Greetings from Nevada, where our family is freezing! After so many months sweating in tropical heat, weather in the 40’s and 50’s feels downright frigid. But we are glad to be at my mom’s house while we re-group and figure out our next steps. I, personally, am feeling better each day about our new reality (hot showers are helping), though I’m still sad about our mission coming to an early conclusion.
I realized from a few comments I received regarding my last blog post that I ought to clarify just why, exactly, we felt the need to leave Honduras early. It was not because Adelina was too sick to stay. She had relatively mild symptoms of both Typhoid and Dengue, and –had they been more severe—I honestly would have trusted the Honduran doctors to treat her more than I would doctors here in the States (Honduran doctors, after all, see these illnesses all the time). By the time Adelina received her Dengue diagnosis, she was already passing through the critical phase of the illness without complications.
The reason a Dengue Fever diagnosis was a “line in the sand” for Eric and me was because of the danger of Adelina getting Dengue a second time. A second Dengue infection carries a significantly higher risk of developing into Dengue Hemorrhagic Fever, a potentially fatal complication of the disease (more below).
I’ve done a lot of research about Dengue in the last week (researching is one of the ways I cope with stress), and I thought you all might be interested in some of the things I’ve learned about Dengue Fever.
Dengue Fever is an illness endemic to many tropical countries, especially in Latin America and Asia. It is a virus, transmitted via mosquito bite. Symptoms typically appear 4-7 days after a bite from a mosquito that has previously bitten someone infected with the disease. A Dengue virus infection involves three phases: febrile, critical, and recovery.
During the febrile phase, temperatures spike and head/joint aches are common. Dengue has been nicknamed “breakbone fever,” which gives you a good idea of how painful it can be; in Adelina’s case, fortunately, her discomfort wasn’t extreme. Additionally, Adelina did not develop the Dengue rash that occurs in 50-80% of infections. Toward the end of the febrile period, it is common to see a sharp drop in blood platelets; before more specific diagnostic testing was available, platelet counts were the primary way of diagnosing Dengue fever.
After the febrile period, Dengue progresses into the critical phase. This is the most dangerous time for an infected person. In the 3-4 days after fever subsides, there is a risk that the disease will progress into Dengue Hemorrhagic Fever (DHF). DHF is a potentially fatal complication involving internal bleeding (usually in the gastrointestinal track), bleeding under the skin, and excessive vomiting. Patients can develop a specific form of shock, called Dengue Shock Syndrome. DHF is considered a life-threatening condition, and it is especially dangerous in children.
Most people with Dengue, including Adelina, do not develop Dengue Hemorrhagic Fever. They progress right through the critical phase without complications and enter into the recovery phase. During recovery, platelet counts normalize and other symptoms improve. It is typical for people with Dengue to experience fatigue for several weeks after infection; we have definitely seen this in Adelina.
Heightened risk of second infection
We ended our mission at the Finca early due to the heightened risk of a second Dengue infection for Adelina. There are four strands of Dengue fever, any of which can –but usually don’t—progress to Dengue Hemorrhagic Fever.
Once infected with a strand, people are typically immune to that specific strand for the rest of their lives. However, if they are infected with any of the other three strands, the body’s immune response is confused and they have a much higher risk of developing Dengue Hemorrhagic Fever than they did with the first infection. The body’s immune system recognizes the Dengue, but for some reason the antibodies it produces actually bind to and spread the virus, rather than attacking it. An article I read compared it to a Trojan Horse effect: the antibodies actually help the virus enter the body’s cells, so a person is much more susceptible to a critical infection. One study put the risk of developing DHF in a secondary infection as eight times greater than in a primary infection.
That’s why we left Honduras. We just couldn’t take the risk of Adelina getting infected again and developing Dengue Hemorrhagic Fever.
A few years ago, a Dengue vaccine was developed and rolled out in a few countries in Latin America and Asia. However, researchers found that vaccinating children who had never previously had Dengue made them more susceptible to developing DHF. Basically, the vaccine was acting like a primary infection and increasing the risk of DHF in a “secondary” infection.
The good news is, if somebody has already had a Dengue infection, the vaccine does appear to work to immunize against the other three strands. In other words, since Adelina has already had Dengue once, we can get her the Dengue vaccination and she should be protected from the other three strands . . . and that elevated risk of DHF.
For me, this is a great relief, as it means Adelina won’t be restricted from traveling to Dengue-endemic regions for the rest of her life. Currently, the Dengue vaccination is only available for people ages 9-45 who have had a confirmed Dengue infection, so we will have to wait four years before we can get the Dengue vaccination for Adelina. All things considered, this just isn’t so bad.
If you, like me, enjoy reading medical articles, you can check out the ones that I’ve posted below, which are among those I’ve read in the last week. Also, just FYI, please stay tuned to this blog: I do plan to finish out my ABC’s of Life on the Finca blog posts. Although we have left Honduras, the Finca mission is still very much alive in my heart!
Links to articles about Dengue and DHF: