Dealing with Dengue

Coincidentally, the dengue fever outbreak can also be described in terms of the pre and post September 11 horrific tragedies. Prior to September 11, people in the East Maui who felt they had a severe case of the flu were unaware that they may have had dengue fever. It was not until September 12 when the Hana Community Health Center’s doctor contacted the Department of Health’s Maui District Health Administrator of an unusual case of rash and illness clustered in a Nahiku family that there was any indication of the extent of the problem.

The Maui Administrator, Dr. Lorrin Pang visited the family and immediately became alarmed after learning that the family had no recent history of out of state or international travel. Dr. Pang has an extensive background in tropical diseases and recognized the illness as dengue fever. Although the Center for Disease Control did not confirm the suspected cases until Friday, September 21 the Department of Health (DOH) proceeded with house to house surveys and localized spraying prior to the confirmation. Unfortunately, some families wanted confirmation of dengue fever before agreeing to the spraying of a pyrethroid based insecticide.

In Hawaii the disease is being spread by the bite of an infected day-biting mosquito (Aedes albopictus) to people. It is presumed that dengue fever was established in East Maui by a person returning or visitors from Tahiti that were unknowingly exposed to the virus and transmitted the disease to local mosquitoes. In French Polynesia the dengue epidemic has grown to significant proportions since first detected in February.

The DOH and CDC were very surprised to learn that dengue was being spread by the aedes albopictus, as that type of mosquito is a very inefficient vector and maybe one of the reasons why Hawaii may avert a full-blown epidemic. The mosquito that is of great concern because it is a very efficient vector is the Aedes egypti, or tiger mosquito, who also carries malaria and yellow fever.

During the last Hawaii outbreak of dengue fever in the mid-1940’s, there was a systematic eradication and control of mosquito populations with the help of the military. Unfortunately, the events of September 11 have eliminated the participation of the National Guard and the U.S. military in addressing this very important public health problem. With the National Guard being assigned airport security duties and the military on alert there are very few organized manpower resources that the DOH can count on to quickly mobilize and efficiently execute a massive plan like we all witnessed and benefited from after Hurricane Iniki. Therefore, it is very important that each of us take precautions to protect our families and communities and to be aware of personal mosquito protection measures, and initiate environmental mosquito control within our kuleana.
Helpful activities include the following:

• Locate all sources of standing water on your properties and empty or remove them. Examples of areas where mosquitoes breed include roof gutters, plastic containers, 55-gallon drums, buckets, used automobile tires, flower pots, cans etc.
• Empty and clean pet watering containers at least once a week.
• Remove discarded bulky items that may collect standing water, including abandoned cars, boats, sheds etc.
• Empty and scour vases with fresh flowers at least once a week.
• Check all screen doors and windows. Repair if there are holes or tears in the screens.
• Plants that collect water (e.g. Bromeliads) should be sprayed weekly with a garden insecticide.
• Wear long-sleeved shirts and pants to limit exposure to mosquitoes. Light-colored clothing is also recommended.
• Use indoor insecticides and repellents if mosquitoes are in the home.
• Apply effective repellants (containing 20-30% DEET) on exposed skin and clothing when mosquito exposure is unavoidable.
• If your home has a water catchment tank, be sure it is "mosquito proof."

Persistent, unrelenting, mosquito control efforts are the only way to stop spread of dengue fever. Everyone is urged to keep their properties free of sites where mosquitoes can breed.

If you become ill you should consult your health care provider. In addition, if you develop a fever, you should protect yourself from being bitten by mosquitoes until you have completely recovered; doing this will help prevent the spread of dengue fever to others in the community. Do not use aspirin to control fever and discomfort, instead use non-aspirin substitutes.

Visit the DOH’s dengue fever website at

www.state.hi.us/health/dengue/index.html,

for more information on the latest public health bulletins, the symptoms of dengue fever and mosquito prevention or please call the Kauai District Health Office at (808) 241-3563.

There are several important environmental lessons and quality of life issues that must be addressed in dealing with this epidemic. Many experts are surprised that this incident did not happen sooner in Hawaii and say it was inevitable and just a matter of time. With the ease of travel, international, national and inter-island, and the movement of vast numbers of people, the spread of infectious disease, much like biological terrorism, and the spread of invasive species can happen in a matter of hours, rather than days or weeks. Travel screening, plant and animal inspections and rapid response mechanisms must be developed to mitigate public health and safety as well as economic impacts.

Other important issues concern healthy eco-systems. With the existence of stream diversions and, aggravated by three years of drought conditions, some East Maui streams have very little flow and pools of standing water, perfect conditions for breeding mosquitoes. For many years avian malaria have been working its way to higher elevations killing off native birds that have no resistance to the virus. The primary breeding grounds for these virus carrying mosquitoes are the little wallows caused by pigs uprooting vegetation. Global warming is seen as one of the major factors for these prolonged drought conditions as well a warming trend that allow for the movement of mosquitoes to higher elevations.

After September 11 much of the State’s focus has been reviving the visitor industry. But, the dengue fever epidemic continues to illustrate that Hawaii’s fragile environment, our unique quality of life and economic issues are all integrated and interrelated. Hawaii’s environment and people must be protected for a viable visitor industry to exist.