While tourism apparently hasn’t suffered much yet, there’s growing concern the visitor industry on the Big Island could take a major hit if the number of dengue fever cases continue to mount.

"This is something definitely the business community is monitoring," said Kirstin Kahaloa, executive director of the Kona-Kohala Chamber of Commerce.

The number of confirmed cases of dengue fever on Hawaii island climbed to 92 Monday, increasing by four since Friday, according to the state Department of Health. The department continues to conduct assessments for mosquito activity and spraying of pesticide in the battle against the mosquito-borne disease, which produces fever, severe headaches, pain behind the eyes, joint and muscle pain, and rash.

On Monday the Health Department confirmed 13 of those infected have been tourists.

Kahaloa said a few hotels have taken some cancel- lations and are fielding questions about the outbreak. Some tourism officials are fearful the outbreak will grow out of control unless state and county officials get more aggressive against the disease, she said.

"They’re really concerned and really worried," Kahaloa said.

While there are signs that concerns are heating up, tourism officials say the growing cluster of locally acquired cases of dengue fever on the Big Island have had few effects on travel.

"To date, we have not seen an increase in cancellations due to dengue fever. And at this point it is too early determine if there has been any economic impact on our industry," said George Szigeti, president and CEO of the Hawaii Tourism Authority.

Szigeti said the HTA is working with the Health Department to keep visitors to the Big Island informed of the situation and educated about how to protect themselves, he said.

"We will continue to work with industry stakeholders and our global marketing contractors to ensure that visitors to Hawaii know that it is safe to travel to the Hawaiian Islands. As a precaution, we recommend that visitors familiarize themselves with information on the Department of Health’s website prior to arriving in the state," he said.

Hotels and travel agencies are following HTA’s lead.

"Generally, everyone in the tourism industry is referring people to the Hawaii Department of Health," said Theresa van Greunen, a spokeswoman for Aqua-Aston Hospitality. "We are referring guests that ask about it to places where they can get more information. So far, we don’t think it’s had an impact on tourism. Our reservations team has only had one call, and that guest decided to book anyway."

Jack Richards, president and CEO of Hawaii’s largest wholesale travel seller, Pleasant Holidays, said the company has had a travel alert on its website since it received notification of the outbreak.

"The alert is up, but we haven’t seen an impact at all," Richards said. "I think any concern that was there has probably died down some with the Associated Press article that ran on Friday quoting an official from the Centers for Disease Control and Prevention as saying, ‘Don’t cancel your Hawaii travel plans.’"

Dr. Lyle Petersen, director of the CDC’s Division of Vector-Borne Diseases, told the Associated Press that nearly 400 million people worldwide are infected yearly and that the outbreak in Hawaii has a smaller footprint than other places where it’s found around the world.

"If you consider how many tens of thousands of people come to the islands every day, the risk is extremely small," Peterson told the Associated Press. "Simple measures like mosquito repellent … can greatly reduce your risk."

Pat Fitzgerald, CEO of the Hualalai Resort and president of the Kohala Coast Resort Association, said he’s experienced one or two cancellations.

"Hopefully, we’ll be seeing the end of this soon," he said.

In the meantime some travelers like David Zeltser are worried. The writer from Santa Cruz, Calif., is scheduled to vacation with his family on Hawaii island in late December.

But now he’s having second thoughts and wants to learn more about the potential risks his family faces.

"We’re keeping an eye on the situation," he said, adding that they haven’t made a decision yet.

Ed Duggan has made up his mind. The 61-year-old Kaneohe resident said he got a good deal on a trip and had planned to take his wife to Waikoloa for her birthday in December. The couple decided to cancel their trip.

"Literally, she’s a mosquito magnet," he said.

Instead, the couple plans to go to Kauai because, Duggan said, it’s the farthest from the Big Island.

Honolulu resident Rob F. Kay, who is a frequent traveler, said visitors should be apprehensive given the growing scope of the dengue outbreak, which merits more responsiveness from the state’s visitor industry.

"There’s no question that this could impact Hawaii if it continues," said Kay, who suffered from dengue after a visit to Fiji years ago and last year was in Tahiti during a mosquito-borne chikungunya virus outbreak. "These outbreaks come with a psychological factor like a dark cloud. If you were to go to Hawaii island, wherever the outbreak is, I bet you that it’s all people are talking about."

Kay said chikungunya had a major impact on Tahiti tourism and that Hawaii could see similar harms from dengue.

"When I was in Tahiti, the national pastime was waving hand-held bug zappers and killing mosquitoes," he said. "Nobody wants fever, chills and those God-awful flu-like symptoms. I’ve had dengue and it’s just terrible."