Ken_dell

This is my first post and I apologies for its length.

This is our first trip to SE Asia and my first posting on the Forum. I have been here lurking since March 2013 and thanks to fellow Fodorites, especially, Kathie, yestravel, wkwb42a, rhkkmk, simpsonc510, dgunbug, crellston and all other Fodorits have been able to plan our trip without any questions until now.

My question, concerns and risks are re Dengue Fever and the prevalence and extent found or not in the places we will be visiting.

Thanks to Richard Barrow’s blog where I have been following the Political turmoil I came across an article re Dengue Fever which I already knew was fairly wide spread but this and other articles I have subsequently turned up has me quite alarmed as it seems it is spreading in epidemic proportions. I have listed the links below to my research as well as my itinerary and would appreciate any additional information anyone may have as well as any helpful advise.

While I am in very good health and hiking fit I am 68yo but have a mechanical aortic heart valve and take the blood thinner coumadin/warfarin. I bring this up because it appears that if one contracts Dengue Fever one of the strains may cause internal bleeding and being on blood thinners I bleed much more easily and appears to be at increased risk.

Based on the information I have read I am seriously contemplating canceling (not going) to Cambodia and Vietnam and substituting China (Shanghai and Beijing) and Japan (Tokyo and Kyoto).

I look forward to any input anyone can offer.

Many thanks in advance.

Ken

Current Itinerary:

Bangkok – 7 days – February 28 – March 6
Siem Reap – 4 days – March 7 – March 10
Hanoi – 3 days : Halong Bay 2 nights – March 11 – March 15
Saigon (HCMC) – 4 days - March 16 – March 19
Phuket – 6 days – March 20 – March 25 (have use of a friend’s house)
Hong Kong – 5 days – March 26 – March 30

Dengue fever links:

http://www.healthmap.org/dengue/en/ (interactive map – click on red dots/spots0

http://www.richardbarrow.com/2013/06...g-in-thailand/
https://www.google.com/#q=deaths+fro...ng+in+Thailand

http://www.richardbarrow.com/2013/06...iland-in-2013/

http://www.bumrungrad.com/healthpoin...things-to-know

http://www.thailandguru.com/dengue-f...-thailand.html

http://www.cdc.gov/dengue/

http://www.promedmail.org/ and then scroll down the latest posts to 16 Oct 2013 Dengue/DHF Update (83): Asia

http://english.cntv.cn/program/asiat...0/105677.shtml

http://www.cambodiadaily.com/news/de...in-2013-49809/

Kathie

Dengue is of concern in all tropical areas worldwide. Did you know that there is dengue in Hawaii? Dengue is spread by a mosquito that can breed in a few teaspoons of water. So it is an urban disease. The mosquitos that spread it are most active during the day. Your best defense is bite prevention. Use an effective repellant (deet 30% or more or picardin), re-apply as needed, and wear long pants, long sleeves as necessary.

I wouldn't cancel my plans. With just moderate watchfulness, you can travel safely.

Kathie

PS, you may not have to worry as much about dengue in China, but you will have to worry about your breathing.

thursdaysd

What Kathie said, especially about the air pollution in China. If you do research on that you won't want to go there either. I am a mosquito magnet, but I find that when I take Malarone (for malaria prevention) I am much less attractive.

Anyway, you only live once, and if you look at the statistice your bathroom is probably more dangerous than travel.

yestravel

I saw on the national news a story about dengue in parts of FLA and that it was starting to be seen also in Texas.
I am a mosquito magnet and took malarone and used bug repellent during our last trip to SEAsia. I think I got bitten once after I had showered off the repellant and forgot to reapply. This was at our hotel in Siem Reap. There are dangers wherever one travels and for me it's a matter of being informed, taking precautions and then enjoying my travels. I hope you decide to do the same. If on the other hand, you are too concerned to enjoy your trip, then go elsewhere. Haven't been to China, but one of the reasons I have avoided it is the horrendous air pollution

Ken_dell

Many thanks for the input.

I to am also a Mosquito magnet and have the weirdest (most unusual) reactions to seemingly innocuous drugs but can tolerate others that are more potent. For example; back in the '80's we used Larium on a trip to Africa. We did read the risks but took it anyway & prayed a lot! Neither my wife or I had any adverse reactions. Not only that, we didn't see, hear or get bitten by any mosquito's! We were in Tanzania, Kenya & Zimbabwe.Since the Cambodia & Vietnam is a short part of the trip and we do not really want to take it for 4 weeks after.Plus, more research is available on Larium and it also now carries a black box warning.

I think I will get a Rx for Malarone and try it out for a few days to see if either my wife or I have any adverse effects.

Kathie: I almost always agree with most of what you say and really value your input but sincerely don't believe "my bathroom is probably more dangerous than travel" - did you read any of the links I posted?

thursdaysd & yestravel: thanks for your anecdotal info on the use of Malarone - very useful.

yestravel

Make sure you get the generic malarone...much less expensive.

Ken_dell

OK - Many thanks

Kathie

Ken, it was Thursdays who made the bathroom remark. And statistically, she is correct. But I understand your concerns and hope you will take appropriate precautions. I think it is a good sign when travelers do their research on health issues before they go.

We use malarone when we are traveling to malarial risk areas and neither of us have had any side effects. Do make sure to take it with food, at the same time each day. The food should have some fat content, as one of the components is fat-soluble. And trying it out for a few days before your trip is wise. If your medical insurance doesn't cover malarian, buy it at the Costco pharmacy - cheapest place to buy it in the US.

Also, if you do get sick and need treatment for something, the best medical care in the region is in Bangkok. Bumrumgrad Hospital is the place we use.

A patient of mine came home from Costa Rica with dengue. It's everywhere.

Ken_dell

Kathie, please accept my sincere apologies for misquoting you.

Many thanks for the tips on the most prudent way to take Malarone and where the least expensive place is to get it It is not covered my my Rx policy and will get it at the Costco pharmacy as per your suggestion.

Thanks for confirming that dengue is 'everywhere' - if you have a moment to open this map of the world link, it is quite scary how far & wide it has spread.
http://www.healthmap.org/dengue/en/
(interactive map – click on red dots/spots for details)

Kathie

It has spread tremendously, even into non-tropical areas. Who knew Idaho had a hot spot?

Ken_dell

Glad you had a chance to take a look at the map.- very scary stuff!

Thanks for the heads up for where to go for the best medical care in the region if necessary.

Dengue fever with its lack of any drug medication options is worrisome for me, specially since I am on warfarin, even although I self test and am stable at INR 2.2.-2.3 and have recently been hiking at high altitude in the Canadian Rockies with no problems.

Marija

Check to see if your destinations require Malarone. Unless you go to distant temples, Siem Reap is low risk, as are Hanoi, HCMC ,Bangkok and Hong Kong.

Ken_dell

Marija - Thank you.

marmot

You should ask your doctor how the different strains of dengue might impact your medications. A large percentage of dengue cases (something like 90-95%) are the flu-like non-life threatening variety. Dengue hemorrhagic fever is rare.

But even dengue-lite is a serious and unpleasant experience (I know!). There's a reason that it's called breakbone fever.

All travel to underdeveloped countries involves risk exposure.
We each have our own level of tolerance which varies according to what worries us most. Statistics aside, only you can judge if fear of dengue will dampen your enjoyment. If you're going to be looking over your shoulder at every mosquito, you should go somewhere else.

Personally I think the benefits of travelling in Southeast Asia outweigh the risks, but that's just me. China has a whole other set of issues to worry about, and Japan, while safe on most counts, is considerably more costly.

I wouldn't change your plans, but I would make sure you have reliable medical evacuation insurance. There's good medical care in the region -- in Bangkok as well as Singapore and KL -- but you have to get there.

crellston

Ken, as marmot has already stated we each have our own tolerance to risk and only you can decide the level of risk that is acceptable, especially given your particular medical condition. A doctor specialising in tropical medicine AND cardiac medicine may be able to address your concerns but the chances of finding one of those i would imagine are pretty remote!

The only way to avoid dengue or malaria is not to get bitten. i am yet another mosquito magnet and even DEET at 50% concentration is not that effective for me. increasingly, i have taken to covering up which seems to be more effective and, although uncomfortable in high temperatures and humidity you can get used to it.

I have just spent 6 months in south america where dengue warnings are everywhere and i certain have notice a lot of warnings in Cambodia when last there. it would be interesting to see some stats on the numbers of tourists that have contracted the disease.

Statistically, deaths may well be on the increase but as with most statistics, they do not tell the whole story. A large proportion of deaths from malaria and dengue will be amongst populations that do not have access to good, if any, medical care. That should not be an issue for you, although you do need to be able to access that care which would n]mean getting to a major city such as KL or Singapore. As marmot has said, good medical insurance is a must.

if you have a low risk tolerance then go to Japan (an amazing country). I would avoid China where the levels of pollution can be extreme and health threatening particularly for those with existing health conditions.

Just one final thought. The best people to assess the statistical risk for you personally may well be your travel insurance company. you would need to disclose details of your medical condition to them which they will consider in conjunction with the region you are visiting. if the risk is high they will charge a massive addition premium or refuse cover completely. if low risk the additional premium may well be negligible.

Lolazahra

I just want to say I love this post. This is what Fodors is all about. Good questions, really good insightful advice from people who really adore travel and give great insights. I honestly cannot imagine planning a trip without Fodors and the advice I've received has allowed me to travel the world in a much more inventive and creative way.

As many of you may know, I always travel with my three young kids, so keeping healthy is always a priority even though we do travel wide and far. Last summer, we explored SE Asia for the first time (Vietnam, Cambodia and Laos). Of course, we consulted a travel doctor and took all necessary precautions but nothing more. I think its important to look at the country, but more even more importantly the region of the country where you will be and a good travel doctor can help you do just that. As we all know, outbreaks can be completely different in many parts of one country. My kids and I are also very different. Two of us are mosquito magnets and have allergic reactions from bites, while three others can go a whole trip without being bitten even though we are all together. For the two of us, myself and my older daughter, we use 100% deet coverage. It's strong stuff that I buy on Amazon called Repel 100 and only use for us. We also cover up from head to toe in light clothing, even in hot countries. For everyone else, I use Ultrathon which has 34% deet and has been very effective in high risk areas. I choose to have all of us take malaria precautions, even the children, when advised to do so by a travel doctor. We never take it if we are in a country with mosquito born diseases but are not visiting the region affected by it. We have taken both Malarone and Mefloquine and have not experienced any side effects from either medication. We take the advice of our travel doctor on which one to take as we have traveled twice to regions where there was a resistance to one of the medications.

Ken_Dell, thanks for your post and interesting and informative links. They were very helpful to read. As many of the posters have said, you are the only one who can ultimately make the decision about the best itinerary for you. Whatever you choose, I wish you good health, great food and fantastic sights! Happy New Year!

GEsssa

Hi:
This information is very helpful. I have one question: when you use Deet and cover from head to foot how do you protect your face, neck, head and hands?
GEsssa

Kathie

Face, neck and hands should have repellant as well. If deet irritates your skin, try picardin. Note that while you can buy 100% deet, it is not to be applied to the skin.

Like crellston, I use barrier bite prevention whenever possible - long sleeves, long pants. That plus a little repellant protects me, even though I, too, am a mosquito magnet.

Ken_dell

Marmot, Crellston, Lolazahra, GEssa: Many thanks for all your input, all of which is much appreciated. I had not thought about evacuation insurance, which I won’t leave home without.

Marmot: your comment “But even dengue-lite is a serious and unpleasant experience (I know!).” I would appreciate it if you could please tell me if you had it while on your trip, what your symptoms were and how it impacted your itinerary or if you came down with it after arriving back home and if so how long it took to recover and if you have made a full recovery and your health is back to 100% the same as before your trip.

Crellston: I will be following up with my cardiologist as well as thoroughly researching evacuation insurance which will include a careful read of the small print.

Lolazahra: A happy New Year to you too – safe travels & be well!

GEssa: I use a head net with insect shield when hiking in Mosquito country from REI
http://www.rei.com/product/799982/se...-insect-shield
& Gloves and/or UltraThon Insect Repellant for my hands also when hiking.
http://www.rei.com/product/686229/3m...t-deet-2-fl-oz