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Hawaii reports outbreak of dengue fever

Local health officials are working to control the spread of first endemic transmission of the tropical disease since World War II.

By Victoria Stagg Elliott, amednews staff. Oct. 15, 2001.

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The Hawaii Dept. of Health is struggling to control an outbreak of dengue fever in a rural area of east Maui, according to the state agency.

Since the middle of September, 18 cases have been confirmed. None of those with the infection had a history of travel to dengue fever areas. The outbreak is being considered the first endemic transmission on the island in more than 50 years.

"We'd never seen folks who hadn't traveled become infected," said Paul Effler, MD, MPH, a state epidemiologist in Hawaii. "It's puzzling to us. Why this time? Why this location?"

The new situation is being watched closely by public health officials around the country, including Texas. Although there have been no reported cases in the state, this year or last, recent outbreaks south of the border have the health department there braced for possible impending trouble.

"We're hearing a lot of reports now about dengue fever in South and Central America, so it's just a matter of time before we have another outbreak," said Julie Rawlings, MPH, an epidemiologist with the Texas Dept. of Health.

Dengue fever has no cure, although a vaccine is currently in clinical trials. The only ways to combat it are vigilant surveillance and controlling the mosquitoes that spread the virus.

These steps, however, are hampered by problems with diagnosis. The mild form of the disease is characterized by symptoms that can be easily confused with the flu. The disease is also just not seen that often in the United States.

"It's important to get the right diagnosis if there are mosquitoes in the area that can transmit it," said Dr. Effler. "You also don't want to treat them inappropriately for other things."

A report published in the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report earlier this year looked at the medical records at several clinics in Laredo, Texas. The report concluded that the disease was significantly underdiagnosed, although the situation improved after the health department sent out notices advising physicians to watch out for it.

In general, a single undiagnosed case of dengue fever is not a cause of concern. It is rarely fatal. The problem is when a patient becomes reinfected with a different variant of the virus. That can be deadly and can affect many. Public health officials say there is no need for concern, but there is a need for additional vigilance. The virus is at epidemic levels in many areas of the world.

"In an age of increased travel with a lot of folks going to Asia and the Pacific, there's a real possibility that cases are landing all over the United States," said Dr. Effler.

The mosquitoes that transmit the virus are present in Texas, Hawaii, Florida, and Louisiana. Infection with the virus has not occurred in the two latter states.

But there is also concern the virus might not stay south. A paper published in Environmental Health Perspectives a few years ago speculated that global warming could bring mosquitoes that carry dengue fever farther north.

"The climate has certainly been supportive of mosquito survival," said Dawn Wesson, PhD, an associate professor of tropical medicine at Tulane University in New Orleans. "But just movement of infected individuals has brought more and more dengue circulation into areas."

A bigger issue, however, may be the developing resistance of the mosquitoes to the insecticide used to control them, something Dr. Wesson is currently researching.

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 ADDITIONAL INFORMATION: 

Dengue fever: rare and difficult to diagnose

18 Locally acquired cases found in Hawaii this year.
50 Years since Hawaii's last case of locally acquired dengue fever.
0 Cases reported in the Texas border town of Laredo before alerts were issued by the local health department in August 1999.
18 Confirmed positive cases in Laredo between August and December 1999.
4 Varieties of the dengue virus.

Source: Centers for Disease Control and Prevention, Hawaii Dept. of Health

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Weblink

CDC dengue fever information (http://www.cdc.gov/ncidod/diseases/submenus/sub_dengue.htm)

Article, "Underdiagnosis of Dengue -- Laredo, Texas, 1999," Morbidity and Mortality Weekly Report, Feb. 2 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5004a2.htm)

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