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Tuesday, December 1, 2015

ABOUT THAT DENGUE FEVER OUTBREAK IN HAWAII


Sure, people are concerned here, but there are only little more than 100 dengue fever cases on the Big Island, compared to 50 million to 100 million worldwide every year.  Legislators are getting hysterical, but I guess that gets votes.

In 2001, dengue fever struck Hawaii.  To quote:

Autochthonous dengue infections were last reported in Hawaii in 1944. In September 2001, the Hawaii Department of Health was notified of an unusual febrile illness in a resident with no travel history; dengue fever was confirmed. During the investigation, 1,644 persons with locally acquired denguelike illness were evaluated, and 122 (7%) laboratory-positive dengue infections were identified; dengue virus serotype 1 was isolated from 15 patients. No cases of dengue hemorrhagic fever or shock syndrome were reported. In 3 instances autochthonous infections were linked to a person who reported denguelike illness after travel to French Polynesia. Phylogenetic analyses showed the Hawaiian isolates were closely associated with contemporaneous isolates from Tahiti. Aedes albopictus was present in all communities surveyed on Oahu, Maui, Molokai, and Kauai; no Ae. aegypti were found. This outbreak underscores the importance of maintaining surveillance and control of potential disease vectors even in the absence of an imminent disease threat.

The 1944 epidemic started in 1943, the first such cases since 1912.  Most of those afflicted came from the war in the Pacific, and totaled 1498 patients in Hawaii.

I once was on the board of Hawaii Biotech, and a dengue vaccine was on our list of potential products.  I guess they failed, for it is reported that none exists today,   A vaccine for malaria, however, appears closer to reality.

Those mosquitos responsible for transmitting the virus certainly all look the same to me, and both the Aedes aeqypti and Aedes albopictus seem most problematic in Hawaii:

More specifically according to another source:

Dengue is transmitted by several species of mosquito within the genus Aedes, principally A. aegypti. The virus has five different types;[1]infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications. As there is no commercially available vaccine, prevention is sought by reducing the habitat and the number of mosquitoes and limiting exposure to bites.

Thus, dengue can be complicated, especially if you are unfortunately infected a second time.  However,  the total cases this year are similar to 2001 and less than 10% that of the 1943-4 outbreak, with what appears to be some stabilization at a little over 100 (112 as of yesterday). An isolated case on Oahu is not related to the Big Island variety, and South Kona, Hilo, Puna and Kau appear to currently be the primary areas of contagion.


Or more specifically when the number was 88:

How do you know you might have dengue fever?



The world-wide dengue epidemic:

In the USA:

So should you go to the Big Island?  Well, 100+ cases thus far compared to 50 million to 100 million worldwide.  I'm glad I don't live in those infected areas, but how will tourism be affected?  If you're a potential visitor with zero tolerance for dengue, there are other islands in Hawaii.

In any case, as terrible as the above symptoms are, in my past travels I encountered worse: chikungunya (also a virus) in Reunion Island and malaria (not a virus but a protozoan) in Papua New Guinea.

In Reunion (the smallest island right of Madagascar on the bottom) in 2005, short excerpt:  There are two other problems:  mosquitoes and cockroaches. In Norway, if you see a leaf rolling on the ground, it is a leaf. In Reunion, it will probably be a roach, especially at night. Actually, I exaggerate, for there are probably more large cockroaches on my roof area on warm nights than in any equivalent space on that island.  I did, though, have an encounter here with the largest flying cockroach I have ever seen. The mosquitoes, though, were the truly worrisome factor. Just this year, Chikungunya appeared. 5,000 now have been infected, and the symptoms are like Dengue Fever, but with a lot more pain. 

You can read the details, but my near catastrophe with malaria comes from a quote from my posting on my trip to Papua New Guinea in 1989:

What really caught my attention, though, was when I mentioned that I had not bothered with malaria precautions and asked, “just how serious was it?” One of them dropped his drink and the others, wide-eyed, expressed alarm. First, Lae is a lot wetter than Port Moresby, and the problem is amplified here. Second, it was too late. Third, those trying to prevent malaria as a resident by taking medication can go blind.  However, S.L. (don’t remember her first name) gave me a bunch of pills and said, all things concerned, it might help. I asked one of them about the getting blind part and asked for some details. He (a colleague from the University of Michigan who was a visiting professor at the University of Lae) said he decided not to take that chance, the blind chance. So, he had malaria.

Oh, I might conclude with the incredibly lucky news that I did not contract chikungunya nor malaria. I certainly don't want to take my chances on the Big Island, so no reason why I can't remain in my cocoon at 15 Craigside until this invasion subsides.  Just to make sure, I won't go for any walks around our building, as I've been stung too many times already.

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