Public mobilized
against dengue
fever outbreak

People are urged to clean
sites that may breed
mosquitoes

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By Helen Altonn
haltonn@starbulletin.com

With cases of dengue fever reported on four islands, the state is urging residents to eliminate mosquito-breeding sites in their neighborhoods to halt the spread of a disease that has reached epidemic proportions on other Pacific islands.

Eradication should not be targeted at households, but at communities, said state Epidemiologist Paul Effler.

"It is time for Hawaii to pull its ohana together and get rid of the virus," he said. "It is a window of opportunity to make a difference in Hawaii. We don't want the window to close with inaction. It is important not only for the health of residents, but the economy of Hawaii."

The outbreak began in East Maui, where 21 cases have been confirmed from blood samples sent to the Centers for Disease Control and Prevention's dengue fever laboratory in Puerto Rico.

Eight other cases tested positive in preliminary screening and 67 cases are under investigation because of symptoms of the virus, according to state Health Department figures tallied yesterday.

The total number of confirmed and suspected cases statewide dropped to 96 at last count after some were some ruled out because of symptoms inconsistent with dengue.

Of the 29 cases confirmed by the CDC and testing positive in preliminary screening, 27 are on Maui, one on Kauai and one on Oahu.

Of the 67 suspected cases being investigated, 61 are on Maui, one on Kauai, three on Oahu and two on the Big Island.

Department of Health spokeswoman Janice Okubo said more than 100 staff members on Maui and Oahu have been mobilized to concentrate on mosquito control, education and public outreach.

"We have a full-court press on the dengue problem," Gov. Ben Cayetano said yesterday. "We assigned people from Oahu, Kauai and the Big Island to go to Maui and see if we can contain the problem. To go in and spray, you need to be certified. There are only 60 or 70 in the entire state who can do this.

"We have it contained over on the Hana side. I am confident we are going to get it under control. What we need are more trained, certified people to go in and do the spraying and help with manpower to remove the kind of things that provide breeding grounds."

Okubo said vector control crews are going to all areas with suspected cases to spray for mosquitoes. They are using permanone, a 10 percent emulsifier concentrate that evaporates quickly, she said.

She said the Health Department will work with the counties and other groups on cleanup efforts to eliminate mosquito-breeding areas.

Dengue fever is transferred when a mosquito bites an infected person, then bites another person.

"We're going out with a lot of educational materials for businesses and schools and the public to ask them to be aware of mosquito-breeding areas, to try to clean up areas around their home and help neighbors clean areas around their homes," Okubo said.

Areas with standing water are prime breeding sites. Residents who see tires lying around, trash piling up or other potential breeding sites should call the vector control division at 831-6767, she said.

The common Asian tiger mosquito, or Aedes albopictus, is the species carrying the virus.

Most people in Hawaii have not been infected previously with dengue, and those who do get it generally recover without complications and no long-term side effects, he said.

However, there is increased risk of a more serious illness for persons getting a second infection, he said.

So far, he said, he is not aware of any Hawaii patients hospitalized.

But he stressed a dual message: "People shouldn't be panicked. The illnesses are relatively mild but there can be adverse effects. Most people recover fine, but if we get enough cases, we can have adverse outcomes."

Symptoms of the virus include a sudden high fever, headache, a rash on the arms and legs, and pain behind the eyes. In rare cases, complications may lead to bleeding in the nose and a loss of body fluids that could result in shock and death.

"There may be a 1 percent chance of a fatality," Okubo said. However, she noted Hawaii has advanced hospital facilities and many specialists who know the treatment for dengue hemorrhagic fever.

Symptoms of dengue fever may appear from three days to two weeks after infection, but some infected people may not show symptoms, she said.

People who are sick should call their doctor and the Health Department, she advised.

Effler said one approach to eradicating mosquitoes is spraying the adult insects, which is being done but has limited effectiveness, he said.

"The most important thing that needs to be done, and I can't stress this enough, is to remove breeding sites from your property," he said.

"Get rid of standing water in and around the home, flowerpots, gutters holding water, containers, cans, tires, rubbish, tree holes and bromeliads. All collect water and can have larva in them."