware that children are often highly sensitive to the chemicals in pesticides and exposure can cause health problems years down the road. -NO pesticide is tested for 'lifetime exposure'.

If you catch dengue, you will become immune to a great degree to that particular strain. It is not 100% immunity and the immunity will wear off after a period of time. This developed immunity is the reason why subsequent exposures to Dengue are often worse if you contract a different strain the next time.

As an additional warning. Virtually every person who has ever had Dengue reports the same thing: If I knew then what I know now I would never have gone to that party / taken that risk / ignored that safeguard etc. It can be an extremely miserable painful disease.

Edited June 3, 2010 by The Snark

[Johpa]

Mosquito repellents are only marginally effective.

Poppycock! DEET is very effective, as are many other repellents. The fact that they are not 100% effective is no reason to imply they are only "marginally" effective. Only a fool would reside within a disease prone area without applying such a repellent. In areas with high incidences of mosquito borne disease one should take multiple steps to prevent infection including repellents, nets, mosquito coils (pyrethrum) and prophylactic drugs.

[The Snark]

Mosquito repellents are only marginally effective.

Poppycock! DEET is very effective, as are many other repellents. The fact that they are not 100% effective is no reason to imply they are only "marginally" effective. Only a fool would reside within a disease prone area without applying such a repellent. In areas with high incidences of mosquito borne disease one should take multiple steps to prevent infection including repellents, nets, mosquito coils (pyrethrum) and prophylactic drugs.

DEET is listed as marginal due to the many variables. The concentration of the DEET solution, a wide variety of factors in regards to the person using the chemical, the type of mosquito, the environment (temperature, humidity, wind, and other factors) etc. If we had a repellent that was even moderately effective in all circumstances we could conceivably get ahead of the various mosquito borne diseases. However, that is presently not the case. Dengue and Malaria incidents are on the rise in spite of the increased use of DEET and other prophylaxis.

Please keep on mind the medical profession is constrained as to what claims can be made and what terminologies may be used. As for field medicine, where 'the rubber hits the road' so to speak, we almost never have ideal laboratory conditions and circumstances. You can coat yourself a half foot thick in the ultimate mosquito resistant paint and an opportunity infecter in the right circumstances can still get through. The major problem health workers have in the field of preventive medicine is people who become complacent, placing their trust in store bought chemicals and drugs rather than common sense and taking precautions. As example, Bill Gates wouldn't have sunk billions of dollars into malaria research if we could simply paint everyone with DEET for a few months.

Edited June 6, 2010 by The Snark

[The Snark]

Mosquito repellents are only marginally effective.

Poppycock! DEET is very effective, as are many other repellents. The fact that they are not 100% effective is no reason to imply they are only "marginally" effective. Only a fool would reside within a disease prone area without applying such a repellent. In areas with high incidences of mosquito borne disease one should take multiple steps to prevent infection including repellents, nets, mosquito coils (pyrethrum) and prophylactic drugs.

Far less than 1% of the people who catch mosquito borne infections have a choice as to where they live. A large portion of the victims of these diseases don't even realize what the exact vector is and it's operating parameters. They may be complacent or they may be poorly educated, or they simply do not have access to the various prophylactics available. Many people don't even know if the area they are in is a high disease concentration.

[Johpa]

.....Bill Gates wouldn't have sunk billions of dollars into malaria research if we could simply paint everyone with DEET for a few months.

I suggest you peruse the Gates Foundation websiteto better understand the thinking behind that worthy effort to eradicate malaria and not just prevent malaria, which is what repellents aim to do. Painting the world's population in a daily chemical bath every few hours is not a long term practical solution nor an affordable solution. Part of the Gates Foundation efforts to eradicate malaria are being channeled to Dr. Elias' PATH organization. Dr. Elias maintains a residence in Bangkok, so you might some day be able to attend a presentation in Thailand on the status of the Gates Foundation's efforts.

[The Snark]

.....Bill Gates wouldn't have sunk billions of dollars into malaria research if we could simply paint everyone with DEET for a few months.

I suggest you peruse the Gates Foundation websiteto better understand the thinking behind that worthy effort to eradicate malaria and not just prevent malaria, which is what repellents aim to do. Painting the world's population in a daily chemical bath every few hours is not a long term practical solution nor an affordable solution. Part of the Gates Foundation efforts to eradicate malaria are being channeled to Dr. Elias' PATH organization. Dr. Elias maintains a residence in Bangkok, so you might some day be able to attend a presentation in Thailand on the status of the Gates Foundation's efforts.

I fail to understand why you wish to turn this into a debate. As stated, if we had a highly effective, easily administrable mosquito repellent, vector control alone would do the lions share in control of these diseases. However, repellents alone are only marginally effective. With vector borne diseases, control equates to eventual eradication.

WHO | Vector control of malaria

[henryalleman]

How high can a Thai mosquito fly? Do they get tired after about the 10th floor and prefer to take the lift?

Apartments above 15th floor should be relatively safe, if you check for hitchhikers in the lift....

Correct I live on the 25th floor and never see any mosquito or tsjiktsok or other memsaabs.

But IMHO the only correct way to avoid this terrible plague is that the Thai officials start to clean up the dirty pools and sewers, and that the Thai public stop to trow all kind of garbage in this pools and sewers.

In many towns you can see dirty filthy swamps on the back. The houses are builded in it. If you see some klongs they are open stinking filthy sewers. No surprise that dengue brakes out every year.

I told this many times to Thai people but there only reaction is mai pen rai, jay yen yen.

[cdnvic]

Cleanliness of the water has nothing to do with mosquito hatching. Plenty of clean water in places where they are so thick that you inhale them.

Snark, thanks for the input. Very interesting.

[tig28]

Dengue mosquitos breed only in containers that hold water. The dengue mosquito does not breed in rivers, swamps, open drains, creeks or mangroves. These mosquitoes do not like to travel far from mosquito breeding sites. Control mosquitoes by getting rid of mosquito breeding sites around the home. If you are bitten it is almost certain the mosquito was born on your property or that of your neighbors. They seldom travel more than 100 m from their breeding site. High risk times are around dusk and dawn.

Dengue mosquitoes breed in containers that hold water, including:

• buckets
• old tyres
• tarpaulins and black plastic
• pot plant bases
• vases
• boats
• tin cans and plastic containers
• roof guttering
• rainwater tanks with damaged or missing screens
• birdbaths
• striking containers (to grow plant cuttings)
• drain sumps
• fallen palm fronds
• coconut shells.

Regular use of a surface spray beneath tables etc. within the home shall deny the mosquito a favorite hiding place and significantly reduce the risk to the occupants.

[RubbaJohnny]

Thanks as an old hand aka know al smug farang bore who has had malariaI though I had heard it all.

However the information above very worthwhile and could perhaps be condensed into a sticky.

CAn I ask all the knowledgeable contribuors here about places they breed, I didnt' realise they had such a smallradius

1. Will they live in fish ponds or will water movement and carp deter/eliminate as considering building one.
2. Will they live in ponds if so will plants.chlorine/salt etc deter
3. Will the live in disturbed water as planning a fountain waterfall feature.It will of course have apump but with frequent power outages here am I just building a breeding grond next to my bedroom
4. Do any sound frequency deter in the way that barkoff and other transmitters can deter dogs teenafers etc.I would have thought if this worked it would be applied but Thais seem resigned to the Mosquito
5. I read that some hill tribes have inborn immunity is this possible.
6. I very seldom get bitten as the long sleeves sprays and colis are second nature at dusk ,I usually lie in while they breakfast!However my bes man visits from UK each Sring and despite sprays and a bag full of stuff always gets bitten to death is this chance or do they like fresh pink Anglo?

Thanks for info on this prescient topic.I read that M Sodt province is badly affected ,while sparsely populated thesad refugge camps on the rd to Mae Sariang are some of the most densly low rise habitation I have ever seen.

Keep safe watch the women don't get the bite on you

[RubbaJohnny]

I have re=posted as unable to edit my own typos?

Thanks as an old hand aka "know all smug farang bore"

who has had malaria though I had heard it all.

However the information above very worthwhile and could perhaps be condensed into a sticky.

May I ask all the knowledgeable contribuors here about places they breed, I didn't realise they had such a small radius 100m?

1. Will they live in fish ponds or will water movement and carp deter/eliminate as considering building one near our bedroom.
2. Will they live in ponds if so will plants.chlorine/salt etc deter
3. Will they live in disturbed water as planning a fountain waterfall feature.It will of course have a pump but with frequent power outages here am I just building a breeding ground next to my bedroom.
4. Overall would you recommend no water features in the garden?
5. Do any sound frequency deter in the way that "barkoff' and other transmitters can deter dogs teenagers etc.
6. I would have thought if this worked it would be applied but Thais seem resigned to the Mosquito in avery Bhuddist jejuene torpor.
7. I read that some hill tribes have inborn immunity is this possible?
8. I very seldom get bitten as the long sleeves sprays and colis are second nature at dusk ,I usually lie in while they breakfast!However my best man visits from UK each Spring and despite sprays and a bag full of stuff always gets bitten to death is this chance or do they like fresh pink Anglo?

Thanks for info on this prescient topic.I read that M Sodt province is badly affected ,while sparsely populated the sad refugge camps on the rd to Mae Sariang are some of the most densly low rise habitation I have ever seen.

Keep safe watch the women don't get the bite on you

[tig28]

I have re=posted as unable to edit my own typos?

These are two of the species of mosquitoes that commonly transmit dengue fever , the The Aedes aegypti and Aedes albopictus .They are quite distinctive in appearance with white bands on the legs and body. They are of similar size to the "common" mosquito.

Dengue mosquito (Aedes aegypti )

Asian tiger mosquito (Aedes albopictus)

RubbaJohnny ----- As far as answering your questions .... I am afraid that is beyond my limited knowledge. I was raised in tropical Australia and (like most others there) was well aware of the risks this disease posed. We were regularly bombarded with preventative measures to be taken.

What I previously posted was from that information. I am no expert.

If you google "dengue mosquito au" you shall find many authoritative sites provided by the Department of Tropical Medicine --- Queensland.

( for some reason I am unable to post links --- sorry!)

[webfact]

Topic continues here:

Dengue fever outbreak in Thailand strikes thousands nationwide

Dengue Fever Outbreak In Thailand Strikes Thousands Nationwide - Thailand Forum

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