The Big Island of Hawaii is in a state of emergency from dengue fever. Here’s what travelers need to know.

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THE BIG ISLAND OF HAWAII IS IN a state of emergency. Since September of last year, the island has seen 252 cases of dengue fever, a mosquito borne illness. Dengue is a particularly nasty virus that causes a high fever, a skin rash, headaches, joint pain, and vomiting. It can potentially be fatal, but if it’s caught early and treated properly, the death rate is below 1%.

The Big Island’s problem hasn’t yet expanded to the other islands of Hawaii, and Governor David Igye says the state of emergency won’t expand statewide unless it moves to other islands, or if Zika starts to spread as well. The Zika virus is a major concern, as it is spread by the same mosquito that spreads dengue. Neither disease is endemic to Hawaii, but they have both been imported by travelers. Hawaii is believed to have had the US-based case of Zika related birth-defects in a child last month, but the mother hadn’t been infected with the Zika in Hawaii: she got the disease during a visit to Brazil.

The state of emergency allowed Billy Kenoi, the Mayor of Hawaii County, to lift a ban on landfills accepting old tires, as old tires are known breeding grounds of mosquitoes, and can be more properly treated in landfills than out in public. Of the 252 known cases of dengue seen in Hawaii, only one of the cases remains contagious, though this is not proof of the disease’s decline: others may still be infected and not diagnosed, and mosquitoes may still carry the virus. Humans cannot pass dengue to one another, only via mosquitoes.

So what should travelers do?

As of yet, there’s no reason to cancel your trip to Hawaii. If you are going to islands other than the Big Island, there’s very little risk, as the disease has not yet been reported on those islands. If you’re going to the Big Island, you’re still probably safe. The Hawaii Tourism Authority released a statement saying, ““travelers should not be alarmed by the County of Hawaii’s state of emergency declaration for Hawaii Island or allow this decision to alter their travel plans to any of the Hawaiian Islands. This declaration is a good strategic move by the County of Hawaii, as it will provide government officials with additional funding and resources to eliminate dengue fever from Hawaii Island.”

The state of emergency, for the most part, just allows public officials to take more direct measures to end the epidemic, and it seems to be working so far, as South Kona, one of the areas most affected, has had its risk level reduced in the last day.

In short, if you’re traveling to the Big Island, you’re probably safe, but you can do a few things to make sure you’re safer. First and foremost: wear Deet-based insect repellent when you go out, and if possible, wear clothing with longer sleeves. You’re less at-risk at night, as Aedes Aegypti, the mosquito that spreads dengue and Zika, is more active during the day, but make sure there are screens on your windows, or just use air conditioning when you’re indoors.

If you do get infected, keep wearing deet so you don’t allow the disease to spread to others, and get proper medical treatment. Again: there is no Zika as of yet in Hawaii, and dengue is rarely fatal. Dengue is not linked to the same birth defects as Zika. There is no reason to cancel your travels, and if you do, you are unlikely to get any refunds unless you have CFAR (“Cancel For Any Reason”) travel insurance.

You can read more at our Zika travel guide here, and more on the link between climate change and mosquito-borne illnesses here.

State Of Emergency On Hawaii’s Big Island Over Dengue Fever Outbreak

Photo by MARVIN RECINOS AFP/Getty Images

The Aedes Aegypti mosquito has been linked to both dengue fever and the Zika virus.

The mayor of Hawaii County has declared a state of emergency on Hawaii's Big Island over an outbreak of mosquito-borne dengue fever.

The island has seen nearly 250 confirmed cases of the mosquito-borne virus since September 2015. State health officials first reported two cases that originated there in late October 2015, Mayor Billy Kenoi says in his declaration.

"Dengue fever is a virus that is transmitted by infected mosquitoes, and although not endemic to Hawaii, is intermittently imported to Hawaii by infected travelers," Kenoi says.

Symptoms of dengue fever include "sudden onset of fever, severe headaches, eye, joint, and muscle pain, and rash," The Hawaii Department Of Health says. They are typically gone in 1 to 2 weeks.

"Of the confirmed cases, 227 are Hawaii Island residents and 24 are visitors," the HDOH says, adding that only two of the cases are still potentially infectious.

Kenoi's declaration also lifts a law banning county landfills from accepting tires. Reuters explains that "tires which are left lying around are a known breeding spot for mosquitoes."

Hawaii Governor David Y. Ige says in a statement that the "state supports the county's effort to break the cycle of dengue fever infection and transmission on Hawai'i Island."

He stopped short of declaring a statewide emergency proclamation, saying that step would come should the outbreak spread to other islands or expand to include the Zika virus, among other factors.

As we have reported, "the World Health Organization has deemed the possible link between serious birth defects and the Zika virus as an international health emergency."

Entomologist Laura Harrington told Renee Montagne on Morning Edition last week that with regard to Zika, "we should be especially cautious about locations where we've had locally transmitted dengue virus." That's because "the same mosquito species that transmits Zika also transmits dengue."

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Hawaii Declares State Of Emergency To Fight Dengue Fever And Zika (UPDATE)

UPDATE: Feb. 12 -- Hawaii Gov. David Ige signed a statewide emergency proclamation on Friday to fight mosquito-borne illnesses, including dengue fever and Zika.

The measure will give the state access to disaster funds and the option of suspending regulations to expedite its response. It also allows the state to seek federal assistance if it needs additional resources, the governor said in a statement.

“There have been no locally acquired Zika cases in the U.S. or Hawaii, and we’d like to keep it that way," Ige said. "This is about getting in front of the situation across the state."

Ige's statewide proclamation comes days after the Big Island -- where an outbreak of dengue has been ongoing for months -- declared its own state of emergency.

The mayor of Hawaii's Big Island declared a state of emergency on Monday amid the state's largest outbreak of dengue fever since the 1940s.

The move comes more than three months after the state Department of Health confirmed the first cases of locally acquired dengue, and less than a week after state and county officials defended the ongoing response against criticism that they had been slow to act.

Much like Zika virus, dengue fever is a viral illness spread by mosquitoes. While it is not endemic to Hawaii, the state does have the mosquito species capable of transmitting the disease. As of Monday, the Hawaii Department of Health had confirmed 251 cases of dengue on the Big Island, including 227 infected Hawaii Island residents and 24 visitors.

Symptoms include fever, rash, joint or muscle pain, headache, or pain behind the eyes. Though often debilitating, the symptoms can be effectively managed if recognized and treated. The virus, nicknamed "breakbone fever," can develop into a more severe form called dengue hemorrhagic fever that can be fatal if left untreated.

Hawaii County's emergency proclamation, signed by Hawaii County Mayor Billy Kenoi, does little by itself. It temporarily suspends a county law that prohibits people from disposing of tires -- known breeding sites for mosquitoes -- at county landfills.

As West Hawaii Today reports, the declaration opens the way for Hawaii Gov. David Ige to make his own emergency declaration, which would provide state funds for mosquito-control efforts.

Ige said late Monday he supported Hawaii Island's efforts to "break the cycle of dengue fever infection and transmission." The state, he said in a statement, would declare an emergency if the outbreak requires additional resources, spreads to other islands or expands to include Zika or other vector-borne disease.

In a December assessment of Hawaii's response to the dengue outbreak, Lyle Petersen, director of the Center for Disease Control and Prevention Division of Vector-Borne Diseases, said there were "critical deficiencies" in the state Health Department that should be "urgently addressed." The state said it's working to release $250,000 to the state Health Department to fund eight vector-control positions, one entomologist and one communications position.

U.S. Rep. Tulsi Gabbard (D-Hawaii) is among those who have urged Ige to declare a state of emergency over the dengue outbreak and to devote additional resources into fighting its spread, including National Guard medical personnel.

Ige has defended state and county leaders against criticism that the response has been slow.

"Mayor Kenoi and his team on the Big Island have been on it from the first report,” Ige said on Feb. 2, according to a Hawaii Tribune-Herald report. “They’ve done a terrific job of engaging the communities and engaging us, and we’ve been cooperating with them from the beginning, providing the resources that they need to ensure that we can respond on behalf of the people.”

Hawaii's tropical environment, which allows dengue-carrying mosquitoes to thrive, makes it especially prone to outbreaks of the virus. The current outbreak is the first locally acquired cluster in Hawaii since four people contracted dengue on Oahu in 2011.

Also on HuffPost:

According to Victoria Cavaliere of, Hawaii County Mayor Billy Kenoi also announced that the estimated 250 confirmed cases of dengue fever have all come since late October 2015, resulting in the biggest outbreak since the 1940s.

As for symptoms of Dengue fever, it is very similar to a traditional flu, but patients must be careful, as it can develop into the deadly dengue hemorrhagic fever. To combat the illness, residents on the Big Island will now be able to throw tires away in the island’s landfills since abandoned tires are ideal breeding spots for mosquitoes.

While the Big Island has already declared a state of emergency, Hawaii Governor David Ige has acknowledged that he will not issue a statewide emergency declaration unless the Dengue fever spreads to the other islands or another illness like the Zika virus is confirmed.

Hawaii Tourism Authority president and CEO George D. Szigeti issued a statement:

“Travelers should not be alarmed by the County of Hawaii’s state of emergency declaration for Hawaii Island or allow this decision to alter their travel plans to any of the Hawaiian Islands. This declaration is a good strategic move by the County of Hawaii, as it will provide government officials with additional funding and resources to eliminate dengue fever from Hawaii Island.”

“As of today, 252 people on Hawaii Island have become ill by dengue fever over the past five months, of which 24 have been visitors. The rate of confirmed cases has been declining since January and, currently, only one case is considered infectious. Moreover, most of the dengue fever cases on Hawaii Island have been confined to the rural southwestern region. No locally acquired cases of dengue fever have been found on any other island of Hawaii.”

“It’s important to note that no health organization has advised against traveling to the Hawaiian Islands at any time since the outbreak of dengue fever began on Hawaii Island. Travelers should also take note that Hawaii Governor David Ige has chosen not to issue a statewide emergency proclamation since none of the conditions for doing so have been realized.”

Hawaii Facing Rise in Dengue Fever Cases

122 cases of the extremely painful, but rarely fatal, disease have been reported since mid-September

THURSDAY, Dec. 3, 2015 (HealthDay News) -- Do your winter travel plans include Hawaii? You may want to pack bug repellent, experts say.

That's because the Big Island of Hawaii is facing an outbreak of dengue fever -- a mosquito-borne virus that can cause terrible headache and crushing pain in the muscles and joints.

State health officials have confirmed 122 cases of dengue fever on the Big Island since mid-September, including 106 local residents and 16 visitors to the island. One other case has been reported on the island of Oahu, but health officials say it was not locally transmitted and is not tied to the new outbreak.

The jump in cases has prompted top experts from the U.S. Centers for Disease Control and Prevention to visit the island this week to try and help, CNN reported Wednesday.

"I don't think travelers should be overly worried, but they should take care to avoid mosquitoes as much as possible," said infectious disease expert Dr. Amesh Adalja, a senior associate at the UPMC Center for Health Security in Baltimore.


Called "breakbone fever" due to the extreme pain it causes, dengue fever can require hospitalization in moderate and extreme cases, according to Dr. Sarah Park, Hawaii's state epidemiologist and chief of the Hawaii Disease Outbreak Control Division.

Symptoms include severe headache, often with piercing pain behind the eyes, and terrible muscle and joint aches, Park said. Sufferers also can develop a full-body rash and run fevers as high as 104 degrees.

The symptoms typically appear five to seven days after being bitten by an infected mosquito. Dengue is not transmitted person-to-person.

There is no cure for dengue fever, although a vaccine is poised for federal approval, said Adalja.

However, the disease is rarely fatal in developed nations, according to the CDC. Only about 1 percent of people die from dengue if the disease is detected early and treated properly.

Both the CDC and the Hawaii Department of Health are urging travelers to protect themselves from mosquito bites.

People particularly should steer clear of areas with lots of standing water, where mosquitoes can breed. These include jungle terrain and other overgrown areas, Park said.


"Surfing or sunning on the beach is not likely to be a risk," she said. "Going out into heavy vegetation areas, that's where you might consider taking precautions."

If going out on a hike in an area with mosquitoes, people should wear long-sleeved shirts and pants, and apply effective mosquito repellents to their exposed skin and clothing, health officials said.

The mosquitoes that carry dengue tend to bite during the day, so visitors and residents can feel safe at night, Park said.

The state also is asking residents to check their property for standing water, fix leaky outdoor faucets, clean their gutters, and regularly flush tropical plants that hold water.

Resort areas tend to perform these mosquito-prevention activities already, and are generally safe from the pests, Park noted. According to CNN, the CDC team that traveled to Hawaii on Tuesday is bringing special mosquito traps that are easier to use and target the strain of mosquitoes that transmit dengue.

Dengue fever is caused by any of four closely related viruses, according to the CDC. Although it's been around for centuries, the illness was first documented in the 1950s during epidemics in the Philippines and Thailand.


Dengue does not occur naturally in the continental United States or in Hawaii, but it can be brought in by visitors. Hawaii last suffered an outbreak of dengue in 2011, on the island of Oahu, health officials said.

Worldwide, about 2.5 billion people -- 40 percent of the world's population -- live in areas where there's a risk of dengue transmission, the CDC says.

In rare cases, dengue can cause life-threatening hemorrhagic fever or shock, Adalja said. However, that most often happens when someone who previously had been infected with one strain of dengue is reinfected with another strain.

None of the cases during this outbreak has progressed to such severe symptoms -- "knock on wood," Park said.

People hospitalized with dengue are given supportive care, she said. Doctors give them fluids and acetaminophen, and monitor their electrolytes.

Watch the video: Pahoa Public Qu0026A On Hawaii Dengue Fever Outbreak


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