[HN Gopher] Good news against dengue
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Good news against dengue
Author : jseliger
Score : 157 points
Date : 2024-04-14 18:36 UTC (1 days ago)
(HTM) web link (www.science.org)
(TXT) w3m dump (www.science.org)
| chupchap wrote:
| Oh this is amazing news. Dengue infection is common in parts of
| India I come from and there is very little that can be done about
| it beyond the basics. My parents have got it couple of times and
| it is similar to long covid in the sense that there is extreme
| body pain and a slow recovery.
| marc_abonce wrote:
| For anyone wondering (because title is clickbaity): Two new
| dengue vaccines were recently announced by the Takeda and
| Butantan companies.
|
| Takeda: https://www.takeda.com/newsroom/newsreleases/2023/Takeda-
| Den...
|
| Butantan: https://www.nejm.org/doi/full/10.1056/NEJMoa2301790
| acoster wrote:
| Butantan is not a company, but a public research institute run
| by the Brazilian state of Sao Paulo.
| weinzierl wrote:
| In addition to that it is relevant because Dengue cases are at
| an all-time currently.
| resolutebat wrote:
| A few years ago I had dengue in Singapore, and while my case was
| mild as far as these things go, I was still almost hospitalized
| because my platelet counts dropped so low. The overall experience
| was sufficiently unpleasant that I was strongly incentivized to
| take Dengvaxia, the only currently approved vaccine, but having
| gone through the process, I can see why very few people do.
|
| - As mentioned in the article, if you have never had dengue and
| you take Dengvaxia, it paradoxically _increases_ the odds of
| getting a bad case. So in Singapore you 're only eligible if you
| have had a confirmed positive blood test for dengue previously.
|
| - I had incredibly good health insurance at the time, which among
| other things happily paid for my dengue management at one of the
| best private hospitals in the country ($$$), but they straight up
| refused to cover Dengvaxia and I had to pay over $700 out of
| pocket.
|
| - Getting the vaccine required 3 shots spaced several months
| apart. Not a huge problem for me, and side effects were minor to
| non-existent (much better than eg COVID vaccines), but obviously
| this reduces compliance.
|
| - Even in Singapore, which is a wealthy, dense tropical country
| with a lot of dengue and thus eligible people, the hospital
| (again, one of the largest and best-resourced in the country) had
| to special order the vaccine every time for my three visits and
| there were a couple of minor hiccups with deliveries etc.
|
| My reward for all this is not immunity to future cases of dengue
| (remember, there are 5 serotypes and getting it once only makes
| you immune to that variety), but a 80% reduction in the odds of
| getting _severe_ dengue the next time around. Which is nice, but
| not a game-changer.
| 101008 wrote:
| I am from Argentina where dengue is an epidemic right now (we
| had it for years but it seems this year is worse), and what
| everyone says about the vaccine is exactly this:
|
| > it paradoxically increases the odds of getting a bad case
|
| So what is it good for?
| brigandish wrote:
| The clause preceding that quote gives you the answer:
|
| > if you have never had dengue and you take Dengvaxia, it
| paradoxically increases the odds of getting a bad case
|
| e.g. _if you have had dengue previously_ , it reduces your
| chances of having a bad case to 20% (according to that
| comment).
| zamfi wrote:
| And, critically, once you have one serotype of dengue, your
| chances of severe dengue from infection by another serotype
| are substantially higher.
|
| First dengue is often not that bad. Second dengue is often
| quite bad. This vaccine makes second dengue not that bad,
| but if you take it without having had first dengue, it just
| leaves you in the same boat as if you'd had first dengue --
| worse off than if you'd had no dengue.
| sn41 wrote:
| Can confirm this. The second attack is potentially fatal.
| ghaff wrote:
| I got Dengue on a business trip to Bali a number of years back
| from the US. Got a very high fever upon return to the US and
| ended up in the emergency room because of crashed platelets
| (which never fully recovered) and white cells. Was impressed
| the on-call infectious disease guy (in New England) immediately
| made the call about what it was--my primary care guy had no
| idea. Cost me something like $1K in spite of good insurance
| between ER and blood work that had to be sent off to Paris and
| basically zero treatment. Vaccine isn't indicated for my
| situation but it basically makes me hesitant to ever travel to
| Dengue-prone areas of the world again.
| lxgr wrote:
| Oh, Qdenga already seems to be authorized for use in the EU, I
| completely missed that! Dengue has always been on my mind when
| traveling to SE Asia.
|
| A real shame that the FDA is dragging its feet once again.
| weinzierl wrote:
| From all I know it is pretty hard to get over here, if you
| cannot prove you already had an infection. This is because the
| official recommendation seems to be against Qdenga for so
| called _" Dengue-Natives"_.
|
| While it technically makes sense it is also not a very
| practical policy since most primary infections are asymptomatic
| or mild. Since you most likely don't know if you already had
| it, your doctor doesn't know if you benefit from Qdenga and
| will most likely stick to the official recommendation.
| eru wrote:
| Are you sure it's dengue-native, not dengue-naives?
| Sakos wrote:
| Doesn't this only apply to Dengvaxia? I can't find anything
| that states that Qdenga should only be used with people
| who've already been infected before. I also can't find
| anything stating there's a risk of ADE (antibody-dependent
| enhancement) with Qdenga as there is with Dengvaxia, which
| would make such a limitation necessary.
|
| https://www.takeda.com/newsroom/newsreleases/2022/takedas-
| qd...
|
| https://www.ema.europa.eu/en/medicines/human/EPAR/qdenga
|
| https://en.wikipedia.org/wiki/Antibody-dependent_enhancement
| zac23or wrote:
| Dengue is not a tropical disease. That does not exist. Dengue is
| a disease of bad governments.
|
| In Brazil, the majority of the population does not have sewage.
| Tap water is not potable and is not distributed every day, in
| some areas twice a week, in some areas less than that. This
| creates the need for everyone to have a water tank at home,
| creating the possibility of a large number of mosquito breeding
| sites. And the Moskito Aedes aegypti is a terrible vector of 52
| diseases [0], among which it transmits a sarcoma (!!!) among
| hamsters.
|
| The current government tried not to buy vaccines[1], trying to
| wait for the Butantan vaccine.
|
| The current Brazilian government is the same or worse (!) than
| the previous one, more censorship, more dead Indians[2], more
| fires in the Amazon rainforest[3], and one thing is really worse:
| all the press covers up the mistakes of the current government .
|
| And...politicians are crazy, intelligent, incredible psychopaths.
| In the last two weeks the discussion has been about freedom of
| expression, about Elon Musk and so on. Economy, education,
| security and health are never priorities. It's clear that the
| government is trying to pass a law to regulate social media (and
| using Musk and Twitter as an example to do so), and the
| mainstream press is very eager to do so, because the law has a
| part that states that social media will pay for links to news
| sites. It is not a problem for a country that needs sewage.
|
| They are incredibly good at doing nothing. Some things in Brazil
| have been discussed for over 100 years, an example is a tunnel in
| the city of Santos[5].
|
| The next government will also be bad, the population will fight
| over policies and nothing will change. I will never understand
| why people fight for these psychopaths. "My psychopath is better
| than yours."
|
| Please, I will not discuss "fascists" or "communists", left or
| right, "everything is politics", "but billionaires are bad", etc.
| These are first-world problems. It is irrelevant for a country
| that needs sewage. Of course this can be discussed, but not in
| the current proportion. Sewers are much more important than that.
|
| [0]
| https://en.wikipedia.org/wiki/Aedes_aegypti#Vector_of_diseas...
| [1] https://saude-ig-com-br.translate.goog/2023-07-03/dengue-
| min... .html?_x_tr_sl=pt&_x_tr_tl=en&_x_tr_hl=pt-
| BR&_x_tr_pto=wapp [2] https://g1-globo-com.translate.goog/jornal-
| nacional/noticia/... -2022-showm-dados-do-ministerio-da-
| saude.ghtml?_x_tr_sl=pt&_x_tr_tl=en&_x_tr_hl=pt-BR&_x_tr_pto=wapp
| [3] https://umsoplaneta-globo-
| com.translate.goog/biodiversidade/... -aponta-
| estudo.ghtml?_x_tr_sl=pt&_x_tr_tl=en&_x_tr_hl=pt-
| BR&_x_tr_pto=wapp [4] https://g1-globo-
| com.translate.goog/sp/santos-regiao/noticia... -no-novo-
| pac.ghtml?_x_tr_sl=pt&_x_tr_tl=en&_x_tr_hl=pt-BR&_x_tr_pto=wapp
| [5] https://g1-globo-com.translate.goog/sp/santos-
| regiao/noticia... -no-novo-
| pac.ghtml?_x_tr_sl=pt&_x_tr_tl=en&_x_tr_hl=pt-BR&_x_tr_pto=wapp
| andreareina wrote:
| Dengue is also an issue in Singapore, despite all the measures
| being taken: public awareness campaigns, release of sterile
| males, mosquito traps, etc. Doesn't mean the Brazilian
| government shouldn't take the steps it can, but this take
| significantly undersells how serious and difficult of an issue
| it is.
| Cayde-6 wrote:
| And even this is selling Singapore's policy and procedure
| short.
|
| On top of those broader measures listed and the general level
| of public cleaning/maintenance, there's reporting of every
| dengue infection diagnosed along with the individual's home
| address and particulars to the National Environmental Agency.
| Cases and trends are monitored for developing clusters,
| publicly publishing up-to-date findings and exact numbers.
| Where a cluster is found, they do additional anti-mosquito
| fogging and significantly increase the local public awareness
| campaign (huge banners, posters in every elevator, distribute
| leaflets, etc).
|
| They then send agents unannounced to inspect inside every
| home/unit in the area for any potential breeding grounds.
| Everything is checked from potted plant trays to dish drying
| racks to toilet bowl scrubber holders. If any breeding is
| found, there's fines in the thousands of dollars. The agents
| are empowered to enter without a warrant; it's taken THAT
| seriously.
|
| The NEA also monitors and takes appropriate action against
| non-residential areas like construction sites, where standing
| water is hard to eliminate unless it's a priority.
| ghaff wrote:
| Even in Massachusetts, I had a call from the town nurse.
| JimDabell wrote:
| They are also using Wolbachia programmes to reduce mosquito
| populations:
|
| https://www.nea.gov.sg/corporate-
| functions/resources/researc...
|
| Dengue is just a difficult thing to fight. In 2020, more
| people died of dengue in Singapore than from Covid (32
| dengue deaths vs 29 Covid deaths).
| andreareina wrote:
| Oh yes it was Wolbachia I was thinking of, not sterile
| males.
| zac23or wrote:
| > Dengue is just a difficult thing to fight
|
| Singapore had 8k cases in 2022. Brazil has 3 million
| cases of dengue in 2024. Is not the same thing.
| JimDabell wrote:
| Why would you quote figures like that without adjusting
| them for population? Brazil has 40x the population of
| Singapore.
| zac23or wrote:
| 0.16% of Singapore's population had Dengue in 2022. 1.4%
| of Brazil's population had Dengue in 2023.
| jajko wrote:
| Just look at the map of Singapore. It doesn't matter how
| hard they try, there is malay jungle maybe 1km from the
| city. Unless its getting the same treatment for another
| 10km from the border, or they somehow raise star trek
| shields between it, little buggers can easily find their
| way to the city even if city itself is sterilized.
| zac23or wrote:
| Singapore had 8 thousand cases in 2022. Brazil has 3
| million cases of dengue in 2024.Is not the same thing.
| The poor distribution of water and the lack of sewage are
| fundamental to dengue fever in Brazil.
| osmano807 wrote:
| Brazil too have notification with the numbers published
| weekly by each State of the country, all cases are notified
| even without laboratory confirmation. They too have
| zoonosis agents which inspect locations, but they're not
| allowed to enter without warrant.
| zac23or wrote:
| Are you comparing 8k cases (Singapore) with 3 million cases
| per year (Brazil)?
| zac23or wrote:
| Singapore had 8 thousand cases in 2022. Brazil has 3 million
| cases of dengue in 2024. Is not the same thing.
| lawgimenez wrote:
| Our health officials really fucked it up with Dengvaxia back
| then. This was also the reason why there is still some vaccine
| hesitancy here especially with Dengue. I'm not sure how the
| government can make amends with the population.
|
| https://www.pharmaceutical-technology.com/features/dangvaxia...
| objektif wrote:
| I posted about this last year. This will soon be an issue in the
| US as well and only then people will start freaking out. Because
| dengue can mess up anyone not just the old. Time to wipe out
| disease carrying mosquitos!!
| mattmaroon wrote:
| Bill Gates has dozens of projects combating mosquitoes, at
| least one of which is intended to replace them with non-
| carrying mosquitoes.
|
| That's what happens in America when we freak out now, one of
| the billionaires fixes it.
| fragmede wrote:
| In 2009, Bill Gates gave TEDTalk in which he released
| mosquitoes to make a point about malaria.
| khaomungai wrote:
| Read about Oxitec[1] a while ago and found their approach
| quite interesting!
|
| [1]https://www.oxitec.com/
| objektif wrote:
| This looks promising. How effective has it been in reality?
| mattmaroon wrote:
| It's early. Studies in Brazil show up to 90% reduction
| (Oxitec's numbers) and they're just now going into their
| third season of testing in the Florida keys, working with
| the EPA. They say the results are good, and I assume they
| must be if the government is letting them expand the
| trials. I think we'll have hard numbers soon.
|
| I've been following this for years just out of curiosity.
| It's a brilliant solution and a brilliant business model.
| Because the genetic alteration kills the mosquitoes, you
| have to keep buying them from the company. It both makes
| it so that there's seemingly little risk to the
| environment and subscription revenue.
| objektif wrote:
| That's great. If we can drive disease carrying ones to
| extinction why do we need to keep buying this?
| mattmaroon wrote:
| You probably can't drive them to extinction this way. The
| introduced mosquitoes only help within a small range
| (~400m I think) of where they put the little devices they
| come from, because that particular mosquito doesn't
| travel far from where it's born. And even within that
| range, a 95% reduction is great, but the year you stop,
| that 5% will just start doing whatever they did before
| and a couple years later you'll be back to where you were
| beforehand.Insect populations grow exponentially.
| average_r_user wrote:
| what do you suggest to stock up, just in case?
| objektif wrote:
| Not sure if you are making fun or not but best thing to do
| would be to ask FDA to take the vaccine approval/development
| seriously.
| average_r_user wrote:
| I'm interested in being prepared for potential health
| challenges, particularly mosquito-borne diseases like
| dengue fever. It seems to be a concern in some areas, and I
| believe knowing how to identify and manage potential
| symptoms can be very helpful. I'd like to learn about
| stocking a minimal amount of essential supplies, like
| mosquito repellent, to help prevent bites in the first
| place
|
| I'm in Europe so not very familiar with tropical diseases
| beside the annoying mosquitoes
| opwieurposiu wrote:
| If you get yourself a supply of Permethrin and some
| mosquito nets, you will be miles ahead of most people.
|
| Permethrin is great stuff, the mosquito lands on
| permethrin treated cloth, the mosquito falls down dead.
| It is something to see. You can treat your clothes with
| it and spray it on your walls and ceilings.
|
| https://en.wikipedia.org/wiki/Permethrin
| objektif wrote:
| Yes but unfortunately dengue carrying mosquitos bite
| during the day and they are very sneaky. They go for the
| feet, ankle etc..
| yosito wrote:
| I live in Thailand, and I've never had Dengue. I'm thinking about
| traveling to Bangkok for a Qdenga shot. Even though ADE doesn't
| seem to be a concern, I have gotten quite paranoid about any
| injections that trigger the immune system as I've now had
| allergic reactions to both vaccines and antibiotics. So I feel a
| little bit nervous about it.
| ankur3 wrote:
| My neighbour suffered paralysis after vaccine shot! Someone
| from known also suffered brain-stroke! My uncle died of cardiac
| arrest a year ago! I had seen lot of such stories around the
| world, yet an industry is moving forward to further increase
| all such activities, which doesn't seem right!
| defrost wrote:
| My neighbour suffered brain-stroke after a haircut! Someone
| else fell over and broke their arm also after a haircut!
|
| Some country like Australia with decades and decades of high
| quality medical records going back to the 1960s would surely
| show a huge increase in heart attacks and brain strokes after
| almost all of their 22+ million people had more than one
| vaccine and yet there were no significant increases in total
| stroke numbers!
|
| And yet many people had strokes, fell over, got hit by cars
| after having vaccine!
|
| How can this be??
| ghostDancer wrote:
| Someone should sent this news to Argentinian government so they
| do something about the problem they're having right now instead
| of looking the other way. https://www.theguardian.com/global-
| development/2024/apr/12/i...
| sofixa wrote:
| > Someone should sent this news to Argentinian government so
| they do something about the problem they're having right now
| instead of looking the other way
|
| They aren't looking away, they're slashing costs everywhere
| without much thought and hiding their heads in the sand to any
| potential consequences. What more could you expect from a
| libertarian who gets advice from his dead dog?
| goodrubyist wrote:
| They really don't have any money.
| sofixa wrote:
| They don't have lots of money, that's for sure. But
| "saving" money by doing slashing costs on things which will
| literally cost you much more money in the short to mid term
| (like the whole dengue epidemic, for which prevention was
| cut, resulting in many more cases resulting in lots of
| healthcare costs and lost productivity) is not a way to
| govern a country.
|
| Using a different form of mismanagement to "fix" a
| mismanaged country doesn't really help.
| ghostDancer wrote:
| I know. He just wants to destroy everything so he can rebuild
| his libertarian paradise along his his tarot reader sister.
| algesten wrote:
| I've spent lots of time in India. It's good to learn what the
| mosquito that can carry Dengue looks like. They are smaller and
| fly much faster and more erratically than a common mosquito - way
| harder to swat! If they settle down, you can see white stripes on
| their long legs and body.
|
| If you notice them, you can sometimes figure out why they are
| congregating, they need blood and standing still water to
| procreate.
|
| At one place I stayed, next door there was a construction site
| where the workers also slept bare skinned at the site. That's the
| only time I caught it. Another place I stayed was also seriously
| infested, I couldn't sit outside. I went looking and found two
| barrels of rain water on the roof, full of larvae. I added a
| small amount of dishwasher liquid to the barrels, which worked.
| Mosquitos went away in a few days.
| worldwidelies wrote:
| I got dengue and typhoid fever at the same time. They call it a
| co-infection. I was pissing blood at one point but they said it
| was due to dehydration and having a kidney stone I wasn't aware
| of until they had me get an ultrasound. Anyway, these types of
| viruses are unavoidable. Everyone gets sick from time to time.
| Incase anyone is curious, I got them both from a restaurant I
| went to. I kept getting bit by mosquitos that night and the water
| they served didn't taste right. I only took a few sips of the
| water but that's all you need to catch typhoid. I google mapped
| the restaurant and found a few open drainage ditches next to the
| restaurant. The mosquitos must have been growing in there.
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