Dengue fever in Bali

Dengue fever is a bone-breaking disease.
Aedes aegypti mosquito, a vector of dengue; Photo: Gettyimages

Dengue infection

Dengue is an infection transmitted by Aedes aegypti mosquitoes.
The virus responsible for this infection is the dengue virus (DENV), which has four serotypes (DENV-1, DENV-2, DENV-3, and DENV-4). This means that a person can get infected with dengue up to four times, and subsequent infections with different serotypes increase the risk of severe dengue.
Symptoms of the disease typically appear 3-14 days after being bitten by an infected mosquito.
Infected individuals act as the primary carriers of the virus and contribute to its replication, serving as a source of the virus for uninfected mosquitoes.
Transmission of the virus from a person to a mosquito can occur even before the person shows symptoms of the disease and for several days after the fever subsides.
Infected mosquitoes can transmit the virus throughout their entire lifespan after an incubation period of 4-10 days.
Aedes aegypti mosquitoes thrive in urban environments and primarily breed in artificial containers. They are active during the day, with peak biting times in the early morning and before sunset.

Symptoms of dengue

The symptoms of dengue can range from asymptomatic infections (where individuals may not be aware that they are infected) to severe symptoms.
The World Health Organization categorizes dengue into two main categories: dengue (with or without warning signs) and severe dengue.
Dengue should be suspected if you have a high fever along with two or more of the following symptoms:
  • Severe headache
  • Pain behind the eyes
  • Joint and muscle pain
  • Nausea
  • Vomiting
  • Rash
Severe Dengue
Between 3-7 days after the onset of the disease, patients typically enter a critical stage. It is during this time, as the fever subsides, that patients may develop complications associated with severe dengue. However, not all patients will experience these complications.
Signs of complications to watch for during the critical stage include:
  • Severe abdominal pain
  • Persistent vomiting
  • Rapid breathing
  • Bleeding gums
  • Restlessness
  • Vomiting with blood.
If patients develop these symptoms during the critical stage, they should be monitored in the hospital for 24-48 hours to provide timely medical care.

Dengue tests

When Dengue is suspected, a blood test is usually conducted on the third day of the illness to definitively determine whether it is Dengue or not.
  1. Some more expensive tests can detect it on the first day. The virus can be detected in the blood within the first few days of infection using the RT-PCR method. Such a test is more expensive as it requires special equipment.
  2. The virus can also be detected by testing for the viral protein, NS1. Diagnostic rapid tests exist for this purpose, providing results in about 20 minutes.
  3. Enzyme-linked immunosorbent assay (ELISA) can confirm the presence of a recent or past Dengue infection by detecting IgM and IgG antibodies to Dengue. IgM antibodies can be detected approximately 1 week after infection and can be present for about 3 months. IgG antibodies take more time to reach peak levels compared to IgM but can remain in the body for years.
If you don't have insurance but want to confirm whether you have Dengue or not, you can go for testing at Prodia or Caya Laboratorium Klinik.

Treatment of dengue

When treating Dengue, it is very important to go to the hospital with insurance to confirm that it is indeed Dengue, determine the stage of the disease, and whether hospitalization is necessary.
If you have gone to the hospital with insurance, you should confirm that it is an insurance case and insist on several days of hospitalization under the care of doctors with intravenous fluids (monitoring platelet levels is crucial).
There is no specific medication for Dengue. The medications prescribed for Dengue address the symptoms of the illness.
During Dengue, it is very important to:
  1. Avoid physical activity, even straining your eyes. Bed rest is crucial.
  2. Never take aspirin, ibuprofen, or diclofenac under any circumstances. These drugs thin the blood and can lead to bleeding, which is dangerous when platelet levels are already low. You can use paracetamol to relieve pain and reduce fever.
  3. Drink as much fluid as possible (intravenous fluids may be necessary in cases of severe dehydration). It's essential to stay hydrated even if you don't feel like drinkin
If you can no longer drink water, try drinking coconut water, electrolyte drinks (e.g., Pocari Sweat), or juices. Guava juice is particularly beneficial during Dengue.
      4. In Bali, locals often drink papaya leaf juice during Dengue. It boosts immunity, increases platelet levels, and quickly alleviates unpleasant symptoms. Papaya leaf juice is very bitter, so it's recommended to mix it with honey or consume it quickly.
If you're looking for papaya leaves, you can ask your Balinese neighbors to find a papaya tree nearby and pick some leaves for you.
Alternatively, you can order papaya leaf juice for delivery from Bali Buda stores. A 300 ml bottle costs 22,000 Indonesian Rupiah. You can contact Bali Buda through WhatsApp at various locations:
  • Bali Buda Canggu: +62 811-3951-501
  • Bali Buda Kerobokan: +62 887-3808-757
  • Bali Buda Ungasan: +62 887-3808-771
  • Bali Buda Ubud: +62 811-3951-202
  • Bali Buda Sanur: +62 812-3822-170

How does the disease proceed?

The duration of Dengue illness varies among individuals, but on average, it lasts from 3 to 7 days. The recovery period can be quite challenging because people often experience extreme weakness.
It's essential to observe bed rest and avoid overexertion during Dengue because failing to do so can lead to complications affecting various organs.

Prevention of the disease

To avoid Dengue infection, it's important to prevent mosquito bites. Carry mosquito repellent spray with you and use it when you're outdoors, especially in the evening when there are more mosquitoes. You can purchase mosquito repellent spray at most convenience stores. Here's an example of one that works well: 
If you're in a restaurant and forgot your mosquito repellent spray, don't hesitate to ask the waiter. It's perfectly normal in Asia, and restaurants often keep them on hand for customers.
In your room, starting around 4:00 PM, you can use a mosquito coil like this one: 
In an open space, on a balcony, patio - burn a spiral. It is sold in any store and is inexpensive:
If you have come to Asia for an extended period, before signing a rental contract, make sure the place is safe. There should be no breeding grounds for mosquitoes nearby, such as:
  • Neglected swimming pools
  • Water bodies with no fish
  • Fountains and pools should be chlorinated, and there should be no debris in them
  • Swampy land is also favorable for mosquito breeding.
If you know you have dengue, try to avoid mosquito bites during the first week of illness. During this time, the virus can be in your bloodstream, and you could transmit it to other mosquitoes, which might infect other people.
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