Dengue: The Complete Guide for 2024
What you really need to know now if you live in a dengue zone
Dear readers,
I finally finished it! I’m excited to present to you today the guide to dengue in 2024 that I’ve been working on for months now.
I’m going to make an effort to start writing one guide a month. They take ages but I really enjoy the process of writing them — I learned SO much about dengue writing this that I feel like an expert now! If there’s any particular topic in the living abroad world that you’re really interested in right now, comment below and let me know!
OK, here’s the guide! I’ve made 50% free for all subscribers, and the other 50% is behind a paywall, reserved for those who so kindly pay me for my work. There’s even a downloadable PDF at the end for anyone who wants to keep a copy for later reference!
Now’s a great time to upgrade if you haven’t already, so you can access the full article.
I got dengue again this year. So did Fraser and Hudson.
I had it last year in September, too.
And as I shivered and sweated and puked my way through my third round of this soul sucking virus, I started researching.
See, many people told me, upon hearing that I had dengue for a third time, that it was very dangerous. But that was kind of the extent of it. It. Nobody really explained to me why it was dangerous or how it could affect me for the rest of my life. They just seemed certain that it would.
I hadn't heard that before. Having lived in the tropics for as long as I have, particularly with dengue at an all-time high worldwide, I'm pretty familiar with the ailment. I knew that malaria could affect your brain over the course of your lifetime. But I had always been told that dengue was so much milder.
I got it for the first time about 8 years ago. Fraser and I were sharing some beers with some friends on Sri Thanu Beach, and then we all started to drop like flies within a couple days with horrible pain behind the eyes, fever, chills, the whole shebang. We assumed that it must be a bacterial infection, since we had been all drinking from the same bottle, and we all had the same symptoms.
I had a flight to Mexico to go and see my parents, which I had to take on day 3 of my first dengue experience. I still remember the Mexican grannies taking care of my shivering self in the lineup for US border control.
Turns out this was not an isolated incident — it's quite common for multiple people to be stung by the same virus carrying mosquito and all contract the virus. This is a big reason why it's not a good idea to be around someone who has dengue during mosquito hour.
I have learned that there are four strains of dengue in the world. Which means that I've almost completed the virus! Which I thought was a good thing, until I spoke to my friend Chris who used to live in the Amazon. He said that the Amazonians have learned to really fear the virus. They have a deep knowledge of just how much it can stay in the body and how getting the virus repeatedly can cause quite severe long-term side effects.
Of course, this totally freaked me out, considering I was getting over my third round of it. So I decided to do a deep dive into what exactly dengue is, what it does to the body, and what the long-term side effects are, as well as new developments in how we can prevent it, and protocols you can undergo to alleviate the long-term side effects if you've had it. I've been working on it for some time now, and now I'm finally ready to share it with you!
If you live somewhere where dengue is a thing, I suggest you read it. Rather than all the generic stuff you can find in any travel guide to the tropics, I'm only including the information that really struck me as significant, interesting and new. Should be an insightful read.
Here we go!
What Exactly is Dengue?
So, what’s dengue? Think of it as the overachiever of mosquito-borne viruses, vying for the title of “Most Annoying Global Infection.”
Nearly half the world’s population is at risk, thanks to its carriers: Aedes mosquitoes, especially Aedes aegypti. (The females, specifically, since they are the ones who feed on blood to produce their eggs. The males stick to a sweet diet of nectar and don’t sting.) Formerly confined to the tropics, these little terrors are expanding their global population at breakneck speed. They’re spreading into the US at a rate of 240 km per year, and in Europe at 150 km per year (ScienceDaily, 2019).
Since the beginning of 2024, already 7.6 million people have gotten the virus, up 54% since 2013 due to factors like population growth, global warming and mass migration (Lancet Countdown, 2024). What’s more, the number of reported dengue cases has increased a jaw-dropping 30-fold over the last 50 years (Rockefeller Foundation, 2022). Most cases are asymptomatic, and just 0.16% of dengue cases develop severe symptoms, and 0.05% result in death.
Here’s how it looks by region:
South-East Asia: Significant surge in Indonesia, Bangladesh, Nepal, and Thailand. Factors include monsoon season and urbanization.
Europe: Mainly travel-related cases; sporadic local transmission. Preparing for limited local transmission in summer and autumn.
Americas: Brazil, Argentina, Paraguay, and Peru most affected. All four dengue serotypes detected. Brazil has the highest number of cases.
Eastern Mediterranean: Outbreaks in both conflict-affected and climate-affected countries. Data sharing remains a challenge.
Western Pacific: High burden of dengue with Malaysia and Vietnam most affected. Risk of further spread due to climate change and increased travel.
Africa: 13 countries with active transmission, Burkina Faso, Mauritius, and Mali being priority countries. Challenges include funding constraints and shortages of diagnostic tests.
There are four serotypes of the dengue virus: DENV-1, DENV-2, DENV-3, and DENV-4. (A serotype is like a different flavor of the same virus, and each flavor can make your body react in a special way.) You can’t catch the same one twice, since your body builds up an immunity to it once you’ve fought it off. But you can catch it four times, each with its unique twist. Oh joy! And no, catching one doesn’t give you immunity against the others. But as a woman, you do pass that immunity to your future children, which is pretty freakin’ cool — I passed immunity to my son Hudson for one strain, for example (and my second child should get immunity to 3! — no, I’m not pregnant, but we’re planning).
Now, let’s break down the serotypes:
DENV-1: Prevalent in Southeast Asia, the Pacific, and the Americas, it’s one of the more commonly encountered strains. The classic version of the virus, with mild to moderate symptoms. This makes up about 50% of dengue cases.
DENV-2: Found in Southeast Asia, the Pacific, the Americas, and Africa. This one tends to be more associated with severe dengue outbreaks and also the most severe symptoms of all the serotypes. Globally, DENV-2 makes up 30% of dengue cases.
DENV-3: Circulates in Southeast Asia, the Pacific, and the Americas. Mild to moderate symptoms but higher risk of severe disease upon secondary infection with a different serotype. This serotype makes up just 15% of dengue cases.
DENV-4: Seen in Southeast Asia, the Pacific, and the Americas, completing the quartet of chaos, DENV-4 is responsible for just 5% of dengue cases globally. (Nature)
What Does Dengue Do to the Body?
Now, what happens when this pesky virus invades your body? For starters, many folks don’t even show symptoms (75-90%). Lucky fuckers. But for the rest of us, we can look forward to high fever, chills, pain behind the eyes (mine usually manifests as a several day-long migraine). And mega muscle pain, which is where it gets its charming name, ‘break-bone fever.’ The brain fog and exhaustion are REAL, and can last well beyond the other symptoms. Many people suffer from nausea and vomiting too. And if all this wasn’t enough, you’ll usually discover a vibrant dengue rash showing up on your chest and back a few days after the fever starts.
Severe cases — which again, are rare — can be downright terrifying: intense abdominal pain, bleeding gums, and plasma leakage. Basically, your body starts to spring leaks like a poorly made boat. Severe dengue can also involve fluid accumulation, respiratory distress, severe bleeding, or organ impairment. (PAHO, Apr 2024) Basically, it turns your body into a war zone.
The immune response to dengue can cause inflammation that affects the brain, leading to severe headaches and pain. See, dengue lowers your platelet count — the cells that help your blood clot — because the virus damages cells that produce platelets and triggers your immune system to destroy them, making it harder for your blood to clot and increasing the risk of dangerous bleeding both internally and externally. This is only in extreme cases, we’re talking dengue hemorrhagic fever or dengue shock syndrome, both of which are potentially fatal (WHO). The risk of these severe symptoms is precisely why doctors forbid anyone with dengue from taking Ibuprofen, which can increase the risk of bleeding since it thins out your blood.
Symptoms typically last 2-7 days, but those days feel like an eternity. Watch out for Day 5, when most people are feeling pretty much recovered. You’re not. Your blood platelets can still be quite low at this time and it’s important to take time to rest and recover.
What Are the Long-Term Side Effects of Dengue?
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