Maui intensifies dengue fever fight
By Timothy Hurley
Advertiser Maui County Bureau
WAILUKU, Maui — Public health officials yesterday said they are stepping up the battle on the East Maui dengue fever outbreak as the number of confirmed cases has risen from four to 19, including a part-time Maui resident who took the ailment back to his Texas home.
All told, there are 65 cases now under investigation in the first locally generated outbreak of the mosquito-borne disease in Hawai'i since World War II.
Health officials said additional workers are being brought into the East Maui area to step up mosquito spraying, investigate cases, do health screening and educate the community. The Army Reserve also has been asked to help, they said, but the troops may not be available since they remain on alert because of the Sept. 11 terrorist attacks.
Control measures include opening a makeshift health clinic in Hana, starting a information hot line (984-8200) and establishing checkpoints on the Pi'ilani and Hana highways — the roads that connect East and Central Maui — where information and mosquito repellent will be offered to motorists, mainly tourists, heading to East Maui.
Dr. Lorrin Pang, administrator of the Maui District Health Office, said that while the road to Lower Nahiku, a dengue fever hotspot, is closed to tourist traffic, the Hana Highway will remain open because it is a key economic link for the visitor industry.
"It's not worth the cost to Hana,'' Pang said.
In addition, he said, officials aren't sure how many dengue sufferers aren't showing any effects, a common phenomenon.
But Maui County Councilman Alan Arakawa questioned the decision, saying health officials should strongly consider closing the roads to Hana to protect the rest of the island.
"If this gets out of hand, it will be a major blow. It'll ruin our tourist trade,'' said Arakawa, a Kahului resident. "Right now we're in a fragile economic position, and I'd be more comfortable if they were able to confine it to a small area.''
Of the 19 cases so far confirmed by the Centers for Disease Control and Prevention, all of them originated in remote Nahiku and Hana. That includes the Texas man and four other members of his family who also appear to have the disease, and an East Maui resident who continues to commute to his Kahului workplace, Pang said.
Pang said health officials are trying to encourage those who have dengue to stay put during the two-week period in which they can transmit the disease.
He said officials continue to monitor health clinics across the island, searching for new cases. Several have been reported in other parts of the island, but none appear to have originated outside East Maui, he said.
Pang said the epidemic so far has baffled dengue fever experts. While most large outbreaks are caused by the Aedes aegypti mosquito, the East Maui outbreak is being carried by the Aedes albopictus, another mosquito commonly found in the area. The aegypti is not believed to exist there.
The typical aegypti epidemic comes on fast and strong and is over in a couple of weeks. This outbreak has "perculated'' since June, the earliest known case, and has slowly built up to where it is today, Pang said.
He said that while there is hope this outbreak can be beaten because of its slow buildup, there is some concern because scientists aren't quite sure what course this epidemic with take.
The CDC is so intrigued, he said, that it is sending specialists to Maui to oversee the capture of sample mosquitoes.
Pang, who has studied dengue fever in other parts of the world, called on the residents of Maui — and of the whole state — to eliminate sources of standing water, which acts as a breeding ground for mosquitoes.
He called the outbreak a wakeup call for Hawai'i.
"I'm surprised it took this long,'' he said. "It could be a lot worse.''
There are many more serious mosquito-borne diseases that could have struck the Islands. He said health officials in tropical regions across the globe make eliminating standing water a regular preventive practice.
Meanwhile, the Maui Visitors Bureau reported receiving some phone calls from potential visitors asking for information about the problem.
Dave Brazda, general manager of the Hotel Hana-Maui, said that while there have been cancellations directly attributable to the Sept. 11 terrorist attacks, he does not believe there have been any in which the dengue problem was identified.
He said the Health Department finished spraying the hotel's 66 acres yesterday, and the guests were informed of what they were doing. He said he's waiting for direction from the Health Department before any other measures are taken.
Of the tests for 31 people so far conducted by the CDC, 13 came back negative. However, the cases with negative results must be tested again before officials will be satisfied the disease doesn't exist, said Dr. David Sasaki, public health veterinarian with the Health Department's epidemiology branch.
Twenty-two cases of dengue fever were previously reported in Hawai'i this year, but those were from people who had contracted the disease elsewhere, Sasaki said. None of the newly confirmed cases involved people who had recently traveled away from Maui.
The last case of dengue fever occurred in Hawai'i in 1943, when nearly 1,500 cases were reported along with three fatalities.
Reach Tim Hurley at thurley@honoluluadvertiser.com or 808-244-4880.
