That's because state health officials are investigating a cluster of dengue fever. Thirty-three people on Hawaii's Big Island have become sick with the mosquito-borne disease since September, according to Hawaii state health officials
. This is the first locally transmitted outbreak of the viral illness on the Big Island and the first outbreak in the state since five people were infected on the island of Oahu in 2011
Twenty-five of those infected in this current outbreak are residents of the Big Island, while eight are visitors. Four children are among those who have become ill. All patients have recovered or are recovering.
The most recent case was identified on November 2. The first patient began exhibiting symptoms on September 11.
Dengue is transmitted to humans
when they are bit by infected mosquitoes.
Dengue usually occurs in tropical Asia, Africa, the Caribbean and the South Pacific. The virus is not endemic in Hawaii but is sometimes brought in by infected travelers.
"It's likely an infected traveler infected the local mosquito population, which led to this cluster," state epidemiologist Dr. Sarah Park said last month
Battling 'bone fever'
Most people with dengue show no symptoms, and only about a fourth of those with the disease become ill (although they can still infect mosquitoes who bite them), according to Dr. Hal Margolis, director of the Centers for Disease Control and Prevention's Dengue Branch. He added that it's the most frequent cause of fever among travelers to areas other than Africa.
Those who do get sick get a high fever and severe joint and muscle pain, which is why it's nicknamed "bone fever." People who have had it describe it as the worst fever and worst body aches they've ever had. Symptoms begin about five to seven days after exposure to the virus. Some individuals develop a rash on their hands, arms, feet and legs, three to four days after their fever began.
When diagnosed properly, dengue is successfully treated and the death rate is only 1%. Acetaminophen is given to relieve symptoms, which usually last for one to two weeks. Treatment with ibuprofen can lead to complications, mainly causing bleeding, which is a complication of severe illness from the virus.
The overall risk to the public is low, Margolis said, mostly because the mosquitoes in the United States aren't very efficient at transmitting the virus. There are two types of mosquitos -- Aedes aegypto and Aedes albopictus -- that can transmit the virus. Both types of mosquitoes are found in Hawaii but they rarely have outbreaks. While there might be additional cases, "it's (dengue) only where mosquitoes (are) so the risk of a second round of transmission is very low," Margolis said.
The best protection against dengue is to prevent mosquito bites. The department of health is monitoring to identify areas where there are infected mosquitoes and in some case they are spraying to control the mosquito population. Residents should eliminate standing water, clean gutters and use screens without holes on windows and doors. Individuals should use bug repellants containing DEET or Picaridin. Permethrin is recommended on clothing.
Earlier this week, state health officials kicked off a campaign to raise awareness about the mosquito borne disease.
"In order to keep Hawaii safe and dengue-free, we are asking the community for their help in following the easy tips and suggestions shared through our campaign and joining us as together we 'Fight the Bite,'" Dr. Virginia Pressler, director of the Hawaii State Department of Health, said in announcing the campaign.
Health officials are asking individuals who have traveled to the Big Island and experiencing a fever and a headache, nausea, a rash, or muscle or joint pain, to tell their healthcare provider about their travel history. This includes more than 2,000 triathletes who convened there for participation in the Kona Ironman on October 10.