The Foreign Service Journal, November 2003

T here are certain unique medical concerns associatedwithbeingpost- ed overseas. In fact, Foreign Service employees and familymembersoftencome face to face with global ailments. The key to protection is education; consequently, we must try to understand the particular medical concerns inour host country and beyond. Every year approximately 100 million peopleworldwide become ill withdengue fever and itsmore serious counterparts— dengue hemorrhagic fever and dengue shock syndrome. This disease is associat- edwith tropical climates and ismost preva- lent in Africa, Southeast Asia, the Middle East, South and Central America, and the Caribbean. Dengue fever is caused by any of four closely-related viruses. The Aedes aegyp- ti mosquito acquires the virus after biting an infected person. Subsequently, after a one- to two-week incubation period, this mosquito is able to pass the disease on to other healthy individuals by inserting the virusunder theprotective layerof their skin. Aedes aegypti ismost activeduringdaylight hours and prefers to reside in urban set- tings. Areas with inadequate water, sewer and waste-management systems provide locations for infectedmosquitoes to lay their eggs. Once hatched, thesemosquitoeswill only travelwithina fewhundred feet, result- ing in a localized area for the spread of the disease. Also known as “breakbone disease,” dengue’s symptoms include a high fever lasting two to sevendays, severe headache, backache, joint pain, nausea, vomiting, eye pain, and a rash on the feet or legs begin- ning three to four days after the inception of fever. More serious complications are a tendency to bruise easily, skin hemor- rhages andbleedingnose andgums, aswell as internal bleeding. Eventually, if enough fluid is lost fromthe blood vessels, the cir- culatory system may fail, followed by the onset of shock. The case fatality rate is approximately5percent inmost countries. Young children, the elderly, and immuno- compromised persons are the most sus- ceptible to the serious complications of this virus. Although there is no vaccine for dengue fever, inMay 2003, researchers at Children’s Hospital Boston and Harvard Medical School announcedapossibleapproach to developing one. The dengue virus uses a protein, named “E,” to enter the human cell’s outer mem- brane. The proteinworks like a fist punching its way inside where the virus can then use cell mechanisms to replicate and spread to nearby cells. Researchers have found a pocket in the protein that canbe filledwith a drug, thus preventing the formation of the fist-like structure. Until a drug is avail- able to the general public, doctorswill con- tinue to use acetaminophen for the pain and, if necessary, fluid replacement thera- py in the caseof denguehemorrhagic fever. Antibiotics areneverprescribed fordengue, as they are not effective against viruses. The Centers for Disease Control and Prevention has identified dengue fever as “the most important mosquito-borne viral disease affecting humans.” In fact, individuals can become sick with each of the four forms of the dengue virus, as no cross-immunity is acquired with each infection. The best way to protect yourself and your family is to take certain basic pre- cautions. Empty containers of standing water includingpet bowls, pottedplants and receptacles of rainwater. Always use win- dowscreens andkeepdoors closedbecause mosquitoes look for shady areas to hide inside homes. Be sure to wear protective clothing such as long sleeves, pants, shoes, and socks especially during the early morning and late afternoonhours. Lastly, spray all exposed areas and clothing with a repellent containingDEET(N,N-diethyl- metatoluamide). DEET can be unsafe for small children, so read all labels carefully. It is most effective in concentrations between 20 and 40 percent. Stronger concentrations can be toxic. While residing in areas with high incidence of dengue fevermaybea fact of life for a large number of Foreign Service families, infection can be avoid- edwithproperhouseholdmaintenanceand careful planning before leaving home. ▫ 6 AFSA NEWS • NOVEMBER 2003 FOREIGN SERVICE HEALTH WATCH Dengue Fever BY SPECIAL CORRESPONDENT EURONA TILLEY AFSA is proud to announce the debut of a new feature, Foreign Service Health Watch, which will appear periodically in AFSA News . Health Watch articles will examine health issues of particular concern to members of the Foreign Service community. Special correspondent and FS family member Eurona Tilley —who has an advanced degree inmicro- biology/immunology — starts off the series with an article about dengue fever. JOSH JOSH