The expat lowdown on dengue fever

Angkor Hospital for Children’s deputy director Dr Ngoun Chanpheaktra lays out some pertinent facts about dengue.
Angkor Hospital for Children’s deputy director Dr Ngoun Chanpheaktra lays out some pertinent facts about dengue. Miranda Glasser

The expat lowdown on dengue fever

With the onset of the rainy season, expats can look forward to (marginally) cooler days and some refreshing breezes but what, if any, are the seasonal hazards? How can we avoid them? And the biggest question of all: does a gin and tonic a day really keep the mosquitoes away?

Insider spoke to Angkor Hospital for Children’s deputy director Dr Ngoun Chanpheaktra and Dr Varun Kumar, co-chief of medical education, to dispense some advice and dispel some myths.

While to most people rainy season might call to mind increased threat of dengue fever and malaria, Dr Kumar is quick to point out an even bigger peril.

“To be honest, people should look out for traffic accidents – that’s by far the worst of rainy season,” he says. “Dengue has this mystique that’s quite exaggerated because it’s unfamiliar.

“For every young healthy expat, by far and probably more than everything else combined, traffic accidents are the most dangerous – at any time of year, but during rainy season you have reduced visibility, you have slippery roads, so maybe even more so.”

He adds that if expats are going to be scared about something, it should be about not wearing a helmet on a motorcycle.

“Almost every day people are killed or injured in traffic accidents so I think it’s more dangerous,” says Dr Pheaktra. “When you see the reports from the dengue centre, less than 20 or 30 children died from dengue fever last year and this year, it’s even less. But last year 1,800 people died in traffic accidents.”

The doctors do acknowledge that dengue increases between May and October, but the symptoms are mostly far milder than people think – in fact some people don’t even know they’ve had it.

“The big thing is first of all with the mosquito bites, everyone’s going to get them, it’s Cambodia,” says Dr Kumar. “The vast majority of mosquito bites don’t lead to dengue.

“Secondly, the vast majority of dengue infections don’t lead to severe disease. And then even amongst severe disease, the mortality of hospitalised dengue is less than half a per cent.”

He says expats should be aware that most of the complicated dengue comes from the second or third infection.

“It’s very rare for a first-time dengue infection to lead to the type of rare complication that leads to death,” he says, adding that mortality usually only occurs in cases where the child has been brought into the hospital very late after contraction, and there are generally other factors involved, such as being given the wrong treatment to start with.

“We see dengue fever almost every day but the majority of the infection is not serious,” Dr Pheaktra says. “Mostly they die here because they come with complications already.

“The illness of dengue is a valid concern among city folk – that’s where it mainly exists, in urban areas,” adds Dr Kumar, “Unlike malaria which, unless you go to very specific hotspots in Cambodia, is not a valid concern. Getting dengue is a valid concern; we’re just saying it’s not a severe disease. I had dengue; I missed a day and a half of work, it was like a bad flu.”

But mild or not, who wants to feel like they’ve got bad flu? Not this expat, who is all ears as to what preventative measures can be taken against what was once known as, ‘breakbone fever’.

Carried by the aedes or Asian tiger mosquito – so-called for its black and white markings – the dengue mosquito is a ‘daytime feeder’ that favours areas where water can collect, such as swimming-pools, rain barrels and planters. Like the villain it is, it also likes hiding out in dark corners.

“When the rain comes it’s important to look at places around the house where water collects, as they are breeding grounds for mosquitoes,” Dr Pheaktra says. “It’s important not to have containers of water, and make sure you protect yourself during the day by wearing long-sleeved clothes and covering up. Mosquitoes like places that are a bit dark, so at school as well it’s important to make sure children’s play areas are very bright.”

As for mosquito repellant, the doctors are somewhat cynical about the ‘natural’ remedies often bandied about. Disappointingly, there is no scientific evidence to back up the popular theory that imbibing gin and tonic keeps the biters at bay.

“By the rigours of science, only one thing has been shown to reduce mosquito bites, and that’s Deet,” says Dr Kumar. “Deet does melt plastic, and so reasonably people will wonder whether they should put it on their skin.”

He points out that in 60 years of Deet use, zero cases of toxicity have been reported – except in one instance where a child drank the whole bottle.

“But things like Vitamin B and Vitamin E which I think have been talked about have not been shown to be effective, says Dr Kumar. “They’ve done controlled research with different repellants, and Deet came way ahead of everything else. Citronella even wasn’t shown to be that good.”

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