I am not a physician nor do I have scientific training in tropical medicine. Please don’t take this as medical advice.
I’ll never forget the day I collapsed onto the street in Siem Reap, Cambodia, two weeks into a seven week trip through that country and Thailand. I had been sick for a few days but we decided to take the bus to Phnom Penh anyway, even though I was burning up with fever that morning. When I hit the ground I dreamily thought the heat of the pavement felt cool on my skin.
Suffice it to say I never got on that bus. Instead I found myself in a Siem Reap hospital, pumped full of fluids and painkillers, and diagnosed with dengue fever. I was released from the hospital after a day or so but it was still a week before I could travel and three more weeks before I started to feel better, really better.
That was almost 14 years ago. Since that time I’ve been the one who is always covered in repellent. I’m the one that hides behind screens at the merest hint of that maddening, whiny buzz in my ear. I’m the one that checks my body for the tell-tale rash if I feel ill after those bitches have pierced my skin with their virus laden proboscises. I’ve been lucky since that time in Cambodia but my luck ran out a month ago in Asuncion, Paraguay.
Mosquitos have been the scourge of the earth and a bane to humankind for millennia. In his book “Slave Trade” author and Georgetown professor John McNeill states that, until the mid-twentieth century, more battle troops were killed by mosquito borne diseases than were killed in actual combat. Malaria was the disease du jour at that time and troops who had not been exposed to the disease promptly got sick and died.
Mosquitos and malaria were also part of the reason why European colonists were unable to penetrate the interior of Africa until the early 1800’s. Quinine, a product of the Cinchona tree native to South America, was brought back to Europe by the conquistadors but it wasn’t until later that British colonists in India discovered that it aided in one’s recover from malaria. The bitter drink was made more palatable by adding sugar and water. Of course, the British took that one tasty step further and added gin to the mixture. What better way to feel like you’re conquering a deadly disease than to do so by knocking back a few G & T’s?
While Africa’s dark interior remained off limits the coastal regions were fair game and in the 15th century when the slave trade began Africa’s mosquitos were stowaways in large numbers. When this same trade expanded to the Caribbean and North America a new breeding ground was formed and those previously unheard of diseases flourished. Mosquitos are opportunists; give them some stagnant water and stable temperatures and they’re almost unstoppable.
Malaria was simply the start. As science progressed more mosquito borne diseases were identified and the numbers are staggering. There’s West Nile virus, equine encephalitis (yes, humans can get it from infected horses), dengue fever, Japanese B encephalitis, yellow fever, malaria, chikungunya, Saint Louis encephalitis, and zika. These are just a few of the mosquito borne diseases that humans contract but they’re the ones most world health organizations pay attention to.
So if you’re traveling to the tropics where these diseases flourish you might think about heading over to the clinic and getting a vaccination, right? Wrong. Currently, the only reliable vaccines available are for yellow fever and Japanese B encephalitis. A vaccine for dengue is available in limited supply in countries hardest hit by outbreaks but it’s not entirely effective. And if you’re in the market for a yellow fever shot you might be out of luck. A current outbreak of the disease in Brazil has effectively depleted the world’s supply of the vaccine. There is no vaccine for malaria but prophylactic medications like doxycycline can reduce your chances of contracting the virus.
As a traveler to mosquito heaven I am keenly aware of the dangers. I was vaccinated for yellow fever in 2011 prior to our trip to the Peruvian Amazon. As a previous dengue victim the vaccine for the virus was recommended to me (priority is given to the elderly, those with compromised immune systems, and people who have had the virus before) but it’s a three shot series over the course of 18 months and weighs in at a hefty 450 USD.
So, back to Asuncion, Paraguay. We had taken a break from camper life and were ensconced in a lovely little apartment. I woke up one morning feeling off and within a few hours I had a massive headache, a fever, and joint pain. I spent that day in bed gulping water and Tylenol and hoping it was just a flu. By the next day I knew I had to see a doctor. I hurled myself into a cab and headed to the nearest hospital. The moment I mentioned dengue to the reception staff I was hustled straight to an exam room. The doctor asked me about my symptoms and promptly sent me to the lab for bloodwork.
As I stated earlier I am no medical professional. However, while I waited for my blood to be scrutinized I did turn to Doctor Google. What they were looking for in my blood was the actual presence of the virus and a check of my platelet and white blood cell count. However, the test for the viral presence is a crapshoot; if the patient has the test too early after symptom onset it’s inconclusive. Antibody tests can also be inconclusive. The test can indicate an active infection or simply indicate that the patient has had the virus at some time in the past. My results were inconclusive for the virus itself, antibody presence was not tested, and my platelet and white counts were low.
That doctor’s diagnosis? Dengue fever. I was sent home with the standard treatment: fluids, rest, and Tylenol.
However, my symptoms never really progressed to the horror I experienced in Cambodia. After a few days I felt better and the fatigue dissipated within a week or so. When I followed up with a different doctor he surmised that I probably had Zika given the relatively mild symptoms. Perhaps I’ll never know what really happened.
But what I do know is this. If you're traveling in the tropics get your shots. Many countries in the world ask for proof of yellow fever vaccination and have the right to refuse entry to those without that proof. And for those who ask questions like, "Do I need a yellow fever card to get into X country" I simply reply to their question with a question.
Do you want yellow fever?
Because mosquitoes don't care about you. They only care about world domination.