I was diagnosed with Dengue Fever.

[masuk]

Maybe time for the new regime to follow Singapore's example. There, the Mosquito Busters check apartments, gardens and so on for water containers. Pot plants with water in the saucers are a big problem, but as the fine is truly high, it's a good deterrent.

The other name for dengue fever is 'breakbone fever'.

Most ASEAN countries have big campaigns to prevent dengue, and the release of sterile males in known breeding zones keeps everyone happy and no fertile eggs.

The female only travels 150 metres to have a feed of fresh blood. If you know where you've been bitten, start looking around.

[stgrhe]

Unless you have got DHF there is no need to worry. There are five strings of DF of which one is dengerous to small children but only the DHF (Dengue Hemorrhagic Fever) is dengerous for children.

[Bleacher Bum East]

I've also had Dengue Fever three times, with each time being a miserable experience but one in which I was able to suffer through at home doing nothing but sleep (when possible) and drink lots of fluids.

I've read through all of the posts, and I think that you can just go back to Sheryl's first post and follow-up and that pretty much tells you all you need to know.

If your platelet count is over 140,000 then you may in fact not have Dengue Fever. And if you do have it, you are probably well out of any danger zone if you stay hydrated.

My recollection is that if you go under 100,000, the doctor may advise you to check into the hospital for observation and hydration--but it isn't absolutely necessary unless you can't care for yourself or have someone to help you. Under 50,000 is the danger zone where they highly recommend you check in. During my last bout I got near 50,000, but never checked in. Once you begin to recover it will spike up pretty quickly. Again however, this is my recollection on the numbers so you need to confirm. But it's good to do so that you don't get scared into an unnecessary and expensive hospital stay.

One thing to keep in mind ... with Dengue you often have an initial miserable period, then you feel better, and then it gets bad again. So I would keep getting your blood tested just to make sure your count hasn't improved temporarily only to drop again in the next phase.

Overall ... don't worry, if you do have it it seems like a relatively mild case ( it really can be the most miserable thing in the world to suffer through) ... you'll come out fine.

But after you feel better don't push it on the booze, late nights, etc. because your immune system will be in a weak state and it's easy to pick up other illnesses during that time. Dengue will go away in 10-14 days, but give yourself a month to recover.

[h90]

He told you to go home. Wow. When i had dengue fever and went to see the doc at the hospital, they wouldn't let me go home. Even after 4 days there(i insisted on a private room so i could masturbate)they told me i had to stay more.

I had to explain it to them that i was going to stay as long as i wanted to.

Masterbate???????? Can't you get a woman? I am not neccessary referring to the ones you pay for, not that there's anything wrong with it.

But than he would still need the private room......

[NoshowJones]

He told you to go home. Wow. When i had dengue fever and went to see the doc at the hospital, they wouldn't let me go home. Even after 4 days there(i insisted on a private room so i could masturbate)they told me i had to stay more.

I had to explain it to them that i was going to stay as long as i wanted to.

Masterbate???????? Can't you get a woman? I am not neccessary referring to the ones you pay for, not that there's anything wrong with it.

But than he would still need the private room......

I should think so.

[wilcopops]

Just about got everything covered. Don't take aspirin!

You have had blood tests... You need to make sure they do the right test at the right time.

The level of incompetence amongst medical staff in Thailand is very high.

This leads on to the next observation......many doctors and other medical staff are now way too keen to diagnose everyone who comes in presenting those symptoms as Dengue......whereas the odds are in their favor, you can't be sure until the right blood tests have been carried out correctly.

It sounds like your lot are doing the right things.... But there are loads of people who happily declare they had dengue when this may not actually be the case.

It is quite important that cases are identified correctly so that the disease can be mapped and statistics compiled.

It is also useful to know for sure from a personal point of view as subsequent infections can be more severe.

[catweazle]

You'll get over it. Vitamins and a lot to drink and lots of sleep...

[billsmart]

I've had Dengue fever once before, Type II I think. There are 4 types.

It's a viral infection so there's no medicine you can take for it. Antibiotics only work on bacterial infections. You should read up on it on the internet, but the biggest thing you need to know is that inhibits your blood's ability to clot (sometimes called "blood thinning") and you'll be prone to hemorrhaging. Your palms or cheeks might be become red-blotchy because of this hemorrhaging. Also DON'T TAKE ASPIRIN or any other "blood thinners". If you are taking high-blood pressure medicine or any other prescription drugs check with you physician to possible alter your dosages while you have Dengue fever. If you have ulcers that could be a problem. See you physician.

Otherwise it just kicked my butt for about a week. I was very, very tired all the time and slept as much as 16 hours a day. But it eventually disappeared and I'm supposedly immune to Type II for 5 years or more and resistant to the other types.

Good luck!

Edited September 15, 2014 by billsmart

[Bababooey]

Better than water is Gatorade.

[nuananddon]

2013 was a bad year for me, had 2 bouts with Dengue, first while in Thailand, in January ,very sick, high fever and vomiting constantly, 4 days in Khe Lang hospital,Lampang,very good care, private room, lots of IV's. Second time was on return to USA in May ,sick on the airplane from halfway to japan then all the way to home, longest flight of my life. Spent 5 days in hospital at home. Doctors didn't know what I had, luckily an India doctor was on staff, asked a few questions, where have you been lately, took the blood work and said you have Dengue. But this bout was Dengue hemmorage, skin on my back and legs turned a purplish color, blood count went slow low they were preparing to give me a transfusion, but it turned around to the better. I still have dis colored feet and lower legs. My doctor jokingly told me I've been tattooed from the inside. I surely don't wish to get it again or see anyone else suffer with it. That year of 2013 there were nearly 20 people in our village who had it.

[steven100]

Don't worry yourself .....

Just book yourself into

Bumrungrad International Hospital and you'll be fine.

They will take care of you and you'll be out in no time.

[lotus260]

@Costas2008

Try this herbal remedy for few days.

1. Mix a table spoon of มหาหิงห์ "Maha Ying" (Asafoetida) with Bee-Honey and take twice a day (preferably empty stomach in the morning and the afternoon).

2. Burn raw Neem (green) leaves and inhale the smoke a bit (at least once a day).

Try at least the first one. It works, as we have experienced it.

(Edited)

BTW,

Paracetamol seems to aggravate the condition.
Drinking lot of Water is a must.
If the temperature is under control there is nothing to worry, as long as you take Doctors advice.

Edited September 15, 2014 by lotus260

[KhnomKhnom]

Does not really sound like Dengue because you are not reporting JOINT PAIN. What I had diagnosed at Bumrungrad as dengue is a virus, incurable, untreatable, and possibly with self-generating reoccurrences without otherwise new exposure.

I can not imagine having Dengue and not having at least minor joint pain. My joint pain was severe and told me why it is called "break bone fever" because you feel your joints are broken the pain is so bad. The pain is unremitting, not responsive to any drug or home remedy, and makes sleeping difficult. The pain lasts three to five days.

Some claim the later exposures are not so severe; some claim, along with doctors, that the virus can stay in your body until you die and pop up at any time with less severe symptoms.

Believe me, if you have BREAK BONE FEVER, you will know it by that pain ! Get well soon.

[sawadee1947]

He told you to go home. Wow. When i had dengue fever and went to see the doc at the hospital, they wouldn't let me go home. Even after 4 days there(i insisted on a private room so i could masturbate)they told me i had to stay more.

I had to explain it to them that i was going to stay as long as i wanted to.

they wouldn't let me go home....oh my God, they used hand cuffs???

[mushroomdave]

As others have stated, I think you have a milder case. Had it a year ago exactly......kept me at the hospital, 4 days of IV and fluids/meds.....but not as expensive as I thought at Lam Plai Mat hospital (east of Korat) no insurance / 4 days private room / meds etc. 6500baht. Welcome to the club friend.

[Jonmarleesco]

If it is dengue, it's likely it will be on and off for several weeks. You'll feel like s..t, like suffering from the 'flu, but much worse. I managed to faint once, just collapsed in a lift. You'll probably feel knackered much of the day and will need to rest. But there isn't much in the way of medication for it.

I was also told by a doctor that it might be ten, or twenty years, but that it would return, and worse. Then it was likely that I - and my son - would be more or less immune.

Have to say that I'm in no hurry to test that theory.

[h90]

I've had Dengue fever once before, Type II I think. There are 4 types.

It's a viral infection so there's no medicine you can take for it. Antibiotics only work on bacterial infections. You should read up on it on the internet, but the biggest thing you need to know is that inhibits your blood's ability to clot (sometimes called "blood thinning") and you'll be prone to hemorrhaging. Your palms or cheeks might be become red-blotchy because of this hemorrhaging. Also DON'T TAKE ASPIRIN or any other "blood thinners". If you are taking high-blood pressure medicine or any other prescription drugs check with you physician to possible alter your dosages while you have Dengue fever. If you have ulcers that could be a problem. See you physician.

Otherwise it just kicked my butt for about a week. I was very, very tired all the time and slept as much as 16 hours a day. But it eventually disappeared and I'm supposedly immune to Type II for 5 years or more and resistant to the other types.

Good luck!

maybe someone has problems about people with heart problems who need to take blood thinning medications? Should they stop them?

[Jonmarleesco]

Does not really sound like Dengue because you are not reporting JOINT PAIN. What I had diagnosed at Bumrungrad as dengue is a virus, incurable, untreatable, and possibly with self-generating reoccurrences without otherwise new exposure.

I can not imagine having Dengue and not having at least minor joint pain. My joint pain was severe and told me why it is called "break bone fever" because you feel your joints are broken the pain is so bad. The pain is unremitting, not responsive to any drug or home remedy, and makes sleeping difficult. The pain lasts three to five days.

Some claim the later exposures are not so severe; some claim, along with doctors, that the virus can stay in your body until you die and pop up at any time with less severe symptoms.

Believe me, if you have BREAK BONE FEVER, you will know it by that pain ! Get well soon.

As with most illnesses, not all symptoms present themselves. Dengue doesn't always come with joint pain.

[wileycoyote]

Good infiormation posting & Get Well Soon

[yanyk]

Its a big problem i must say because the students will be at the receiving end. The funniest thing is that they give no apologies and sometimes act as if you are plain dumb. For example, a friend of mine works in a school, in his contract , it stated he will be working 17 hours per week, the school will pay for visa expenses , accommodation would be provided and BOOM , he signed

1. accommodation was a very old Village house inside the school, no air conditioner, no fan , no fridge no bed.

he was to buy everything by himself. of course he rejected it and he was told he can pay for a good place himself.

2. one month gone, 4 hours were added to his time and the HOD told him they have done so to all teachers.

haha on a bad day the HOD was to travel and begged him to teach his class and unconsciously handed over his timetable to him.

my friend immediately noticed he had just 13 hours per week.

3. He was later told to do Morning talks and teach a new word every morning.

4. He was told he was not allowed to organize extra lesson for students. (they initially told him he was free to do it )

Th problems are just too much and he has lost interest in the job...

but the truth is every institution has its problems

[Bleacher Bum East]

Personally, I would discount the advice from many that say "check yourself into a hospital" ... and this goes for the doctors who say this as well.

I think in more than 90% of Dengue cases, probably even higher, hospitalization is completely unnecessary unless:

1. You can' get yourself back and forth to the doctor for blood tests every other day or so.

2. You can't care for yourself (get food and especially liquids) and don't have anyone to help you.

3. You're terrified of being very sick in a foreign country and just need the peace of mind (which actually is legitimate for those who haven't traveled or been away extensively)

You will probably FEEL like your going to die, and feel like you actually want to die, but you won't. And you can get through it at home as easily as in a hospital.

Most Thai doctors will push you to be admitted. I believe this is because they are afraid that if they don't admit you and something happens, then they will be blamed. Not to mention the fees and costs you will incur.

A big caveat on this advice: There are some cases where hospitalization is a good idea even if none of 1-3 above applies. This is when you have very low counts in the danger area, have other conditions that may complicate the risk, etc. But you are able-bodied you can probably just ride it out. This is from experience--I've done this 3 times already in cases where there was no question it was Dengue.

Also, I may be wrong but I think the people saying Dengue can come back are confusing it with malaria. Each time I've had it I did pretty extensive research and never came across this. There are 4 strains as people have said, and once you have one strain you're immune from that strain for a few years. But the doctors told me that the risk of Dengue being dangerous actually increases, rather than decreases, the more times you've had it.

[ggt]

Personal bout with the fever...was truly incapacitated for 10-14 days...it took all of my energy just to get off the bed and go to the toilet...drink lots of fluids...Gatorade may help keep up your strength...had lingering affects for weeks afterward...just totally drained of energy...weakest I have ever been...good luck my friend...

[Emster23]

Had it twice. Just lots of rest and drink plenty of gatorade as mentioned or get some of those electrolyte replacement packets to mix with water or juice. Got over mine in 8 days both times. Hospitals can't really do anything more than at home other than relieve you of some cash.

[Costas2008]

I would like to Thank every and each one of you, for your great advice and concern.

It's nice to know that there are still good people around.

Reading your posts and past experiences with Dengue, I got a much better understanding of the disease and now I know that this is not the first time I contracted Dengue.

About 6 years ago, during my first 6 months in Thailand, I went through a very bad patch for about 10 days,

High temperature, severe joint pains, shivers, sickness, headaches.

And I thought it was a very bad cold and treated it with paracetamol, till it gone away.

My then future wife was asking me to take me to go and see a doctor.

But me being Greek and super brave (what an ..... ) I wouldn't submit to any stupid cold.

So it's not really the first time I'm going through Dengue, but this time on a very mild scale.

I can also understand Doctor No 2 for giving me Antibiotics as she wants to prevent any systemic infection that can lead to septicaemia.

As she said to my wife, doesn't matter if he's got dengue or not, it's better to be sure than be sorry later.

Once more I Thank you very very much.

Have a nice evening.

PS. The antibiotics I was given is UTO CEFTRIAX ONE.

Edited September 15, 2014 by Costas2008

[Sheryl]

Thank you Sheryl,

As always a good and sound advice.

My platlet count was 140,000 - 400,000

The only other thing they detected is the Hematocrit being high 50.4%

White blood cells 2890

I'll see tomorrow morning again what they say.

That indicates dehydration. You need to really push the fluids.

The low WBC is par for the course with dengue.

I forgot to mention, be prepared for feeling depressed especially in the recuperation phase, and it may last quite a while. It is one of the effects of dengue.

Hi Sheryl,

This is the continuation of my story.

This morning went back to the hospital, wife took blood again and I got the results 30 minutes later.

The only difference was platlet count was 144,000 instead of 140,000 yesterday.

I was asked to see a different doctor as doctor No1 that saw me yesterday was off.

Now No 2 doctor decided that I don't have Dengue fever but a viral infection.

And she based that on the fact that my platelet count was higher and not lower as expected if I had Dengue.

She prescribed for me to have an intravenous drip with some kind of antibiotic.

And the same procedure has to be repeated twice in the space of 4 days.

But have to admit, wife was very satisfied pocking me with needles I could see that in her eyes.........

Please, tell me should I be worried or just go along with Doctor No2 instructions?

Thank you very much in advance.

You should indeed be concerned if you have correctly reported what the doctor said.

Dengue IS a viral infection. And viral infections do not respond to antibiotics. Furthermore other than dengue I do not know what virus would be consistent with your symptoms and lab results.

A low WBC and a platlet count of 140-144,000 is perfectly consistent with uncomplicated dengue.

What hospital is this at, may I ask? If an upcountry private hospital I would be more than a little suspicious of both competency and possible ulterior motives ($).

There are blood tests that can specifically diagnose dengue which larger hospitals should have, though most of them do so by detecting antibodies and thus aren't reliable early in the illness.

Are you still having fever?

[Sheryl]

Personally, I would discount the advice from many that say "check yourself into a hospital" ... and this goes for the doctors who say this as well.

I think in more than 90% of Dengue cases, probably even higher, hospitalization is completely unnecessary unless:

1. You can' get yourself back and forth to the doctor for blood tests every other day or so.

2. You can't care for yourself (get food and especially liquids) and don't have anyone to help you.

3. You're terrified of being very sick in a foreign country and just need the peace of mind (which actually is legitimate for those who haven't traveled or been away extensively)

You will probably FEEL like your going to die, and feel like you actually want to die, but you won't. And you can get through it at home as easily as in a hospital.

Most Thai doctors will push you to be admitted. I believe this is because they are afraid that if they don't admit you and something happens, then they will be blamed. Not to mention the fees and costs you will incur.

A big caveat on this advice: There are some cases where hospitalization is a good idea even if none of 1-3 above applies. This is when you have very low counts in the danger area, have other conditions that may complicate the risk, etc. But you are able-bodied you can probably just ride it out. This is from experience--I've done this 3 times already in cases where there was no question it was Dengue.

Also, I may be wrong but I think the people saying Dengue can come back are confusing it with malaria. Each time I've had it I did pretty extensive research and never came across this. There are 4 strains as people have said, and once you have one strain you're immune from that strain for a few years. But the doctors told me that the risk of Dengue being dangerous actually increases, rather than decreases, the more times you've had it.

You are correct, they are confusing the two. Dengue does not recur (though you can be newly infected with a different strain). And the duration of illness can vary fro mas little as a few days to 2 weeks or so, just as severity greatly varies.

Complicated dengue, e.g. the hemorrhagic form, absolutely requires hospitalization. "Simple" dengue does not unless the person is unable to stay adequately hydrated at home (for example, is vomiting, as sometimes happens). People who have bad cases and lack anyone to help care for them at home might optionally want to be admitted just for the nursing care, though.

First time I had it, though it was uncomplicated dengue it was a very severe form. I was flat on my back, unable to move, requiring narcotics for the pain and needing IVs for hydration (could not keep anything down) for 2 full weeks. So I was hospitalized. 2nd and 3rd time, much milder, just rode it out at home.

[farangmerou]

I've had it 2-3 times (third time was a little unclear on diagnosis) and most long term expats have had it at least once; if you do a search of dengue in this forum you'll find lots of stories. It is virtually a rite of passage here....

Most cases of dengue are self-limiting and uncomplicated (though highly unpleasant), especially in adults. A minority of cases develop a complicated hemorrhagic form; mostly this occurs in children.

That you are already itching just 2 days after starting a fever indicates you have a comparatively mild case; the itching usually comes when one is starting to improve and is most pronounced in people with a mild version of the disease (it is related to the body's immune response).

Presumably they checked your platlet count in the hospital and it was fine. If you continue to have fever, should recheck that every 2 days or so (more often if it starts to drop). Sounds like you already have an appointment to get this done.

Aside from monitoring platlet count (it will drop significantly before there is any risk of hemorrhagic complications), the rest of management is purely supportive: rest, paracetemol for fever and aches, and maintain hydration through drinking plenty of fluid. When fever is extremely high and the person unable to keep fluids down it becomes necessary to hospitalize for IV rehydration but you don't sound like that.

Welcome to the club.

In the Philippines the common (working successfully) approach is: Go to hospital and get them to buy suitable blood (group) get a few units into your system (must be fresh) and wait if the white blood particles decline afterwards you are winning, if they dont get some FRESH blood until they decline. Dont believe anything Thai doctors etc. are telling you they are the worst in the world dont knowing most stuff.

[h90]

Thank you Sheryl,

As always a good and sound advice.

My platlet count was 140,000 - 400,000

The only other thing they detected is the Hematocrit being high 50.4%

White blood cells 2890

I'll see tomorrow morning again what they say.

That indicates dehydration. You need to really push the fluids.

The low WBC is par for the course with dengue.

I forgot to mention, be prepared for feeling depressed especially in the recuperation phase, and it may last quite a while. It is one of the effects of dengue.

Hi Sheryl,

This is the continuation of my story.

This morning went back to the hospital, wife took blood again and I got the results 30 minutes later.

The only difference was platlet count was 144,000 instead of 140,000 yesterday.

I was asked to see a different doctor as doctor No1 that saw me yesterday was off.

Now No 2 doctor decided that I don't have Dengue fever but a viral infection.

And she based that on the fact that my platelet count was higher and not lower as expected if I had Dengue.

She prescribed for me to have an intravenous drip with some kind of antibiotic.

And the same procedure has to be repeated twice in the space of 4 days.

But have to admit, wife was very satisfied pocking me with needles I could see that in her eyes.........

Please, tell me should I be worried or just go along with Doctor No2 instructions?

Thank you very much in advance.

You should indeed be concerned if you have correctly reported what the doctor said.

Dengue IS a viral infection. And viral infections do not respond to antibiotics. Furthermore other than dengue I do not know what virus would be consistent with your symptoms and lab results.

A low WBC and a platlet count of 140-144,000 is perfectly consistent with uncomplicated dengue.

What hospital is this at, may I ask? If an upcountry private hospital I would be more than a little suspicious of both competency and possible ulterior motives ($).

There are blood tests that can specifically diagnose dengue which larger hospitals should have, though most of them do so by detecting antibodies and thus aren't reliable early in the illness.

Are you still having fever?

Sorry for being super critical without knowing all the facts, again.

If there is a test that can identify dengue and a small hospital doesn't have the test kit it as dengue is sooooo rare in Thailand wouldn't they send a blood sample to the next bigger hospital for checking?

We send things from Bangkok to Nakhon Si Thammerat in less than 24 hours per train (and there are these flying things called airplanes), so a blood sample to a bigger hospital should be a matter of hours and the results back per email or fax a matter of seconds.....Not having a test kit shouldn't be a problem, or?

And to transport a few Milliliter of blood can't cost much.

[denby45]

Does not really sound like Dengue because you are not reporting JOINT PAIN. What I had diagnosed at Bumrungrad as dengue is a virus, incurable, untreatable, and possibly with self-generating reoccurrences without otherwise new exposure.

I can not imagine having Dengue and not having at least minor joint pain. My joint pain was severe and told me why it is called "break bone fever" because you feel your joints are broken the pain is so bad. The pain is unremitting, not responsive to any drug or home remedy, and makes sleeping difficult. The pain lasts three to five days.

Some claim the later exposures are not so severe; some claim, along with doctors, that the virus can stay in your body until you die and pop up at any time with less severe symptoms.

Believe me, if you have BREAK BONE FEVER, you will know it by that pain ! Get well soon.

Point of order: Breakbone fever is not Dengue but instead Chikungunya fever which is the one where you want to kill yourself because of the excruciating joint pain. Mostly occurring in the wrists. Although they are different, they are actually carried by the same mosquito Aedes aegypti. Problem with those little barstewards they are daytime feeders both indoors and out.

I personally have had Dengue twice and Chikungunya once. I could handle the Dengue without too many real problems except the uncontrollable shaking of course. I thought I got the Dengue for the third time until the onset of the joint pain. It comes after the fever has subsided. I had big problems with my wrist joints for six months afterwards.

Den

[Costas2008]

Thank you Sheryl,

As always a good and sound advice.

My platlet count was 140,000 - 400,000

The only other thing they detected is the Hematocrit being high 50.4%

White blood cells 2890

I'll see tomorrow morning again what they say.

That indicates dehydration. You need to really push the fluids.

The low WBC is par for the course with dengue.

I forgot to mention, be prepared for feeling depressed especially in the recuperation phase, and it may last quite a while. It is one of the effects of dengue.

Hi Sheryl,

This is the continuation of my story.

This morning went back to the hospital, wife took blood again and I got the results 30 minutes later.

The only difference was platlet count was 144,000 instead of 140,000 yesterday.

I was asked to see a different doctor as doctor No1 that saw me yesterday was off.

Now No 2 doctor decided that I don't have Dengue fever but a viral infection.

And she based that on the fact that my platelet count was higher and not lower as expected if I had Dengue.

She prescribed for me to have an intravenous drip with some kind of antibiotic.

And the same procedure has to be repeated twice in the space of 4 days.

But have to admit, wife was very satisfied pocking me with needles I could see that in her eyes.........

Please, tell me should I be worried or just go along with Doctor No2 instructions?

Thank you very much in advance.

You should indeed be concerned if you have correctly reported what the doctor said.

Dengue IS a viral infection. And viral infections do not respond to antibiotics. Furthermore other than dengue I do not know what virus would be consistent with your symptoms and lab results.

A low WBC and a platlet count of 140-144,000 is perfectly consistent with uncomplicated dengue.

What hospital is this at, may I ask? If an upcountry private hospital I would be more than a little suspicious of both competency and possible ulterior motives ($).

There are blood tests that can specifically diagnose dengue which larger hospitals should have, though most of them do so by detecting antibodies and thus aren't reliable early in the illness.

Are you still having fever?

Hi Sheryl, Thank you for your answer.

It's our local public hospital, that takes care of the local community and my wife has been working there as a nurse for the past 18 years.

Got the usual, ER, out patient, inpatient, maternity, dentist, TB clinic but for more serious cases they put the patient on an ambulance to Khon Kaen central hospital.

The fever has dropped to 37.2 and this without any paracetamol from 4:00 in the morning.

The itching is getting worst but no pains or sick feelings.

And still me and the wife think it's dengue.

Thank you very much Sheryl.