Live vaccine for dengue fever

[Graham64]

My son lives in Bali. He is in the middle of a very severe bout of dengue fever. I am going to visit him for 3 weeks in July. He has suggested I should have a vaccine before I go. I can find that it is called a " live attenuated dengue tetravalent vaccine". Even the vaccine side effects can be pretty bad, with headache and rash normal.

I have seen that CLL sufferers cannot take a live vaccine for shingles. Is that the same for other live vaccines, like that for dengue?

Graham

[cajunjeff]

Graham, my understanding is that, as a general rule, those with us with cll should not take any live vaccines.

There are almost always some exceptions to general rules, particularly among us with cll, given that we all have somewhat different types of cll and that we all in different stages.

Your question is really one for your doctor. If you are committed to going to Bali and will be in an environment where dengue fever would be a real risk to you, maybe your doctor might think the risk of you being unvaccinated and getting a severe case of dengue is greater much greater than the risk a vaccine presents to you. Your doctor will know your antibody levels and if your individual risk for a vaccine is greater than or less than the average cll person.

Good luck, I am sure you must be excited about going to see your son in Bali.

[Graham64 in reply to cajunjeff]

Thanks Jeff. I plan to consult my CLL doctor before I go.

[seelel]

The dengue virus is nasty. Amongst other things it attacks the platelets. It's not unusual for them to crash to zero within 48 hours. That's why it's sometimes referred to as haemorrhagic fever.

Alternatively, you may react to the live vaccine in a similar manner to catching the virus.

I would definitely suggest specialist advice on this matter.

[Graham64 in reply to seelel]

Thanks Seelel. I will get the doctors best advice before doing anything.

[Graham64]

Thanks Jammim. This is a bit more complicated than I thought.

[CLLerinOz Administrator Volunteer]

There are two dengue vaccines. Both are live and not recommended for those with CLL.

One, Dengvaxia, should never be used as a primary preventative in those who've not had Dengue fever as it may increase their risk of more serious disease.

Australians travel to Bali in great numbers. Nevertheless, the Australian advice on Dengvaxia is this:

"vaccination in individuals who do not have laboratory, clinical, and epidemiological evidence consistent with previous dengue infection appears to increase the risk of hospitalisation and serious disease

Australian travellers are NOT recommended to receive Dengvaxia® for short-term stays in dengue-endemic areas, even in people who have had previous dengue infection, as the risks outweigh any potential benefits

vaccination with Dengvaxia® should only be considered for Australians on very rare occasions when all of the following conditions are met:

• aged 9-45 years; AND

• have had previous dengue infections; AND

• are intending to reside in highly dengue-endemic regions for an extended period; AND

• only if the potential benefits are deemed to outweigh the risks."

health.gov.au/news/clinical...

The other vaccine for Dengue fever, also a live vaccine, is Qdenga. It isn't yet available in Australia but it was granted marketing authorisation in the UK (where you are) in Feb 2023. I think it is still awaiting JCVI recommendations for use.

prnewswire.co.uk/news-relea...

The UK package leaflet for Qdenga states:

"Do not use Qdenga if you or your child

• are allergic to the active substances or any of the other ingredients of Qdenga (listed in section 6).

• had an allergic reaction after receiving Qdenga before. Signs of an allergic reaction may include

an itchy rash, shortness of breath and swelling of the face and tongue.

• have a weak immune system (the body's natural defences). This may be due to a genetic defect or

HIV infection.

• are taking a medicine that affects the immune system (such as high-dose corticosteroids or

chemotherapy). Your doctor will not use Qdenga until 4 weeks after you stop treatment with this

medicine.

• are pregnant or breast-feeding.

Do not use Qdenga if any of the above applies."

medicines.org.uk/emc/files/...

Get good medical advice before proceeding (although it looks as if accessing a vaccine in the UK could be difficult, anyway) and take measures to prevent infection from mosquitoes. If you can travel outside the rainy season, that can help to reduce your risk, too.

CLLerinOz

[CLLerinOz Administrator Volunteer in reply to CLLerinOz]

Just remembered you’re planning to travel in July which will be in the dry season so that’s a plus 👍

CLLerinOz

[Graham64 in reply to CLLerinOz]

Thanks, yes.

[Graham64 in reply to CLLerinOz]

Thanks for your advice. That's pretty unequivocal. I will go for repellent, long sleeve shirts and trousers.

[CLLerinOz Administrator Volunteer in reply to Graham64]

If you get time, the podcast I posted below has some helpful advice, too.

[jijic in reply to Graham64]

Get 50% DEET spray from Boots as well

[MovingForward4423]

Unfortunately it’s not recommended, and if you catch dengue fever, it can be nasty (from what I have been told). It is spread via mosquito bites, so taking precautions not to get bitten will help. However, if you are like me and attract them, it can be tough to avoid all bites. I love South Asia, and I do have to travel there for work. I avoid being outside in the early morning and late afternoon to dusk. In the evening, I wear trousers and long sleeve shirts.

[Graham64 in reply to MovingForward4423]

Thanks. Following everyone's advice, I will dress the same.

[CLLerinOz Administrator Volunteer]

This episode of an Australian podcast that aired on 6 March 2024 covers the topic of mosquitoes and what makes them more or less attracted to some people.

"Why are mosquitoes so attracted to me?"

"Some people are mosquito magnets. The blood suckers do, in fact, have their favourites.

And this could pose a major health risk. After all, mosquitoes are the deadliest creatures on earth."

It's only 16 minutes long and has some practical, helpful hints.

It also discusses the science behind these topics:

- Mosquitoes use vision to associate odor plumes with thermal targets

- Olfactory responses and field attraction of mosquitoes to volatiles from Limburger cheese and human foot odor

- Composition of Human Skin Microbiota Affects Attractiveness to Malaria Mosquitoes

abc.net.au/listen/programs/...

CLLerinOz

[MovingForward4423 in reply to CLLerinOz]

I’ve watched these programs over and over. I take recommendations on stopping them biting. Here are two points. First, before I was diagnosed with CLL I never got bitten, even if you don’t react you will see small swelling from bites. About two years before being diagnosed, I started to see large numbers of bites, and stronger reactions as I my B symptoms escalated. Now, if I am near water, or plants in anywhere humid, they will find me. I can be with 10 other people, they don’t get bitten, I will end up with 8 or 10 bites.

Second, nothing seems to stop them biting me. Doesn’t matter how much protection I use. However, I have found a simple skin moisturiser that seems to repel them. It’s works for me, but may not work for others.

I truly believe there is some link between CLL and increased attractiveness to mosquitoes. I would really like to see some research done on why CLL seems to have an attraction Mosquitoes find truly irresistible.

[Graham64 in reply to MovingForward4423]

Thanks for the information. That's quite worrying, although I haven't noticed that I get bitten more than others around me, so far.

[esn1967 in reply to MovingForward4423]

MovingForward,

Thanks for sharing this observation. I was diagnosed in 2022. Mosquitos had rarely bothered me before. They liked to bite my daughter and for decades we had a standing joke that she was my mosquito repellant. However, post diagnosis the mosquitos were very intersted in me and I am now quite reactive to their stings with itching, redness, large welts, etc.

Best Wishes on your trip!

Emily

[MovingForward4423 in reply to esn1967]

Everyone seems to have the same issue. I always have antibiotics with the bites. The faster I take the antibiotics the less reactive I am to the bites. There seems to be an overreaction to the bacterial infection……

[Sunfishjoy in reply to MovingForward4423]

Which moisturizer did you use may I ask?

[SofiaDeo in reply to Sunfishjoy]

I bet it's Avon's Skin So Soft bath oil FWIW I read some people find extra B-12 helps with mosquitos, it seems to help me with them as well as no-see-um's.

bcmj.org/articles/mosquito-...

mosquitoreviews.com/mosquit...

[mrsjsmith in reply to SofiaDeo]

Sofia I also take B-12 during the warm weather and I also add garlic in the hope they don’t like the smell. I read that somewhere.

Colette

[Graham64 in reply to SofiaDeo]

Thank you Sofia. So the summary is that the everyday DEET mosquito repellent performs better than the Avon Skin product.

[MovingForward4423 in reply to Sunfishjoy]

avon.uk.com/products/skin-s...

[MovingForward4423 in reply to Sunfishjoy]

avon.uk.com/products/skin-s...

[Graham64 in reply to CLLerinOz]

Many thanks. Very useful to try and understand mosquito habits.

[freddog]

My granddaughter is an epidemiologist currently working on dengue, and as I understand it from her, the current dengue vaccine is not recommended for children.

[Graham64 in reply to freddog]

Thanks for passing this on.