Dengue Hemorrhagic Fever is Endemic in Indonesia, How to Prevent It? - Abdi Waluyo Hospital
December 9, 2023

Dengue Hemorrhagic Fever is Endemic in Indonesia, How to Prevent It?


Oleh:  Thalia Kaylyn Averil

Dengue Hemorrhagic Fever (DHF) is a disease that is transmitted through the bite of infected mosquitoes, primarily from the Aedes species, such as Aedes aegypti. The characteristic feature of the Aedes aegypti is its smaller size compared to mosquitoes in general and its black color
with white spots. Infected female mosquitoes carry the dengue virus (DENV) which then enters the human body through their bites. Dengue virus reproduces in the intestines of mosquitoes after biting an infected human and then spreads to other tissues, such as the salivary glands.
Places with clean water and close to residential areas (usually no more than 500 meters) are the main breeding places for Aedes mosquitoes. Examples are barrels used to store drinking water, bathtubs, or pots, flowers, cans, bottles, drums and car tires found in gardens or yards that collect rainwater. Aedes mosquitoes can also breed in natural places, such as taro leaves, banana leaves, coconut shells, bamboo poles and tree holes that collect rainwater. Female mosquitoes are more likely to suck human blood during the day, especially at sunrise (08.00–10.00) and before sunset (15.00–17.00). Aedes mosquitoes usually rest in bushes or grass in parks or yards. Apart from that, items that are usually found at home, such as clothes, sarongs, skullcaps and other hanging items can also become resting places for mosquitoes. In the wild, an adult female mosquito is estimated to be 10 days old.

Figure 1. Aedes aegypti.

Over the last 50 years, Indonesia has experienced an increase in the incidence of dengue hemorrhagic fever which reaches its peak approximately every 6-8 years. In contrast, since 1980, the death rate for dengue hemorrhagic fever cases has decreased by about half every ten years. The highest annual average number of cases reported occurred in Java, followed by Bali and Kalimantan. On the other hand, Papua has experienced the lowest incidence rate in recent years. The signs and symptoms experienced by each patient infected with the dengue virus may vary, but commonly include high fever with temperatures reaching 40°C that persists continuously, as well as a rash or red spots on the body for 2–7 days. Apart from that, other signs and symptoms that can be experienced by patients are headaches, nausea, vomiting, muscle and joint pain, or pain felt in the area behind the eyes. These signs and symptoms usually appear 4–10 days after infection. Most patients will recover in approximately 1-2 weeks, but there are some individuals who experience severe dengue hemorrhagic fever and require hospital treatment. The dengue virus can also cause Dengue Shock Syndrome (DSS) which is accompanied by hypotension and a fast and weak pulse. Organ damage and internal bleeding can occur due to severe dengue fever which can be fatal in certain circumstances and may cause death. Expanded Dengue Syndrome (EDS) is a term used to describe dengue fever which is rare, but has the potential to be fatal and even death because it causes problems with vital organs.

Figure 2. Common signs and symptoms experienced by dengue hemorrhagic fever patients.


Individuals infected with the dengue virus for the second time are more likely to experience more severe symptoms, necessitating prompt medical attention. Symptoms of severe dengue hemorrhagic fever often appear after the fever subsides, such as:

  • Extreme stomach ache
  • Rapid breathing
  • Bleeding gums or nose
  • Feeling tired and restless
  • Blood appears in the stool or vomit
  • Extreme thirst
  • Pale and cold skin

Dengue hemorrhagic fever can be prevented by avoiding mosquito bites. Aedes mosquitoes are
widespread in most tropical and subtropical countries around the world, so you should take extra
preventive measures if you live in or are considering vacationing in these countries.

  • Wear thick clothing to cover as much of your body as possible because mosquito bites
    can still penetrate thin clothing
  • Sleep in a place covered by curtains, windows, and doors and use air conditioning. If not
    possible, use a mosquito net while sleeping
  • Use mosquito repellent that contains one of the active ingredients, such as DEET,
    picaridin/icaridin/KBR 3023, IR3535, eucalyptus oil with lemon, para-menthane-diol
    (PMD), or 2-undecanone
  • Prevent mosquitoes from laying eggs in water by emptying items that hold water (such as
    tires, buckets, plants, toys, pools, birdbaths, flower pots, trash cans) once a week

Figure 3. Countries at high risk of experiencing dengue hemorrhagic fever (shown in dark purple).

Another prevention that can be done is through vaccines, namely the Dengvaxia and Qdenga vaccines which are available in Indonesia. The first dengue vaccine discovered was Dengvaxia and can be used by children aged 9–16 years who have already been infected with the dengue
virus, thereby preventing them from experiencing more severe symptoms. The latest vaccine developed is Qdenga and can be used by patients aged 6–45 years. Qdenga has received a distribution permit from the Badan Pengawas Obat dan Makanan (BPOM) in August 2022. Both vaccines are weakened virus vaccines that can stimulate the body’s immune system. If you want to get the dengue vaccine, you can come to Rumah Sakit Abdi Waluyo as the dengue vaccine is already available.


  1. Harapan H, Michie A, Mudatsir M, Sasmono RT, Imrie A. Epidemiology of dengue
    hemorrhagic fever in Indonesia: analysis of five decades data from the National Disease
    Surveillance. BMC Res Notes [Internet]. 2019 Jun 20 [cited 2023 Nov 21];12(1):350.
    Available from:
  2. World Health Organization. Dengue and severe dengue [Internet]. Geneva: World Health
    Organization; 2023 Mar 17 [cited 2023 Nov 21]. Available from:
  3. Center for Disease Control and Prevention. About dengue: what you need to know
    [Internet]. Atlanta: Center for Disease Control and Prevention; date of publication
    unknown [cited 2023 Nov 21]. Available from:
Chat with us