With no new cases of dengue fever reported in 30 days, it appears the Hawaii island dengue fever outbreak has come to an end.
But Gov. David Ige and his lieutenants on Wednesday were reluctant to declare the crisis over. Instead, they said the state needs to remain vigilant because of growing worldwide threats from mosquito-borne diseases such as Zika, dengue and chikungunya.
“It’s critical for everyone to understand this is not the end,” state Health Director Dr. Virginia Pressler said at a state Capitol news conference. “This is just the beginning of a new phase, for we need to be prepared every day for a new mosquito-borne disease outbreak.”
Ige said the emergency proclamation extension he signed April 11 will remain in place while officials work on a statewide strategic response plan for future outbreaks.
“It will help us to be proactive and better positioned toward vector-borne diseases,” he said.
In addition, a statewide public awareness and education campaign will be launched this year to help people understand the risks of mosquito-borne diseases and how best to prevent them from taking hold in Hawaii.
A total of 264 cases of locally acquired dengue fever were confirmed on Hawaii island during the seven- month period beginning on Sept. 11.
Officials said the state and Hawaii County are cutting back on some emergency response activities now that three periods of the maximum human incubation — 10 days for each period — have passed. The final day of the infectious period for the last reported case was March 27.
But officials said the Health Department would continue to immediately investigate all travel-related cases and conduct mosquito assessments or treatment of potential areas where mosquitoes proliferate.
Dengue is not endemic to Hawaii but imported by infected travelers.
Rather than declare victory over dengue fever at his press conference Wednesday, Ige and his staff described the 30-day marker as only a significant milestone.
“As we hit this milestone, we do believe that this dengue fever incident has helped us to be better prepared as we move forward,” the governor said.
Ige praised the state Legislature for allocating $1.27 million to hire 20 additional people for vector control and related tasks.
The funding will help to re-establish the beleaguered Vector Control Branch, which was crippled in recent years by furloughs and budget cuts. With the new positions, the agency will have a total of 45 people to combat future outbreaks.
“The dengue incident really reminded us about how important vector control is,” Ige said.
Mosquito-borne diseases have become a global concern, with the World Health Organization declaring a public health emergency for the Zika virus. The mosquito that carries the dengue virus also carries the Zika virus and chikungunya — and is firmly established across the islands.
“Every day we have suspect cases we are investigating,” Pressler said.
So far this year there have have been four imported cases of Zika, one imported case of chikungunya and six confirmed imported cases of dengue, she said.
“By no means are we out of the clear for any future threat or introduced virus or trauma,” said Darryl Oliveira, administrator of the Hawaii County Civil Defense Agency. “So we need to continue vigilance on everyone’s part. We’re always at risk.”
During the recent dengue outbreak, vector control teams surveyed 523 private properties and 310 public spaces, officials said. Of those, 220 private properties and 65 public spaces were treated for mosquitoes.
In addition, more than 1,900 potential cases were evaluated and/or tested by state disease investigators and laboratory staff, they said.
Oliveira said Hawaii island won’t necessarily see a reduction of resources in the fight against mosquito-borne diseases. Rather, he said, there will be a change in focus — from response to prevention.
That, he said, includes the cleaning up of tires, which collect water and become breeding grounds for mosquitoes. The Hawaii National Guard recently cleared one property with more than 1,000 tires.
Oliveira said this year’s strong El Nino climate pattern appears to have played a major role in the outbreak. Record summer rain in Kona helped to accelerate mosquito breeding, he said, while an extended winter and spring drought helped to reduce breeding grounds.
George Szigeti, president and CEO of the Hawai‘i Tourism Authority, said news about the end to dengue fever is a huge relief to the tourism industry.
Hawaii is fortunate that locally acquired cases of dengue never got beyond the Big Island, he said, and that the vast majority of cases occurred before February.
Despite negative publicity about the outbreak, visitor arrivals statewide, including those to Hawaii island, are ahead of last year’s record-setting pace through the first quarter, Szigeti said.
“That speaks well of Hawaii’s enduring brand as a quality global destination and to the response of both the state and County of Hawaii in halting dengue,” Szigeti said.
Officials are expected to take aim at the Zika virus in the upcoming public awareness campaign.
Pregnant women, they said, need to take special precautions against the Zika virus and should avoid travel to areas where Zika is actively circulating. The Centers for Disease Control and Prevention has confirmed Zika can cause microcephaly, a birth defect in which a baby’s head is smaller than other babies’ of the same sex and age.