Dengue gone but not to be forgotten

That's the advice health experts offer if island wants to keep disease at bay

The Maui News
May 11, 2002

By EDWIN TANJI
City Editor

WAILUKU — State health officials say the dengue virus has been eliminated from the mosquito population in Hawaii but warned the disease can be re-introduced from other parts of the world.

Maui District Health Officer Dr. Lorrin Pang said the disease normally recurs during the warm summer months and anyone infected with the virus can easily bring it back to Hawaii.

It also can be easily established in Hawaii if residents fail to take precautions, including the continuing effort to control mosquito populations around their homes, he said.

So far this year, six individuals were diagnosed with dengue after they had traveled to areas of the Pacific where the disease was established, according to the Department of Health. The travelers had been to Samoa, Tahiti, Rapanui (Easter Island) and Cambodia.

That is in addition to the 119 cases of illness that occurred in patients who had not traveled outside of Hawaii in the past year. The last case of locally transmitted illness in Hawaii was reported during the week of Feb. 3 — 13 weeks ago.

The life span of the Aedes albopictus mosquito that is responsible for spreading the virus from person to person in Hawaii is about six weeks. With two mosquito lifetimes passed with no new local infections, state Health Director Bruce Anderson on Friday said it appeared that the mosquito control efforts had stemmed the outbreak in Hawaii.

“This is great news, but we must not let this lead to complacency,” he said. “Hawaii will always be at risk of dengue, and we must continue to control mosquito populations if we are to keep dengue out of our communities.”

State Sen. J. Kalani English echoed the concern, noting that the state Emergency Environmental Work Force had a key role in helping residents to eliminate mosquito-breeding sites.

English said additional funding has been provided for the work force.

“The immediate and forceful response to the outbreak was the key to eradicating dengue,” he said. “By continuing with the Emergency Environmental Work Force, we are making a critical investment to prevent future outbreaks.”

Anderson discussed a long-range management strategy for preventing a recurrence of the outbreak that began last summer and resulted in residents and visitors infected on Maui, Kauai and Oahu.

The program includes a statewide surveillance system, a mosquito population study and continuing efforts to control mosquito populations. Anderson said the state mosquito population study also is carefully looking for another mosquito species that is considered a more efficient dengue vector — Aedes aegypti.

The aegypti mosquito is more common in countries where dengue has been established and may be responsible for maintaining a reservoir of infection that results in recurring outbreaks.

Anderson said health officials believe the albopictus mosquito — which is commonly found on all of the islands — is the species responsible for the Hawaii outbreak. But he said experts consider it to be an inefficient vector, or carrier, of the virus.

Determining where the Aedes aegypti mosquito is present will help the department map out targeted vector control efforts, according to Anderson’s announcement.

Health officials also will be keeping tabs on countries where there are dengue outbreaks and monitor travel from infected areas, the department said.

State vector control crews will continue to spray around homes when there is a suspected case of dengue to eliminate mosquitoes that could pick up the virus and infect others. Dengue is spread by mosquitoes that bite an infected patient and carry the virus to other people.

Symptoms are compared to a bad flu, including high fever, severe headaches, joint and muscle aches, nausea and vomiting. A potential clue to the disease is the appearance of rash. But some people infected with dengue do not display the severe symptoms, according to Pang.

Pang, an epidemiological specialist who has worked in Brazil, noted that Brazil had not suffered a dengue problem after World War II until 1992, when an outbreak occurred.

But when the 1992 outbreak faded, disease prevention efforts lagged, he said. The disease reappeared — concentrated in northern areas of Brazil, the tropical regions closer to the equator where outbreaks recur every year — while in Rio de Janeiro, there are outbreaks reported every two years, he said.

With a new epidemic reported this year in Brazil, Pang said the country is seeing 15 times more illness as had occurred 20 years ago.

Hawaii also last had an outbreak of dengue during World War II, which was eradicated by an intensive mosquito treatment effort. During the World War II outbreak, 1,500 people became ill, prompting the closure of Waikiki. It was believed the virus was brought to Hawaii through U.S. servicemen who had traveled through the South Pacific.

For the more recent outbreak, the Health Department used up to 300 workers and exhausted $1.5 million on its latest effort to eradicate mosquitoes.

‘‘I think $1.5 million was a relatively small amount to pay considering what we were able to accomplish with that money,’’ Anderson said.

Dr. Paul Effler, the state epidemiologist, said the outbreak could have been much more costly in terms of health care expenses, diverted resources and lost business from tourism.

“The long-term costs are much worse if you’re not able to respond effectively and that’s what we had to do,” he said.

Pang noted that when physicians and other specialists with the U.S. Centers for Disease Control and Prevention were advised of the Hawaii effort, “they laughed,” questioning whether Hawaii could prevent the disease from becoming established. “It’s nice to know that you can control it,” he said.

But it requires cooperation of the patients to inform health officials of their illness and to allow treatment of their homes and yards to eliminate mosquitoes, he said.

With a more educated population, it may be easier to keep the virus from re-infecting mosquitoes in Hawaii, he said. But it means anyone who is ill must provide information to the health officials, he said.

One of the positive factors in Hawaii’s outbreak is that the patients were treated at their homes. In other countries, officials learn of the illness by patients who show up at hospitals, with complications that can include severe hemorrhaging.

Re-infection is a concern because new infections can lead to complications, Pang said.

Preventing re-infection, as well as re-introduction to Hawaii, means a continuing effort to protect people, with insect repellent provided to visitors and residents, as well as ongoing programs to eliminate mosquito breeding sites, he said.

Mayor James “Kimo” Apana said the county will continue to waive landfill fees for residents to encourage them to continue to keep their yards clear of mosquito-breeding trash.

“It’s not only to fight dengue, but it’s good to see people are taking pride in their yards,” he said.

The Associated Press contributed to this story.

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