The Dengue Fever

by Lindsay Lafreniere

You are in paradise. Swimming in a tropical ocean, lazing away the afternoon in a hammock, and taking that dive course you’ve always wanted to do, when suddenly, you have a high fever, sever headaches, nausea, pain all over and rashes. You have been bitten by a mosquito carrying the dengue virus.

Dengue is a widespread virus in many parts of the world. It has received far less attention than malaria, but can also develop into a potentially fatal condition. Many travelers to tropical countries do not realize the likelihood of being infected by dengue. While it is rare for a healthy adult to develop dengue hemorrhagic fever, getting the dengue virus can definitely put a damper on your travel plans.

Dengue virus

The symptoms of dengue fever develop four to six days after receiving the virus. The virus is transferred from person to person by female Aedes mosquitoes. This mosquito has a white spotted body and legs; it breeds in clean water and bites during the day, with the highest intensity being two hours after sunrise and two hours before sunset.

Generally there is a sudden onset of fever accompanied by aches and pains. There is usually nausea or vomiting that can last for five to seven days. With the dengue virus, a rash generally appears on the body. This distinguishes the illness from other common traveler ailments.

A major complication of the dengue virus is dengue hemorrhagic fever (DMF). DMF can occur after the initial fever has come down, when the person believes they are getting better, and can have severe consequences. DMF usually begins with intense abdominal pain and can have symptoms of vomiting, black stools and bleeding of the skin, nose, gums and intestinal tracts. In severe cases, there can be circulatory failure, convulsions and even death. But DMF very rarely develops in healthy adults. Usually those with weakened immune systems, such as children and seniors, are more likely to develop DMF after acquiring the dengue virus.

There are four strains of the dengue virus. Recovery from dengue fever results in immunity to that one strain of the virus. But subsequent infections of the virus can result in greater chances of developing DMF. Many people report a second case of dengue fever to have much more severe symptoms than the first.

Treatment

The treatment of the symptoms of dengue fever is simple – rest, drink lots of fluids (with rehydration salts working best) and eat nutritious food. Paracetamol, or Tylenol, can be used to decrease fever and joint pain. But aspirin and brufen should never be used, as they increase the risk of bleeding. Complete recovery from dengue fever can take up to one month.

If you start to feel worse or believe you may be suffering from DMF, go to the doctor or nearest hospital immediately.

Prevention

There are currently no available medications that create immunity to the dengue virus. The best prevention is ensuring that mosquitoes do not bite you, which is beneficial as it also lowers your risk of acquiring malaria. Wear mosquito repellent with a high level of DEET. Put repellent on at the beginning of each day, as mosquitoes carrying the dengue virus bite during the day, and reapply as needed.

Make sure to sleep under a mosquito net, especially in the wet season and in bungalows that are not fully enclosed. If infected with the dengue virus, continue to rest under a mosquito net at all times. This ensures that you do not transfer the virus to another traveler by way of a shared mosquito.

Global Occurrences

The global incidents of dengue fever have greatly increased in the past few decades. The World Health Organization (WHO) reports that before 1970, only nine countries were regarded as endemic, but now it is prevalent in more than 100 countries. This is thought to be the result of increased mosquito populations in cities and increased use of airplanes for travel. Many also believe that climate change is to blame, as a result of the now warmer, wetter weather, which promotes mosquito breeding.

Dengue fever is most prevalent in Central and South America, South and South-east Asia and Africa. WHO believes that 2.5 billion people are at risk for developing dengue fever and an estimated 50 million dengue infections occur each year. In 2007, Indonesia reported 127.687 cases of dengue fever and a whopping 1296 deaths.

The main way that dengue is being controlled is by management of mosquito populations. The fogging of insecticide is an expensive endeavor that is generally done only after an epidemic. The main method of control is to eliminate mosquito breeding grounds – any containers of clean, still water. Education is essential though in ensuring that people understand the risks of the illness and what preventative measures they can undertake.

Meet the Author:

Lindsay comes from Canada and has endured intense humidity, chaotic traffic, noisy children, and the spiciest food she’s ever eaten for the opportunity to live and work as an English teacher in Thailand for a year. The weekends away at the beach made it all worth it!

Travel First Aid Kits

Backpacking First Aid Kits

Written for Startbackpacking.com by Erik McLaughlin

Backpackers need to be carrying a first aid kit on their travels, of some sort.  As you are gathering supplies for your first aid kit, ask people who have already been to the area you are going.  What problems did they run into?  Be careful asking for advice on your travel first aid kit from too many health care professionals or you will end up carrying “a portable emergency room” that requires its own seat on the plane and is filled with “must have” items you’ll likely never use or things that require special training.

A good approach is to try and anticipate the medical issues you’ll likely run into, on your travels.  Have some supplies ready for common ailments like diarrhea, sore muscles, fevers, urinary tract infections, fungal infections, cuts and scrapes and respiratory infections.

Here are some options for your travel first aid kit:

Antibiotics

Most all travelers want to be self-sufficient and be prepared.  For many, this means carrying antibiotics in their first aid kits to take when they spot signs of infection.  The thing to remember is that antibiotics only work on bacteria and have no effect on viruses.  Differentiating between virus and bacterial infection is tough, even for doctors.

• Amoxicillin—A very commonly used antibiotic, worldwide.  Treats infections of the ears, mouth, urinary tract and pneumonia.  A derivative of penicillin, it should not be used by those with penicillin allergy.

• Penicillin—An older medicine with less potency than amoxicillin but very good for throat infections, not for those with penicillin allergies.

• Erythromycin—a great alternative for those with allergy to penicillin and looking to treat similar infections as amoxicillin.  Has some effect on diarrheal illness, as well

• Metronidazole—A borad spectrum antibiotic that works great for vaginal infections and parasitic problems such as  amoebas, giardia and protozoa.  Causes a bad reaction if you drink alcohol while taking this medicine.

• Tmp/Smx—A common antibiotic with broad spectrum activity.  Very good for treating urinary tract infections and diarrhea.  Contains sulfa and should not be used by those with allergies to sulfa containing medicine.

• Ciprofloxacin—A great antibiotic for treatment of travelers diarrhea, provided it is of a bacterial cause.  “Cipro” also has some activity on bacteria that can cause pneumonia.

• Doxycycline—An old antibiotic that is very broad spectrum.  Has many uses including pneumonia and antimalarial effects.

• Chloramphenicol—An antibiotic that is not seen too much in developed nations due to safer alternatives with less side effects being available.  Use this under the consult of a health care professional

• Gentamycin—My favorite antibiotic for conjunctivitis (pink eye) with great broad spectrum coverage for eye infections

• Mupirocin—Broad spectrum cream used to treat  superficial skin infections, cuts and scrapes

Pain Killers in your first aid kit

• Acetaminophen (paracetamol)–is a very effective and in-expensive pain reliever that also breaks fevers.  A safe drug if taken at instructed doses, an overdose can cause significant liver problems.

• Ibuprofen—Part of the family of drugs called NSAID (non-steroidal anti-inflammatory drugs), ibuprofen works great for muscle aches and pain, inflammation.  This may cause stomach irritation and should not be taken in high doses for extended period of time.

• Aspirin—cheap and effective pain reliever that should be taken with food.  Aspirin has anti-inflammatory activity and works great for muscle and joint pain.  Aspirin can interfere with clotting and increase bleeding time, so do not use if there are bleeding complications.  Do not use for children under 12 years.

Anti-histamine

For use in allergic reactions ranging from seasonal allergies (pollen), pet and animal allergies and even life threatening food allergies and anaphylaxis.  All travelers should carry an antihistamine with them, at all times.

• Loratidine—less sedating medicine that is available over the counter as Claritin

• Diphenhydramine—known as Benadryl, this is over the counter, as well.  Overall, more sedative effects but also stronger activity.

Motion Sickness

• Scopalamine—often used in trans-dermal patch form, this is a potent medicine that effects many systems in your body.  Speak with your doctor before taking this medicine and if it is right for you.  Overall, a very effective way to prevent motion sickness.

• Meclazine—known as Antivert, this is an alternative to scopolamine, taken as a tablet.  This medicine works in a different method that scopolamine and generally has less side effects.

Anti-fungals

• Miconazole cream—a common and over the counter available medicine for treatment of fungal skin and vaginal infections.  Anti-fungals are very useful, especially in tropic climates.

Altitude Sickness

The best prevention for altitude sickness is a slow and gradual ascent.  If your plans do not allow for this or your transportation suddenly finds you at high altitude (plane or car), a prophylactic medicine might be a good idea.  The best treatment for altitude illness is a quick descent to lower levels.

• Dexamethasone—a powerful steroid used  to treat a confirmed case of altitude sickness or for those who cannot use acetazolamide as a preventative medicine

• Acetazolamide—A medicine taken twice per day to prevent altitude sickness.  Ideal for those whose plans require rapid ascent to altitude and little time to acclimatize.

Nausea/Diarrheals

• Loperamide—known as Immodium, this is a medicine that slows down bowel movement.  Good for bus rides and times when you do not have regular bathroom access.  Use this medicine with caution as you can potentially trap infection bacteria in your bowels, giving the bacteria more time to do damage.  A good rule of thumb is to avoid loperamide if there is blood in the stool.

• Metoclopramide—a cheap and effective antiemetic that keeps you from feeling nauseous.  This should be sued with some caution as some of the side effects, though rare, can be severe.  Speak with your doctor about using this medicine.

Teeth/Oral

• Cavit—a dental paste that can be bought in most pharmacies.  Cavit is great for repair of damaged of missing fillings, tooth chips and dental work.  Remember that this is a temporary solution and you should seek dental help, the cavit will just keep you more comfortable while you look.

Respiratory system

Inhaled Nasal Steroids—a spray that goes up the nostrils, these work great for symptoms of allergies and respiratory infections that cause runny or blocked noses.  Steroids defeat inflammation and have limited effects elsewhere in the body if taken nasally.  They also help blocked ears from flying.

• Pseudoephedrine—known as Sudafed, this medicine helps relieve nasal congestion and blocked noses.  Also good to use before flying to help with ear pressure and pop.

Add these to your travel first aid kit to stay healthy on the road!

About the author:

Erik McLaughlin, M.D. lives in Chicao and is dedicated to helping travelers around the world stay healthy. He writes for Gaddling, Matador, and runs the website http://adventurehealthclinic.com.

Vaccinations for travel

“Health is the greatest gift, contentment the greatest wealth.” – Buddha

Vaccinations for Travel

So that we don’t feed the lawyers: This info is not to take the place of advice from a real doctor, eat your vegetables, look both ways, etc…

Are Vaccinations for Travel Really Necessary?

No one enjoys needles, and paying for those vaccinations with your own money adds even more insult! However, most of the nasties you can get while traveling will last a lifetime, some will kill you sooner — get vaccinated!

Have I met lots of travelers who never got a single vaccination? Sure. You may survive just fine, or you may get an unhealthy dose of incurable hepatitis beating up your liver.

The problem is that even if you do things correct such as not drinking the local water, do you think that local restaurants wash dishes in bottled watered? One bead of water on a wet plate could contain human feces — and viruses such as hepatitis — without you knowing.

Personal Experience: I was actually living in DengFeng, China, when a Typhoid epidemic broke out in 2007. A quarantine zone was created, and a couple of people at my Kung Fu school became deathly ill. It was a scary time, no doubt, but I was able to sleep a little better than the other guys at night knowing that I had been immunized. Needless to say, I got my money’s worth out of my vaccinations for travel.

Sometimes proof of a particular vaccination — such as yellow fever — is required before you will be allowed a visa into a country. This is especially true in South America and parts of Africa. Keeping good record of what you received and when can save you pain and money!

The good news is that most of the immunizations last for five or even 10 years, so this is something you have do not do too often.

How Do I Get Vaccinations For Travel?

Usually you will have to visit your local travel clinic to get vaccinations. Don’t wait too long to make an appointment! Sometimes — as in the case of the hepatitis shots — you have to wait 30 days between injections, and then another 30 days for it to have an effect. Don’t wait until the last minute to schedule your appointment — start early!

How Much Do Travel Vaccinations Cost?

Some of the vaccinations for travel can be surprisingly expensive. Japanese Encephalitis, a shot sometimes recommended for rural areas of Southeast Asia, can be $80.00 a shot, and requires a set of three! The problem with travel clinic doctors is that they will always err on the safe side and recommend everything in the book.

I was recommended a rabies shot — which I declined — just because there are a lot of stray dogs in Thailand. Do your own research, and make an educated decision. Average costs of a trip to Southeast Asia, with no prior immunizations: US$250 – $400.  Considering that many of these diseases are completely incurable and could afflict you for the rest of your life, vaccinations can be well worth the cost.

If you are heading to Thailand, check out these Vaccinations for Thailand.

Your health insurance may cover some of the shots or just the anti-malarial tablets. It is definitely worth a call to them to review your policy. Sometimes hepatitis-A and polio are covered.

If you do not have health insurance at home, at least consider getting a disaster policy with a very high deductible ($5,000 dollars). The monthly cost is cheap and covers you if you get run over by a tuk-tuk. Your travel insurance will only cover you while abroad; once you return home, you will have to pay for further treatment out of pocket.

• If you are leaving your job and need some high-deductible, personal coverage, EHealthInsurance.com can give you a quick quote.

If you have been in the armed forces or worked as a public servant (i.e., fireman, policeman, or nurse) you undoubtedly received some of these vaccinations for travel already. Researching your prior immunization records could save you money.

Which Vaccinations For Travel Do I Need?

Obviously we are not the final authority, but regardless of your destination, these are good basic immunizations to get which will protect you from a lot of nasties in developing countries.:

Other common vaccinations to consider for developing areas like Southeast Asia or South America:

Research what vaccinations for travel are required or recommended for your countries on the CDC Website or the World Health Organization website.

TIP: Keep a record of your vaccinations in a folder. You will never be able to remember which ones you received five or 10 years later; getting duplicates is a waste of money.

Even though it is tempting to skip the return visit to a clinic once you get home – GET YOUR BOOSTER SHOTS WHEN NEEDED! Otherwise, you may have to start an entire series of shots over again just to guarantee immunity. There are better things to spend your hard-saved travel funds on!

Malaria

Taking anti-malarials is hit or miss. A doctor will tell you to do so, I have not taken them in five years of rough travel and have been fine. Even still, every time you are bitten by a mosquito at night you play a little Russian Roulette with your bloodstream.

Read more about Malaria information for travelers on our site and how to avoid insect bites. You can only get malaria if you are bitten in the first place.

Dengue Fever

This is a very common yet usually not-fatal disease that is carried by mosquitoes. The mosquitoes have white and black markings and can be found all over Southeast Asia, Central and South America, Australia, and islands in the Pacific. Although Dengue will not kill you, it will certainly make you hate life for a few weeks, and may even end your trip completely.

There is no Dengue vaccination for travel at this time, but being smart and avoiding mosquito bites whenever possible can greatly reduce your chances for becoming infected.

What Else?

Some travelers opt for a pre-departure checkup. This is your choice, obviously a good bet if you are not feeling well before long term travel.

• If you take a regular prescription medicine, make sure you have enough to cover you for your trip.

• Keep a copy of the prescription with the medicine so that you will not raise eyebrows with a load of pills coming through customs. Keep the pills in the original, labeled bottles if possible.

• If you wear contacts, take along your glasses and prescription as a backup in case you lose one. Many of the environments will be extremely dusty during the dry seasons, which will be a nightmare for contact lenses.

• You might want to see a dentist.  Don’t wait until the last minute in case you need several appointments to get a problem fixed.If you are in Southeast Asia, Bangkok has great dentistry. Read about Thailand dental.

In Summary

Don’t be depressed after reading about all the nasties out there. Chances are that you will feel more alive and healthier than ever thanks to exercise, sunshine, and lack of television! As always, survival is a matter of playing it smart and not taking stupid chances with the trip of a lifetime.

Check out the backpacking medicine section on our site for tips about staying healthy while vagabonding.

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