Confirmed cases of dengue fever on Hawaii island today climbed to 92, increasing by four since Friday.

The state Department of Health reported today that 22 children and 70 adults — including 13 visitors — have fallen ill in an outbreak that could continue for months and spread into new areas.

The disease is transmitted by mosquitoes, and symptoms include fever, severe headaches, pain behind the eyes, joint and/or muscle pain and rash.

To contain the outbreak, the health department has been conducting assessments for mosquito activity 

 and sprayed pesticide.

The most recent onset of the illness is now Nov. 17, with the earliest being Sept. 11.

The health department says 143 potential cases have been ruled out by negative tests or because of not meeting the criteria.