To help tackle the latest outbreak of dengue fever, a member of the state House Health Committee wants to restore at least a handful of positions at the state Department of Health, where a wave of cost-cutting in 2009 eliminated dozens of workers tasked with controlling mosquitoes and rats.
Cuts to the vector control unit at the Health Department have meant there are far fewer public health workers to help control the spread of a dengue fever
outbreak, which climbed this week to four confirmed cases and 12 unconfirmed cases — the first locally acquired incidents in a decade.
The four cases, two confirmed yesterday, were traced to one Pearl City neighborhood, but the others involve people who live in various areas around Oahu.
David Henkin lives on the edge of mosquito country in Kahaluu, chairs the Kahaluu Neighborhood Board and works as a staff attorney for the environmental law group Earthjustice. He called the cuts to the Health Department’s mosquito abatement program “penny wise and pound foolish.”
“The cost of addressing a major health problem like dengue affects people’s lives, the well-being of their families and their children,” Henkin said.
State Rep. John Mizuno, a member of the House Health Committee, said yesterday he will try to get funding restored for three to five vector control worker positions that once helped Hawaii residents reduce mosquito breeding grounds — and occasionally issued citations to neighbors who refused to control mosquitoes on their property.
During the 2001 dengue fever outbreak that hit East Maui, Oahu, Kauai and the Big Island, the Health Department had dozens of vector control workers on Oahu alone who helped homeowners eliminate standing water, put larvicide in pools and other standing water and even introduced mosquito-eating fish into ponds, said Gary Gill, the Health Department’s deputy director for environment. The 2001 outbreak sickened 153 people.
The Health Department also relied in 2001 on an additional 250 employees, outside vector control, who volunteered to “go into dengue-infested areas around the North Shore with teaching tools and demonstrated how to eradicate mosquitoes,” Gill said. “There was the real possibility they were exposing themselves to dengue fever, but 250 people were willing to go beyond the call at great personal risk. These are good people.”
Today what’s left of the vector control operation on Oahu is staffed by two entomologists, a worker at Honolulu Airport and one inspector each for East Oahu and West Oahu.
“Controlling rats and mosquitoes to control bubonic plague and malaria are legacy programs that go back 100 years or more. Today it’s virtually nonexistent. We still get calls but there’s no way to respond,” Gill said.
The cuts to the Health Department’s vector control unit coincide with the elimination of other positions that investigate everything from restaurants to mortuaries and tattoo parlors.
“We used to have lots of guys out in the field treating broad areas of known vector breeding areas on a regular basis,” Gill said. “We had dozens of workers, inspectors and supervisors. The inspectors used to mostly manage complaints that came over the phone. But with only two people, if they’re out in the field, they’re not taking calls.”
But the hit to vector control came after a rich history of aggressively attacking mosquitoes in the islands.
When 1,200 cases of dengue fever were diagnosed between 1943 and 1944, more than 1,000 temporary vector control workers fanned out across Oahu, said Jon Winchester, a graduate student studying mosquitoes at the University of Hawaii’s John A. Burns School of Medicine.
“They did educational posters in 10 languages,” Winchester said. “The workers used mirrors and flashlights to find mosquitoes and put larvicide in the water. They also visited every house in Honolulu every seven to 10 days.
“Somebody needs to keep doing that job of monitoring mosquitoes.”
Tom Heinrich remembers the legions of vector control workers who came to his neighborhood “on the wet side” of Manoa Valley during the 2001 dengue fever outbreak to educate homeowners about how to cut down on the number of mosquitoes.
“In the big picture it’s a matter of public health and safety,” Heinrich said. “It’s easier to make cuts than it is to rebuild a program.”
Greg Knudsen contracted dengue fever in 1974 as a Peace Corps volunteer in Chuuk, and he said plenty more can be done to stop mosquitoes from breeding in the islands.
“Hawaii is prone to mosquitoes,” Knudsen said. “You don’t want dengue fever. It is not pleasant: high fever, rashes, blurry vision. It knocked me out for more than a week with sharp headaches. We need public education for getting rid of mosquito breeding grounds.”
Studies show that the best anti-mosquito campaigns involve grass-roots, community efforts, said Shannon Bennett, an assistant professor in the UH medical school’s Department of Tropical Medicine, Medical Microbiology and Pharmacology.
When her daughter’s preschool class canceled a hike up the Makiki Loop Trail out of concerns about dengue fever, Bennett explained that the children were unlikely to be infected by the mosquitoes found along the trail.
The class still canceled the hike, Bennett said.
“I would love to see vector control re-established here,” Bennett said. “They’ve had a valuable history. Today it’s not really possible — or realistic — to control mosquitoes with the resources they have.”