DENGUE FEVER: Once Bitten, Twice Shy.
By Brittany Somerset, Intrepid Reporter, Portmore, Jamaica.During a previous trip to Jamaica in July of 2007, I was told by a customs agent in Montego Bay airport that Jamaica was a malaria-free island. After perusing my passport, and noticing that I had been to Peru, I was subsequently ordered to the Minister of Health’s office, to be examined for malaria. I explained to the customs agent that I was on the anti-malarial medicine Malarone the entire time I was in Peru, and did not pose a health threat to the citizens of Jamaica. I further explained that malaria is not spread by airborne proximity. Unless I had managed to carry a malaria-infected mosquito back from Peru as a pet, kept it in New York, and then brought it to Jamaica with me two months later, I was probably safe to enter the country.Unfortunately while the customs agent impressed upon me that Jamaica was a malaria-free country, she completely failed to inform me that Jamaica wasn’t a dengue-free country. I didn’t pose a health risk to the island, however the island, unbeknownst at the time, certainly posed a serious health risk to me. I definitely should have periodically checked the Internet for health risk factors associated with visiting Jamaica. I usually do that when traveling to any other destination, however since I’d lived on and off the island since the year 2000, I thought I was aware of all the specific Jamaican health risks. I was completely unaware, however, of the 2007 outbreak of dengue in Portmore and Kingston. On a more recent trip to Jamaica in April of 2008, I fell deathly ill. At first, I assumed I had the flu, and took over-the-counter acetaminophen accordingly. My naive attempts to self-medicate with aspirin, acetaminophen or ibuprophin, were completely detrimental to my health, and in this particular case, could have been fatal. This is terribly unfortunate, as in most situations, aspirin may be the first readily available drug of choice to treat a broad spectrum of painful ailments.According to the New York Times “Aspirin and aspirin-like drugs must be avoided at all costs when treating Dengue, because they can lead to bleeding and complicate matters. Children with Dengue who take aspirin could develop Reye Syndrome.”After a few days of pure agony, when I could no longer stand the pain and was too sick to fly home, I went to a clinic in Portmore. I was diagnosed with dengue fever on the spot. Dengue is often referred to colloquially as “breakbone fever” because of severe muscular pains. I certainly felt like my bones were breaking. Never in my life had I previously experienced that magnitude of pain. I was immediately referred to a hospital in Jamaica. I was told the government would be notified and I would be placed under quarantine.It was Friday evening, and my heart sank as I realized the US State Department or Embassy wouldn’t be open until Monday morning. As the hospital nurse drew blood from me, for testing purposes, and asked me to wait two hours for the results, I contemplated activating my Medivac insurance. I imagined being airlifted by helicopter to St. Vincent’s hospital in New York. Unfortunately the Medivac pin # was programmed in my Sidekick PDA, which I didn’t bring with me to the hospital. General germaphobia and loathing of hospitals prompted me to give the nurse my local mobile phone number and beg her to call me in two hours with the blood test results. I became increasingly irritable and cranky, and was unable to think clearly.It’s a good thing I decided not to wait the estimated two hours for the blood test results. In typically Jamaican style, the doctors periodically called me over the weekend to inform me that the blood results would “soon come,” and reminded me that I was under quarantine and couldn’t leave the island. I returned to my friend’s house, exhausted, where I slept on and off for two or three more days.My symptoms included severe body pain; my muscles, joints, bones, toenails and hair hurt, accompanied with delirium, hallucinations, irritability, mental confusion, paranoia, (like an absinth binge gone horribly wrong), and severe sweating. I soaked the bed sheets through my pajamas and my hair was wet with sweat. I urinated in a bedpan, because I was too weak to make it to the bathroom. At one point, I couldn’t tell if I wet the bed with urine, or with sweat. I also had fever, chills, and other flu-like symptoms. I was so hot and slicked with sweat I wanted to strip naked and lie under the fan at one moment, and then I was shivering while wearing two sweaters over my pajamas, the next. I also developed deep vein thrombosis (DVT) in my left leg.I would have a day or so of activity and lucidity and then relapse into a dark abyss of pain. I later learned that the feeling of being cured and then relapsing is common, as the fever may be biphasic (i.e. two separate episodes or waves of fever).At one point, I was so incredibly weak, I couldn’t carry or even open a bottle of orange juice. Nothing quenched my thirst or swollen lymph nodes. In my sleep, I feverishly cried out, “Maman” repeatedly (French for “Mommy”). I had developed bleeding of the gums, and was vomiting. I dumped out my medical kit and searched for anything besides aspirin that would help alleviate my symptoms. Antibiotics were useless, as dengue is a viral, not a bacterial, infection. Luckily, I had 18 Vicodin painkillers remaining from a dentist’s prescription, following the removal of a wisdom tooth, weeks earlier. The last time I took two Vicodin for pain, I overdosed, passed out and slept like the dead. Perfect. The Vicodin was much more effective (and less deadly!) than aspirin and was the only thing that dulled the pain. I took the maximum dosage of 500mg every four hours and slept fitfully, sweating and thrashing, for three days, but mostly, I literally couldn’t move.After the fever broke, my body temperature was low and I had abdominal cramps. Having gone untreated properly for nearly a week, the disease had progressed to its more dangerous form, Dengue Hemorrhagic Fever (DHF).After a few anxious conversations with my doctor in New York, I learned that dengue is not an airborne virus (like the flu) and, therefore, I didn’t need to be quarantined, although the Portmore area probably did, because the infected mosquito might still be at large. I didn’t need to sit around waiting for blood test results that would probably never come, while my health was rapidly deteriorating. On his advice, I fled the country, and returned home.The entire time I was at the airport, I was nervously waiting for government officials in Mylar bio-suits to snatch me up and carry me away. Scenes from the movie “ET,” where Drew Barrymore’s house in quarantined, flashed through my mind. I hid from the imaginary quarantine police in the Air Jamaica business class lounge. My mind was still muddled, however, so I repeatedly shook out the contents of my purse, to make sure there were no hitchhiking mosquitoes hiding in it. I didn’t want to evolve from my current social standing of intrepid reporter, to Manhattan’s answer to Typhoid Mary. I thought if I arrived home and a mosquito in New York bit me, and then bit someone else, I could cause an outbreak. Remaining in Jamaica, however, without a private medical practitioner, was not the best option for me.Considering most types of mosquitoes breed in water, any quantity of water, from a swamp to a puddle, it makes sense that Portmore, Jamaica, which is built on land that was excavated from a swamp, and is divided by a canal, would be endemic and thriving with mosquitoes, some dengue-infected. Despite taking every precaution while in Portmore and in Kingston, such as using a mosquito zapper, sleeping under a mosquito net, burning citronella candles, wearing Avon Skin So Soft mosquito repellant, and wearing long pants and sleeves at night, I was still bitten hundreds of times. My morning and evening ritual consisted of slathering myself in Gold Bond medicated anti-itch lotion, as the itching of the non-dengue infected mosquito bites became increasingly unbearable. Being itchy, however, ultimately proved to be the least of my concerns.I took similar mosquito-bite precautions in Africa and Peru to what I did in Jamaica; however, in Africa I had the essential malaria-preventative measure of Malarone. Although malaria is more deadly than dengue, malaria can be prevented and is curable with doses of Quinine or Artesunate. There are no specific preventives, vaccines, or cures for dengue. Microsoft millionaires Bill and Melinda Gates have contributed over 50 million dollars towards the development of a dengue vaccine, and for treatment of those afflicted with the virus. As far as dealing with dengue, you just have to patiently ride it out, drink plenty of fluids, and hope it goes away, rather than develop into Dengue Hemorrhagic Fever (DHF). There is nothing else you can do.Clinically speaking, the Dengue virus is a flavivirus, (like West Nile, Yellow Fever, etc), of which there are four serotypes (variations). Dengue fever is transmitted by the Aedes Aegypti mosquito, which bites during daylight hours, not at dusk, as other mosquitoes do. The infected mosquito transmits the disease by biting someone and then biting someone else. There is no direct person-to-person transmission, which is why no one else in close proximity to me caught my “flu”.On one hand, one exposure to one of the variants of infection usually grants the afflicted with a lifetime of immunity to the disease. On the other hand, you are still at risk for catching the other three types of dengue. Studies indicate that it is the second infection that can lead to the more advanced form of Dengue Hemorrhagic Fever. DHF causes the capillaries (tiny blood vessels between the endings of the arteries and the beginnings of the veins) to leak fluid. If this isn’t treated in an expedient manner, DHF causes life-threatening loss of blood volume and death from Dengue Shock Syndrome.According to the World Health Organization (WHO), “Dengue Shock Syndrome supervenes in a small proportion of cases. Severe hypotension (low blood pressure) develops, requiring urgent medical treatment to correct hypovolaemia (a blood disorder consisting of a decrease in the volume of circulating blood). Without appropriate treatment, 40-50% of cases are fatal. With timely treatment, however, the mortality rate is 1% or less.”Many cases of dengue produce only mild flu like symptoms that last for 3-5 days, or no symptoms at all. Even if a first infection goes by undiagnosed and undetected, the second infection will increase the risk of the more severe DHF. The average incubation period of the virus is 3 to 14 days. In my case, it is highly probable I was infected during one of my frequent trips to Jamaica, left the island during the incubation period, and returned to Jamaica a week or two later to experience the onset of the virus on the night I arrived, without ever having known I was previously infected. Or perhaps I was infected once before, albeit mildly, passed it off as a cold or the flu and was re-infected, much worse the second time around. Considering how many mosquito bites I unavoidably sustained in Jamaica, it seems like it was only a matter of time before I caught dengue.After a lengthy recovery that is currently still in progress, I can only hope my experience can prevent others from experiencing this virulent virus. As I gear up for Sumfest in July, 2008, don’t be surprised if instead of seeing me in my normal attire of shorts, a tank top and flip flops, I am sporting a new fashion – an entire body camouflage mosquito net. Having been once bitten, I’m now twice shy.For more information about Dengue Fever please view:http://www.jamaica-gleaner.com/gleaner/20070928/news/news3.html http://sped2work.tripod.com/dengue.html http://www.wordtravels.com/Travelguide/Countries/Jamaica/HealthAdditional Sources:The New York Times, Personal Health by Jane E. Brody, Tuesday May 13th, 2008World Health Organization website