State health officials said Tuesday the number of confirmed locally acquired dengue fever cases has climbed to 33 from 27 in Hawaii County.

Twenty-five are Big Island residents and eight are mainland visitors. A Kalama Valley resident on Oahu got the disease on a Southeast Asia trip.

State health workers have been interviewing those who contracted the disease, and plotted the areas on a map of the Big Island. As of Friday, of the 23 confirmed cases, all of the 23 infected had possible exposure to mosquitoes in South Kona.

The potentially fatal disease is transmitted when an infected human is bitten by a mosquito that bites another human.

The outbreak has prompted a round of community meetings on the Big Island by health officials to spread the word about the disease.

Although the earliest case of dengue known to the Health Department was Sept. 15, the department first learned Oct. 28 of the locally acquired cases.

The department’s actions have led a 38-year-old Volcano woman, who is awaiting test results for dengue fever, to criticize the department for failing to quickly notify and inform health care providers and the public about the virus.

Melissa Fletcher said she was “eaten alive” Oct. 26 by mosquitoes at a Honaunau property and at a roadside fruit stand in Hookena in South Kona, now known as a hot spot for dengue fever exposure, and developed a high fever, rash and back pain, among other symptoms.

“I had no idea dengue was on the island,” she said.

However, a Department of Health spokeswoman said the department notified Big Island health care providers by email or fax on Oct. 29, the day after learning about the locally acquired cases.

Fletcher said she began showing symptoms Oct. 30, with a 102-degree fever, vomiting, chills and severe low back pain. The following day she developed a rash on both sides of her neck and down her arms. The next day, she said, she felt worse, with excruciating pain in her neck.

Fletcher said she learned Nov. 2 that the virus was on the island.

Fletcher said that on Thursday she was sent to a hospital, where her blood was drawn, but she has not gotten the test results.

Dr. Christian Whelen, state Department of Health Laboratory director, said he sent out a notice Oct. 30 to all major local laboratory networks to forward all requests for dengue testing to the state lab, at least in the short term. The testing is being provided free of charge to patients for now.

Turnaround time is two to three business days from the time the specimen is received, or close to it, he said. He said if the specimen is from an early-onset case and the person might still be infectious, it is considered a high-priority specimen, and those cases are expedited.

“We want to make sure a person with the virus in the blood is not exposing themselves to mosquitoes, and they can do mosquito abatement around the person’s home,” he said.

The state lab is now equipped for the molecular testing to show the presence of dengue virus during the first five to seven days from the onset of illness.

A second test, which looks for antibodies against dengue, is performed more than seven days after symptoms appear.