Dengue!
Outbreak of dengue fever hits Nahiku, Hana
Disease spread by mosquitoes - Spraying underway in East Maui
By Don Gronning, Haleakala Times, October 3, 2001
The state's first cases of home-grown dengue fever since 1945 were confirmed in Nahiku and Hana on Maui's east end. Debby Stoner of Nahiku was one of the first confirmed cases of the disease, which is spread by a day-biting mosquito.
"It knocks you right on your back," says Stoner, who figures she contracted the disease the first week of September. She ran a 102-degree fever that would climb to 106 unless she knocked it down with Tylenol. She also experienced the classic joint pain that earned the fever the nickname breakbone fever.
"The bones behind my ears hurt, the joints of my fingers hurt. Basically anything on your body that bothered you before hurts," she says. After the five or six days of fever came an itching rash.
"As soon as the fever ended, I got a super itchy rash," says Stoner. "Then the itch went away and the rash lasted a couple more days."
She was bedridden for five or six days and is slowly regaining her energy and strength. It takes about a month to fully recover, she says.
Cases most likely contracted on Maui
The U.S. Center for Disease Control and Prevention officially confirmed four cases of dengue fever Sept. 14, according to Janice Okubo, information officer for the state Department of Health. Forty-one cases have been preliminarily diagnosed and are expected to be confirmed by the CDC, she says.
"None of the confirmed East Maui cases had recent travel history off the island of Maui, verifying that their illnesses were acquired on Maui," says Okubo. The original source of this outbreak was likely an undetected case in a visitor from or returning resident that traveled to an endemic area.
Dengue fever is a viral disease spread by mosquitoes. The type of mosquito that transmits the virus feeds during daylight hours and likes the morning and dusk. Symptoms vary from individual to individual, but often include fever, headache, body ache and a rash.
For some, symptoms are severe, while others have no symptoms. Dengue hemorrhagic fever is a more serious form of the disease that kills 24,000 annually, according to the World Health Organization.
Nobody has died or been hospitalized from the Maui outbreak of dengue, says Okubo.
No cure, vaccine for dengue
There is no vaccine or cure for dengue fever, although treatment helps. Stoner's blood pressure dropped so low she received intravenous application of fluids at the Hana Community Health Center. Dehydration is a common problem.
Younger children tend to have a milder illness than older children and adults, says Okubo. Symptoms may last up to ten days, but complete recovery can take two to four weeks. Treatment consists of rest, fluids, and medications to reduce fever, such as acetaminophen. Aspirin should not be used, she says.
The state is taking the dengue fever outbreak seriously. They are canvassing door-to-door and will hold meetings with the community.
"With these confirmed cases, the Department of Health's focus is now on containing the outbreak quickly with aggressive mosquito control efforts," says Dr. Bruce Anderson, Director of Health for the state. "It is critical that the community provide assistance by taking precautionary measures such as draining standing water and supporting efforts by our staff to control the spread of this disease."
State started voluntary spraying program
The state has started voluntary spraying of houses and 200-feet around the perimeter of the homes of people who have contracted dengue and others who want to have their premises sprayed. Permanone 10percent E.C. (Emulsifier Concentrate) is the spray used. Permethrin base is commonly found in household insect spray products, says Okubo. It is harmless to pets and dissipates quickly.
Stoner says she was able to return to her home within a few hours of spraying. For the first time in years, it was mosquito free, she says.
"There were no mosquitoes for a week," she says. While some of her neighbors, even people who got dengue fever, didn't want their places sprayed, Stoner is all in favor of spraying.
"You should spray more than once," she says.
Other members of the Stoner family contracted the fever, including her husband, Bruce. He didn't get the rash, she says. Health officials believe that symptoms are mild or non-existent for many people. Many who probably contracted dengue may not have reported it or sought treatment, says Okubo.
Worldwide, 50-100 million people contract dengue fever, with hundreds of thousands getting the more dangerous dengue hemorrhagic fever (DHF), according to the Center for Disease Control. About five percent of those getting DHF die.
Symptoms of DHF initially are indistinguishable from dengue fever, but the illness progresses to faintness, shock, and generalized bleeding. The best prevention is to not get bitten by mosquitoes. That means removing standing water where mosquitoes breed.
On September 20-21 East Maui Irrigation released about a million and a half gallons of water down their Makipipi stream in an effort to flush out mosquito larva in standing pools of water in the stream bed.
Garrett Hew, manager of EMI, says that the water went down a sink hole under the Hana Highway, over a mile from where the standing water they hoped to flush. Hew says hundreds of millions of gallons of water would be required to adequately flush the stream, which is 60 to 80 feet wide at the bottom.
"We need a downpour to flush it out," says Hew. He said it has been almost four years since Maui has had the type of rains that would flush out the streams.
He says releasing an inadequate amount of EMI water may actually make the problem worse by creating more standing water in the stream. Instead, he recommends using larvacide on the standing pools.
Stoner and her family have lived in Nahiku for 20 years. They do all the things to eliminate standing water they can, but there still have been plenty of mosquitoes. Since their house is so open, it is impossible to keep them out. But they never have had a problem like dengue fever before.
Long distance air travel is one of the reasons cited for the spread of dengue. When people used to come by boat, it took long enough that the fever would have run its course by the time they arrived. Once at their destination, they were no longer able to pass the virus to local mosquitoes and the virus didn't spread. That has changed and mosquito control is more important now than ever in Hawaii.
Here are some tips on controlling mosquito populations:
- Cover or properly discard items that collect rainwater or are used to store water (plastic containers, 55-gallon drums, buckets, used automobile tires).
- Empty and clean pet and animal watering containers at least once a week.
- Reduce the risk of being bitten indoors by using air conditioning or windows and doors that are screened.
- Dress protectively (long-sleeved shirts and long pants) and apply effective repellents (those containing 20 percent to 30 percent DEET) on exposed skin and clothing when mosquito exposure is unavoidable.
- If you do become ill, be sure to protect yourself from mosquitoes while experiencing any symptoms (such as fever) and a few days after to avoid spreading the disease.
- Preventing epidemic disease and further spread of dengue in Hawaii will require sustained, community-based, integrated mosquito control combined with judicious use of insecticides.
- All Hawaii residents, not only East Maui residents, are urged to keep their properties free of sites where mosquitoes can breed. Information on dengue fever can be accessed at the CDC website at www.cdc.gov under Health topics A-Z - Dengue.
- For more information call the dengue hotline at 984-8214 or Glenn Iinuma at the Maui District Health Office at 984-8216.
- Reports of suspected cases should be made to the Epidemiology Branch of the Department of Health at 984-8213 on Maui, Moloka'i, or Lana'i.