# Those Touring In Tropical Regions - Dengue?



## Psamathe (6 Jan 2023)

Question for those who tour in more tropical regions which likely match well to endemic Dengue regions.

Looks like while the world has been focusing on Covid the number of Dengue cases in most endemic countries has been massively increasing. Not much reported (a few news articles and WHO reports) but the increase looks horrendous. New vaccine approved in EU (but not UK) and in some endemic countries but a lot of people not eligible (not after age 45 years) and things like Wolbachia looking good but still only in localised trials.

So people visiting such areas these days, in Dengue a concern and what to do. Insect repellant and daytime bite avoidance must be harder cycling (sweat washing off repellant?).

Interesting that all the reports I've seen in the increase of cases only quote the number of cases and not the serious infection rates - a bit like comparing the number of broken toes in Luxembourg vs in China (it's rate or cases per population that seems important).

(Moderators - if this is not the appropriate forum section then please do move).

ian


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## Cycleops (6 Jan 2023)

Best stay at home then.


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## Psamathe (6 Jan 2023)

Cycleops said:


> Best stay at home then.


Thanks for your helpful suggestion.

Ian


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## bobzmyunkle (6 Jan 2023)

'_Aedes aegypti_ mosquitoes most commonly feed at dusk and dawn'
So less concern of repellent washing off if cycling in the day. 
In the evenings get the Deet on, cover the body and use a mosquito net.
I'm not an expert.


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## Arrowfoot (6 Jan 2023)

Read travel advisories on countries affected by dengue. Pick alternates or take preventive steps. Ensure you have travel insurance. 

Kruger National Park is in High Risk Malaria Zone for decades yet thousands visit it each year taking the necessary precautions. 

Or else stay home and let the World go by.


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## HobbesOnTour (6 Jan 2023)

Psamathe said:


> Question for those who tour in more tropical regions which likely match well to endemic Dengue regions.
> 
> Looks like while the world has been focusing on Covid the number of Dengue cases in most endemic countries has been massively increasing. Not much reported (a few news articles and WHO reports) but the increase looks horrendous. New vaccine approved in EU (but not UK) and in some endemic countries but a lot of people not eligible (not after age 45 years) and things like Wolbachia looking good but still only in localised trials.
> 
> ...



It's not 100% clear if you are looking for information in relation to _visiting_ or _touring_ Dengue infected areas, or indeed plans for any specific places.

https://www.cyclechat.net/forums/touring-adventure-cycling.8/ is the Touring forum which may offer more views or at least a more helpful response. If you place an @ in front of moderators that will effectively "call" them to the thread. 

I recently toured through Central and (parts of) South America and have to say that I spent little time being concerned with Dengue. There was no vaccine so little I could do other than the usual mosquito prevention. As always on a bike tour, the greatest risk to my health is from traffic. Given the conditions that many live in, I believe there is a potential danger of reading too much into dry statistics.

It's not at all surprising that rates are increasing. I'd bet that the rates of most diseases are rising after the downriver effects of Covid flows through the world.


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## OneCogDown (6 Jan 2023)

> HobbesOnTour said:
> 
> 
> > It's not at all surprising that rates are increasing. I'd bet that the rates of most diseases are rising after the downriver effects of Covid flows through the world.
> ...



Assuming the OP is considering a trip to an affected country, then follow those precautions you would expect to take for avoiding malaria etc...localized serious outbreaks are often subject to internal travel restrictions, local hotelier/tour operators and tourist boards will caution against entry.
However and despite the above if you experience flu like symptoms and start running a fever then start re-hydrating from the outset. Its a simple blood test that will confirm Dengue, often available at small private hospitals and blood testing companies which operate on a walk in basis. You will lower the risk of it becoming a critical condition if you are well hydrated during the early stage. So drink, drink and drink electrolytes. Expect a brutal headache, hallucinations and a serious fever over at least 7 days; much like "Covid" it will take time to recover; I doubt you would be wanting to continue a cycle tour, as it hits pretty hard even in its mild form.


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## Teamfixed (6 Jan 2023)

I think this is what is commonly referred to as sand fly fever? Tiny little things the size of a tiny speck.
Lots of repellent morning and evening. I seem to remember the morning being worse and when the humidity was high. This was in W.Africa.


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## Psamathe (6 Jan 2023)

(As OP) to clarify, I'm pretty fed-up with being in the UK (several months since anything overseas) but when I head-off it tends to be for a fair time (apparently - I just regard it as "travel"). And that will undoubtedly be to a region with endemic Dengue. But also wondering about taking the bent. Last trip to SEA (local buses/boats, no cycle) was curtailed by Covid and I saw Southern Vietnam, Cambodia, Southern Thailand and Burma so wondering about taking cycle and heading north through Vietnam, then across into Laos. I don't plan in advance much - wonder about options then suddenly decide, go online and buy a one-way ticket for flight next day (or maybe day after if cheaper) and go.

Number of Dengue infections seems massively higher now than back immediately before Covid and wondering sweating whilst cycling would make risks significantly worse, if Dengue has become a real nightmare of if case numbers are much higher if rates are still low. Not a lot reported as Covid is getting all the attention so wondering is others had info or experiences.

Either local buses/boats or take cycle.

Ian


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## Ming the Merciless (6 Jan 2023)

Basically you want to cover up, and repellent. Usual precautions around mosquitos. I’ll want parrot medical advice as that’s easily found and kept up to date.

Suggest visit with GP or travel clinic about 6-8 weeks before your trip to get latest advice for area you are planning to travel to.


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## Psamathe (6 Jan 2023)

Ming the Merciless said:


> ...
> Suggest visit with GP or travel clinic about 6-8 weeks before your trip to get latest advice for area you are planning to travel to.


Last specialist travel clinic (recent enough) were basically just reading the standard UK NHS web sites. NHS clinic but most of vaccinations were private/charged (as not covered by NHS) I'm not being critical as there is no way they can be expected to know details for every country open around the world and seems their resources are the same as those on the open internet. This one was particularly "paranoid" (or thorough) and recommended vaccines not previously suggested (e.g. cholera).

Ian


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## Psamathe (6 Jan 2023)

HobbesOnTour said:


> ...
> It's not at all surprising that rates are increasing. I'd bet that the rates of most diseases are rising after the downriver effects of Covid flows through the world.


It's an interesting aspect. I did read a more specialist article (can't remember source - but a reliable one) about long-Covid and researcher was reporting that in some cases they had identified EBV re-activation so in those cases they felt that the "long-covid" was likely to be CFS (or the start of CFS). Their findings were not for all long-Covid cases but for some EBV tests showed EBV activation presumably from an earlier infection. I found it interesting - though I'm not suggesting this has anything to do with Dengue.

Ian


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## Ming the Merciless (6 Jan 2023)

Psamathe said:


> Last specialist travel clinic (recent enough) were basically just reading the standard UK NHS web sites. NHS clinic but most of vaccinations were private/charged (as not covered by NHS) I'm not being critical as there is no way they can be expected to know details for every country open around the world and seems their resources are the same as those on the open internet. This one was particularly "paranoid" (or thorough) and recommended vaccines not previously suggested (e.g. cholera).
> 
> Ian



I had Cholera vaccine in 2001 , be aware it is only effective for about 8 months. It was oral back then.


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## Psamathe (6 Jan 2023)

Ming the Merciless said:


> I had Cholera vaccine in 2001 , be aware it is only effective for about 8 months. It was oral back then.


Still is oral (or at least the 2 doses I had were). Dukoral. But quoted as lasting 2 yrs now (although I suspect much must depend on what those doing the validity period consider adequate protection levels). Although official validity is 2 years, I did read clinical trial result summaries that found better protection with interval between doses longer than the minimum. I was only searching out more details as when I was in my 30's travel nurses said how it was only 50% effective so "don't bother" and current cost was £50 (2 doses) so I wanted to check the protection was better.

Ian


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## Ming the Merciless (6 Jan 2023)

Psamathe said:


> Still is oral (or at least the 2 doses I had were). Dukoral. But quoted as lasting 2 yrs now (although I suspect much must depend on what those doing the validity period consider adequate protection levels). Although official validity is 2 years, I did read clinical trial result summaries that found better protection with interval between doses longer than the minimum. I was only searching out more details as when I was in my 30's travel nurses said how it was only 50% effective so "don't bother" and current cost was £50 (2 doses) so I wanted to check the protection was better.
> 
> Ian



Ha I was in Melbourne (Australia) travel clinic at the time getting some boosters as I was travelling for more than a year. They had some spare from a batch and offered it for free.


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## Psamathe (6 Jan 2023)

Ming the Merciless said:


> Ha I was in Melbourne (Australia) travel clinic at the time getting some boosters as I was travelling for more than a year. They had some spare from a batch and offered it for free.


At the moment in the UK it's very difficult to get hold of. I was phoning round pharmacies, they'd say "we don't have stock, I'll check on the computer ... no expected availability from importer for foreseeable future". In the end I found a pharmacy branch of chain where pharmacist trained for travel clinic had left and replacement not yet trained so they still had stock of vaccine because nobody to prescribe it (and I only needed to purchase the stuff for self-dosing). Even then I got their last 2 doses (single box).

Ian


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