State preparing response to dengue fever outbreak

By Yasmin Anwar
Advertiser Staff Writer

Hawai'i's outbreak of dengue fever still appears to be concentrated in East Maui, with 26 cases on the island confirmed by the U.S. Centers for Disease Control and Prevention.

However, the full scope of the mosquito-borne disease around the state won't emerge until next week at the earliest, when dozens of blood test results start to arrive from the federal health agency's dengue fever laboratory in Puerto Rico.

Of about 100 suspected cases reported on Maui, O'ahu, the Big Island and Kaua'i, about 10 percent have tested positive in preliminary screenings. State Health Director Bruce Anderson said such tests are at least 50 percent reliable.

The virus appears to have arrived independently on Hawai'i's various islands from such places as Tahiti and American Samoa. It is the first indigenous outbreak of dengue fever in Hawai'i since World War II.

The Advertiser reported yesterday that one dengue case had been confirmed on O'ahu in Ka'a'awa. However, health officials are still waiting for the CDC to confirm that test.

Assisting the state's anti-dengue effort are some of the nation's leading dengue experts. CDC entomologist Paul Reiter just arrived on Maui, and a group of CDC epidemic intelligence service officers are on their way.

"We've got some of the best minds working on this," Anderson said.

In the best-case scenario, Anderson said the problem would be contained by Christmas. However, if little or no action is taken, he said the outbreak has the "potential to become a serious problem."

Earlier this week, Anderson said in a worst-case scenario, the virus could infect perhaps 20 percent of the population in Hawai'i if nothing is done to eradicate the dengue-carrying mosquitoes.

But Gov. Ben Cayetano yesterday said that worst-case scenario is "highly unlikely to happen."

"Worst-case scenarios happen only if you do nothing about it, you sit on your 'okoles, you do nothing about it. ... On this dengue fever, we are doing something about it, and I believe that, not withstanding the press reports, we have this problem under good control."

He said the state is planning a publicity campaign to urge Hawai'i residents to get rid of standing water around their homes that provide a mosquito breeding ground.

Meanwhile, vector control crews are spraying insecticides where cases are suspected, although Anderson acknowledged that the agency is "spread pretty thin." Refuse crews also are collecting trash that could act as a potential breeding place for mosquitoes.

"We've gotten a wake-up call," said state epidemiologist Paul Effler, who has assigned most of his 45-member staff to the matter. "It's time to get rid of mosquito breeding sites in Hawai'i."

Dengue fever is a viral infection spread via mosquitoes that bite an infected person and then carry the virus from one person to the next. People cannot infect other people.

In Hawai'i, carriers are Asian tiger mosquitoes, also known as Aedes albopictus, which are small, striped, soundless mosquitoes that tend to bite during the day.

Victims usually suffer high fever, headaches, muscle pains and rashes on the arms and legs. Symptoms can last from two to four weeks after infection. The more serious dengue hemorrhagic fever has a fatality rate of 5 percent. There is no treatment for the disease.

However, no serious illnesses as a result of dengue has been reported in Hawai'i, leading public health officials to believe that the DEN-1 strain in the Islands is a relatively mild one.

"The fact is, it isn't a widespread outbreak at this point in time, and we're doing everything we can to keep it from becoming that," Anderson said.

Effler said the good news is that the mosquito is not the more serious Aedes aegypti.

While Aedes aegypti tends to feed only on humans, and usually lives in trash in densely populated areas, the albopictus also dwells in forest areas and feeds on animals as well as humans, which means it may pose less of a threat.

Nonetheless, some are bracing for the worst.

Sandii Kamauna, proprietor of Military HQ, a military surplus store on Sand Island Access Road, said she started stocking up as soon as she began hearing whispers of dengue fever.

First priority: a military version of mosquito repellent that contains more than twice the usual dosage — 71 percent — of diethylmetatoluamide or DEET, a pesticide controlled by the Environmental Protection Agency because of its toxicity and potential for damage to the environment. Ten cartons arrived yesterday afternoon.

"This is the stuff that really works," she said. "This is the stuff they used in Vietnam."

Kamauna said she advises customers to use it on sleeve cuffs and pant legs, or to dab it on bare limbs. She said she thinks the environment won't be harmed, as long as people refrainfrom dumping it by the gallon into drinking water.

And if it does turn out that DEET has even more nasty characteristics than those identified by the EPA?

"Well," she said. "I'll take my chances with DEET. But then, a lot of these people who are buying this stuff now are the same people who were in last month, buying gas masks."

Diana L. King, education director for Hawai'i Nature Center, said she and her co-workers reluctantly decided yesterday that they should begin advising children scheduled to tour high-mosquito areas of the state's nature centers sites to wear mosquito repellent with DEET.

But she said she would not advise repellent with DEET levels even close to the potions Military HQ is selling.

"DEET is nasty stuff," King said. "But when you compare DEET to dengue fever? Well, dengue fever is pretty nasty, too. I say: Wear your DEET, baby."

The state Health Department, on the other hand, are spraying Permanone from backpack kits, said Ken Hall, program manager for the agemcy's vector control branch. A larvicide consisting of petroleum distillates, or mineral oil, is used to kill larvae in water.

Hall said the department ordered a special shipment of Permanone after state stores fell to about 15 gallons — about enough to treat two football fields. Fifty to 100 gallons are expected to arrive Monday, he said.

Mayor Jeremy Harris is arranging for a garbage pickup program where refuse workers will haul away discarded furniture, old tires and other items that collect water and provide places where mosquitoes potentially could breed.

Harris also encouraged residents to check their own property for standing water in plants, such as bananas and bromeliads, plant pots, and other places where the insects could develop. Residents can call 523-CITY (2489) for help disposing of abandoned vehicles, boats and other large items.

Harris also is asking for help from community, religious, sports and professional groups with an islandwide cleanup. The city will provide trash bags and trucks.

Maui County is taking similar measures. Starting Monday, the Department of Public Works and Waste Management will temporarily increase the number of curbside pickups around Hana Nahiku and Hamoa. The county also announced that it would waive residential tipping fees at the Hana Landfill starting Nov. 30.

Meanwhile, the Maui District Health Office plans a series of community meetings. Meetings will take place at 4 p.m. Monday at Helene Hall in Hana; 6:30 p.m. Tuesday at Lahaina Civic Center; and 6:30 p.m. Wednesday at Wailuku Community Center.

Staff writers Karen Blakeman, Kevin Dayton and Robbie Dingeman contributed to this report.