As Hawaii health officials wrestle to contain a dengue fever outbreak on the Big Island, a review of how the state handled a 2001 outbreak on Maui reveals some of the challenges in store. ADVERTISING As Hawaii health officials wrestle
As Hawaii health officials wrestle to contain a dengue fever outbreak on the Big Island, a review of how the state handled a 2001 outbreak on Maui reveals some of the challenges in store.
An April 2012 study published on the Centers for Disease Control and Prevention website discusses the importance of control measures, and also looks at factors that may hinder efforts to contain a dengue fever outbreak.
Entitled “Lessons Learned during Dengue Outbreaks in the United States, 2001-2011,” the study looks at a Maui’s outbreak, as well as an outbreak in Brownsville, Texas, and southern Florida.
The Maui outbreak was reported to the DOH on Sept. 12, 2001, by a non-island physician temporarily employed in the rural region of Hana, the report says. Efforts to confirm the cases of dengue were impeded, however, because the terrorist attacks of Sept. 11 caused the suspension of air travel around the country, slowing the shipping of blood specimens to the CDC. The outbreak was not officially confirmed until Sept. 21.
“After dengue cases in Maui were discovered, state Health Department officials began an aggressive campaign of public engagement involving town hall meetings, door-to-door campaigns to identify case-patients and educate the public about mosquito abatement, and media messaging (television, radio, and Internet),” the report reads. “A public relations agency was hired to help manage questions from the public.”
Vector control activities included spraying to kill adult mosquitoes within a 200-meter radius around homes of case patients, breeding-site control activities such as trash collection and elimination of standing water, and door-to-door campaigns to educate the public about eliminating mosquitoes around homes.
The report noted interviewees told investigators that during the outbreak, “tension existed between responding parties over jurisdictional issues that largely remained unresolved.”
In addition to control efforts, state officials had to weigh issues that were “politically and publicly sensitive,” the study says.
“Because the Hawaii economy depends on tourism, the response had to balance the need for protective action on the part of local residents and tourists with the need to avoid discouraging tourism,” the report states. “Additionally, although some members of the public were concerned about the negative effects of pesticide use, others demanded that spraying be conducted around schools (which had questionable utility in combating the outbreak).
All told, 122 cases of dengue fever were laboratory-confirmed through 2002, including 92 on Maui, 26 on Oahu, and four on Kauai.
