Number of typhus The number of typhus cases in Hawaii has climbed to 12, and more are expected because of mouse infestations in some areas and greater surveillance and awareness by residents and doctors, state health officials say.
incidents rises to 12
A health official says it is not
an epidemic but that it is "serious"By Helen Altonn
haltonn@starbulletin.com"The peak was 10 (cases per year) in the past, and we're only halfway in the year," Dr. Paul Effler, state epidemiologist and chief of the Health Department's Communicable Disease Division, said yesterday.
The two newest cases -- a Kihei man and a Kahului man -- contracted the infection in early and late July, respectively, and were hospitalized but did not experience complications, health officials said.
"We are investigating several more suspected cases of typhus. Most of them are from Maui," said Dr. Paul Kitsutani, medical officer for the Centers for Disease Control and Prevention assigned to Oahu.
"We are concerned about the increases in the number of cases, especially on Maui," Kitsutani said.
Ten of the state's dozen cases have occurred on Maui, which is experiencing a big increase in mice. Oahu and Kauai have each had one case.
Effler said the recent dengue fever outbreak, which also hit Maui harder than any other island, probably has spurred reporting and testing of typhus cases.
Murine typhus is a bacterial infection, a milder form of typhus, spread by fleas that bite infected rodents and then bite humans. It can be treated with antibiotics and is seldom fatal.
Residents are urged to take steps to control rodents and fleas around their homes and workplaces, just as they did with mosquitoes to prevent dengue fever.
Kitsutani presented these statistics on cases to date:
Of the 10 cases on Maui, eight were in Kihei, one in Kahului and one in Lahaina. The last two were in Kihei and Kahului, with the latest one confirmed yesterday morning.
Patients ranged from 13 to 57 years of age and averaged age 43. Nine were males.
Seven were hospitalized with the infection; only one was serious and he was released after treatment.
The surge in mouse infestations is believed to be related to changing weather patterns, officials said. When there is a lot of rain, there is grass and food in pasture areas for rodents to live on, said Kenneth Hall, chief of the Vector Control Branch.
With little or no rain, the grass dries up, seeds are consumed and rodents begin migrating into communities to look for food and water, he said.
A fourfold increase in mice from last year in some areas of Maui and the Big Island was reported July 30 by the health agency.
State officials have taken steps to reduce the rodent population on various islands, including Maui, where about 12 workers who formerly were used to fight dengue fever have been enlisted to reduce the rat and mouse population.
"I haven't seen an outbreak like this since I've been here," said Warrick Aiwohi, a state vector inspector who has worked on Maui since 1981.
Aiwohi said the mice appear to be searching for food in residential areas of Lahaina and Kihei, where the nearby brush in pastures and former sugar cane fields has dried out under the hot summer sun.
Leptospirosis and salmonellosis are associated with rodents, as well as murine typhus, so residents are cautioned to plug any holes that mice could squeeze through into homes.
Officials also advise removal of pet food, bird feeders, fallen fruit and any other food sources.
Spring-loaded or glue rodent traps should be set near baseboards because rodents tend to run along walls, Hall said. And dead mice should be removed quickly before fleas can jump from them and infect people.
Hall said his crews are aggressively monitoring rodent infestations and conducting surveillance and abatement activities. They are using baited traps and rodenticides to control rodents in areas with significant problems.
The crews are starting the next round of surveillance trapping this weekend on all islands, Hall said.
"We really encourage communities to let us know if they have problems," Hall said.
People should call 483-2535.
While residents are asked to be vigilant, they "shouldn't be frightened" since typhus has always been in Hawaii, Hall added. "It's not like malaria or the plague."
Although it is not termed an epidemic, Effler said, "It is serious. We're going to monitor it closely." Physicians have been alerted statewide to look for symptoms and test patients for typhus, he said.
Anyone with the flulike symptoms -- high fever, body aches, a temporary rash, nausea and vomiting -- should see a doctor.
Star-Bulletin reporter Gary T. Kubota contributed to this report.
Department of Health