Dengue in Bali
Dengue and its Complications
Dengue is a mosquito-borne virus that occurs worldwide in tropical and subtropical areas, especially during the rainy season. Spread by Aedes mosquitoes, there are four different strains of Dengue in Bali, and (unluckily for us). Once infected with a particular strain of the Dengue virus, an individual becomes immune to this strain and cannot become re-infected by this specific strain.1,2
Unfortunately, this is not as good as it sounds. If you’ve had Dengue before, subsequent infections tend to be a more severe strain and more likely to cause Dengue Hemorrhagic Fever (DHF). DHF, or severe Dengue, is the potentially fatal complication of leaking blood plasma, fluid accumulation, respiratory distress, severe bleeding, and or organ impairment.1,2
Dengue Shock Syndrome (DSS), which is the most severe form of DHF, is the dangerous combination of increasingly permeable veins, heart issues, and dehydration. It is more likely when an individual has been infected with two strains (serotypes) of Dengue at the same time but generally occurs mainly amongst children, especially infants. In older children and adults, DHF is the more common complication.
Dengue is a biphasic illness (an illness with two distinct phases). After an incubation period of 3-14 days (commonly 4-7 days) it starts with the sudden onset of a severe headache, high fever, and joint and muscle pain. After 3-7 days, the patient enters what is called the critical phase. At this time, the fever starts dropping (below 38°C/100°F) and warning signs associated with severe Dengue can manifest.
Warning signs that tell you to see a doctor immediately are :
- Severe abdominal pain
- Persistent vomiting
- Rapid breathing
- Bleeding gums or nose
- Restlessness or somnolence (strong desire to sleep)
- Blood in vomit
How Dengue is transmitted
People catch Dengue in Bali after being bitten by female Aedes mosquitoes (mainly Aedes Aegypti). This species is usually active during the day, especially the two hours after sunrise or before sunset. 2,3 Mosquitoes are the vectors of Dengue, so your best defense is to avoid getting bitten in the first place. Aedes mosquitoes typically lay eggs near standing water in containers that hold water, like buckets, bowls, animal dishes, flower pots, and vases.2,4
- Use reliable mosquito repellent products (containing DEET or Icaridin)
- Hang a mosquito net to sleep under and make sure that open windows have screens
- Wear long-sleeved shirts and long pants at night
- Do not have stagnant water (where mosquitoes breed) nearby; e.g. empty containers after rain, used tyres, empty flower pots
- If you are also using sunscreen, apply sunscreen first and insect repellent second
If you suspect Dengue Fever, it is crucial to observe the situation. Unfortunately, there is no specific treatment for this illness. Rest and drink plenty of fluids such as water, juice, coconut water or soup. Supplement with IV fluids if unable to consume enough fluid, or you feel dehydrated. Fever reducers and pain killers can be taken to manage muscle ache and fever symptoms – the best option being Acetaminophen/Paracetamol. NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen and Aspirin, should not be taken. These medications increase the risk of bleeding (due to slowing clotting time), and, in a disease with risk of hemorrhage, may exacerbate symptoms.1,2,4 Platelet level monitoring is also recommended via frequent blood tests.
Dengue symptoms can be quite similar to other illnesses and diseases, leading to misdiagnoses or delays in treatment. If you suspect you have Dengue, we recommend confirming the diagnosis through a Dengue blood test. After which your doctor can advise on the best plan for treatment and ongoing monitoring. 1,2,4
For cases of severe Dengue, medical care by physicians and nurses experienced with the effects and progression of the disease can save lives – decreasing mortality rates from more than 20% to less than 1%.
Dengue has the potential to become a serious emergency, so proper care with a medical professional is always recommended.
- Dengue and severe Dengue [Internet]. [cited 2019 Dec 11]. Available from: https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue
- Special Programme for Research and Training in Tropical Diseases, World Health Organization, editors. Dengue: guidelines for diagnosis, treatment, prevention, and control. New ed. Geneva: TDR: World Health Organization; 2009. 147 p.
- CDC. Transmission [Internet]. 2019 [cited 2019 Dec 11]. Available from: https://www.cdc.gov/dengue/transmission/index.html
- CDC. Prevent Mosquito Bites [Internet]. 2019 [cited 2019 Dec 11]. Available from: https://www.cdc.gov/dengue/prevention/prevent-mosquito-bites.html