LIFE SE ASIA MAGAZINE

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In our on going series of health issues in SE Asia,  we are not doctors or medical people so will use Health sites and rely on USA and World health Org, as sources and will give LINKS. Our goal is to provide reliable sources and LINKS for you to use.

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Link to WHO  for Dengue Fever

Dengue and severe dengue

Fact sheet N°117
Updated February 2015


Key facts

  • Dengue is a mosquito-borne viral infection.
  • The infection causes flu-like illness, and occasionally develops into a potentially lethal complication called severe dengue.
  • The global incidence of dengue has grown dramatically in recent decades.
  • About half of the world’s population is now at risk.
  • Dengue is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas.
  • Severe dengue is a leading cause of serious illness and death among children in some Asian and Latin American countries.
  • There is no specific treatment for dengue/ severe dengue, but early detection and access to proper medical care lowers fatality rates below 1%.
  • Dengue prevention and control solely depends on effective vector control measures.

Dengue is a mosquito-borne viral disease that has rapidly spread in all regions of WHO in recent years. Dengue virus is transmitted by female mosquitoes mainly of the species Aedes aegypti and, to a lesser extent, A. albopictus. The disease is widespread throughout the tropics, with local variations in risk influenced by rainfall, temperature and unplanned rapid urbanization.

Severe dengue (also known as Dengue Haemorrhagic Fever) was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand. Today, severe dengue affects most Asian and Latin American countries and has become a leading cause of hospitalization and death among children in these regions.

There are 4 distinct, but closely related, serotypes of the virus that cause dengue (DEN-1, DEN-2, DEN-3 and DEN-4). Recovery from infection by one provides lifelong immunity against that particular serotype. However, cross-immunity to the other serotypes after recovery is only partial and temporary. Subsequent infections by other serotypes increase the risk of developing severe dengue.

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Before 1970, only 9 countries had experienced severe dengue epidemics. The disease is now endemic in more than 100 countries in the WHO regions of Africa, the Americas, the Eastern Mediterranean, South-East Asia and the Western Pacific. The America, South-East Asia and Western Pacific regions are the most seriously affected.   

In Asia, Singapore has reported an increase in cases after a lapse of several years and outbreaks have also been reported in Laos. In 2014, trends indicate increases in the number of cases in the People’s Republic of China, the Cook Islands, Fiji, Malaysia and Vanuatu, with Dengue Type 3 (DEN 3) affecting the Pacific Island countries after a lapse of over 10 years. Dengue was also reported in Japan after a lapse of over 70 years.

An estimated 500 000 people with severe dengue require hospitalization each year, a large proportion of whom are children. About 2.5% of those affected die.

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The Aedes aegypti mosquito lives in urban habitats and breeds mostly in man-made containers. Unlike other mosquitoes Ae. aegypti is a day-time feeder; its peak biting periods are early in the morning and in the evening before dusk. Female Ae. aegyptibites multiple people during each feeding period.

Characteristics

Dengue fever is a severe, flu-like illness that affects infants, young children and adults, but seldom causes death.

Dengue should be suspected when a high fever (40°C/104°F) is accompanied by 2 of the following symptoms: severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands or rash. Symptoms usually last for 2–7 days, after an incubation period of 4–10 days after the bite from an infected mosquito.

Severe dengue is a potentially deadly complication due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or organ impairment. Warning signs occur 3–7 days after the first symptoms in conjunction with a decrease in temperature (below 38°C/100°F) and include: severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue, restlessness and blood in vomit. The next 24–48 hours of the critical stage can be lethal; proper medical care is needed to avoid complications and risk of death.

Treatment

There is no specific treatment for dengue fever.

For 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%. Maintenance of the patient’s body fluid volume is critical to severe dengue care.

Immunization

There is no vaccine to protect against dengue. However, major progress has been made in developing a vaccine against dengue/severe dengue. Three tetravalent live-attenuated vaccines are under development in phase II and phase III clinical trials, and 3 other vaccine candidates (based on subunit, DNA and purified inactivated virus platforms) are at earlier stages of clinical development. WHO provides technical advice and guidance to countries and private partners to support vaccine research and evaluation.

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Link to WEBMD 

Symptoms of Dengue Fever

Symptoms, which usually begin four to six days after infection and last for up to 10 days, may include

  • Sudden, high fever
  • Severe headaches
  • Pain behind the eyes
  • Severe joint and muscle pain
  • Nausea
  • Vomiting
  • Skin rash, which appears three to four days after the onset of fever
  • Mild bleeding (such a nose bleed, bleeding gums, or easy bruising)

Sometimes symptoms are mild and can be mistaken for those of the fluor another viral infection. Younger children and people who have never had the infection before tend to have milder cases than older children and adults. However, serious problems can develop. These include dengue hemorrhagic fever, a rare complication characterized by high fever, damage to lymph and blood vessels, bleeding from the nose and gums, enlargement of the liver, and failure of the circulatory system. The symptoms may progress to massive bleeding, shock, and death. This is called dengue shock syndrome (DSS).

People with weakened immune systems as well as those with a second or subsequent dengue infection are believed to be at greater risk for developing dengue hemorrhagic fever.

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An Overview of Birth Control Methods

The Childfree Filipina

With the limited sexual and reproductive health education most of us receive in grade school and high school, it’s no wonder that so many people have no clue which birth control methods are available to them and how much they cost. We have one of the highest rates of teenage pregnancies in Asia, and our population has ballooned to more than 100 million as of 2014. So I’ve compiled a list of readily available birth control methods in order of ease of access for regular Filipinos like you and I. This list is by no means comprehensive. Some methods like birth control pills and the IUD will be discussed more extensively in other posts. If you need to know more, follow the links provided, conduct your own research, and talk to your OB-GYNE.

Most stats here are based on the NYT article, “How Likely Is It That Birth Control…

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Hand Foot Mouth disease

Hand Foot Mouth disease inside the mouth

This is the first of what will be an on going series of articles about healthcare/medical in SE Asia

We are not doctors so will rely of resources that we trust and sometimes on our own personal experience

my experience

My son (2 yrs old) just had a case of hand/foot/mouth disease in Thailand.  At first I thought he just had an accident because his lips were swollen.  That evening was running fever and not eating very much which did not alarm me.  Baby tylenol and all was OK. Next day still running fever, not eating, but what worried me was not drinking.  That evening confused, very fussy, and fever.  This was sunday so thought we could wait till Monday to go to the clinic.  He was confused and I believe dehydrated.  I spent 6 yrs in Iraq were dehydration can be life serious.  So off we go to to the hospital  Phuket International Hospital .  Its about 22:00 so not many patients and so not long to wait.  They did the normal stuff and prescribe medicine for us to leave.  I am thinking “what about the dehydration”?  I asked the doctor if he thought my son was dehydrated?  he said yes, Do you think he needs to be admitted. The doctor said up to you!   Wow!  So we admit my son, go to his room and they quickly add an IV!  GOOD!  He is 2  crying scared dehydrated confused and was not going to relax or go to sleep. Fighting us trying to pull out the IV.  I went to the doctor and ask for something to sedate him just a little.  He said we dont do that for kids his age.  I am not a doctor just a parent but was not buying what the doctor said.  After some strong words from me the doctor agreed.  Good! my son was sleeping and the next morning after the medication in the mouth to ease the pain, IVs  was much better. Before I finish my experience at the hospital will give some information on hand/foot/mouth disease.

the medical

Source is CDC USA Gov http://www.cdc.gov/hand-foot-mouth/about/index.html

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overview

Hand, foot, and mouth disease is a common viral illness that usually affects infants and children younger than 5 years old. However, it can sometimes occur in adults. Symptoms of hand, foot, and mouth disease include fever, blister-like sores in the mouth (herpangina), and a skin rash.

Hand, foot, and mouth disease is caused by viruses that belong to the Enterovirus genus (group). This group of viruses includes polioviruses, coxsackieviruses, echoviruses, and enteroviruses.

  • Coxsackievirus A16 is the most common cause of hand, foot, and mouth disease in the United States, but other coxsackieviruses have been associated with the illness.
  • Enterovirus 71 has also been associated with hand, foot, and mouth disease and outbreaks of this disease.

Hand, foot, and mouth disease is often confused with foot-and-mouth disease (also called hoof-and-mouth disease), a disease of cattle, sheep, and swine. However, the two diseases are caused by different viruses and are not related. Humans do not get the animal disease, and animals do not get the human disease. For more information, see the U.S. Department of Agriculture National Agricultural Library, Foot-and-Mouth Disease.

Signs & Symptoms

Hand, foot, and mouth disease usually starts with a fever, poor appetite, a vague feeling of being unwell (malaise), and sore throat. One or 2 days after fever starts, painful sores usually develop in the mouth (herpangina). They begin as small red spots that blister and that often become ulcers. The sores are often in the back of the mouth. A skin rash develops over 1 to 2 days. The rash has flat or raised red spots, sometimes with blisters. The rash is usually on the palms of the hands and soles of the feet; it may also appear on the knees, elbows, buttocks or genital area.

Some people, especially young children, may get dehydrated if they are not able to swallow enough liquids because of painful mouth sores.

Persons infected with the viruses that cause hand, foot, and mouth disease may not get all the symptoms of the disease. They may only get mouth sores or skin rash.

 

For my sons case, the blisters were in the back of the mouth and few bumps or red spots on his soles of his feet.

Diagnosis

Hand, foot, and mouth disease is one of many infections that cause mouth sores. Health care providers can usually tell the difference between mouth sores caused by hand, foot, and mouth disease and other causes by considering —

  • how old the patient is,
  • what symptoms the patient has, and
  • how the rash and mouth sores look.

Depending on how severe the symptoms are, samples from the throat or stool may be collected and sent to a laboratory to test for the virus.

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Going to the Doctor

adventure pengembara

We are lucky that we are both fairly healthy individuals.  But even the healthiest person in the world is bound to need a doctor from time to time.  We’ve had a few experiences at the clinic now, and overall I am impressed with both the quality of health care and how it is administered.

Our very first experience with a doctor was early in the fall.  Micah had some pain in his foot, so much so that he couldn’t really walk comfortably.  In the U.S., in a new city, we would consult our insurance website to find a doctor near us.  So that’s what we did.  We found a doctor in private practice a few blocks away.  Micah called and tried to make an appointment, but they told him to just show up, so we did.  Apparently it’s first come first serve.  I don’t really know if there are considerations…

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