A British tourist on a dream Bali holiday thought she had just fallen ill with the flu, but it turned out to be potentially life-threatening dengue.
Emma Cox, 27, had been on the tropical island in Indonesia for just 10 days before coming down with muscle and joint pain and a severe headaches so painful she had to wear sunglasses indoors.
Urgently booking a flight home to the UK, she developed a full body rash shortly following her arrival and the ‘terrified’ West Yorkshire-native rushed to A&E where medics confirmed she had been infected with the mosquito-borne virus.
‘The virus gave me a rash that spread right across my body — I felt horrendous, and thought it wasn’t ever going to go away,’ she said.
Experts warn Ms Cox’s experience could be coming much closer to home with the dengue cases having exploded in Europe as the mosquitos which carry the virus become increasingly common on the continent.
Emma Cox, 27, had been on the tropical island in Indonesia for just 10 days before coming down with dengue
Three days after returning to the UK she awoke to find a ‘horrendous’ rash covering her body
The content creator also experienced muscle and joint pain and a severe headaches so painful she had to wear sunglasses indoors
With the insects now being reported in France, public health scientists now fear the Paris Olympics in July could turn into a dengue ‘superspreader event’.
Ms Cox arrived in Indonesia on May 6 this year and began feeling unwell on the fifth day of her trip, but initially dismissed this as just being due to the air-conditioning.
She woke up with muscle pain and joint pain — as well as a burning sensation behind her eyes, classic signs of dengue infection.
Ms Cox also felt exhausted – but paradoxically too restless to get any sleep with painful headaches forcing her to wear sunglasses inside 24/7.
With hindsight she now knows it was the mosquitoes that were plaguing her in the night that gave her the dengue virus.
‘In my room, the glass on the window was cracked and there was a big hole in it,’ she said.
‘It sounds so stupid, but I couldn’t see it because it was covered by a curtain.
‘Every night while I was staying there, I’d wake up, covered in bites.
‘The only precaution I really took was spraying myself with repellent.’
At the time the content-maker thought she had just come down with the flu and decided to cut her trip short.
‘My next thought was ‘oh god, I’m going to have to spend 23 hours flying home,’ she said.
‘I genuinely thought I had the flu, and I was expecting it to go fairly quickly.’
On the day of her departure and arrival back in the UK Ms Cox said she started to feel much better.
‘The symptoms went away,’ she said. ‘I was absolutely fine – I thought I must’ve got away with it.’
However, three days later she awoke to find a ‘horrendous’ rash covering her body.
‘It was so strange, I felt fine within myself,’ she said. ‘But I’d woken up with bumps all over my body – I’d never seen anything like it.
Ms Cox sought advice about the rash from social media and she eventually went to A&E for help from medics
The 27-year-old originally thought she had fallen ill from the air-conditioning but it was eventually revealed a crack in a window in her accommodation was letting mosquitoes in
Dengue is spread by infected mosquitoes passing the virus onto to people through bites. Pictured are some of the NHS blood tests Ms Cox undertook while seeking help for her condition
Dengue is a potentially deadly virus passed to people by infected mosquitoes and was historically known as ‘breakbone fever’
‘They were really itchy, and they kept spreading.’
Posting about the experience on social media users advised her to go to call NHS 111 and mention she’d been in a dengue hotspot.
Advised by the NHS to go to A&E Ms Cox found herself being put into quarantine while medics ran tests in attempt to uncover the cause of her symptoms.
‘They put me on an IV, and together we came up with a complete timeline of each place I’d visited,’ she said.
‘I had blood tests for loads of things – like Malaria, and HIV.
‘It felt like they didn’t really know how to treat someone with dengue.
‘I was there for an hour, and they told me, because I didn’t seem fatal, I could go home. They checked up on me with phone calls, once a day, for seven days’.
Ms Cox’s rash eventually cleared up on its own, within eight days.
While Ms Cox caught dengue in the tropics where the virus is most common, cases of the potentially deadly virus are on the rise in Europe and British holidaymakers heading to the continent could be at risk.
A total of 130 cases of the disease were recorded in the EU and EEA last year, almost double the number compared to the previous year.
And health officials fear this is part of a growing trend. Case totals for 2023 and 2022 are a huge spike compared to the 73 cases recorded on the continent between 2010 and 2021.
Dengue historically known as ‘breakbone fever’ because of the severe pain it can cause in the muscles and the joints, is normally endemic to Central and South America, the Caribbean and Southeast Asia.
But experts warn that climate change is making the Mediterranean more hospitable for the mosquitoes that carry the disease.
Dengue symptoms typically strike between four to 10 days after being bitten, which means holidaymakers may still need to keep an eye for potential signs upon their return to Britain.
A dengue infection typically manifest as flu like symptoms.
Typically, patients suffer a fever that lasts for between two and seven days — this may peak, reduce and then peak again during this time.
During the first days, this may be accompanied by facial redness.
Other common symptoms at this stage include a severe headache, pain behind the eyes, muscle and joint pain — giving the disease its ‘bone-breaker’ moniker — nausea and vomiting and swollen glands.
A flat, red rash may appear over most of the body within three to seven days after the fever starts — thought to be caused by an immune system reaction to the virus. This is itchy is around a quarter of patients.
Although less common, bleeding gums may also be seen.
Brits with dengue symptoms who have been in an area where the disease is prevalent are advised to contact their GP or NHS 111 for an urgent appointment.
This is due to a risk of a potentially life-threatening complication that typically strikes just as people start to feel better.
While people infected with dengue recover after one to two weeks, there is a chance some can develop a far more serious form of the infection.
Called ‘severe dengue’ this is a life-threatening condition that develops in about one to 20 cases (five per cent) of people being infected with the virus.
Experts estimate this version of dengue kills half of people who suffer it.
Dengue is normally transmitted by mosquito bites, but exposure to infected blood can also result in people catching the virus
Symptoms of severe dengue include severe stomach pain, repeatedly being sick, fast breathing, bleeding gums, nose bleeds, extreme tiredness, restlessness and blood in your vomit or faeces.
These typically strike after between 24 to 48 hours after the initial wave of dengue symptoms has passed and people start to feel better.
It is a serious medical emergency and people with symptoms are advised to call 999 or head to A&E as soon as possible.
People who have had dengue previously are known to be more at risk of suffering a severe version of disease in the future from subsequent infections.
It also advises that people who are more vulnerable to dengue, such as young children, the elderly, pregnant women and those with a weakened immune system should avoid traveling to areas where the virus is present.
Dr Simon Clarke, an infectious disease expert University of Reading, told MailOnline that Brits heading to the continent needed to be aware of potential dengue symptoms even after they returned home.
‘Dengue fever is something that has traditionally been associated with more unusual and exotic destinations, but more recently France, Italy and Spain have recorded multiple infections, so travellers from the UK should be more aware of this potentially fatal infection,’ he said.
‘Travellers need to be made aware not only of the increasing risk, but also of the symptoms, the 4fourto 10 days it can take for them to appear after someone has been bitten by an infected mosquito, and the importance of getting medical advice if they think they’ve contracted dengue.’
He added that as climate change is predicted to make the mosquitos that carry dengue more common in Europe controlling the insects would be an increasing important consideration for holiday destinations.
Professor Ian Jones, a virologist at Reading, also told this website that while there was no need re-think holiday plans yet, dengue in Europe is likely going to get worse.
The risk of contracting dengue in Europe remains low, far more cases are imported from countries where the infection is common, but the numbers are increasing, and we should expect this trend to continue in the near-term,’ he said.
‘A number of virus infections, including dengue, are transmitted by insects and as climate change expands their range, the incidence of virus infection also increases.’
He urged holidaymakers to take sensible precautions to reduce their risk of catching the virus when travelling in known dengue areas.
Prevention is considered the best way to avoid getting dengue and people visiting areas where the disease is prevalent are take steps to reduce their risk of mosquito bites.
Dengue fever is a viral infection transmitted by mosquitoes that has been historically confined to tropical or subtropical climates . It infects an estimated 400million people a year. Pictured: A house in Peru being fumigated against mosquitoes to prevent the spread of the disease
This map shows areas where mosquitoes capable of carrying dengue have been introduced in Britain. These populations have not yet established a permanent presence in the UK but experts have warned climate change means their spread is inevitable
These include wearing long sleeved clothing and trousers, using insect repellent, keeping unscreened windows closed in their accommodation, and sleeping under a mosquito net.
People should be especially cautious during the early morning and early evening as these are when mosquitoes are most active.
Dengue transmission is currently not considered a risk in the UK, though mosquitoes capable of carrying the virus have been found in the wild in Britain previously.
Normally, people with dengue cannot pass the virus to others directly, though mosquitoes can bite them and then go on to infect other people.
However, very rare cases of dengue being passed on through contact with infected blood via transfusions or organ donation have been recorded.
A total of 634 dengue cases were recorded by The UK Health Security Agency (UKHSA) in 2023.
These were all imported cases, where someone was infected while overseas and then fell ill upon returning.
UKHSA officials warned the figure was now approaching pre-Covid levels after cases naturally dived during the pandemic due to travel restrictions and urged travellers to be vigilant.
Experts have previously warned dengue is among a number of diseases that could become established the UK due to a ‘slow march north’ of insects due to climate change.
Globally, there were a reported 6.5million cases of dengue of which 7,300 resulted in death in 2023, according to the World Health Organization (WHO).
However, the WHO says modelling suggests there are 390million actual infections per year.
