Dept of Health dropping the ball on Big Island dengue?

Dengue is a serious disease caused by a bite from an infected mosquito.  With many popular surf spots in overseas endemic Dengue areas, we generally have a few cases brought back every year.  On Maui aggressive steps, under Public Health officer Dr. Lorrin Pang, to prevent Dengue from taking hold in our local mosquitoes has isolated these cases and prevented a recurrence of the 2001 situation where East Maui mosquitoes became infected with Dengue.

Prior to that, the last known Autochthonous (caused by our mosquitoes rather than contracted overseas) dengue infections in Hawaii were in 1944.  Allowing dengue to get a toe hold in our home-grown mosquitoes, would be a disaster.  For instance the island of Bali has yearly outbreaks which fill their hospitals to 100% occupancy.

But now dengue has taken hold on Big Island.

The Maui outbreak was stopped and eradicated by a major public information campaign including flyers and free mosquito repellent placed along the Road to Hana, public service announcements on TV and radio, community meetings and close monitoring of possible cases.  The Public Health department on Maui still insures that dengue doesn’t take hold by eradicating mosquitoes around a suspected case home and going door to door to warn neighbors to eradicate mosquitoes, take precautions not to be bit and be aware of symptoms.

But what is Big Island doing?  According to residents, not much.

Oahu office is overseeing the crisis but it is not clear that they are responding to the outbreak with the quick action that is required to prevent dengue from becoming entrenched on Big Island (and as we’ve seen with the coqui frogs and Little Fire Ants, spreading to the rest of the Hawaiian islands).

  • They have not identified the infected areas.  Kona-Kailua, Kaloli Point, and Volcano have been mentioned in social media as sites with dengue cases but DoH is mum.
  • They have not done education outreach
  • It is unclear as to whether they are even eradicating mosquitoes around infected patients and warning neighbors.

Since the Health Department is letting us down on this threat, it is up to the residents to do their job for them.  Make sure this information gets out.

  1. Clean up all old tires and containers which could hold water for mosquitoes to breed in. Plants which hold water at the base of their leaves like Bromeliads should be taken out or squirted daily with soapy water.
  2. Wear mosquito repellent. Consider a mosquito net for your bed.
  3. If you experience fever, bad headache, bone aches and fatigue, suspect dengue and report it to Oahu Dept of Health at 808 586-8362.  Rash is also a symptom in some cases.
  4. If you suspect you have dengue, your biggest danger will be dehydration.  Dengue attacks the platelets in blood. These are the clotting factors and with low platelets you may have many small hemorrhages which appear as red dots (especially on the feet) and dark dots obscuring your vision.  Don’t worry, all this will go away a few months after you recover.  Your immediate danger is shock due to loss of fluids.
  5. Have someone take care of you and insure you have plenty of fluids and are fed.
  6. Tell your doctor you suspect Dengue and that they should take a platelet count.  Your platelets don’t start dropping until a few days after the other symptoms appear.  If they drop below 80,000 you might need to be hospitalized for supportive care like IV fluids.  There isn’t much else that you can do.
  7. Stay in bed and rest.
  8. Notify your neighbors and give them this information
  9. Allow Dept of Health to spray around your house to kill the infected mosquitoes.  I know many people don’t like pesticides (with good reason) but this is one of the few circumstances where they are life savers and worth the side effects.
  10. Organize community information sessions and make sure the Dept of Health shows up to educate and inform residents and visitors.
  11. Visitor accomodations should inform visitors about wearing mosquito repellent.

If the Big Island Department of Health won’t get on the ball and treat this as the emergency it is, we will have to pick up the slack.  Here are some informational handouts:

Preventing Dengue

Recognizing and caring for dengue patients

Prevent Mosquitoes to Prevent Dengue

12 thoughts on “Dept of Health dropping the ball on Big Island dengue?

  1. NOT TRUE that Big Island Health Officials are “dropping the ball” in any way. They are all over this 24/7 and deserve our full support, confidence and cooperation by eliminating potential mosquito breeding areas in our populated areas and by ensuring our loved ones apply mosquito repellent generously on all exposed skin daily. We are one very mobile island family–in this together–because we all move about the island freely and regularly. No identifiable location is more or less vulnerable than the rest of us. Cooperate no criticize!

    • Our criticism is based on DoH’s lack of communication. They haven’t identified the locations of infected patients. They haven’t held any community meetings saying exactly what you just said. That info needs to get out ASAP. And I would disagree with you that no one area is more or less vulnerable. Areas surrounding patients are most likely to harbor infected mosquitoes and need the most outreach and attention. That is not happening.

      More communication to the community is needed immediately. It is one thing to say there are suspected cases on the big island but there should be flyers, meetings, radio ads telling people how to clean up mosquito breeding grounds and use repellent.

    • They are also not putting any protocols in place for people who may have the virus to get the testing they need in a timely manner. I called my PCP, Urgent Care, and the ER. I have excellent insurance. My PCP (Hilo Bay Clinic for now) said that they couldn’t get me in for 3 – 5 weeks, but that I could walk in and wait for hours and they might see me, no guarantees, they were busy you see… Urgent Care said they wouldn’t see me at all, they would refer me to HMC. HMC said they’d see me, and then they’d likely refer me to the lab for the tests. So I’d need to go in with my 3 year old daughter (no child care right now) and we’d wait for hours, then go to the lab, wait for a while more, then take the 30 mile drive back home. It’s a bit insane, don’t you think? Most of my symptoms have passed now, I just still have the rash. I’ve got a lot of work to do and a child to take care of. I’m trying to do the right thing, but dang!!! What the heck!? Wouldn’t you think health care providers should be forced to cut the red tape and actually assist and make potential cases a priority? Because of these experiences, I’m certain the number of cases is actually much higher than we think. That, and, the first time a person gets bit, they won’t likely get very sick for very long. But the second time? Severe reactions are likely.

      • This IS insane. I have emailed my phone number. Here’s the protocol for suspected Dengue.

        1. If you have these symptoms: Fever, blinding headache, horrible bone aches, fatigue and maybe a rash on your palms or feet or all over and you may have been exposed to Dengue by being in an area with an active infection (e.g. Big Island) then steps need to be taken IMMEDIATELY. Above all, notify DoH Public Health the minute you suspect you might have dengue!

        A. You should be carefully monitored and cared for since people die when left alone and dehydrated.

        B. After 3 or 4 days of symptoms you should have a blood test for platelets level. If your platelets are dropping, it is quite likely you DO have Dengue.

        C. Monitor your platelets every other day or so and go to the hospital if they drop below 80,000.

        D. The DoH SHOULD spray around your house to kill any mosquitoes that may have bitten you and now be infected with Dengue. If they don’t it would be really good to call in a pest service. I know that most people don’t like pesticides but this is one situation where they can save people from a really bad disease.

        E. The DoH SHOULD notify all your neighbors so they can take steps to eradicate mosquitoes and protect themselves from bites.

        F. It is important that YOU don’t get bit either — because that will spread the disease. You cannot give it to anyone EXCEPT by mosquito.

        G. Go to bed and use a mosquito net. Make sure that someone is checking on you twice a day and bringing you fluids and food. That is the only treatment – keeping the patient well hydrated.

        H. Don’t worry about spots in your vision – that’s little hemorrhages and they will go away with time.

        I. As long as you rest and stay hydrated, you WILL completely recover but expect to be very fatigued for a couple months.

      • One thing that is good is that there are 4 strains of Dengue and you can’t get the same strain more than once. I’m betting we have only one strain going. Although if you get it, you will be at greater risk when you go elsewhere and are bit by a mosquito carrying another strain. That’s what happened to my son. We theorize he got a really mild case of Dengue on Maui in 2001 and later when he went to Bali he got it again and got the hemorrhagic version.

        • Well, and it’s crucial to keep in mind that if another gets brought in at any point in the ‘next times’ and this strain has taken root permanently on the Big Island, then we have a BIIIIG problem.

    • I spoke with DoH this morning and they said:

      1. They are inspecting and spraying within 200 years of CONFIRMED cases
      2. They are NOT informing neighbors of the Dengue case
      3. They are NOT informing neighbors of the steps that need to be taken in order to eliminate mosquitoes and risk of bites
      4. They are NOT holding community meetings

      I suggested that they start doing these things and also consider action sooner when there is a suspected case now that we know our mosquitoes are infected.

      Hopefully this discussion will cause DoH to go into high gear and become more aggressive about community communication and education as well as perhaps moving faster (prior to confirmation) on mosquito eradication.

  2. Update: DoH has released some geographic information. The Star Advertiser reports that:

    “Among Big Island areas where health officials found similarities in a few cases are Hookena and Honaunau in South Kona. Park advises residents and visitors to take precautions and use DEET insect repellent.

    Staff from the Health Department’s Vector Control Branch have already started spraying around the homes of some affected residents as a precautionary measure against the virus, which is transmitted through the bite of an infected mosquito. “For each new case they are sending crews out to assess the property around a 200-yard radius,” Park said.

    http://www.staradvertiser.com/newspremium/20151103_10_cases_of_dengue_fever_confirmed_on_big_island.html

  3. What are they spraying with? Just for conspiracy theory sake ~ way to override our Ban/restrict Glyphosate efforts/ released Dengue to show need for GMO Mosquito’s ~ Monsanto is desperate to ruin our Isalnd too!!! NO WAY!

    • I realize people are concerned about pesticides in food. But this is one situation where pesticides are LITERALLY a life-saver. When you analyze the upside vs downside of spraying to kill off mosquitoes around an infected person’s home, the upside is so much greater than the downside that analysis has to come down in favor of killing the mosquitoes.

      This is the ONLY way we have a chance (and at this point it may only be a chance) of eradicating Dengue on the Big Island. Otherwise this invasive disease is going to be a thousand times worse than LFA or coquis. On Bali where it has taken hold, Dengue literally fills their hospitals to 100% capacity during bad outbreaks and people are left without care. We do not want that for the Big Island.

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