State stepping up efforts to contain dengue fever
By Walter Wright
Advertiser Staff Writer
With federal health authorities confirming two more cases of dengue fever in Hawai'i, the state, counties and tourism agencies yesterday increased efforts to contain the disease — and contain any tourism backlash it may bring to an industry already reeling from terrorism fears.
"We have a full-court press on the dengue problem, and we've assigned (certified mosquito control) people from O'ahu, Kaua'i and the Big Island to go to Maui and see whether we can contain this problem," Gov. Ben Cayetano said yesterday. "I'm confident we're going to get it under control."
But on a day when the number of confirmed cases reached 21, experts warned of the challenge that poses.
Some other cases that did not test positive may have involved people infected too long ago for the antibodies to be detected in their blood samples, State Health Department spokeswoman Janice Okubo said.
The number of suspected cases in the current outbreak has reached 116, a figure that includes one case from Ka'a'awa, O'ahu; one from Anahola, Kaua'i; and four from Kailua in Kona on the Big Island.
The patients had no recent travel history off their islands in any of those cases.
Cayetano acknowledged that some people may change Hawai'i travel plans because "most people think of dengue fever as something you encounter only in Third World countries."
To deal with the threat to both public health and tourism, state and visitor industry officials have begun massive information campaigns that eventually may extend to handing out leaflets to passengers at airports here.
Although Hotel Hana-Maui was believed to have had some cancellations because of the scare, Maui Visitors Bureau Director Marsha Wienert said the resort may be one of the safest spots in the state because the hotel and its grounds have been so thoroughly sprayed.
Wienert said her office is getting about 25 telephone calls and a couple of dozen e-mails a day from prospective visitors asking about the outbreak.
She responds with a "Dear Maui Visitor" letter outlining the problem in Hana and East Maui, describing symptoms and listing precautions such as using mosquito repellent containing DEET, wearing full-length pants and long sleeves, and avoiding damp, dark areas where mosquitoes may be.
"Under control" may not mean completely eliminated, but Dr. Paul Effler, state epidemiologist, said he hopes that Hawai'i may be able to wipe out dengue as it did after major outbreaks in the 1940s.
No easy task
It could be an uphill battle.
Effler said that when he asked federal experts at the Atlanta-based Centers for Disease Control and Prevention what could be done to eradicate dengue here, "there was this sort of surprised laughter.
"It wasn't cruel, but they said, 'We have never encountered a situation in other countries where eradication seems possible,' " Effler said. "That should tell you about the potential tenacity of this very difficult situation."
But Effler said that because the Aedes albopictus mosquito involved here does not appear to be a good transmitter in other parts of the world, and because the virus has not established itself here for more than 50 years,Hawai'i may have a better chance.
"Maybe conditions don't highly favor it here," he said. "Maybe we will be favored by nature alone."
An entomologist from the federal health agency in Atlanta arrived in Hawai'i yesterday to assist in the effort.
Control now is focused on the wholesale elimination of mosquito breeding spots — such as old tires or other places where standing water can collect — and on ground spraying of mosquitoes anyplace an infection is reported.
Transmitted by insect
Dengue is passed by mosquitoes that bite an infected person and then carry the virus to another person when the insects bite again. So the first key to reducing dengue's spread is to keep infected people away from mosquitoes, and vice versa.
Because many individuals, especially children, escape the excruciating pain suffered by some, infected people without symptoms may unwittingly carry the disease from one community, or island, to another, Effler said.
That reality makes any idea of quarantine impractical, he indicated.
With the first known case now believed to have occurred in June — though not identified until months later because the individual didn't seek medical attention — the virus may have spread beyond Hana and to Neighbor Islands long before the first medical case was confirmed Sept. 12, Effler said.
Spraying pesticides from aircraft may have worked years ago when DDT was used, leaving deadly residual toxins around for a long time, Effler said, but the CDC says such spraying is ineffective with the insecticides now permitted.
The new pesticides kill only the adult mosquitoes they strike directly, so spraying over a forest canopy would miss many, Effler said.
Staff writer Kevin Dayton contributed to this report.
