My dream holiday to Bali ended when I feared my organs were failing and death was imminent. I had assumed I would be safe with just mosquito spray…

Debra Morgan had just landed in Britain after a dream holiday in Bali and was exhausted, but she put this down to the 18-hour flight.

But the next morning she woke up feeling “horrified” and quickly realized it was more than post-travel fatigue.

“I was shaking and shivering and couldn’t get warm,” said Debra, 57, a dog walker from Upton, Chester. ‘When I touched my skin it hurt. I had no energy, a horrible headache and I was in pain all over.’

Her temperature was 39 degrees (normal is 36 degrees) but a Covid test came back negative.

Debra Morgan contracted dengue fever from a mosquito bite during a trip to Bali. Dengue fever is a potentially fatal mosquito-borne infection and the number of cases among British holidaymakers is increasing, according to data from the UK Health Security Agency (UKHSA).

Two months after the holidays, Debra still feels weak.  “I love Bali, it's our favorite destination, but this has made me more cautious,” she says

Two months after the holidays, Debra still feels weak. “I love Bali, it’s our favorite destination, but this has made me more cautious,” she says

The mother-of-three went back to bed and used her mobile to call her husband Owen, 53, an aircraft engineer, who was downstairs, to ask for a hot water bottle as she was too weak to walk.

“I’m not exaggerating when I say that that night I was in so much pain all over that I felt like my organs were shutting down, and I had a strange feeling of fear, like I was dying,” Debra says.

‘It was the worst thing I’ve ever experienced.’

The next day, Owen helped her to the GP surgery, where a nurse glanced at Debra – now visibly sweating – and, hearing that she had been to Bali, said: ‘I think it’s dengue fever.’

Debra was sent straight to the hospital, where she had to take antibiotics for a week due to a dangerously high fever.

Dengue fever is a potentially fatal mosquito-borne infection and the number of cases among British holidaymakers is increasing, according to data from the UK Health Security Agency (UKHSA).

In 2023, 634 cases of dengue were reported among returning holidaymakers in England, Wales and Northern Ireland. This compares with 448 in 2022 and an average of 505 per year in the five years between 2015 and 2019.

Cases are also increasing globally, increasing tenfold between 2000 and 2019, reaching a record high last year, with 6.5 million cases and more than 7,300 dengue-related deaths.

In addition, dengue fever is now being reported in areas once unaffected by the infection, including Croatia, France, Spain and Italy, while numbers are already three times higher than last year in Latin America, a popular luxury holiday destination.

The infection is transmitted through the bite of a female mosquito. And while it causes no or only mild symptoms in 75 percent of patients, according to Dr Philip Veal, public health adviser at the UKHSA, others will suddenly develop a high fever.

The fever is often accompanied by severe headache and pain behind the eyes, muscle and joint pain, nausea, vomiting, abdominal pain and loss of appetite.

These cases should also disappear within a few days if paracetamol is used to relieve temperature and pain (anti-inflammatories such as ibuprofen should not be used as they can cause bleeding problems if you have dengue).

However, around 5 per cent of patients, like Debra, will develop severe dengue with more extreme versions of the symptoms – including ‘breakbone fever’, which can cause severe joint pain and bleeding – and although this is rare among holidaymakers, this is rare. can be fatal.

Analysis published in the Journal of Travel Medicine in 2021 reported on nine people, with an average age of 32, who died from dengue fever between 1995 and 2020 after holidays in Mexico, Ecuador, Malaysia and Thailand.

“Severe dengue is more common in children, adolescents, the elderly and pregnant women,” Dr. Much to Good Health.

When Debra and Owen headed to Bali for a 16-night holiday in February, they only took insect repellent with them, thinking they would be safe if they stayed in luxury locations.

When Debra and Owen headed to Bali for a 16-night holiday in February, they only took insect repellent with them, thinking they would be safe if they stayed in luxury locations.

‘It is also seen in people with certain underlying conditions including asthma, diabetes, obesity, high blood pressure, kidney disease, bleeding disorders and in those taking anti-clotting medications.’

‘That’s because bleeding can quickly become serious for someone taking anticoagulants that inhibit blood clotting.’

Although the infection is most common in South and South East Asia, the UKHSA is warning of a rise in cases among those returning from the Caribbean and Central America. (In Argentina, cases are so high that people are panic-buying mosquito repellent and supermarket shelves have been empty for weeks.)

Furthermore, the UKHSA says, dengue is already ‘an emerging disease outside tropical regions, including parts of Europe’.

“Aedes aegypti (the mosquito that causes most cases of dengue worldwide) is now established in Cyprus, around the Black Sea and in the outer region of Madeira,” says Dr Veal.

“Aedes albopictus (a species that causes the most infections in Europe) is found in much of Europe,” he adds.

‘In southern Europe, more specifically in Italy, France, eastern Spain and on the east coast of the Adriatic Sea, the mosquito has established itself and is gradually spreading towards the northern latitudes of Europe.

‘This is because Aedes albopictus can establish itself in more temperate regions, can tolerate temperate winters and the eggs can survive temperatures down to -10 degrees Celsius.’

Dr. Veal says several factors are driving the rise in cases, including “increased global travel, climate change that is expanding the geographic range of Aedes mosquitoes, and urbanization, with densely populated areas providing ideal breeding grounds.”

Steps to prevent dengue include using insect repellents containing 50 percent DEET and covering exposed skin. Air conditioning can also help, as mosquitoes prefer warm, humid conditions.

Sleeping under an insecticide-treated mosquito net is not considered as effective for preventing dengue because the Aedes mosquito, unlike other species, also bites people during the day.

When Debra and Owen headed to Bali for a 16-night holiday in February, they only took insect repellent with them, thinking they would be safe if they stayed in luxury locations.

Debra remembers being bitten by mosquitoes during her nights in Bali.  'I felt them all over my arms and legs, even though I had used spray'

Debra remembers being bitten by mosquitoes during her nights in Bali. ‘I felt them all over my arms and legs, even though I had used spray’

“Some people take malaria pills for Bali, but we didn’t think that was necessary,” says Debra.

On March 11, they took a boat from Bali to the nearby island of Lombok, and when their return trip was canceled due to rough seas, they decided to sleep at the ferry terminal.

‘We had nowhere to stay overnight and wanted to be sure we would be ready when the seas calmed down as our flight home was in three days. So we – and other holidaymakers – decided to sleep in the ferry port, on the floor with our bags.’

Debra remembers being bitten by mosquitoes at night. ‘I felt them all over my arms and legs, even though I had used spray.’

The mother-of-three, 57, is a dog walker from Upton, Chester.  She said contracting the disease was 'the worst thing I've ever experienced'

The mother-of-three, 57, is a dog walker from Upton, Chester. She said contracting the disease was ‘the worst thing I’ve ever experienced’

The next day they were able to return to their hotel and then spent two more days in Bali before flying home.

Debra felt ill within hours of returning home to Chester.

She recalls: “I felt so sick that I even posted in a Bali travel Facebook group where I saw a post about dengue fever. I had never heard of it before, so I asked if anyone else had it.

‘Someone replied that it was widespread and that she had had it and it took about four days to breed. I thought back to the situation and it had been exactly four days since I had slept on the ferry dock floor and been bitten so many times.”

On the advice of the practice nurse, Owen took Debra to hospital, where she was given an intravenous fluid drip as a precaution while they waited for the blood test results.

‘I also had ECGs (tests to check the electrical activity of the heart) because my heart rate was going all over the place. I also had a chest x-ray. Then they told me that my blood was being sent to a special laboratory for tropical diseases to test for dengue fever.’

After seven hours she was allowed to go home, but returned the next day because her temperature had risen enormously. Debra was readmitted and given more antibiotics and battled fever and pain for the next week.

“I was so sick, I lost half a stone in a week and felt so weak,” she says.

‘After that my fever finally went away and I felt better, but for the next few days I was left with a terrible headache that no medicine could cure.’

Two months later, Debra still feels weak. “I love Bali, it’s our favorite destination, but this has made me more cautious,” she says.

She still wonders why her husband wasn’t affected. But Dr. Veal says some travelers are more at risk than others, although it’s not clear who or why.

“The fact is that all travelers to countries where dengue occurs are at risk,” he says. ‘It is crucial that people protect themselves.’

For more information, visit travelhealthpro.org.uk