Dengue is on the rise around the world. Can you be immunized, what are the symptoms and how is it treated? Here’s what travelers need to know about dengue fever before visiting tropical destinations.
Photo © iStock.com/CHBD
- What is dengue fever?
- Symptoms of dengue fever
- Dengue reinfections
- Is there a vaccine for dengue?
- Dengue fever prevention
What is dengue fever?
Dengue fever is carried by the Aedes aegypti and Aedes albopictus mosquitoes, which are known to bite both in daytime and nighttime.
Although dengue is nicknamed “breakbone fever” for its severe muscle aches and fevers, most people experience mild symptoms. However, it can be life-threatening, especially for children or people with underlying health conditions.
And dengue is on the rise globally – cases have doubled each year since 2021, and 2024 saw a record-breaking number of cases. This increase can be attributed in large part to hotter, wetter weather, which has allowed the habitat of dengue-bearing mosquitos to expand.
Though dengue is most common in tropical or subtropical areas of the Americas, cases have also been reported in the Eastern Mediterranean, Europe, Southeast Asia, Africa, and the Western Pacific.
Symptoms of dengue fever
Symptoms of dengue usually appear 4-10 days after being bitten and include:
- pain in muscles or joints
- high fever (104°F/40°C)
- headache
- nausea
- vomiting
- a flat, red rash
If you have dengue, rest as much as possible, stay hydrated, and take acetaminophen to alleviate pain and fever.
Severe cases can progress to DHF (dengue hemorrhagic fever), which can be life-threatening.
Symptoms of severe dengue fever usually start a day or two after your fever goes down and include:
- severe stomach pain
- persistent vomiting
- bleeding from gums or nose
- blood in urine, stool, or vomit
- difficult or rapid breathing
If you’ve been traveling in an area where dengue fever is known to occur and experience any of the above symptoms, seek medical assistance immediately.
Dengue reinfections
While many dengue cases are mild, reinfections can cause much more severe reactions.
Dengue is divided into four strains, or serotypes. If a person gets infected again with a different strain of dengue, it can create more severe illness, including progression to DHF. Unfortunately, the first dengue infection frequently goes unnoticed or is attributed to a flu-like virus.
Is there a vaccine for dengue?
There are currently two dengue vaccines available – however, they are recommended only for children 9 through 16 years old who have been previously infected with dengue and live in areas where dengue is common. And manufacture of Dengvaxia, the only vaccine available in the US, will be discontinued in 2025 due to lack of global demand.
The other vaccine, TAK-003 (aka Qdenga), was prequalified by the World Health Organization (WHO) in May 2024 and is approved for use in the EU, Indonesia, Thailand, Argentina, and Brazil, among others.
According to WHO, travelers living in non-endemic countries who have previously been infected might benefit from the TAK-003 vaccine before traveling to an endemic country. Check with your doctor or healthcare provider to see if they feel a vaccine would be beneficial.
Planning a tropical adventure? Find out how travel insurance can cover lost or stolen baggage, sudden illness, or other mishaps.
Dengue fever prevention
The best way to avoid dengue fever is to not get bitten by mosquitoes. Take a multi-step approach:
- use a mosquito net if sleeping outdoors or with open windows
- apply insect repellent to the skin
- wear permethrin-treated clothing and long sleeves and pants when outdoors
Avoid areas with standing water such as upturned canisters, flowerpots, tires that may contain water, and lakes or large puddles. Public health campaigns are focusing on the destruction of these standing water breeding grounds and implementing proper water storage options to try to eliminate or decrease the Aedes mosquito population.
Travelers headed to areas with dengue fever present should travel prepared. Use caution when deciding which time of year to travel, especially during rainy seasons.
While dengue fever can be dangerous, it shouldn't stop you exploring the world. With the proper planning and by taking the right precautions, you can still travel to amazing tropical destinations.
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15 Comments
Question 7 and Question 10:
I'm with you. I got DHF in Thailand (or Cambodia I can't really be sure) in May 2012. I had a full on fit and muscle seizure on a bus and then was hospitalised for 10 days. Between these two incidents about a week past during which I failed to get any decent medical attention. I don't know if this is why I ended up with the worst form of Dengue you can get but I certainly would advise you both to get decent insurance and be ready for the warning signs. If a dengue sufferer can get excellent medical help straight away in THEORY it should be survivable, even if it's hit number 2 or 3.. or who knows, maybe even 4.
I don't know what's worse... dying of DHF or only going to the North Pole on holiday from now on. I desperately want to do South America but we need to fully understand the risks.
Does anyone know? Do the serotypes mix and match or are they specific to certain regions?
I'm going to keep researching and come back with any info I find. Perhaps we need to see how many people survive dengue 4 times.
Good luck travellers.
PS. My insurance was with WorldNomads, and they literally saved my life. Excellent support and in a time of literal crisis they were amazing.
Looking for answers too. Got dengue fever 4 days after returning from sri lanka in 2005. Not sure what type i had since i was misdiagnosed by US doctors for months. It was the worst 2 months of my life for sure. Had the high fever, nausea and throwing up for days, purple rash on legs for weeks, bruised easily, etc. Has anyone who had it twice had the rash amd the easily bruising the first time too? I know the say it's alway worse the second time. The first time seemed really bad for me already so concerned about the risk since i'm planning to go to SL next month. Is early detection and care key to surviving the second time or is it all up to luck?
M, we actually went back to the good doctor with this question.... his answer is presently on the front page of the WorldNomads safety hub, but here's a direct link:
http://safety.worldnomads.com/dengue-repeat-infections
I think you'll find it answers your questions (at least a bit better).
good luck
Phil at the safety hub
my dad just got dengue fever and he was bitten twice is he still safe or no?
Hello, i have dengue the third time due this date, the first is the worst where i almost had blood tranfusions, second just have minor bleeding in nose but just pass away in a week, i have never been sent to hospital, i even attended school, third is what i am experiencing right now it started 4 days ago when i had chills and high fever and runny nose but right now i am feeling better, what do you mean getting more dengue can have greater risk of death? Is it by having more types or more instances of the same type?
I read that one needs to be hospitalized if platelets are below a certain level. How would I know if my platelets are too low? Would that only happen if there was outer bleeding? I have Dengue now but am feeling better so I don't feel I need to go to the Dr. I just wonder is it possible to be feeling better but still have low platelets or to still be at risk for more severe complications?
I have just recovered from dengue which turned into dengue hemorragic Fever (DHF). I live in Myanmar but traveled to Sri Lanka. One Dr said that I had had it before but I never went to the Dr about it and thought it was flu or something but the next Dr said this was the first time since my blood test after the fever hit showed negative!
I was at home dealing with the extremely high fever and really should have gone back to the Dr because it progressed to hemarragic fever and I had to fly to Bangkok for treatment. My second visit had the Dr worried and he retested me and it was positive for DHF and very low platelets. Bruising and red 'stains' on my skin were quite scary when you realize what is causing it.
I do think that travelers should do everything to prevent being bitten but being able to know if it is Dengue would be crucial as well. The infections after DHF are nothing to laugh at or 'grab your tissues' for (I'm thinking Jake has not had it :) and travelers need to be aware of this.
I was told the Dengue mozzie tends to be urban not rural which means you will find it in cities, not necessarily out in the boonies! But get the health care if you are going into infected areas as said by Pip. IF it progressed to DHF, you will probably need a hospital and the health coverage will take care of you. At least in those countries, they know how to diagnose it properly!
The Dr from the CDC in Bangkok told me that I would be immune now for about a year... so if your traveling occurs quickly (not more than a year between), you might be OK :)
Hello,
I am a second year medical student and I just wanted to give a quick medical input on the topic.
Unfortunately I do not have any geographical advice to give, however I would be able to help with the medical aspect.
There are 4 main types of Dengue- when one gets bitten by the Aede's mosquito (there's a chance that the mosquito is carrying the virus- Flavivirus- positive single stranded RNA virus, and there's a chance it doesn't carry it- for this case we'll presume it does) then the body will react by producing "immediate attack complexes" (aka macrophages and cytokines) that will cause a lot of inflammation and increase Fever! could also manifest bone pain. Next step the body will make "memory attack complexes" (IgG's) to protect the body from future next attack of that virus.
So!
Remember we said there are 4 types of that virus- if the next attack happens and the virus is THE SAME strand of dengue- then the body will be able to get rid of the virus with no problem. HOWEVER, if the other 3 strands were to infect the same person (75% chance) then the body will be fouled into thinking that it's the same strand and try to kill the virus with the same "memory attack complexes" and miserably fail. This will result in consequent attack by the initial "immediate attack complexes" which will result in massive release of signals to the body to do all sorts of inflammatory actions including: vasodilation (dilation of blood vessels) causing blood to rush out of the vessels and potentially cause massive reduction in blood pressure. This could subsequently cause hypovolemic shock and death if not treated right away.
I myself have actually just recovered from Dengue fever and had a personal scare when we learned about the topic in class not long ago.
I hope this helps,
-Juda
“In about 1 percent of cases, dengue advances to a life-threatening cascade of immune responses known as hemorrhagic or shock dengue. This potentially mortal condition generally happens only after a second dengue infection."
Please note, it's *only* 1% of the cases, most commonly after a first infection, but not necessarily - even if the 1st and the 2nd are of different strains (which is basically a given since people are usually immunized for life after an infection). Rio de Janeiro has all 4 types of dengue, population is not dying plague-like of hemorrhagic dengue.
Take precautions, avoid peak mosquito time if you can, and you will most probably be fine
(yes, most probably, as you most probably won't die of a plane crash on your next travel. Life has risks and shit happens, but if you can't take any risks, you won't leave your bed - because, you know, you might trip on your carpet, fall, hit your head and die :P)
Stay away from asia!if you think that cause you have not got dengue yet you are safe the first time you are mistaken by far.
First you must make a test to make sure you were not infected previously.
Second.i got dengue last year in manila philippines for the first time.It made complications and developed to dengue hemmoragic fever.I had to b hospitalised for days with no quarantee for my life.Thank God there are plenty of more beautyful absolutely safe and cheaper places in the rest of the world.Not to mention the rude behavior especially of the thais.no compare to the western hospitality.Whole europe has so much to show.From spain italy to the 3500 Greek islands paris praque budapest turkey cyprus etc.everyone of each unique.Every place in europe or america is unique.asia looks everywhere more than less same.And from culture archaeology not much.You may not take all these under serious consideration now and believe it ll not happen to you.well dengue has developed to epidemic the last years and unfortunately no warning to travelers cause lot of money behind obviously.When you ll get it and you will not know if tomorrow you will be alive you will regret you traveled and you will remember me but it will be too late.God bless!Ashe vaccine of sanofi it will not protect you absolutely and no quarantee for the second time infection.PEOPLE!ITS JUST NOT WORTH THE RISK.
Dengue can kill human being in case of ignorance. According to experts one can bit danger of dengue with timely cure and hygiene lifestyle.
I have a question, I think I got Dengue fever on the last day in Bali going to Korea. And I now have fever, chills, muscle ache, stomachache, diarrhea in Korea (lives in NY). No vomiting or cough. i bought a trip protection for Bali only but I was wondering if dengue usually occurs right away or a little after and if later, how can I get insured? Thinking of going to korean hospital.
Hi Jenjen,
Sorry to hear you are feeling unwell. The best thing you can do is contact your travel insurance provider's emergency assistance team immediately who will be able to advise you on what to do in terms of your travel insurance and your condition.
Kind Regards,
Allyson@World Nomads
Im hearing first time dengue is not bad but there are different strains which one is the serious one, and also can dengue cause heart issues like myocarditis can anyone answer who had it, thinking of going to Pakistan but their is a dengue outbreak.
I got Dengue the first time in Chiang Mai, Thailand in 2017. I had 4/5 days of very high fever (40c) and constant muscle and bone pains. My platelet levels were checked every 3 days for the next two weeks and luckily were always strong. The doctor complimented me on my immune response, but warned that this same immune response means that if I get Dengue a second time I am at higher risk of developing complications as my strong immune system will be fooled and damage me more than the virus! I was strongly considering going to thailand in August and September, but I have been reading about 2nd dengue infection.... and I have decided that until I can get vaccinated safely I will not make any life threatening trips... I am sure the situation in Thailand is MUCH worse than they let us know because so many of my friends who went there got it... and they all went at different times and to different cities. 7 out of the 10 close friends of mine who went to Thailand were infected with dengue. 2019 was the worst year, then covid broke out and the reporting became less reliable, I believe its worse than ever! The locals I know warned me not to come during rainy season.