‘Fight the Bite’

Dr. Sarah Park, state epidemiologist and chief of Disease Outbreak Control Division, talks about dengue fever at the Monday, Nov. 9 community meeting in Captain Cook.

Note that the total number of area visits is higher than the confirmed 23 cases. The numbers indicate how many confirmed people visited each area.

Karin Stanton | Hawaii 24/7 Editor

Resident should remain vigilant, but need not panic, even though the state Department of Health has confirmed 27 cases of dengue fever.

The first in a series of islandwide meetings Monday evening drew more than 130 concerned residents to Yano Hall, near one of the disease’s hot spots in the Hookena area. The meeting also marked the launch of the state Department of Health’s “Fight the Bite” public education campaign.

“We don’t want people to be scared. When you get symptoms, that’s when mosquitoes can bite you and spread it,” Mayor Billy Kenoi said. “We need people to tell us when they are sick. It’s not that you get dengue and we quarantine you. We want information to spray (where infected mosquitoes might be).”

Kenoi was joined by state Department of Health Director Virginia Pressler, state epidemiologist and chief of Disease Outbreak Control Division Dr. Sarah Park and county Civil Defense Administrator Darryl Oliveira at the community meeting.

“The minute we get information, we want to make sure you get it. It’s about communication, coordination and collaboration. When people work together, positive things happen,” Kenoi said. “The County of Hawaii has been working closely with the state Department of Health to respond quickly and efficiently to the cases of dengue fever in Hawaii and we are dedicated to minimizing its impacts on Hawaii Island and the state.”

Pressler said state and county agencies are conducting daily conference calls and working as a team.

“We have the experience, expertise and resources to nip this problem,” she said.

Following their first briefing Wednesday, Nov. 4, Kenoi said the county activated its emergency operating center to mitigate any further outbreak of dengue fever.

“The health and safety of our community and visitors is paramount, and the Department of Health is working collaboratively with all of our partners – including fellow state agencies, the counties, healthcare providers, business leaders, nonprofit service providers and more – to address this important situation and end the spread of dengue fever in Hawaii as quickly as possible,” Pressler said. “In order to keep Hawaii safe and dengue-free, we are asking the community for their help in following the easy tips and suggestions shared through our campaign and joining us as together we Fight the Bite!”

Also Monday, four more cases of dengue fever on Hawaii island were confirmed by the state Department of Health. That brings the recent number of locally acquired cases of dengue fever to 27.

That figure includes at least eight visitors. Health officials said they came from the mainland, but declined to identify which states.

Park said the vast majority of patients experienced mild symptoms and now are recovering.

Dengue fever is spread through mosquito contact – mosquitoes carrying the illness from an infected individual can spread it from one individual to another through mosquito bites. Travelers to areas with infected mosquitoes where dengue fever is endemic are at the highest risk of acquiring the disease.

Symptoms of dengue fever typically begin within a week after a bite from an infected mosquito and may include fever, joint or muscle pains, headache or pain behind the eyes, and rash.

It can only be diagnosed with a blood test. Previously, tests were sent to the mainland and results could take a week. Now, Pressler said, the state lab can produce results in one day.

People cannot infect other people. Additionally, animals – other than primates – cannot be infected with Type 1 dengue, which is the mildest of the four strains.

While dengue is not endemic to Hawaii, it is intermittently imported from endemic areas by infected travelers.

The recent cases, which date back to mid-September, mark the first cluster of locally acquired dengue fever since the 2011 outbreak on Oahu, when four cases were confirmed.

Following the meeting, County Councilwoman Maile David, who represents the South Kona area, said she was concerned, but encouraged the state was taking action.

“I’m very concerned because it’s where I was born and raised,” she said. “It’s very concerning that something like this can happen in such a small community. It’s never happened before.”

News of the first cases was a shock, she said.

“You live your everyday life and suddenly your neighbors are sick. It hits close to home, hits home how vulnerable we are,” David said. “We are a people that are patient, humble and deal with what we are dealt. We are self-sufficient and self-reliant and we accept and we adjust. We’ll do whatever it takes to get through this.”

The DOH recommends applying mosquito repellent containing 20 to 30 percent DEET, wearing long sleeved shirts and pants, using indoor insecticides, and reducing the amount of mosquitoes on your property by clearing areas with standing water.

Park admitted the state was “behind the 8-ball” in its initial response to the outbreak and now is working backward to try to find the first case as well as forward in quickly identifying new cases.

“As soon as we have a suspect case that fills our clinical criteria, they have fever, headache, they’ve got aches and pains, they’ve got a rash, a couple of these and you only need two of those symptoms, they’ve been on the Big Island during that period, we talk to the vector folks and go out,” Park said. “Generally, we’re not finding new cases. That’s a good thing.”

Park said authorities may never identify every case.

“We are getting a lot of reports of ‘Well, I might have this’ from the public who says, ‘I didn’t see my doctor but it sounds like I might have this,’” she said, “Right now our threshold is low to test these people because we are in the middle of an outbreak investigation.”

Park said she will feel comfortable the outbreak is over when no new cases are reported for four weeks.

“We can’t be sure when there will be an end to the outbreak,” Pressler said. “We’re still identifying where the disease was initiated, but it will end a lot sooner as we all continue to work together, get the word out, and get people to help themselves prevent the spread of the disease.”

The first identified case was confirmed to have been contracted on the Big Island.

“The earliest case we know is a local case and never traveled anywhere else so that’s not our zero case,” Park said. “He’s in South Kona but he also was in other areas north. Hookena is definitely a problem area that we have identified.”

Meanwhile, county officials said Hookena Beach Park remains closed and it’s not clear when it might reopen.

“The Department of Health has been going down there on a regular basis,” Oliveira said. “I’m assuming at this point that we are waiting on the arrival of the traps that they’re going to be setting out at Hookena, and that’s to sample the mosquito counts in that area.”

Oliveira also said Civil Defense is coordinating resources across the island, including monitoring mosquito repellant. He said some stores have run out, but “there is still an abundance on the island.”

Meanwhile, county authorities are spraying suspect areas with Aqua-Reslin, a restricted-use pesticide employed during public health threats. They said they will work with organic farmers to protect crops as best they can.

Uncovered catchment tanks also may present a problem, authorities said, but they will work with homeowners to ensure the threat is kept to a minimum.

County Civil Defense has a liaison working with the Big Island Visitors Bureau and contacting all the hotels to share ‘Fight the Bite’ tips.

To report a suspect case, contact the Department of Health, Disease Outbreak Control Division at (808) 586-4586.

Public Information Meetings Schedule:

* Tuesday, Nov. 10 at 6 p.m.

Naalehu Community Center

95-5635 Mamalahoa Hwy., Naalehu

* Thursday, Nov. 12 at 6 p.m.

Konawaena High School Cafeteria

81-1043 Konawaena School Rd., Kealakekua

* Friday, Nov. 13 at 6 p.m.

Honokaa High School Cafeteria

45-527 Pakalana St, Honokaa

* Monday, Nov. 16 at 6 p.m.

Hilo High School Cafeteria

556 Waianuenue Ave, Hilo

* Tuesday, Nov. 17 at 6 p.m.

Keaau High School Cafeteria

16-725 Keaau-Pahoa Rd, Keaau

— Find out more:

health.hawaii.gov

Schematic depiction of the symptoms of dengue fever