By Nigel Crockett, GMS (nigel.crockett@santafe.com.hk), Director Sales and Marketing, Asia, Santa Fe Relocation Services
On Friday 24 June 2013 at approximately 3pm whilst doing a little sight-seeing in Northern Chennai, an innocuous looking female mosquito dined briefly on my ankle.
My fever started eight days later, two hours after I landed back in Hong Kong. Two days after that I was in isolation in a Hong Kong public hospital for a week on saline and glucose drips, sleeping 18 hours a day and sweating so much that my sheets had to be changed every couple of hours. Take it from me – Dengue fever is not sexy.
This article doesn’t pretend to be a source of scientific research, but if you wish to look into Dengue in more detail, references for all the data contained in it are provided below. You’ll find some interesting facts and comparisons about Dengue, and at the bottom you’ll find some useful guidance about what you should tell your assignees or business traveler.
I didn’t know much about Dengue Fever before I got it. Heck, I wasn’t even sure how to spell it. What I know now is that Dengue has to be the most under-reported killer disease in South-East Asia. It doesn’t discriminate against locals or tourists – if your ankle is exposed, and there is blood pumping through it, you are fair game.
How does Dengue measure up against some of the more recent health scares in Asia? There are a few names that really stand out. I’ve put together a little summary here so you can have a quick trip down memory lane.
These diseases were mostly classed as Pandemics. They had global news coverage, caused changes in customs documentation, and received the highest level of government attention.
Dengue, by comparison in the recent data table below, has infected far more people, but has never quite managed to capture the limelight.
Global (NIH data) Estimated annual numbers 50-100 million 180,000+*
*This figure is not given in any official reports. It is arrived at by taking the calculated average government reported mortality rates of 0.36% in the rest of the table, and applying that to the lower end of estimated number of infections per the US Dept of Health and Human Services NIH figures (citation below). It is likely an overestimate given that not all Dengue cases are reported to authorities, but most Dengue deaths would be.
Given that the NIH (a part of the US Department of Health and Human Services) estimates up to 100 million people get Dengue every year, and around half a million people are hospitalized from it each year, it seems clear to me that the numbers reported by each country are likely to be only the tip of the iceberg.
Whilst I’m not suggesting that diseases like SARS and H1N1 don’t deserve their Rockstar reputations, I do wonder what isn’t sexy enough about Dengue to get the attention of the media. Is she the ugly little sister of Malaria that nobody wants to dance with? (And yes, I think it is correct to give Dengue a gender, since only female mosquitoes bite!) Male mosquitoes don’t eat – like real Rockstars, they burn out rather than fade away.
Malaria is transmitted in a similar way, and infects around 200 million people a year and kills over half a million (around 0.25% mortality rate). Malaria therefore has earned its own day (world malaria day is on 25 April each year), and the patronage of one of the world’s most active and wealthiest philanthropists (The Gates Foundation). By contrast, Dengue infects about a quarter to a half of that number, and has a mortality rate of somewhere between 1-10%. Dengue simply isn’t sexy enough it seems, so Dengue’s fate has been sealed for some time. Dengue doesn’t have its own day, and the funding for vaccine research in the past has mostly been up to the governments and NGO’s with less deep pockets – in Mexico, India, and Thailand.
Since the Aedes mosquitoes (the carrier of the Dengue disease) likes warm temperatures, it is ironic that global warming may be its downfall. Much like the American eradication programs for Malaria in the middle of the 20th century, I predict we will also soon see a volley of new vaccines coming out for Dengue as well. And Why? Well, as the planet continues to warm, the South American Aedes mosquito will be making it’s way slowly northwards ….. and just recently, the Aedes mosquito (although, not carrying the Dengue disease) was found in California in 2013. Isolated cases of Dengue are now being found in parts of the Southern United States (Florida and Texas). Now that Dengue is actually threatening a population that can afford the research and effort required to take commercialization of vaccines to the next level, you can bet that the pharmaceutical companies are looking forward to vaccinating the 50 million people or so that live in California and Florida… at a hundred bucks a shot I’m sure that would be a great incentive! Some time later, I have my fingers crossed that a cost effective option will also reach the millions of people in the poorer parts of the world that have desperately needed a vaccine for decades.
Creating a Dengue vaccine is not easy – and here’s the brief layman’s explanation on why that is, for the non-scientists among us. There are at least ten vaccines in various stages of development right now, but none of these are ready for the general public. There are four different types of Dengue (some sources say five types). Once you get one of the types, those antibodies give you immunity to that type of Dengue for the rest of your life. However, once you have antibodies to one of them, you get sicker if you catch one of the other three. So, in order to create an effective vaccine, you have to vaccinate against all four Dengue types at the same time – otherwise you risk making people much sicker.
For the Mobility and HR managers out there who are responsible for sending your people out on assignments and business travel to Dengue affected areas of the world, Santa Fe recommends that you provide the following guidance :
• Use insect screen doors and keep them closed
• Use air conditioners
• Encourage the use of mosquito nets, particularly if sleeping with windows open
• Control mosquitoes in your home or hotel with insect spray
• Mosquitoes are more prevalent at dusk and dawn. At those hours particularly, wear long pants and shirts to prevent mosquito bites.
• Apply insect repellent on your body and clothing if you have to go out. Pay particular attention to your ankle areas and legs (this is the favourite bite spot for Aedes mosquitoes)
• Exercising outside at dawn or dusk is not a good idea. Mosquitoes are attracted to lactic acid and CO2, two things that you produce more of when you are exercising.
So please, when you’re on the beach this year sipping your MargarIta and enjoying a well-earned vacation, just remember that Ms Aedes is looking for you, and she bites!
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