Dengue cases still popping up despite eradication efforts

The Maui News
November 15, 2001

By MARK ADAMS
Staff Writer

WAILUKU — Cases of mosquito-borne dengue fever continue to be reported on Maui, even as extensive eradication efforts continue across the island.

Maui District Health Officer Lorrin Pang said Wednesday there were four clinical cases of dengue fever reported in the last week. Three of those cases — in which patients exhibit symptoms of dengue that have not been confirmed through blood tests — are in Hana, and the fourth was reported by a Makawao resident.

New illnesses confirmed to be dengue indicate that mosquito-eradication efforts are failing to eliminate the infected mosquitoes spreading the disease.

There have also been four newly confirmed cases of dengue in the state. Dengue cases are now being confirmed by blood tests conducted by the state Department of Health, which has its own facility up and running for the confirmation tests that were previously done by the Centers for Disease Control in Puerto Rico. The lag time for test results has been decreased markedly as a result, Pang said.

One of the confirmed cases was in Hana and the other three on Oahu. The total number of confirmed cases in the state is now 82, with 60 on Maui, 17 on Oahu and five on Kauai.

Eradication of mosquito breeding grounds continues on Maui in the face of the dengue threat.

A couple dozen students from St. Anthony Junior Senior High School spent Wednesday afternoon at St. Anthony Cemetery on Lower Main Street, picking up trash and emptying flower receptacles of standing water.

Volunteer mom Susan Sommers drummed up about two dozen students for the effort, mostly by telling her sons Joshua, an 11th-grader, and Joel, an 8th-grader, to ask their friends to help.

Sommers said news of new cases of dengue needs to be widely reported to make people realize the dengue threat isn't over on Maui, so residents will keep cleaning up their neighborhoods.

"There's got to be a really good reason to keep people motivated, and I think there is," she said of the new cases.

This is the second time in recent weeks that the cemetery has been the focus of a cleanup, and Sommers said she and the students have poured out "gallons and gallons" of standing water where mosquitoes can breed.

Makeshift receptacles like tin cans are being tossed into trash bags, while more permanent vases are being turned upside down if they are empty so they don't collect water.

The students have also collected mounds of trash thrown out of cars by careless motorists and passersby, including scores of beer cans and other debris.

Looking at the piles of trash bags piled up after a couple of hours, St. Anthony junior Patricia Badura said the students were making a difference in their part of Maui.

"I feel really proud," she said.

Classmate Carlie Wulf said they normally would be doing homework or maybe taking a trip to the mall after school, but decided to pitch in on a project that also fulfills a portion of their community service requirement.

"We wanted to help make the school and the cemetery look better," Wulf said.

The Hana/Nahiku area has been hardest hit by the dengue outbreak, and Waianapanapa State Park and Nahiku Road remain closed to visitors.

A Hana tourist attraction facing a difficult financial situation after being closed by the DOH earlier was allowed to reopen Wednesday, Pang said.

Kahanu Gardens has been thoroughly inspected and workers will be passing out mosquito repellent to tourists and asking anyone who may come down with dengue symptoms after they leave Maui to report to the DOH.

If no new cases are reported in an area for six weeks — roughly the life span of a mosquito — the state Department of Health can consider an area free of the disease.

None of the areas where dengue has been reported on Maui is close to that benchmark.

Prevention teams have been organized across the state to go door-to-door showing residents how they can help prevent the spread of dengue fever.

About two dozen Hana residents were trained by CDC personnel on the island last month to identify and eradicate mosquito breeding sites, Pang said. They are capable of training and supervising additional work crews and spraying larvacide to kill mosquitoes.

Pang said the DOH is trying to obtain funding to pay the crew and continue eradication efforts in Hana, Nahiku, Haiku and beyond on Maui. The money will likely come from the $1.5 million recently allocated by the state Legislature through the efforts of Maui Sen. J. Kalani English for a civilian work force aimed at battling dengue-carrying mosquitoes and other invasive pests.

There is concern by some over a perceived lack of information on which areas have been affected by the disease and the potential health risks involved.

Sommers, the St. Anthony parent involved in the cemetery cleanup, said she is concerned about people who have contracted dengue who are now at risk of contracting another of the four strains of the illness.

She also said there hasn't been enough information about where the cases have occurred, saying she heard there were 17 cases in Kihei alone.

Pang said there have been only three cases in Kihei and that information on possible complications from dengue fever is now being distributed, particularly to segments of the population most affected.

Immigrants new to Maui who may have already been infected by one strain of dengue in their homeland are another target, he said.

Complications of dengue include the potential for contracting hemorrhagic fever as well as dengue shock syndrome.

A problem is that the complications can set in after the initial fever goes away, Pang said, with victims thinking they will be OK when new problems occur.

Symptoms of more severe problems with dengue include bleeding, such as nosebleeds or skin bleeding; severe headaches; abdominal cramps; cold or clammy skin; and any change in mental status, including irritability.

Complications must be treated within 12 to 24 hours, Pang said.

All of the Hawaii cases have involved a single strain of the disease to date, Pang said, and that's a good thing.

Chances of acquiring hemorrhagic fever or dengue shock syndrome in an initial illness are 1 in 1,000, he said. But being reinfected with another strain of the illness raises the chances of serious complications to 10 or 20 percent.

Pang said there is now a proposal before the DOH to set up dengue information booths at Kahului Airport and other airports in the state.

The booths would target three separate groups with specific information tailored to their risk level.

Mainland visitors would be informed of the presence of the illness and told the risk is low, but using mosquito repellent and taking other precautions would be wise.

Travelers from areas where dengue is endemic would be warned of the risk of another infection, and Maui residents who have been away — particularly to regions where dengue is common — would also be presented with dengue information.

One of the chief goals of the airport booth would be getting visitors and residents who come down with dengue symptoms to report them immediately to DOH, Pang said.

"It could be a good way of detecting cases coming in," Pang said, and one way of keeping a second strain of dengue from being established on Maui.

The proposal for the airport booths is being considered by DOH officials in Honolulu, Pang said.

The health officer said he is impressed with the effort of the Maui community in cleaning up potential areas of mosquito infestation.

County information officer Karlynn Kawahara said Wednesday that the Department of Public Works is picking up bulky items and larger than normal loads daily across the island.

For information on pickups in specific areas, Kawahara advised residents to call the Mayor's Office at 270-7855.

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