This is six more cases than the number reported Thursday, when Dr. Virginia Pressler, director of the Hawaii Department of Health, said there has been a "slow trickle" of new cases every day.
"The community needs to understand that we expect to see new cases identified on a daily basis," Pressler said during a news conference Thursday.
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. However, this outbreak is being likened to the last widespread outbreak, which was on Maui in 2001
. It lasted for 10 months and more than 120 people became ill.
"This could go on for a number of months to come," said Dr. Lyle Petersen, director of vector-borne diseases at the Centers for Disease Control and Prevention. He said it's not possible to predict how many cases will occur.
During the Maui outbreak it took eight months to reach a similar number of cases that the current outbreak has reached in two months, which Peterson said is concerning. But he made the distinction that there are more people in the outbreak area this time.
The key to ending the outbreak is controlling mosquitoes, which transmit the virus, and that takes time. "If [this outbreak] continues for a number of months it's not a failure of the system. We don't have tools yet to minimize outbreaks rapidly," Petersen said.
The CDC has been offering technical and laboratory assistance
as well as advice. Peterson and an entomologist and a technician from his team have been working with local and state officials on the Big Island since Wednesday.
There are two types of mosquitoes -- Aedes aegypti and Aedes albopictus -- that can transmit the virus, and both types are found in Hawaii. They are particularly hard to control because they breed in even the smallest pockets of water. Darryl Oliveira, with the Hawaii county civil defense agency, said it's impossible to eliminate them.
"The public can help by using repellant, minimizing mosquitoes on property and getting medical attention without delay," Petersen said.
Most people with dengue fever do not have symptoms. Those who do get sick develop a high fever and severe joint and muscle pain, which is why the illness is nicknamed "bone fever." People who have had it describe it as the worst fever and body aches they've ever had. Symptoms begin about five to seven days after exposure. Some individuals develop a rash on their hands, arms, feet and legs three to four days after the fever begins.
When diagnosed properly, dengue is successfully treated and the death rate is 1%. Acetaminophen is given to relieve symptoms, which usually last for one to two weeks.
Peterson said the number of cases in Hawaii is small compared to the 100 million clinical cases of dengue fever that occur each year in areas where it is endemic, or regularly found. He believes the likelihood of the disease becoming endemic to Hawaii is low.