Dengue fever

[Chicog]

I got it 2.5 months ago ended up in Sripat Hospital....I was mis-diagosed at Maharaj 2 days earlier.....those ER 'docs" are the worst...moronic students doing some work experience.....dire service in that hospital.

Lucky I had medical insurance...it racks up fast in the "developing world"

Time slows down and you go a bit mad at the peak of the infection depending on severity.

My g/f had to go and get a visa extension on my behalf..god bless her, she is a lifesaver. Went and queued from 7am.

It is a daytime female tiger striped mosquito. If you get bit by the other 4 strains it can be fatal next time, you don't build an immunity to the other strains.

There is a vaccine coming next 2 years. It is a rapidly increasing problem globally.

There is no timetable for a vaccine.

Well according to these boys there is.

(Reuters) - French drugmaker Sanofi, developing the first vaccine against dengue fever, said its product reduced disease cases by 60.8 percent in a large final clinical trial.

Sanofi has invested more than 1.3 billion euros ($1.7 billion) in the project, undertaking two decades of research on the world's fastest-growing tropical disease.

The final study - conducted on 20,875 children aged 9-16 across five countries in Latin America - confirmed that the vaccine was safe, provided high protection against dengue hemorrhagic fever and cut by 80 percent the risk of hospitalization, the Paris-based company said on Wednesday.

<snip>

The first batches - produced at a dedicated plant outside Lyon in southeastern France - will be ready next year and Sanofi aims to sell the first doses in the second half of 2015.

http://www.reuters.com/article/2014/09/03/us-sanofi-dengue-idUSKBN0GY0C520140903

Edited October 3, 2014 by Chicog

[searcher22]

Covering yourself in clothes from head to toe not only helps protect you from Dengue, it also makes you more desirable to Thai women.

However, be careful. Love can bite too.

[wilcopops]

There is no timetable for a vaccine.

Well according to these boys there is.

(Reuters) - French drugmaker Sanofi, developing the first vaccine against dengue fever, said its product reduced disease cases by 60.8 percent in a large final clinical trial.

Sanofi has invested more than 1.3 billion euros ($1.7 billion) in the project, undertaking two decades of research on the world's fastest-growing tropical disease.

The final study - conducted on 20,875 children aged 9-16 across five countries in Latin America - confirmed that the vaccine was safe, provided high protection against dengue hemorrhagic fever and cut by 80 percent the risk of hospitalization, the Paris-based company said on Wednesday.

<snip>

The first batches - produced at a dedicated plant outside Lyon in southeastern France - will be ready next year and Sanofi aims to sell the first doses in the second half of 2015.

http://www.reuters.com/article/2014/09/03/us-sanofi-dengue-idUSKBN0GY0C520140903

You need to read the reviews - the company may be saying this but as far as I can find out, it doesn't account for the 5th strain. They have carried out tests in Thailand and other places. You also red to be aware that the vaccine is not a "cure" as such - it has some effect of some patients...... a universal 100% effective vaccine is not on the books....yet.

[AnotherOneAmerican]

I live in CM and was diagnosed with dengue at CM Ram Hospital, but it was after a trip I took to Doi In, Mae Sariang, Pai, Mae Hong Son, and points north. This was ~April 2013. I know a great many people in CM and have never heard of anyone who lives here and stays here contracting it. Maybe the most important measure you can take is wearing long sleeves and trousers at and after dusk. BTW, for me dengue was akin to having the flu for a week, not worse.[/size]

I know many expats in CM that have had it.

Somewhere between 1 in 10 or 1 in 20.

Not serious for most people.

The children's wards in most CM government hospitals are full of victims every wet season.

[chiang mai]

10% of the Chiang Mai population contracts Dengue Fever, are you sure about this?

[AnotherOneAmerican]

10% of the Chiang Mai population contracts Dengue Fever, are you sure about this?

Between 5% and 10% of expats I know in CM have had it.

Many of them have been here over 10 years.

Which is different from 10% of all CM having it last year.

(How are you reading my posts, you promised to put me on ignore yesterday?)

I also have 1 Thai cousin who works for 4 seasons in Mae Rim, who caught it and was in hospital for 3 days last year.

That's the only person I know who went to hospital with it, everyone else had fluey symptoms for 3 days to a week, treated at home.

Edited October 3, 2014 by AnotherOneAmerican

[Ulysses G.]

At most, 2% of the expats I have known have had it in 25 years. At most.

[Sparkles]

I live in CM and was diagnosed with dengue at CM Ram Hospital, but it was after a trip I took to Doi In, Mae Sariang, Pai, Mae Hong Son, and points north. This was ~April 2013. I know a great many people in CM and have never heard of anyone who lives here and stays here contracting it. Maybe the most important measure you can take is wearing long sleeves and trousers at and after dusk. BTW, for me dengue was akin to having the flu for a week, not worse.[/size]

I know many expats in CM that have had it.

Somewhere between 1 in 10 or 1 in 20.

Not serious for most people.

The children's wards in most CM government hospitals are full of victims every wet season.

Gross exaggeration ,this wet season dengue fever affected very few and that's information from a Dr who treats patients. In 14 years here I only know of one expat has contracted Dengue and she was up on the northern border. Obviously you must know a lot of people.

[chiang mai]

I can't find any stats that seem too reliable, the numbers vary from between 3,500 and 11,000 during 2013. As a percentage of the CM Province population (1.7 mill.) infection rates are somewhere around 0.3% which seems reasonable to me.

http://202.47.224.92/en/news.php?id=255110060005

number of 87,533 Thais were infected by dengue fever during January-July, according to the Public Health Ministry.

http://www.nationmultimedia.com/national/Dengue-fever-claims-83-fatalities-30211865.html

Nationwide numbers would seem to support the lower figure. 69 million people x 0.3% seems right also.

Edited October 3, 2014 by chiang mai

[Chicog]

There is no timetable for a vaccine.

Well according to these boys there is.

(Reuters) - French drugmaker Sanofi, developing the first vaccine against dengue fever, said its product reduced disease cases by 60.8 percent in a large final clinical trial.

Sanofi has invested more than 1.3 billion euros ($1.7 billion) in the project, undertaking two decades of research on the world's fastest-growing tropical disease.

The final study - conducted on 20,875 children aged 9-16 across five countries in Latin America - confirmed that the vaccine was safe, provided high protection against dengue hemorrhagic fever and cut by 80 percent the risk of hospitalization, the Paris-based company said on Wednesday.

<snip>

The first batches - produced at a dedicated plant outside Lyon in southeastern France - will be ready next year and Sanofi aims to sell the first doses in the second half of 2015.

http://www.reuters.com/article/2014/09/03/us-sanofi-dengue-idUSKBN0GY0C520140903

You need to read the reviews - the company may be saying this but as far as I can find out, it doesn't account for the 5th strain. They have carried out tests in Thailand and other places. You also red to be aware that the vaccine is not a "cure" as such - it has some effect of some patients...... a universal 100% effective vaccine is not on the books....yet.

You can qualify it how you like, but you said "There is no timetable for a vaccine".

I'm simply informing you that there is.

It might not be 100% effective (the information I posted states its effectiveness in trials), but it is a vaccine and it has a timetable.

The fifth strain is not considered significant at this stage as it was only identified from subsequent analysis of one isolated outbreak in 2007.

Certainly it is a vast improvement on no vaccine, especially if it reduces infections by 60.8% and hospitalisations by 80%, because that is a massive help to countries with limited healthcare resources.

Edited October 3, 2014 by Chicog

[mikey88]

The literature says the dengue mosquito is most active during the day particularly in urban areas in the wet season. The public health response in Thailand seems to be woeful. There are ponds and buckets and pools and decorative urns and every form of mosquito breeding vessel you can imagine outside many thai places and businesses....the Mosquitos from one poorly attended decorative pond at an hotel I stayed in once....we're positively swarming.

Edited October 3, 2014 by mikey88

[wilcopops]

There is no timetable for a vaccine.

Well according to these boys there is.

You can qualify it how you like, but you said "There is no timetable for a vaccine".

I'm simply informing you that there is.

It might not be 100% effective (the information I posted states its effectiveness in trials), but it is a vaccine and it has a timetable.

The fifth strain is not considered significant at this stage as it was only identified from subsequent analysis of one isolated outbreak in 2007.

Certainly it is a vast improvement on no vaccine, especially if it reduces infections by 60.8% and hospitalisations by 80%, because that is a massive help to countries with limited healthcare resources.

no that's not a timetable - the company/media is talking up the product...it has to be trialed more and those trials have to be successful then the product needs approval by the various national regulatory bodies such as there FDA........

you don't seem to understand the figure either....they are not established as yet and it is impossible to postulate a timetable.

Edited October 3, 2014 by wilcopops

[Chicog]

I'll tell you what, I'll keep posting and you keep floundering.

Japanese Pharma Plans to Market Vaccine against Dengue Fever in 2017

TOKYO – The Japanese pharmaceutical company Takeda is developing a vaccine against dengue fever that is expected to be marketed in 2017, the newspaper Nikkei reported Monday, coinciding with the first outbreak of the disease in decades in Japan.

The vaccine, still in an experimental phase, uses a live weakened virus of the mosquito-borne disease and is the work of the U.S. company Inviragen which was acquired by Takeda in 2013.

The safety and efficacy of the new drug have been tested in Colombia on 100 people between 18 and 45 years old, according to the results of tests published this month by a British medical journal.

Out of the 100 people who received the vaccine, 76 developed antibodies against the virus and 96 percent of them had effective defenses against three serotypes of dengue, and 60 percent against all four known serotypes.

The second stage of the clinical tests is to analyze the effects of the treatment on a bigger subject group and which is being carried out in Colombia, Singapore and Thailand, the daily reported.

If there are no setbacks then Takeda will start the manufacture of the vaccine in 2017 in regions where dengue is most common: southeast Asia, Latin America and Africa.

For the moment the company will not sell the vaccine in Japan, where the first outbreak of dengue since 1945 has occurred over the past several weeks, affecting more than 70 people.

French pharma company Sanofi is also developing a vaccine against dengue which is already in its final stage of testing with an estimated release date of 2015.

Every year around 50 to 100 million dengue infections are registered all over the world with a mortality rate of around 2.5 percent, much lower than that of other diseases like Ebola, which can reach 90 percent, according to data from the World Health Organization.

Edited October 3, 2014 by Chicog

[Chicog]

Just so you know, here's what's required by the FDA (hardly necessary, since the USA is not their primary market) after the final clinical trials are completed and analysed (which is the case with the Sanofi Pasteur product):

Pre-marketing (pre-licensure) vaccine clinical trials are typically done in three phases, as is the case for any drug or biologic. Initial human studies, referred to as Phase 1, are safety and immunogenicity studies performed in a small number of closely monitored subjects. Phase 2 studies are dose-ranging studies and may enroll hundreds of subjects. Finally, Phase 3 trials typically enroll thousands of individuals and provide the critical documentation of effectiveness and important additional safety data required for licensing. At any stage of the clinical or animal studies, if data raise significant concerns about either safety or effectiveness, FDA may request additional information or studies, or may halt ongoing clinical studies.

If successful, the completion of all three phases of clinical development can be followed by the submission of a Biologics License Application (BLA). To be considered, the license application must provide the multidisciplinary FDA reviewer team (medical officers, microbiologists, chemists, biostatisticians, etc.) with the efficacy and safety information necessary to make a risk/benefit assessment and to recommend or oppose the approval of a vaccine. Also during this stage, the proposed manufacturing facility undergoes a pre-approval inspection during which production of the vaccine as it is in progress is examined in detail.

Following FDA's review of a license application for a new indication, the sponsor and the FDA may present their findings to FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC). This non-FDA expert committee (scientists, physicians, biostatisticians, and a consumer representative) provides advice to the Agency regarding the safety and efficacy of the vaccine for the proposed indication.

Vaccine approval also requires the provision of adequate product labeling to allow health care providers to understand the vaccine's proper use, including its potential benefits and risks, to communicate with patients and parents, and to safely deliver the vaccine to the public.

And from 2013, after only two stages of trials, they were confident enough to start building a $300 million manufacturing plant.

Sanofi Pasteur is poised to produce the first validation batches of their dengue vaccine at the company’s state-of-the-art production centre near Lyon, France.

According to Antoine Quin, manager at the site in Neuville-sur-Saone, the plant has a design capacity of 100 million doses of the vaccine, tetravalent CYD-TDV, annually. Starting around 2015, Sanofi Pasteur expects to manufacture one billion doses over the following decade.

[narkeddiver]

At most, 2% of the expats I have known have had it in 25 years. At most.

I was unlucky enough to have to years on the bounce so I must be personally responsible for upping the average

[Robert24]

Personally I perceive the risk of getting dengue higher than 2% in 25 years. But I have no data to substante this - only know 3 people that had it and 2 of them had to be hospitalised because of it. This over a period of 4 years in Thailand. I also know 4 people who got dengue in Singapore where I stayed before. So I recommend everyone to use all precautions mentioned by people before.

[Konini]

I've learned a lot about dengue fever on here. I've had it once for sure, but I'm now thinking maybe I've had it twice.

When we first retired, we sold up house and home and travelled for a couple of years carrying pretty much everything we owned. Both of us came down with heavy colds and flu, as you would expect, nothing out of the usual. Learning that the second time is much worse than the first, I wonder if one of the heavy flu's I had was a mild case of dengue.

About 3 years ago, here in Chiang Mai I had a terrible fever, just took paracetamols and stayed in bed to sweat it out, as I always do with with a particularly heavy flu. Then, after the fever broke, I think 5 days or so, it started. I know now why they call it break-bone fever. It was horrible. Every joint in my body was literally screaming with pain. We'd just been to Vietnam, so I could have caught it there, but a bloke who lived in the same building as me was also diagnosed with it at the same time - he had it pretty bad for about 6 weeks, so I'd say it was the same strain that I had, maybe the same mozzie or maybe just a co-incidence. The pain - and I have a very high pain threshold - was indescribable and continuous. Couldn't get comfortable in bed or standing up or anywhere inbetween, and couldn't sleep for long because of it, I was exhausted (from the fever I suppose, doctors aren't much help when you're not really listening) but I was only able to doze for short periods as I was in so much pain. After about 2 weeks, either the pain level dropped a little or my body had just got used to it so it wasn't registering as much and the sleeping started. I was sleeping 18-20 hours a day. I got up mornings, had breakfast, checked emails and was then so tired I had to go back to bed. I'd wake up around 4pm, get up, try to get comfortable, have a very light meal and by 6 or 7pm I was shattered and had to go back to bed where I slept, soundly for the next 12 hours or so and repeated the whole thing. I wasn't just tired, I was actually sleeping. But that was good, because while I was asleep, I wasn't in pain (although my husband said I was moaning and groaning all the time I slept, but at least I was able to sleep). This went on for more than 5 weeks but not quite 6 weeks, then gradually each day I was able to stay awake a little longer and the pain became less and less and after 3 weeks or so, I was OK. It was almost 3 months in all, and not during rainy season but in February.

It was one of the most horrible times of my life. I wouldn't wish dengue fever on anyone, not even someone I didn't like and they'd done something really horrible to me or my husband, and I'm a very revengeful person. At times during the 2 weeks of not being able to sleep because of the pain there were several times when I just wished it was all over. It's only the second time in my life that I wanted to give up and face the grim reaper - the first was an acute colitis which was misdiagnosed as 'a bit of diarrhea' by a doctor in Accident and Emergency in Australia and sent home to suffer for 30 hours before being rushed into hospital where I spent a week hooked up to several drips.

Please don't dismiss anyone who tells you they had dengue as being a bit of a drama queen when they tell you how bad it is. I really did want to give up on life altogether because the pain was so unrelenting and it just didn't stop, continuous like toothache, it just wouldn't go away.

It's not something you want to get, but the chances of contracting it are so small, especially if you make sure there is no still water anywhere near where you live (as said by another poster, mozzie's only roam about 200 meters in diameter, but be aware and alert for stagnant water if you live here full time. Of course, you can have your personal surrounds clear of stagnant water, but when you go out for a walk or to shop or for a meal, you're going to walk past stagnant water and not even know about it. So are all the tourists, and it's quite rare for them to come down with it, unless it's the really mild strain which, if they are a get better and get on with it type of person like me, they may not even register that they have it, just a bad case of flu, so real numbers are probably not known, which makes the statistics invalid.

Even though I had that really bad dose of it, I still don't use repellent unless I'm going somewhere where I know there is a strong likelihood of there being a lot of mozzies or if we go out for a meal, I always spray my ankles and feet and if outdoors I ask for a mozzie coil to put under the table. Providing that your home surrounds are clear of stagnant water, just like any tourist you have to be really, really unlucky to be in the wrong place at the wrong time.

EDIT: I should have been in hospital but I declined that option, all they can do is give you painkillers (and not the really strong stuff) and keep you hydrated - I prefer the comfort of my own bed, and I'm sensible enough to take electrolytes twice a day and keep my water intake up. And having just come back from Vietnam had enough of the strong painkillers to tide me over - it should have been a year's supply for when my back is really bad, but I used them all up, and they really only took the edge off the pain, but I'm glad I had them (and plenty of laxatives).

Edited October 3, 2014 by Konini

[watgate]

This will be my 5th year wintering in Chaing Mai ( 5 months this time) and although I have been remiss in prior years about taking necessary precautions to try and avoid coming down with Dengue fever, I think this winter I will go the extra mile so to speak. After reading about other folks encounters and suffering with this disease, I think it wise to try and exercise caution. I don't like using Deet but will start using it in the evenings when I am out and about strolling around the City of Chiang Mai. Also, in prior years I used to live primarily in shorts, even at night, but this winter I think I will be wearing long pants to protect my legs. I am not going to get crazy over this but I do think it wise and beneficial to be proactive to make the odds of getting it even more remote.

[Konini]

This will be my 5th year wintering in Chaing Mai ( 5 months this time) and although I have been remiss in prior years about taking necessary precautions to try and avoid coming down with Dengue fever, I think this winter I will go the extra mile so to speak. After reading about other folks encounters and suffering with this disease, I think it wise to try and exercise caution. I don't like using Deet but will start using it in the evenings when I am out and about strolling around the City of Chiang Mai. Also, in prior years I used to live primarily in shorts, even at night, but this winter I think I will be wearing long pants to protect my legs. I am not going to get crazy over this but I do think it wise and beneficial to be proactive to make the odds of getting it even more remote.

As long as where ever it is you stay is good about not letting stagnant water hang around, the chances of you getting it are very remote. It's a nasty thing when you do get it, but the chances are so slim; don't wear long pants if you didn't previously, just a bit of repellent on your ankles and lower legs - you really don't need a lot to discourage them.

Ask at the place you will be staying if any of the staff have had dengue - make it not like a 'I'm afraid I might get it too' but more just conversational as you check in. If the answer is no and you see no obvious signs of carelessness with water, you have as much chance of winning the lottery as getting dengue. (Good luck with your ticket tonight).

[Rancid]

Had dengue, not a lot of fun. If got it again would hit it with MMS, knocks out malaria so should work for that as well.

Google it, long history of successful case studies. FDA doesn't approve of course as cheap and no profit for Big Pharma.

[Chicog]

Had dengue, not a lot of fun. If got it again would hit it with MMS, knocks out malaria so should work for that as well.

Google it, long history of successful case studies. FDA doesn't approve of course as cheap and no profit for Big Pharma.

Again: It's not a huge problem in the US, so why would any drug company care?

The majority of cases are to be found in Latin America and Asia.

http://www.healthmap.org/dengue/en/

[Rancid]

Ah, drug companies make money regadless where they sell, especially if can charge to governments or UN.

[Chicog]

Ah, drug companies make money regadless where they sell, especially if can charge to governments or UN.

Exactly, but my point is that they aren't going to wait for the FDA.

It's only a fraction of the potential market.

Edited October 4, 2014 by Chicog

[watgate]

Rancid- What is MMS? Also, Konini I am not concerned about the area where I stay since it is very clean and they are on top of caring for their surroundings. What concerns me is sometimes I will be sitting on a bench next to the moat in the Thapae area at night and I would think that water could be construed as stagnant. In the past, while sitting there in the evening I would encounter mozzies pestering me and am thinking I either have to stop sitting there or take necessary precautions. I think with the winter season approaching, this should go a long ways toward lessening the chances of getting infected by a mozzie since I think the cold adversely affects the mozzies.

[Konini]

Rancid- What is MMS? Also, Konini I am not concerned about the area where I stay since it is very clean and they are on top of caring for their surroundings. What concerns me is sometimes I will be sitting on a bench next to the moat in the Thapae area at night and I would think that water could be construed as stagnant. In the past, while sitting there in the evening I would encounter mozzies pestering me and am thinking I either have to stop sitting there or take necessary precautions. I think with the winter season approaching, this should go a long ways toward lessening the chances of getting infected by a mozzie since I think the cold adversely affects the mozzies.

I think there are fish in the moat, certainly at some sections, but I think all. The Thai's have known about dengue fever for a lot more centuries than we have, and they wouldn't have built a moat with stagnant water. The stagnant water you need to be aware of is the tyres and plant pots and garden ornaments etc

[freedomnow]

Well done Konini for highlighting how bad it can get vs just mild flu symptoms.

[Tokay]

Haven't heard any news of recent outbreaks.

a young girl (13yrs) from Mrs G's village was unbelievably misdiagnosed with something else! by a quack at Hang Dong Hospital a couple of weeks ago. She was sent home, then her sickness got steadily worse. She passed away at Suan Dok a few days ago with multiple organ failure . . . cause - Dengue.

One would think that in this region of the world, all docs would know Dengue when they see it. That is, if they are real doctors and didn't simply pay for their paper to hang on the wall.

[onthedarkside]

3 off topic posts removed. The topic is about Dengue. So let's not spin off to another topic.

[wilcopops]

Haven't heard any news of recent outbreaks.

a young girl (13yrs) from Mrs G's village was unbelievably misdiagnosed with something else! by a quack at Hang Dong Hospital a couple of weeks ago. She was sent home, then her sickness got steadily worse. She passed away at Suan Dok a few days ago with multiple organ failure . . . cause - Dengue.

One would think that in this region of the world, all docs would know Dengue when they see it. That is, if they are real doctors and didn't simply pay for their paper to hang on the wall.

this is a major problem with Dengue - many other diseases present with similar symptoms - you can't tell by "just looking". You need to conform with blood tests and although there is a now test floating about that is more universal, the previous tests had to be taken at the right time in the progress of the disease.........some doctors are way to keen to say "Dengue" without testing or testing incorrectly.

Even haemorraghic version is not unique - E-bola is a haemorraghic fever too....

doctors are not "doctors" the same all over the world.....many doctors in Thailand are grossly undertrained or seriously out of date when it comes to current medical practices.

Edited October 5, 2014 by wilcopops