Epidemics: Fever in Hanoi

The disease strikes abruptly but insidiously, and many treat it as if it were flu. After three days of fever, headache and vomiting, victims often deteriorate rapidly, with skin hemorrhages, nosebleeds, bloody vomiting, clammy hands and feet and abdominal pain. The febrile, blood-depleted patient may enter shock, which proves fatal for half of those who do.

What began in North Viet Nam as the Year of the Cock has become the Year of the Mosquito. Aëdes aegypti, a versatile vector best known as the primary carrier of yellow fever, has brought a crippling epidemic of hemorrhaging dengue-like fever to the Hanoi area.

In the past month, the fever has killed considerably more than 1,000 North Vietnamese, nearly 90% of them between the ages of two and 15. From expressions of concern by the government radio and press, Hanoi watchers infer that the disease has already cut into the North’s industrial productivity.

Dandy Walk. The onset of the epidemic coincided with the end of the summer floods. The worst in the country’s history, they polluted municipal water supplies, damaged sanitation facilities and dotted the Hanoi area with myriad mud puddles. And even the smallest will do for A. aegypti—”the water in a stalk of bamboo is enough to get them going,” says one authority. They are among the most urbanized agents of epidemic: they breed and live in or near human habitation and readily, even preferentially, bite man. To boot, they are all but exclusively daylight and twilight feeders, so that bed netting is of little or no help.

Similar hemorrhagic epidemics appeared in Manila and Bangkok in the mid ’50s. Singapore was hit in 1960, and Bangkok has undergone another siege this summer. The current disease is a viral variant of dengue (pronounced dengghee), a less virulent malady that has some different symptoms (aching muscles and joints, no hemorrhaging). The affliction is sometimes called “dandy fever”—for the peculiar mincing gait of those whose joints have been affected.

Bangkok’s populace has been advised to empty standing containers of water, to fill in ruts, potholes and other potential mosquito-breeding sites. Hanoi newspapers are urging the citizenry to “kill mosquitoes and larvae, prevent mosquitoes from biting,” and closely supervise “daily sanitation in houses, gardens and streets.” There is neither a preventive vaccine nor a specific cure for the fever. A patient’s biggest asset is a constitution strong enough to see him through the five or six critical days. Treatment is palliative at best. The most advanced medication suggested by Hanoi authorities is a fermented mixture of green beans, horse-radish and earthworms.