With the current peak of Dengue in Singapore, there are a lot of people worried for the health of their children.
That’s why we asked Dr. Leong Hoe Nam, specialist in infectious diseases, for his advice and expert tips. He gives us valuable information about how to prevent Dengue and what to do if you notice the first symptoms.
General Information about the Dengue virus
There are 4 Dengue strains, meaning that you can get Dengue 4 times. All those 4 strains exist in Singapore, however strain 1 and 2 are more common than strain 3 and 4. Outside of Singapore, all 4 strains are equally common, e.g. in Indonesia.
Symptoms of Dengue in Singapore
Most Dengue infections (around 70%) don’t show any symptoms. This means that you may have been infected by Dengue without knowing it.
Younger people are more likely to have milder or no symptoms at all. Older people tend to show stronger symptoms and suffer from a more severe illness. Hence adults are at greater risk.
After the Dengue infection, you may suffer from post viral fatigue, which is also more severe for adults than children.
A first Dengue infection can be symptomatic or asymptomatic. The second Dengue is worse than the first one. Contrary to general public opinion, the third Dengue is better and the fourth is mild. The most common symptoms of Dengue are a headache, fever and muscle aches, quite like influenza or other viruses. Characteristics of Dengue are back pain and pain behind the eyes. Rashes may only appear in a later stage of the illness.
Severe Dengue (which may represent a death risk) is often accompanied by abdominal pain, nausea and vomiting.
Other markers are significantly raised liver enzymes (in the liver blood test) or very low platelets in an early infection state.
Dehydration worsens the situation. It is therefore essential to drink as much water as possible.
Dr. Leong Hoe Nam’s expert advice: Drink until your urine is clear. This usually is more than 2-3l.
Diagnosis of Dengue fever
Dengue fever can be diagnosed with 3 different tests.
- Dengue Ns1 antigen. The test is best suited on day 1-3 on those who never had Dengue fever before. It is not 100% sensitive (on day 3 it is about 90% sensitive). Results are available in 15 min to 3h.
- Dengue pcr. This test is rather expensive and hard to get. The results take 1 to 2 days after evaluation in specialised labs. Suitable for days 1 to 7.
- Dengue Igm / Igg. This test is best done from day 5 of illness, but it also may take day 7 or 8 of illness to turn positive.
Treatment of Dengue
As already explained by Dr. Hoe Nan Leong, it is essential to drink enough water. It is advised to take fever lowering medicine such as paracetamol. Aspirin or ibuprofen should be avoided as they affect the quality function of the platelets.
The fever usually lasts for 7 days. It gets slightly better after day 5 and usually clears by end of day 7. The platelets will be at the lowest at day 8 of illness and it recovery happens afterwards.
The more concentrated your blood is (check the hematocrit value), the worse it will get. That’s why water is key. A platelet transfusion would only be done in case of internal bleeding but not for normal Dengue stages.
How can you protect yourself and your children against Dengue?
Avoid mosquito bites! They are especially active during day time (10am to 4pm). Wear mosquito repellents containing DEET or Picaridin.
Expert advice: Be sure to apply the repellent also to your exposed scalp, ears and feet. Top up the repellent every few hours as sweat and water can wash it off. Wear long sleeves and cover your skin with clothing.
Do standard insect repellants work?
Yes. The ones containing DEET (at least 15%) or Picaridin are proven to work. Citronella may also work (not scientifically proved to be as strong as DEET).
Any advice when first symptoms are appearing?
Water water water! Consider doing a swab for influenza (nasopharynx swab) to test for influenza on your first day of symptoms. Influenza is hard to differentiate.
How can you distinguish between a normal fever and Dengue?
Check out the above listed symptoms. However, a differentiation is not always easy.
Are there any “home treatments” against the fever?
Again: Be sure to drink water, water and water. Paracetamol also helps, together with a lot of sleep.
Are people with Dengue contagious?
Only if they get bitten by a mosquito.
Curious facts about Dengue in Singapore
- Dengue mosquitoes generally bite 7-8 times before they stop. That is why most family members are affected during family time.
- Most of aedes mosquito bites don’t swell and you might not notice them.
- In a Dengue hotspot, only 1% of all the aedes mosquitoes carry the virus. In highly endemic areas as our neighboring countries, this goes up to 7-8%.
- Aedes mosquito are able to fly up to the 20th floor!
- In Singapore the risk of getting Dengue is normally small.
Specialists use a factor called Dengue seroprevalence at aged 9 years (SP9) to compare infection rates. In Singapore, less than 9% of the children had Dengue at the age of 9. The figures in the neighbouring countries are way higher: 30-40% in Malaysia, 50-60% in Thailand and Indonesia , 90% in the Philippines.
- Dengue vaccines exist but they are only suitable for those aged between 12 and 45 years and if they already had Dengue once. Remember that Dengue can be asymptomatic in 70% of all cases.
More information about Dengue in Singapore
You can find more information about Dengue in Singapore on our blog:
- Information article: All you need to know about the Dengue virus
- Video Testimonial: Clément from UEX tells us how he got Dengue, his first symptoms and the actions he took to get better!
About Dr. Leong Hoe Nam
Dr. Leong Hoe Nam is an Infectious Diseases Physician. He graduated from NUS in 1996, and obtained his M Med and MRCP in 2001. Afterwards, he began his advanced specialist training in infectious diseases. Dr Leong pursued his studies at the Royal Free and University College Medical School, London and the University of Columbia, New York in virology and emerging pathogens.
He is currently practising at Mount Elizabeth Hospital at Novena and is widely recognized as an expert in Infectious Diseases. Dr. Leong Hoe Nam is an assistant professor at the Duke-NUS Graduate Medical School while working at Mount Elizabeth Novena Hospital. He also is a visiting consultant at the Singapore General Hospital, the National Cancer Centre Singapore, and the Dover Park Hospice Hospital.
You can learn more about him here.
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