KAILUA-KONA — The day to celebrate isn’t just yet.
With more than 30 days past since the last case of dengue fever on the Big Island, state and county officials could have declared “breakbone fever” officially pau.
They didn’t.
Instead, flanked by Hawaii County Civil Defense, the Department of Health and the Hawaii Tourism Authority, Gov. David Ige on Wednesday said that much has been learned from the outbreak — and the battle against mosquito-born diseases and the need to educate the public and health care professionals about the threat is just beginning.
“In today’s day of international travel, ‘Fight the Bite’ becomes the norm,” Ige said. “It’s about engaging the community to be thoughtful, appropriate and good travelers.”
DOH director Virginia Pressler told reporters that entomologists will continue to map the presence and types of mosquitoes that carry the diseases, and that education efforts targeting the public and health care professionals will be ramped up this year.
The last documented dengue case was a month ago.
That 30-day mark represents three periods of the maximum human incubation period of 10 days, a significant milestone but one that officials celebrated only cautiously.
“I don’t think there will be a day anytime soon when we will declare the outbreak over,” Pressler said. “We will not let our guard down. This is just the beginning of the war against mosquito-borne diseases.”
A total of 264 cases were confirmed since the outbreak began on Sept. 11, 2015. Another 1,643 potential cases were ruled out. The last case was documented March 23 and declared no longer infectious March 27. The DOH has provided a daily count of cases up until earlier this week, but the lack of new activity prompted the department to stop issuing updates unless there is a change in status.
Travel caution
Travelers to areas where Zika and chikungunya are endemic need to be aware they can carry the disease with them, said Ige, who touted the importance of $1.27 million in funding being provided by the Legislature for 20 new positions in the DOH Vector Control Branch, depleted by downsizing during the Great Recession.
“The dengue incident really reminded us how important Vector Control is,” said Ige.
The governor praised the collaborative effort of state and local agencies to combat the outbreak, highlighting community outreach efforts by CD and the DOH.
Those who have traveled to areas where the diseases are endemic should report promptly to their health care professional and the DOH if they don’t feel well, Pressler said. The department continues to test for the diseases on an ongoing basis, she said.
The department investigated and ruled out two suspected cases of the Zika virus in East and West Hawaii in mid-April, according to a DOH spokesperson in an email unrelated to the press conference. Four Zika and six chikungunya cases have been confirmed in the state, none of them locally transmitted.
Civil Defense Chief Darryl Oliveira said that public outreach and education will go on at the county level. Cleanup efforts with the Hawaii National Guard to collect tires is ongoing, he said. Eleven soldiers are on-island in the midst of several weeks of helping to remove thousands of tires from where they are being stored on private property.
“By no means are we in the clear,” Oliveira said. “Cooperation and collaboration between the state and county have been exemplary but we continue to identify actions and efforts that we can improve on in the future.”
Dengue started quickly
The mosquito-borne virus progressively trailed off in the first part of 2016 coming off a peak period during early winter months when a half dozen new cases a day were popping up around the island.
Hawaii County Civil Defense closed Hookena Beach Park — the first known epicenter of the outbreak — in early November, and went on to close Milolii Beach Park and Waipio Valley Access Road in the following months as cases cropped up there. Honaunau remained a hotspot for months, but the virus crept into nearly every community around the island.
Teams of Civil Defense and DOH workers held community information meetings around the island starting last fall, detailing the response effort and ways for residents to “Fight the Bite.” Teams pulled long days surveying 523 private properties and 310 public spaces, spraying 285 sites to knock back the mosquitoes. DOH labs scrambled to test blood samples for the diseases, investigating more than 1,900 potential cases of the disease.
A team from the Centers for Disease Control and Prevention arrived on island in late November to assess the response, make recommendations for fine-tuning and to trap and test mosquitoes in an effort to better understand the location of the disease and how it was spreading.
The battle against the dengue gained an unexpected ally — the weather. El Nino helped create worst drought in decades on the island, drying up mosquito breeding habitat, Oliveira said.
Lessons learned
The CDCs credited the DOH and Civil Defense for tireless work with the resources they had. But the outbreak also pointed out glaring deficits in DOH Vector Control manpower, prompting the introduction of legislation this session to increase the staffing of that branch.
The response to the disease also brought forth criticism from worried residents and Big Island lawmakers frustrated with delays in getting test results and challenges in getting access to health care for some with the disease. Some complained that they couldn’t get through on the phone lines to state or county officials to make reports, and that officials were slow in responding when they did get the reports.
Critics felt more needed to be done to warn tourists of the outbreak and to assure that testing was available to marginalized populations not likely to seek treatment on their own. Mosquito repellent ran short, and store shelves remained bare for days until donations and new shipments helped buoy the supply.
Residents lathered up with repellent when they could get it, cleaned up and emptied standing water around their property, launched social media sites containing updates on the outbreak and avoided areas favored by mosquitoes.
These folks are key to making sure history doesn’t repeat itself, officials said.
“This is a continuing challenge for us,” Ige said. “We all need to remain aware.”