The Dengue and Chikungunya Epidemic in Southeast Asia
It?s for real. Local medias may not be raising the alarms, but Dengue Fever, and Chikungunya Fever (which is also a mosquito-borne virus, with similar symptoms to Dengue) prevalence is rising at an alarming rate.
In the case of Dengue, which I?ll focus more on than Chikungunya, The World Health Organization and The Centers for Disease Control?although neither seem to have current statistics for the public?are calling Dengue an epidemic and have shown the disease to have about doubled in the last decade?ending in 2007. As for Chikungunya, its impact is also hard felt, more so than Dengue in many areas. (Current public comparative data for this disease is also lacking greatly and therefore not offered.) Since a lot of people choose to nomad and live in the most affected areas of Thailand, Vietnam, Malaysia, Indonesia, Sri Lanka and Singapore, it?s a significant concern to us at the Nu Nomad. According to the World Health Organization?s most recent report, 75% of the reported 50 million cases are occurring in Southeast Asia.
And, yes, I?m here to see it?and feel it.
I first noticed the extreme rise in these two mosquito-borne viruses in 2008 while living on Koh Lanta. Then, many of my fellow island nomads, expats, neighbors and myself were experiencing flu-like symptoms. The first concern we usually had was that it might be Malaria. More often than not though, it was something else: like Dengue Fever. So, testing for Dengue soon became near automatic. And, yup, many of them had caught it. At least for those who contracted Dengue they now knew where they stood (err, more likely, where they curled-up into a ball and sweated for a week) and could size up the risks of remaining in that area. But, then came Chikungunya Fever. With it being a relatively new major disease, with very few hospitals even in Bangkok able to do rapid testing, people often thought that if their flu-like ailment weren?t Malaria or Dengue, then they just had the flu. Maybe no, maybe so?who?s to know?
Since those healthier more care-free days of Koh Lanta, however, the south of Thailand has exploded in cases of both Dengue and Chikungunya. Moreover, there?s now even a significant increase in these diseases here in Bangkok?where yours truly is recovering nicely from a bout of Dengue himself.
Oh, yes, my own Dengue experience. (I?ll try to be brief.)
Well, I decided to spend December on Ko Phayam (a little-traveled island near Burma?s border) with a dozen or so friends in celebration of my 50th birthday. (I had a great time. Thank you to all who shared it with me.) Anyway, while on Phayam it quickly became noticeable how many people were feeling sick. (In fact, many people coming over to Phayam from neighboring Ko Chang island were also complaining of unusually high levels fever-related ailment there. So, by no means is the problem just on Phayam.) Half of my friends and many people I?d met on Ko Phayam island began experiencing all sorts of ailments that included: fever, chills, loss of energy, body aches and headaches. (I, however, felt just fine.) Although the affected were concerned, they understood their options were limited to two: either leave the island for a mainland hospital for a blood test (small islands like Phayam and Ko Chang have no testing facilities), or wait a few more days to see if the symptoms go away by themselves. Of course most had chosen the later hoping to Buddha it was just the flu. And in a normal year, they would most likely have been fine to do so. Not this year though. (The unusually persistent rain this year has only exacerbated the epidemic.) Anyway, most of my friends and people I?d met there who shared similar symptoms were eventually diagnosed with either Dengue or Chikungunya. (FYI: though both Dengue and Chikungunya share very similar symptoms, Dengue tends to produce more aches to ones muscles and Chikungunya to ones joints.) I?d learned the news of my friends? diagnosis?s not long after I?d returned just after the New Year, safe and sound (or I thought) to Bangkok?my current base.
More than a week after my return it was my turn to feel flu-like symptoms. Though not really worried about it, I thought I should still go pay Dr. Nick of Mission a visit. (?Dr. Nick? is not only my personal physician and contributor to my co-authored book, the Nu Nomad and to our blogs on Malaria prevention, but he is a tropical disease and preventive medicine specialist.) After some poking and prodding, Dr. Nick and I agreed it was most likely that: the flu. Not having many of the associated symptoms of Dengue or Chikungunya (rash, extreme muscle pain, los of appetite, to name just three) put me at ease enough to not bother to order a blood test. (Silly me.)
To make a very long story short?a story that includes a bout of acute intestinal infection severely complicated with (probably mild) food poisoning?About ten days later I paid Dr. Nick another visit to learn that, yes, I had indeed contracted Dengue?and that it was unclear if I?d contracted it on the island or here in Bangkok. Because of my recent ailments and having left the island several weeks earlier, it wasn?t all that odd that Dengue was just now being identified.
The lesson here is that one should not shy away from getting the blood tests for Dengue, Chikungunya and also Malaria if they?re experiencing flu-like symptoms, especially this year with Southeast Asia being drenched in water. The cost is not all that great and, anyway, that?s what your travel insurance is for.
During the hour we waited for my lab results to come back Dr. Nick and I talked about the recent surge in Dengue and Chikungunya. He was astounded by how many new patients he?s been treating in the past few months alone (Most were coming in from tourist islands. And since Dr. Nick is American, he sees a lot of the Internationals.) Where he usually sees only a few Dengue and Chikungunya cases per month this time of year?it being the so-called ?dry season,??this year the caseload has ?sky-rocketed.? (He was unable to offer specific numbers.) This, naturally, made me wonder: Why aren?t there public alerts on this? The answer could be the lack of national and international funds to properly monitor and advertise the rise of these diseases, or perhaps it has something to do with not panicking the tourists in an already anemic high-season. Who knows. So, consider this such an alert.
Both Dengue and Chikungunya are caused by the Aedes mosquito. This bad boy has black and white stripes on its legs and body. It bites during daylight hours. Since mosquitoes breed in clean, stagnant waters in shady areas, like those lush, green garden-like areas we are so fond of, it important to take extra precautions when leaving, say the hot, dry, sandy beach for the cool, shade. Wear clothing that covers your skin more completely than just shorts and short sleeve or tank tops. And use mosquito repellent; there are several natural options. (Naturapel available at REI stores is the best I?ve come across so far.) Mosquito coils are helpful, just like a fan is when in your room. When taking a nap, use that mosquito net.
Because Dengue and Chikungunya are caused by a virus, there are no specific medicines or antibiotics to treat them. For typical dengue, the treatment is purely concerned with relief of the symptoms. Rest and fluid intake for adequate hydration is very important. Acetaminophen/Paracetamol (Tylenol) and codeine may be given for severe headache and for the joint and muscle pain. However, Aspirin Ibuprofen, and nonsteroidal anti-inflammatory drugs should only be taken under a doctor’s supervision because of the possibility of worsening hemorrhagic complications.
Long Term Effects of Dengue Fever*
Usually, there are no long term serious concerns for someone who gets dengue fever. However, as with any serious virus infection, there is the possibility for a person to form a chronic fatigue-type syndrome after recovering from dengue, but this is also true for the flu and a number of other viruses, such as with mononucleosis. It is rare for it to happen, and is more often seen in people with a past history of depression, anxiety or similar mental illness. It is more common in women than men.
Dengue, unlike some kinds of malaria, has no potential for “coming back” again in the future. If a person contracts dengue again, it is a new infection, not a reactivation of the old infection.
There are four kinds of dengue virus. Once you have had one kind, you are immune to it. However, you can still become infected with another type. A second infection with dengue tends to be more severe.
There is a higher likelihood of having a complication due to dengue with a subsequent infection, such as dengue hemorrhagic fever or dengue shock syndrome. Dengue hemorrhage fever is when there is bleeding and dengue shock syndrome is when the blood pressure goes down and there is leaking of fluid out of the blood vessels into other parts of the body, such as the feet or the lungs.
The majority of people who have a first episode of dengue fever can be treated as an out patient. The opposite is true with a subsequent infection where most need to be hospitalized.
The good news is the dengue will go away on its own. The people to be most careful and concerned with when there is a dengue infection, is children. They are much more likely to have a more severe form and many of the people who die from dengue fever are children.
Although deaths do occur with dengue, most of the younger, healthier, travelers are at very low risk for this. People with heart disease, diabetes, immune problems, children and the elderly need to be followed closely when they have dengue and should not just try to “tough it out”. Although there is no medicine to kill the dengue virus, hospitals such as Mission do have good treatments to handle or even prevent the complications of dengue fever.
* Information and advice provided in great part by Dr. Nick Walters, MD.
Photo by: spcbrass