Dengue outbreak puts a chill on holidays

Residents of the tiny fishing village of Milolii along the Kona Coast are a welcoming sort. But this Christmas, there is one unwelcome visitor: the Aedes aegypti mosquito, rare in the state, and the most efficient transmitter of dengue fever.

A state Department of Health entomologist spotted a swarm of this species in Milolii, where a number of the residents have contracted the mosquito-borne illness.

“This is the first time the department has identified more than a few aegypti mosquitoes in one area,” the Health Department said in a written response to the Honolulu Star-Advertiser’s questions.

Previously, a total of seven Aedes aegypti were caught in South Kona traps — four in Hookena and three in the Telephone Exchange Road area near Captain Cook.

The common Aedes albopictus also carries dengue, but not as efficiently as aegypti. A concerted effort was made to eliminate the aegypti on Oahu amid a large dengue outbreak during World War II.

In 2002 health officials became aware of pockets of Aedes aegypti during a dengue outbreak on Maui. At that time a statewide surveillance of 300 sites found aegypti in three communities on the southern part of Hawaii island, according to a report by former state epidemiologist Paul Effler.

On Wednesday the Health Department identified Milolii as one of two high-risk areas in the ongoing dengue fever outbreak. The other area is South Kona, where the locally acquired outbreak got its start.

Milolii is south of Hookena and Honaunau in South Kona, which has consistently been a hot spot for dengue since the Department of Health first recognized the outbreak in late October. The Naalehu area of Kau had been a high-risk area but is no longer considered an area of risk.

Hawaii island now has 180 confirmed dengue fever cases, according to the department’s tally released Thursday. Eight of those individuals are still potentially infectious, and their initial onset ranges from Dec. 13 to 20. The first known case had an illness onset of Sept. 11.

Milolii Beach Park, a popular visitor attraction and community recreational area, was shut down Tuesday until further notice to reduce the number of visitors to the area, and camping permits have been canceled or moved to other parks, the county said.

Civil Defense and Health Department officials went door to door in Milolii on Wednesday with information and repellent. The county reports that a team was on-site to screen anyone with symptoms or reporting symptoms and connect them to health care services.

Health Department spokeswoman Janice Okubo said spraying will begin this weekend.

The outbreak is deflating the holiday spirit in Milolii, said Kai Kahele, executive director of Paapono Milolii, a community advocacy group.

“It’s supposed to be Christmas,” Kahele said. “There’s supposed to be a candlelight vigil, but (the mood) has been up and down this holiday.”

Kahele said “Hawaiian-style homes that are very open,” with breezes flowing through doors and windows, “unfortunately lets the mosquitoes in.”

In an effort to raise $3,000 to buy 100 mosquito nets, mosquito coils and DEET-free mosquito repellent lotions and sprays safe for young children, many of whom live below the poverty line, Kahele has created a gofundme page with a link on the organization’s Facebook page.

“We need this stuff now,” he said.

Kahele said the “extremely rural” fishing village has no dedicated water service, and residents rely on water catchment tanks. Most have mesh covers rather than solid covers for the water tanks, which have become breeding grounds for mosquitoes if they are not treated or chlorinated.

“You can see how that problem can multiply,” he said. “What you’re seeing in South Kona is rural communities relying on catchment tanks.”

Kahele describes the area as generally hot and arid but with areas with vegetation and brackish water ponds. But he maintains that the catchment tanks are the primary breeding grounds.

In addition to the fishing village, there is a private subdivision in the area, bringing the estimated total number of residents to between 500 and 750 people.

The Hawaii County Civil Defense Agency and Health Department teams were in the area Tuesday and Wednesday to meet with residents and identify mosquito hazards.

Working in tandem with Centers for Disease Control officials, a Health Department vector control team is focusing on the following efforts to step up effective mosquito abatement:

>> Changing to a mosquito larva pesticide instead of soapy water for standing water that cannot be removed. The CDC points out that Aedes mosquitoes do not lay their eggs directly on the surface of the water, and instead lay them on the walls of a container above the waterline. Soap breaks the tension of the water and discourages mosquitoes from laying eggs.

>> Compressing the spraying intervals for adult mosquitoes to two spray sessions in seven days rather than three sprays in 21 days.

>> Making a concerted effort to improve the percentage of households consenting to a survey of their property within a 200-yard range of cases, with a target of 90 percent compliance.

“The challenge thus far has been having someone at home to give consent,” health officials said. Vector teams are reviewing their schedules to shift work hours to times when people are more likely to be home.

County and other Health Department staff have assisted vector teams, and staff from other islands have also assisted.

The Health Department will continue to focus its vector control efforts only in areas where suspected and confirmed cases of dengue exist.

“People who live there use Milolii Beach Park for swimming, extracurricular activities, hiking, barbecues, picnics, and there’s a church there and people come from other areas,” Kahele said.

Kahele said the closure of the beach park is warranted because it is a tourist attraction including the Hauoli Kamanao Church, which was built in the 1860s.

Hookena Beach Park in South Kona, where the outbreak is said to have started, remains closed.