What is Dengue Fever?
Dengue Fever is a serious illness caused by a virus transmitted by the female A. aegypti mosquito. It is estimated that over 400 million people worldwide get Dengue each year. The highest risk of dengue occurs during rainy season (in Bali this is October to March) but it is possible to get it at any time of year.
- high fever (40°C/104°F)
- headache, especially a pain behind the eyes
- joint and muscle pain that can be severe
- swollen glands
- nausea, loss of appetite
- skin rash
Dengue fever can develop into a life threatening condition known as dengue hemorrhagic fever. If you develop the following symptoms, go to the hospital:
- rapid breathing
- severe abdominal pain
- bleeding gums
- nose bleed
- blood in vomit
There are 4 serotypes of the virus that causes dengue. Recovery from one only gives you immunity to that serotype. Getting dengue more than once increases your chances of developing the much more dangerous dengue hemorrhagic fever.
The only treatment is bed rest, staying hydrated and paracetamol for the pain.
The vaccine for Dengue fever is not yet widely available. In 2016, it became available in the Philippines and Indonesia but it is only partially effective. It is not yet recommended for travellers because you need to get 3 doses over the course of 6 months.
When You Least Expect It
I have always been quite lucky that mosquitoes generally do not bite me. They love biting my husband and child but they have always left me alone. Perhaps this made me overconfident. I always use mosquito repellent on my son but I never use it on myself and certainly not during the day.
Unfortunately, the daytime is exactly when the Dengue carrying A. aegypti mosquito likes to bite. We had not been in Bali for more than a couple of days, when I noticed a bite on my ankle, just below my leggings. I was surprised but thought no more about it.
We moved from Kuta to a hotel in Sanur near the beach. Bali can be quite hot and humid in February and I thought that it was the heat that was sapping my energy and making me feel so run down. I fainted twice in Sanur and thought that the humidity might be to much for me. We decided to pack up again and go to Ubud.
It was less humid in Ubud and I couldn’t figure out why I was so tired all the time. Then I woke up one morning with the worst headache of my life. Many people have described the early symptoms of Dengue as being something like a hangover or the flu. This was a sharp, stabbing pain behind my eyes. As the day progressed, I developed horrific pain in my legs and lower back. Dengue is also known as breakbone fever and it is easy to see why. The pain could get very intense and it never let up.
I still had no idea what was wrong with me. I got the hotel owner to drive me to Ubud Clinic. I could barely stand up in the waiting room. The doctor suspected Dengue right away but said that I would have to come back the next day for a blood test to confirm. She sent me home with paracetamol and some medicine containing echinacea to “boost my immune system”. The blood test the next day confirmed that it was Dengue and revealed that my blood platelet level had already dropped to 113,000. The doctor said that if it fell under 100,000, I would probably need to go to the hospital for treatment.
The next week is just a blur of pain and nausea. Paracetamol does not make the pain go away and the doctors would not give me anything stronger. Micheal had deadlines at work and had no choice but to leave me alone with the baby in the mornings while he worked from a cafe next door. Fortunately, L.N. was content to sit on the bed and watch cartoons while I tried not to cry in front of him.
I did end up getting the rash but I didn’t even see it in the darkened hotel room (light hurt my eyes) until after my fever broke.
The day after my fever broke, we went back to Kuta to arrange travel back to Bangkok. I could stand up but not much more. Micheal thought it would do me good to walk next door to the bakery with him to “get some fresh air”. I fainted in the bakery. From the day I was diagnosed, it took about 9 days before I felt okay again (so the entire illness lasted about two weeks).
Treating Dengue Fever
If you are unfortunate enough to get Dengue, the best thing you can do is stay hydrated. From the studies I read, every glass of water you drink up to 5 a day, decreases the probability of needing to be hospitalized. I alternated plain water with a sports drink called Pocari Sweat. In Thailand, there is also a powdered electrolyte beverage called Royal-D that you can pick up at any 7-11.
Where to Go for Testing and Treatment
Bali International Medical Centre – this is a private hospital and reported to be quite expensive. They speak English and cater primarily to foreigners. If you need to be admitted overnight, you will be asked for payment for the room upfront, even if you have travel insurance. Reports indicate that this is around $650 USD per night.
Kyoia Medical Services – can come to your hotel room to collect blood for dengue test and email results to you a couple of hours later. This will be more expensive than walking into a clinic.
The Dose Bali – will come to your hotel to do the blood test and can provide an IV drip in your hotel room. This is only for helping you to recover from a mild to moderate case of dengue fever. If you have developed dengue hemorrhagic fever, you need to be in a hospital.
Ubud Clinic Website says 24 hours service and lab but they made me come back the next day for my lab results.
Ubud Health Care Clinic – will come to your hotel room.
Preventing Mosquito Bites
The risk of getting Dengue is not something you can ignore if you want to travel in Asia.
1. You absolutely must wear mosquito repellent every day if you are in an area that has a high risk of Dengue Fever. Don’t forget your ankles and feet! Experts will tell you that you need a mosquito repellent containing at least 10 percent DEET. However, I have had success with using Badger Anti-Bug Balm
, which contains no DEET; only citronella, cedar, and lemongrass oils.
2. If you have a small child, get a mosquito net to cover their stroller/pushchair if you are going to be out in the evening. If you have an infant that can’t use mosquito repellent, I would consider covering their pram with netting during the day if there is a current Dengue outbreak. It is possible to rent a cot with a mosquito net cover from Bali Baby if your hotel does not provide one.
3. Stay in accommodation with air conditioning so that you don’t need to leave a door or window open. If you absolutely must stay in a budget, fan-only room, keep your doors and windows closed during dawn, dusk and night. Keeping a fan aimed at you while you sleep will help keep mosquitoes from landing on you while you sleep.
4. If you are staying in accommodation that has large openings in the bathroom wall for ventilation, keep the door between the bathroom and the rest of your room closed at all times.
5. If you want to sit outside on a patio or terrace, use a mosquito coil. If you are allergic to these like I am, try citronella candles.
6. If you are at an open air restaurant, try to sit with a fan blowing directly on you.
What is the best mosquito repellent?
Popular brands of repellent available in Bali are Soffel, Utama Spice, and Autan but these have very mixed reviews of effectiveness so if you have a brand that works for you, bring it from home. A lot of Australians swear by Bushman gel since it is water resistant (meaning you won’t sweat it off) and it contains a sunscreen. Keep in mind that the 80% DEET formula can’t be used on children. There is also a 20% DEET formula.
Consumer Reports Magazine tested several mosquito repellents specifically against Aedes mosquitoes, the type that carry Dengue and Zika but all of them were American brands that are not widely available outside the US. However, that study at least tells us that there are some effective solutions for people who are allergic to DEET. The top three they tested were all effective for up to 7-8 hours:
- Sawyer Fisherman’s Formula Picaridin – Active ingredient: picaridin 20%.
- Ben’s 30% Deet Tick & Insect Wilderness Formula
- Repel Lemon Eucalyptus – Active ingredient: oil of lemon eucalyptus 30%
Other herbal insect repellents such as Burt’s Bees Herbal insect repellent were tested but found to only be effective for up to an hour. That doesn’t mean you shouldn’t use them, especially if you are are allergic to DEET, just that you will need to apply them more frequently.
Hair Loss After Dengue Fever
Three months after recovering from Dengue Fever, my hair started falling out. It became noticeably thin and I was very worried because I did not know it was connected to the previous bout of Dengue and the doctors in Spain did not know what was causing it. This type of hair loss is called telogen effluvium, and it can occur after any serious illness or a traumatic event. The hair will shed for 1-2 months but it will grow back. One study I found showed that 45% of people experienced some amount of hair loss after getting Dengue Fever.
When the Joint Pain Does Not Go Away
Some people have been emailing me and telling me that they experienced joint pain for months after getting Dengue. There is another disease called Chikungunya that is very similar to Dengue, except that the joint pain and fatigue can linger much longer. In fact, it is possible to be infected with Chikungunya and Dengue at the same time. I will try to do some more research on this, until then you can look at the Wikipedia entry for Chikungunya.
I always use World Nomads Travel Insurance.