Health: Prevention

Thailand’s tropical climate, with its heat, humidity, and heavy sweating, can lead to skin problems like fungal infections, secondary infections, heat rashes, and boils.

Thailand is also home to numerous parasites found only in tropical regions, including amoebas, filaria, malaria, and dengue. If you plan to visit Thailand, pack sufficient dermatological products like disinfectants, bandages, and dressings. It’s also wise to bring some basic medications if you’ll be venturing into forests or isolated areas.

While rabies is declining in Western Europe, it remains a concern in many countries, particularly in tropical regions like Thailand. Dogs (and, to a lesser extent, cats) pose the greatest risk to travelers. However, monkeys can also be infected, and in some villages, they are numerous and semi-domesticated. Be cautious. Consider getting vaccinated against rabies, especially for extended stays.

Don’t forget your international vaccination certificate (not mandatory but useful) and carry your blood type card. It’s also advisable to get travel insurance with medical repatriation coverage. But don’t worry: Thailand has a relatively well-developed healthcare infrastructure with hospitals, clinics, and urban doctors.

With a bit of common sense and adherence to preventive measures, you can have a wonderful trip without health problems. Remember, Thailand is inhabited, and Europeans live there year-round (and enjoy it).

Dengue fever is an acute infectious disease caused by a virus, a flavivirus. It is an arbovirus, meaning it is transmitted by an arthropod (in this case, the Aedes mosquito). There are over 400 known arboviruses, the most well-known being the viruses that cause Yellow Fever and Dengue Fever.

Dengue fever is widespread in tropical regions. While usually mild, its hemorrhagic forms can be dangerous.

There are four variants of the virus (serotypes 1 to 4), which unfortunately do not provide cross-immunity. This means you can get dengue 1 and then dengue 2 a few months later, for example.

Humans are the primary reservoir for the disease. Unlike the Anopheles mosquito, which transmits malaria and bites at night, the Aedes aegypti mosquito is active during the day, starting in the early morning and ending at sunset. It thrives in urban and peri-urban areas.

There are approximately 50 million cases of dengue fever annually, affecting a population of 3 billion people spread across 100 countries.

The incubation period for dengue fever is about a week. Symptoms are similar to the flu: a sudden onset with high fever, chills, headaches (often with retro-orbital pain, behind the eyes), muscle aches, joint pain, and occasionally digestive issues and a rash. In areas where malaria is endemic, these symptoms may also suggest malaria.

After a few days, symptoms typically subside, with a possible slight rebound around the 6th or 7th day. Recovery begins a few days later, but patients often feel weak for several weeks.

Forms and Complications

There are milder forms of the disease with only fever, severe forms with liver damage (significantly elevated liver enzymes: transaminases), and serious, thankfully rare, forms: dengue hemorrhagic fever.

After a typical initial onset, patients with dengue hemorrhagic fever can experience a sudden deterioration around the 3rd or 4th day, with the appearance of purpura (purple spots on the skin) and digestive or nasal bleeding.

At this stage, the patient may either recover quickly or worsen and go into shock due to reduced blood volume (blood loss from bleeding can be significant). Death occurs in 5-10% of cases. Severe forms primarily affect children under 15 and immunocompromised individuals. The WHO estimates 500,000 annual cases of dengue hemorrhagic fever.

Once recovered, patients are permanently immune to the serotype that caused their illness but remain susceptible to the other three serotypes.

Clinical diagnosis of dengue fever can be difficult, especially in the case of the classic flu-like form. It is practically impossible to differentiate dengue from other arboviruses, as well as other tropical fevers like malaria, or even a true flu, which does not spare hot tropical regions as some might think.

Dengue hemorrhagic fever can be mistaken for meningococcal infection.

A positive paraclinical diagnosis relies on serology, looking for antibodies in the blood. Testing should not be performed too early, as it may be negative. It takes about a week for antibodies to appear in the patient’s blood. Serological testing is primarily for epidemiological purposes.

Diagnosis is also possible by isolating the virus. This is helpful early in the illness, when serology is still negative.

Treatment is purely symptomatic, focusing on relieving disease symptoms (fever, pain, etc.). There is currently no curative treatment for dengue fever or available vaccine. Hence, mosquito control is crucial (anti-vector control): prevention during the day against dengue and at night against malaria.

Treatment for the classic, uncomplicated form involves antipyretics and analgesics based on paracetamol. Severe, hemorrhagic dengue fever is usually treated in a hospital.

Important Note: Due to the risk of bleeding, aspirin derivatives are contraindicated in the treatment of dengue. Therefore, for any viral illness in an endemic area, avoid aspirin and opt for paracetamol-based medications. For the same reasons, avoid NSAIDs (non-steroidal anti-inflammatory drugs).

Vaccines are under development but are unlikely to be available for several years.

This includes water used to wash raw foods. Drinking water can transmit diseases like typhoid, cholera, and amoebiasis. Drink bottled water, preferably capped, or during treks, filter and disinfect it. You can use easy-to-carry and relatively robust travel filters (Katadyn filters). For water treatment, use Aqua Tabs (1 tablet per liter). Avoid ice, unless it’s commercially produced.

Bathing can expose you to various diseases, including schistosomiasis. The soil may contain parasite larvae (filaria, for example). Therefore, avoid:

– Walking barefoot or insufficiently protected, especially during forest treks
– Bathing in freshwater, rivers, streams, lakes, rice paddies, essentially any stagnant water.

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