Report examines how state handled 2001 outbreak

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As Hawaii health officials wrestle to contain a dengue fever outbreak on the Big Island, a review of how the state handled a 2001 outbreak on Maui reveals some of the challenges in store.


As Hawaii health officials wrestle to contain a dengue fever outbreak on the Big Island, a review of how the state handled a 2001 outbreak on Maui reveals some of the challenges in store.

An April 2012 study published on the Centers for Disease Control and Prevention website discusses the importance of control measures, and also looks at factors that might hinder efforts to contain a dengue fever outbreak.

Titled “Lessons Learned during Dengue Outbreaks in the United States, 2001-2011,” the study looks at Maui’s outbreak, as well as an outbreak in Brownsville, Texas, and another in southern Florida.

The Maui outbreak was reported to the DOH on Sept. 12, 2001, by a nonisland physician temporarily employed in the rural region of Hana, the report says. Efforts to confirm the cases of dengue were impeded, however, because the terrorist attacks of Sept. 11 caused the suspension of air travel around the country, slowing the shipping of blood specimens to the CDC. The outbreak was not officially confirmed until Sept. 21.

“After dengue cases in Maui were discovered, state Health Department officials began an aggressive campaign of public engagement involving town hall meetings, door-to-door campaigns to identify case-patients and educate the public about mosquito abatement, and media messaging (television, radio and Internet),” the report reads. “A public relations agency was hired to help manage questions from the public. The state public health department announced daily case counts at press conferences, and highway checkpoints were established for distribution of mosquito repellent. In addition, health officials engaged car rental agencies and hotels to distribute educational brochures for travelers and tourists.”

Vector Control activities included spraying to kill adult mosquitoes within a 200-meter radius around homes of case patients, breeding-site control activities such as trash collection and elimination of standing water, and door-to-door campaigns to educate the public about eliminating mosquitoes around homes.

The report noted interviewees told investigators that during the outbreak, “tension existed between responding parties over jurisdictional issues that largely remained unresolved.”

In addition to control efforts, state officials had to weigh issues that were “politically and publicly sensitive,” the study says.

“Because the Hawaii economy depends on tourism, the response had to balance the need for protective action on the part of local residents and tourists with the need to avoid discouraging tourism,” according to the report. “Additionally, although some members of the public were concerned about the negative effects of pesticide use, others demanded that spraying be conducted around schools (which had questionable utility in combating the outbreak).

“Finally, community engagement practices had to be tailored to the needs of specific localities. For example, on one island, attendance at town hall meetings was high, but on another island, attendance at similar meetings was low. However, public health officials believed that residents of this second island were more receptive to receiving information from fliers distributed in general stores.”

All told, 122 cases of dengue fever were laboratory-confirmed through 2002, including 92 on Maui, 26 on Oahu and four on Kauai.

Following the outbreak, an unpublished communications study was conducted by the state Health Department to assess the public’s response to health messages. It found messaging was effective, with 40 percent of residents surveyed stating they took action to prevent dengue.


“Of those who took action, 74 percent eliminated stagnant water outside their homes and 63 percent took action to prevent mosquitoes from entering their homes,” the report says.

Email Colin M. Stewart at

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