Tests confirm 35 cases of dengue fever in state

By Yasmin Anwar
Advertiser Staff Writer

The number of dengue fever cases confirmed in Hawai'i rose to 35 yesterday, with one case on Kaua'i, indicating that the locally transmitted outbreak is not limited to Maui.

The latest batch of blood test results to return from the U.S. Centers for Disease Control and Prevention's dengue fever laboratory in Puerto Rico established 34 dengue cases on Maui and one in Kalaheo on Kaua'i.

However, health officials said there is evidence that the Kaua'i victim traveled to East Maui, the hot spot of Hawai'i's dengue outbreak, and could have contracted the virus there.

Meanwhile, a team of CDC epidemic intelligence services officers are headed to Kaua'i today to investigate suspected cases on that island. A group of Kaua'i surfers had complained about dengue-like symptoms after a visit to Tahiti, where dengue fever has reached epidemic proportions.

Of nine locally transmitted cases that have tested positive in preliminary screenings, two are on Kaua'i, two on O'ahu and five on Maui.

"Obviously, Maui stands out but we're not limiting our investigation to Maui, and we are trying to look for cases elsewhere," said Dr. Paul Effler, chief of the state Health department's epidemiology branch. "So I think it behooves us all to take this problem seriously and to start mosquito control efforts statewide."

Another 127 suspected cases are under investigation. However, state health officials say many of those may turn out to be other illnesses that include flu-like symptoms, and do not reflect the scope of the mosquito-borne disease in Hawai'i.

Nonetheless, they are treating each potential case seriously.

"We have over 100 possible cases on other islands that we are pursuing and we need to assume the worst, that at least some of those cases will be confirmed," said state Health Director Bruce Anderson.

The results of dozens of more suspected cases will emerge in coming months. It takes one to two weeks for Hawai'i to receive the results of blood samples sent to the dengue fever laboratory in Puerto Rico.

A spokeswoman for the state Health Department said the agency is considering the feasibility of setting up a testing laboratory in Hawai'i. The last dengue outbreak in the Islands occurred during World War II.

There have been about 20 imported cases of dengue fever this year, with most originating in Tahiti and American Samoa, and a few coming from Thailand and the Philippines.

But what makes this latest outbreak unusual is that the 35 confirmed cases are locally transmitted.

"This is the first time we've ever had cases where exposure has been local, where mosquitoes here are implicated in causing the disease," Anderson said.

Jose G. Rigau, chief of epidemiological services at the CDC's dengue branch in Puerto Rico and one of several CDC officers assisting the state, applauded Hawai'i's effort to drive out dengue.

"Dengue is not an easy disease to topple," Rigau said. "It requires putting together many parts of public health: diagnosis, vector control, community education and medical care."

He said it appears fortunate that the suspected dengue carrier in Hawai'i is the Asian tiger mosquito known as Aedes albopictus rather than the Aedes aegypti, which is to blame for dengue epidemics in Puerto Rico and Southeast Asia and is more efficient at transmitting the virus.

"Aedes aegypti is much better at doing the job," Rigau said.

Dengue, the Spanish word for affectation, was first named in 1801 by the Queen of Spain.

It 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. To date, there is no treatment for the disease.

Hawai'i's dengue outbreak surfaced in East Maui in June, but was not established until September because the victim did not immediately seek medical help.

After catching mosquitoes in East Maui, entomologists have concluded that the most likely dengue carrier, in that region at least, is the Aedes albopictus, a small, soundless, striped mosquito that bites during the day.

Victims usually suffer high fever, headaches, muscle pains and rashes on the arms and legs. The more serious dengue hemorrhagic fever has a fatality rate of 5 percent.

However, no serious illnesses as a result of dengue have been reported in Hawai'i so far.

In an effort to curb the spread of dengue, state vector control crews are spraying insecticides where suspected cases have been reported. Health officials are tracking suspected cases reported by hospitals and physicians.

Meanwhile, residents are being urged to get rid of stagnant water and trash that could serve as a potential mosquito breeding ground

Honolulu Mayor Jeremy Harris yesterday said more than 550 O'ahu residents responded to a call to get rid of garbage that provides breeding grounds for mosquitoes.

The city has been towing abandoned vehicles, picking up old tires, boats, appliances and furniture.

"We picked up 110 tons of bulky items islandwide and we're going to be picking up bulky items all week long."

He said that most of the rubbish brought in yesterday came from urban Honolulu which had 75 tons, another 15 tons from Wahiawa and 20 tons more from other rural areas. City officials today expect to target Kailua, Kane'ohe, Pearl City, Waialua and La'ie.

People are encouraged to put those large items out by the curb for city crews and to call and request pick-up.

Harris is still looking for support from community and business organizations with an islandwide clean-up on Saturday to help go door-to-door to help pass out brochures warning of the dangers of dengue fever. "City crews are going to be doing the heavy lifting on Saturday in stream areas that may have mosquito problems."

Those who want to help can call 523-CITY (2489) to volunteer. Harris said groups will pick up some litter but do the most good by getting the word out to as many people as possible about cleaning up their yards and using mosquito repellent to prevent the spread of the serious disease.

Staff writer Robbie Dingeman contributed to this report.