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A Centers for Disease Control official lauded Hawaii County and the state for their handling of the ongoing dengue fever outbreak, despite harsh criticism from some state lawmakers and others who maintain that not enough is being done to contain the virus. Read more

A Centers for Disease Control official lauded Hawaii County and the state for their handling of the ongoing dengue fever outbreak, despite harsh criticism from some state lawmakers and others who maintain that not enough is being done to contain the virus.

The response efforts by the state and county were “timely, well considered and appropriate,” Lyle Petersen, CDC Division of Vector-Borne Diseases director, said at a Hilo news conference Thursday as the number of confirmed cases on the island climbed to 130.

“The coordination between the state and county was among the best I’ve actually seen in many outbreak situations,” he said.

The state Department of Health has been criticized by some Big Island legislators who maintain that more could be done to stop the steady rise in cases. Because the disease is spread through infected mosquitoes, they have called for more aggressive spraying of pesticides, quarantines, faster testing and more information for doctors.

The CDC was brought in this week at the request of the county and the state to undertake a third-party assessment, said dengue incident commander Darryl Oliveira, who also serves as Hawaii County Civil Defense administrator.

Petersen said, “I cannot predict how long the outbreak will last,” but noted that it appears to be somewhat similar to the 2001 outbreak on Maui, during which cases slowly trickled in and the outbreak continued for 10 months, totaling 122 cases.

That count was exceeded this week. But Petersen pointed out that the Maui outbreak was in the small and remote Hana area, while the current dengue fever outbreak has “just more people here in the outbreak area.”

The range for onset of the illness this time is from Sept. 11 to Nov. 28. Among those who have fallen ill are 30 children and 16 visitors.

“It’s not the failure of response measures. It’s just that we do not have the tools yet to eliminate dengue outbreaks instantly,” Petersen said.

He called the outbreak “rather small” compared with the hundreds of thousands of cases that can occur in dengue endemic areas. Even so, it’s still of concern, he said.

South Kona, including Hookena and Honaunau, initially identified as a hot spot for the virus, is the only area on the island identified as high-risk. Moderate-risk areas include Hilo, Naalehu (formerly a high-risk zone), Mountain View and Pahoa.

Petersen said the one possible reason for the spread of dengue in Kona is that that side of the island has historically had the Aedes aegypti mosquito, which spreads the dengue virus better than the Aedes albopictus.

“We currently would like to find out really whether those populations are in the places where the outbreak is occurring, and potentially contributing to the outbreak or not,” Petersen said. “We don’t really know, and it’s going to be part of our assessment.”

A CDC entomologist, who will remain another two weeks with a third team member, will conduct an evaluation of the mosquitoes causing the outbreak and help with on-island training. The federal agency has also provided new surveillance mosquito traps.

Petersen said mosquito control efforts have to be mobilized quickly. “It is imperative that additional effort be put into evaluating the current control methods.”

But he said there are thousands of potential breeding sites on any one property in tropical areas, making it nearly impossible to eliminate mosquitoes entirely.

“The goal is to reduce the number around case houses, (which) would temporarily prevent secondary transmission,” he said.

In an effort to better inform travelers, Oliveira said the county is working with the Hawaii Visitors Bureau and the Hawaii Tourism Authority, and providing multi­language materials for visitors at resorts and rental car agencies. In addition, dengue fever informational material will be provided to the visitor industry.

Oliveira said an effort is underway to work with social service providers to help educate and provide treatment to homeless individuals and the migrant workforce.

Petersen said quarantine as a means to control dengue outbreaks is ineffective. Oliveira added that such a strategy can yield the negative effect of discouraging individuals from coming forward for testing.

The county is pursuing an effort to supply mosquito netting and repellent to homeless people living outdoors, and looking for accommodations that would limit exposure to mosquitoes for ill individuals.

Petersen said the state laboratory has had an “extremely” rapid turnaround time to get dengue test results to physicians, and he praised health department and county personnel for mobilizing with partner organizations.