Dengue fever cases About 30 suspected cases of dengue fever are under investigation by state health officials in the East Maui communities of Hana and Nahiku.
reported on Maui
Officials have sent blood samples
from about 30 cases in Hana and
Nahiku to disease control labsBy Helen Altonn
haltonn@starbulletin.comNo cases have been confirmed officially, but preliminary laboratory tests support a diagnosis of dengue fever, said Dr. Paul Effler, chief of the Health Department's Epidemiology Branch. He said blood serum samples have been sent to the Centers for Disease Control's dengue fever lab in Puerto Rico for confirmation.
But the department is not waiting, he said. "Were getting control measures off the ground." If the cases turn out to be transmitted locally by mosquitoes, it will be the first time since 1945, Effler said.
About five to 20 cases are imported each year, when someone comes into Hawaii with dengue from a Pacific island or Asia, he said. "That has been occurring more frequently over the past couple months," he said, with 21 cases of imported dengue confirmed.
Symptoms of the mosquito-borne viral illness include high fever, a rash that starts on the arms and legs, severe headaches, fatigue and pain behind the eyes.
None of those being examined in East Maui was severely ill, he said, noting only some sought physician care. The physicians recognized the symptoms could be dengue, he said.
Kris Mills, Health Department epidemiology specialist on Maui, said Dr. Lorrin Pang, Maui District health officer, has seen about 400 cases of dengue around the world.
It has a distinctive rash, she said. "We saw the rash (on Maui patients), and it was very suggestive of dengue fever."
There is no specific treatment for the illness, just "supportive care," Effler said. Aspirin should not be used because it can lead to complications.
The first report of an unknown viral illness occurred Sept. 12, the day after the World Trade Center attacks, Mills said. Specimens were taken in suspected cases, she said, but there was a delay in sending them to state and Centers for Disease Control laboratories because air travel was shut down for several days.
A rapid test for dengue fever was conducted on ill people that provides positive or negative results, she said. They can be false either way, she said.
But combining the test results with the symptoms and characteristic features of dengue fever, she said, "We're pretty sure it's confirmed. We're not willing to wait any longer to act.
"Chances are slim to none that the Puerto Rico tests will come back counter to what we're finding."
Mills said the cases appear confined to Hana and Nahiku, and are mostly in Nahiku, about nine miles from Hana. Three epidemiology specialists are there collecting specimens and case history. Several town meetings were held to update residents.
People of East Maui are concerned about the environment, Mills said. "We're trying to take into account everyone's concerns, using a combination of spraying for mosquitoes and using insecticide, a very safe spray that dissipates from the environment in 24 hours."
She said health officers are working with East Maui Irrigation to open up flows to the stream going through Nahiku to get rid of standing water, a mosquito breeding ground.
They have evaluated the type of mosquitoes in the area and know they can spread the disease down through their eggs, she said.
Residents in the affected areas are asked to use repellents to protect themselves and to eliminate spots where mosquitoes can lay eggs.
Effler said there have been no documented cases in Hawaii since 1945 of dengue affecting people who have not traveled off the islands. "But we're looking at people who were ill that haven't left Hawaii as possible cases and trying to determine if there is local spread. ...
"This would represent somewhat of a change, but it is not unexpected considering the level of activity in other islands."
The health officials pointed to dengue fever throughout the Pacific with epidemics in Tahiti and Samoa, saying there are many people who travel between Maui and those islands.
The viral infection is not spread from person to person but can be introduced into local mosquitoes if they bite an infected person who comes into Hawaii, Mills said. Those mosquitoes can bite people and spread the infection.
Even though there have been no indigenous or local transmissions for more than half a century, he said all cases are taken seriously. Besides mosquito control measures, people in affected areas are advised to wear long sleeves and long pants and to use air conditioning to minimize chances of infection from a mosquito bite.
Effler said there is speculation that dengue fever has not spread locally over the years in Hawaii because of "mosquito ecology."
There has been a lot of development here since World War II; mosquito-breeding sites are less prevalent, and air conditioning is not conducive to mosquitoes, he said. Also, Hawaii is mostly populated with mosquitoes that are poor dengue transmitters, he said.