For Cambodians, dengue fever is a serious childhood disease, although, if they survive, most will have been exposed to all four strains of the virus by adulthood and have developed some degree of immunity. For most foreigners the mosquito-borne disease remains a risk throughout life. Because there are so many strains, a previous infection with the virus does not guarantee immunity and in some cases a second infection with a different strain can prove more serious than the first.
Scientists believe the dengue epidemic sweeping the region at the moment may be a result of climate change, with periods of monsoon rain followed by unseasonably warm spells, creating perfect breeding conditions for the day-biting Aedes mosquito, which loves cool, shaded water and has been doubly blessed by the building boom in the capital, which provides ample breeding pools for the large, striped mosquito Khmers call Mu Klaar (tiger mosquito).
There is no vaccine for dengue. There is also very little that can be done to treat milder cases, so once it has been contracted, patients can only wait out the symptoms, which are usually the most severe in the first week.
Prevention is therefore by far the best option. You can help reduce your chances by making sure there are no collections of water around your home, such as in old car tires or discarded plastic bags which tend to pool water. Abate (pronounced Ahh-bait), which kills the mosquito larvae in water, is widely available from Cambodian pharmacies and should be placed anywhere water may collect, such as trays underneath pot plants and in water storage containers. Costing as little as 500 riel for a small bag, Abate is non-toxic for humans bathing in it and comes in pellet form. If you have ornamental ponds or outdoor fish tanks, ask your local aquarium for a species of larvae-eating fish to keep mosquitoes under control. Female betta, or fighting fish, love mosquito larvae and, unlike the flashy males of the species, the females can live in harmony together. The male also love mosquito larvae, but careful-only one male per water source, or they will live up to their name and fight to the death.
If you are concerned a neighbor is breeding mosquitoes and you can't do anything about it, don't despair. The Health Ministry is authorized to go into private homes if it receives a complaint that a home may be a source of potentially dengue carrying mosquitoes and deliver Abate and an educational chat to the owner. The Sangkat, or local police will also take action if a complaint is made.
The Aedes mosquito is most active just after sunrise and for the few hours just before and after sunset, according to experts. The female mosquito spreads dengue with her bite, and it takes as little as one bite to contract the virus, so wearing long sleeves, covering up and using a mosquito repellant, preferably one containing DEET, are good options to help reduce your risk. Sleeping under a mosquito net also goes some way to avoiding the dengue bite, and spraying around your home every couple of days will also help keep mosquito numbers down. Remember, unlike malaria, dengue is very common in urban areas, so it is not safe to let your guard down just because you are in the bright lights of the city. The next month is expected to signal the peak in the annual dengue season.
Main symptoms of dengue generally include high fever, severe headache, backache, joint pains, nausea and vomiting, eye pain, and a rash. Patients are advised not to use types of painkillers which contain Aspirin by doctors. Patients must keep up their fluid intake. If they cannot take fluids, they should seek medical assistance.
The more serious Dengue hemorrhagic fever (DHF) begins with a high fever that lasts from two days to a week and may be associated with generalized symptoms including nausea, vomiting, abdominal pain, and headache. However as white cell counts and platelets drop, the patient may show signs of bruising easily, begin bleeding from the nose and gums and sometimes suffer internal bleeding. In severe cases the circulatory system can fail and shock can set in, followed by death. If you feel that any of the early symptoms of DHF are appearing, it is wise to seek medical help as quickly as possible. Transfusions and other procedures administered by medical experts are highly effective in helping overcome DHF.
Dr Beat Richner, who runs the Angkor Children's Hospital and Kantha Bopha hospitals, is on the record as saying that most fatalities seen at his hospitals are the result of parents presenting at a late stage of the illness or taking children to unqualified or inferior doctors who administer the wrong types and mixtures of drugs.
There are a number of clinics and physicians who can treat dengue in Cambodia-look for someone qualified in tropical diseases and ensure they are properly qualified doctors. International SOS Clinic has a fact sheet available on dengue symptoms and treatment. However it is always a good idea to have up to date medical evacuation insurance in case complications make it necessary to seek hospital care in Bangkok or Singapore.
Those who need particularly close monitoring during a bout of dengue include children, pregnant women, those on blood thinning treatment or people with stomach ulcers. Do not hesitate to seek qualified medical advice if you fear you or a patient is becoming dehydrated or showing symptoms of DHF.
Despite the grim death tolls, dengue is most often a self-limiting although highly unpleasant experience. Try to avoid contracting it in any way possible, but don't panic if you or someone in your family does come down with it. With proper medical advice and monitoring, dengue is not fatal in the vast majority of cases, although it can sometimes take weeks or months to recover from and is not a great memory to take home from the holidays.
However the sad truth remains that the majority of deaths from dengue continue to be amongst impoverished, young Cambodians. This year for the first time the Dengue Control Program (CNM) has appealed publicly to donors and individuals to dig deep to assist it prevent dengue.
If you wish to make a donation, you can call CNM director Dr Duong Socheat on +855 12 815 950 or email him on socheatd [at] cnm [dot] gov [dot] kh or d_socheat [at] yahoo [dot] com. The CNM website is www.cnm.gov.kh/
Kantha Bopha is also requesting funding. It treated 16,815 inpatient cases in June alone, according to Dr Richner and is currently treating up to 4,000 outpatient cases per day. If you wish to make a donation to the four children's hospitals operating under the foundation, go to http://www.beat-richner.ch/ and click on the details for online donations in the bottom right corner of the page.