Some resisting convention in anti-dengue fever efforts

By Yasmin Anwar
Advertiser Staff Writer

Many who have made the lush, remote East Maui area of Hana their home enjoy a self-sufficient, unconventional lifestyle.

Department of Health inspector Raphael Vares sprays insecticide after finding standing water at a home. Inspectors canvassed homes in Kapahulu, Kaimuki and Hawai'i Kai near those of persons suspected of having the illness. Bruce Asato • The Honolulu Advertiser

But some say East Maui's alternative lifestyle has been an impediment to launching an effective dengue offensive in the area.

When Maui district health administrator Lorrin Pang attended town meetings in Hana to suggest tough ways to curb the mosquito-borne disease, he encountered some resistance.

"I've been accused again and again at these town meetings, 'We don't need your Western science,'" Pang said yesterday after a dengue briefing before members of the state House Committee on Health.

"A lot of people are legitimately concerned, but now is not the time to test out (alternative remedies) that might not work, might not be effective and might be diversionary," Pang said.

Still, Pang credits many around Hana for doing their best to cooperate with authorities. Besides, the counter culture comes with the territory. "They're looking for universal harmonious ways to address this disease," Pang said. "This is Maui."

Although some in East Maui have objected to the use of commercial mosquito repellents and insecticides, others were reluctant to let vector control crews and public health officials into their homes for fear that they would be cited for building-code violations or growing marijuana.

•	Dengue update More than 200 cases of dengue fever are under investigation by health officials. Most are suspected cases that have not been confirmed by officials at the Centers for Disease Control and Prevention. Here's a breakdown so far:
•	Confirmed cases Statewide: 40 Maui (total: 39) Hana area: 34 Ha'iku: 3 Pukalani: 1 Lahaina: 1 Kaua'i (total: 1) Kalaheo: 1
•	Cases tested positive (In preliminary screening) Statewide total: 9 MAUI Hana: 1 Kihei: 2 Wailuku: 2 O'AHU Ka'a'awa: 1 Honolulu: 1 KAUA'I Anahola: 1 Hanalei: 1
•	Suspected cases* Statewide: 165 (This number includes anyone who complains of two denguelike symptoms, in addition to fever.) * Under investigation

Pang recalls asking the first dengue victims in Nahiku why they had not sought medical attention after experiencing severe dengue-like symptoms.

"They said, 'Well, we just tried to handle it on our own.' When I said, 'Maybe it was mild, maybe you weren't that sick?' they said 'No, it was the worst thing I ever had in my life.'"

At the moment, East Maui is undoubtedly ground zero in Hawai'i's dengue outbreak. Of 39 federally confirmed dengue cases reported on Maui, 34 are in the Hana area.

The U.S. Centers for Disease Control and Prevention has confirmed one dengue case in Kalaheo, Kaua'i. But that victim is believed to have recently visited the Hana area and may have contracted the virus there.

However, there are nine other cases that have tested positive in preliminary screening, and four of those are on O'ahu and Kaua'i.

Pang says the rapid field tests used in preliminary screening are mostly reliable when they test positive. Ultimately, though, all suspected cases require final confirmation from the CDC dengue fever laboratory in Puerto Rico.

However, Hawai'i expects to set up its own dengue fever laboratory with confirmatory testing by the end of the month.

The dengue virus in Hawai'i is transmitted by the vector mosquito Aedes albopictus. Victims typically suffer high fever, headaches, rash and muscle aches. In severe cases, the disease can develop into dengue hemorrhagic fever, which has a fatality rate of 5 percent.

The incubation period from when victims are bitten to when they experience symptoms is usually 5-8 days and the symptoms can last one to three weeks.

Pang said there is little incentive for dengue victims to give blood samples to test for antibodies to the virus once they have recovered because there is no treatment or vaccine for the disease.