Saturday, October 6, 2001


The fight against
dengue fever

Officials act to stem the spread
of the viral disease by
organizing community cleanups


By Helen Altonn

Hawaii's dengue fever outbreak is growing, with 26 confirmed cases -- all on Maui -- and an extra 115 suspected cases statewide, according to the latest Department of Health figures.

Nine of the cases under investigation tested positive in preliminary screening but have not been confirmed by the Centers for Disease Control and Prevention's dengue lab in Puerto Rico.

The 26 confirmed cases were identified out of 37 blood samples examined by the lab.

The suspected cases include 14 on Oahu, eight on the Big Island, one on Kauai and the rest on Maui. They are in scattered areas, said Janice Okubo, Health Department spokeswoman.

Hawaii has had increased "imported" dengue cases this year, brought in by people infected in Pacific or Southeast Asian areas with dengue epidemics.

Mosquitoes also are believed transmitting the virus locally, feeding on an infected person, then biting others.

City refuse crews on Monday will start collecting any junk or discarded items that collect water -- potential homes for mosquitoes.

The state has asked the counties to cooperate in a massive effort to prevent spread of the viral disease, which started in East Maui.

Mayor Jeremy Harris said yesterday the county is taking immediate action to eradicate or minimize the threat, and he asked all residents to help.

They can call 523-CITY (2489) for assistance in disposing of abandoned or unwanted autos, boats, trucks or other junk on their property that are or could be mosquito breeding sites.

Unwanted items also can be left curbside in front of homes for pickup.

Although thousands of people could be affected if the outbreak is not controlled, Gov. Ben Cayetano stressed that is a worst-case scenario.

"If you want to put it in context, we have a couple hundred tuberculosis cases a year, and we have about 1,000 cases of food poisoning from botulism," he said. "If you sit on your okole and do nothing, it becomes a self-fulfilling prophecy."

But, he said, "We are doing something about it," and "it's under good control."

The state is spraying all areas where cases have been confirmed or suspected and is conducting an education program "to teach people how to help themselves," Cayetano said.

Mayor Jeremy Harris announced public service announcements to encourage community, civic, religious, sports and professional groups to join him next Saturday for an islandwide cleanup. Volunteer groups are asked to call 523-CITY (2489) to offer support and receive instructions.

Cayetano said Harris' announcement "is not surprising. He has run public service announcements on many things. We may be calling him Dr. Harris pretty soon."

People who think they may be infected with the dengue virus should see a physician and call the state Department of Health, 241-3563.

Residents are asked to inspect their yards, eliminate any standing water, make sure windows have screens and doors are intact, and spray potted plants with an insecticide or mixture of 4 ounces of liquid detergent to 1 gallon of water.


Basic facts about dengue fever

Islanders will hear a lot about dengue fever as state and county governments monitor an outbreak of infections across the state and attack mosquito breeding areas. Following are answers to common questions about the viral disease:

Question: What is dengue fever?

Answer: The most important mosquito-borne viral disease affecting humans, with four closely related strains, DEN-1, DEN-2, DEN-3 and DEN-4. It is often mistaken for typhoid, influenza, measles, malaria or scarlet fever.

Q: What type is showing up in Hawaii?

A: DEN-1, known as the Hawaii strain because it was identified in Hawaii during World War II by Albert Sabin, who discovered polio vaccine.

Q: What is dengue hemorrhagic fever?

A: A more severe form of illness with bleeding as well as other dengue symptoms. Dengue hemorrhagic fever is fatal in about 5 percent of cases, mostly among children and young adults. Still more severe is dengue shock syndrome. It can lead to circulatory failure and shock. About 10 percent of those cases are fatal.

Q: Are you immune if you get infected once?

A: No. You can still get any of the other three types of fever. Risks are greater when a person is infected a second time.

Q: What are the signs of dengue fever?

A: A sudden onset of high fever, severe headaches, joint and muscle pain, nausea, vomiting and rash on the arms and legs. The rash may appear three to four days after fever begins. The illness may last up to 10 days, but complete recovery can take up to four weeks.

Q: How are symptoms treated?

A: With rest, fluids and medications to reduce fever, such as acetaminophen. Avoid aspirin.

Q: Is there a vaccine for dengue fever?

A: No. Some candidates are in trial in Thailand and other places, but it is difficult to develop one vaccine effective against all four viruses.

Q: Without vaccine, how can I keep from getting infected?

A: Cover your arms and legs, remain in well-screened or air-conditioned areas, use mosquito repellents on skin and clothing. Spray with common household insecticides, and get rid of larval breeding sources.

Q: What mosquitoes carry the virus?

A: In Hawaii it is the day-biting Asian tiger mosquito, Aedes albopictus, about 1/8-inch long, black with white stripes. Hawaii has pockets of Aedes aegypti, the fly primarily responsible for the infection in other regions, but it is not found in parts of the state where cases have been reported.

Q: Where do Asian tiger mosquitoes live?

A: They like containers, laying eggs in anything holding water, such as tires, flowerpots, urns, vases, rain gutters, ornamental ponds, even bowling ball finger holes. Larvae are found in tree holes and natural containers.

Q: Has Hawaii had dengue fever before?

A: The last time was in 1945, but there were several outbreaks in the late 1850s.

Q: Why is it back after 50 years?

A: "Imported cases" have increased with infected travelers coming here from epidemic Pacific Island and Southeast Asian areas. Local transmission occurs when a mosquito bites an infected person, then bites someone else.

Q: What is the international status of dengue fever?

A: It is spreading quickly around the globe, particularly in the tropics and subtropics. The World Health Organization estimates 2.5 billion people are at risk for the infection. The number of dengue cases diagnosed in the U.S. doubled between 1997 and 1998.

Sources: State Health Department, Centers for Disease Control and Prevention, International Research Institute for Climate Prediction, World Health Organization

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