Already Struggling With Dengue, Hawaii Braces Itself For Zika

The CDC says the Aloha State has "critical deficiencies" in its ability to fight the virus.

The mosquito-borne Zika virus could hit Hawaii especially hard if it arrives in the Aloha State, according to an expert from the Centers for Disease Control and Prevention.

While a widespread outbreak of Zika in the Hawaiian islands remains unlikely at the moment, the state is at higher risk because of its tropical climate and large number of foreign travelers. And many experts are voicing serious concerns about the state's ability to handle such an event, should it occur.

Hawaii is already battling its largest outbreak of dengue fever since the 1940s, a disease that is carried by the same species of mosquito that carries Zika.

In a December assessment of Hawaii's response to the current dengue outbreak, Lyle Petersen, director of the CDC’s Division of Vector-Borne Diseases, said there are "critical deficiencies" within the Hawaii Department of Health that should be "urgently addressed."

"Introductions of other mosquito-borne diseases such as Zika and chikungunya are likely and will require entomologic expertise at the State Department of Health that currently does not exist,” Peterson wrote in December. “I am concerned about staff fatigue and a potential crisis if another health event develops.”

As the Honolulu Civil Beat reports, the Hawaii Department of Health is woefully understaffed. Over a seven-year period, budget cuts narrowed the department from 52 vector control workers to 23, and from four entomologists to two. That’s fewer vector control workers than most individual counties in Florida, according to the publication. Cities in East Asia of a similar size to Honolulu are expected to have dozens of vector workers.

Like dengue and chikungunya virus, Zika is spread by the Aedes aegypti mosquito, which is found both on Hawaii's Big Island and Molokai. The virus bears extremely mild and short-lived symptoms, but is strongly suspected to be fueling Brazil's dramatic increase in cases of microcephaly, a birth defect that can cause developmental disabilities.

While there have been no locally acquired Zika cases in the United States, 31 people have been diagnosed with Zika after contracting the virus overseas and returning home, and one person in Texas has contracted the virus through sexual transmission. Last month, a microcephalic baby was born in Hawaii to a woman who had traveled to Brazil in the early stages of her pregnancy and later tested positive for a past case of Zika, marking the first case of the birth defect in the U.S. that has been linked to the disease.

And on Monday, the World Health Organization declared a public health emergency of international concern, or PHEIC, in response to the virus. While there is no vaccine for Zika, the designation should help funnel resources to the race to develop one.

The CDC said last week an outbreak of Zika in the U.S. is "likely," and the WHO warns it will spread across the Americas. The PHEIC declaration is just the fourth in WHO history, following the 2014 outbreak of Ebola in West Africa.

Brazil saw a spike in babies born with microcephaly after a widespread Zika outbreak.
Brazil saw a spike in babies born with microcephaly after a widespread Zika outbreak.

The steps Hawaii is taking

Last week, U.S. Rep. Tulsi Gabbard (D-Hawaii) urged Hawaii Gov. David Ige (D) to declare a state of emergency over the dengue outbreak and put additional resources into fighting its spread, including deploying National Guard medical personnel.

Gabbard said that what she heard in meetings with local officials on the Big Island is that "the resources on the ground are not sufficient in a variety of ways."

To assist in the effort, Hawaii lawmakers plan to introduce several bills this legislative session that would allow the Department of Health to address the issue of vector control and establish an emergency fund for outbreaks.

Keith Kawaoka, deputy director of the Hawaii Department of Health's Environmental Health Administration, told Hawaii News Now he hopes to fill another 10 vector control positions at a total cost of $500,000 per year. The additional staff, he said, could help the department get dengue under control while preparing for a Zika threat.

Kawaoka also told Civil Beat that the DOH is providing local doctors and hospitals with information about how to identify the virus.

“I think overall we are very concerned about Zika getting into here and establishing some kind of foothold,” he said.

Hawaii launched a "Fight the Bite" campaign to spread information about dengue fever.
Hawaii launched a "Fight the Bite" campaign to spread information about dengue fever.

Ultimately, if an outbreak of Zika occurs in the U.S., it will look much like dengue, according to Jared Aldstadt, a medical geographer at the University at Buffalo.

"If you live in parts of Hawaii, Key West or on the U.S.-Mexico border, it’s a concern because of the nature of the mosquito, but this is not something that is going to affect large parts of the country,” he said in a release. “This is something the U.S. can handle."

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