Responding to Hawaii’s largest dengue fever outbreak since World War II has stretched state resources thin, an issue that the state will have to address in order to be prepared for future outbreaks, Gov. David Ige says.

“We reallocated resources statewide to respond to the Big Island outbreak, and we do know that makes us vulnerable in other places,” Ige said Tuesday.

Ige’s comments came during a press conference largely praising the state’s response to the dengue outbreak. The conference was scheduled just days after U.S. Rep. Tulsi Gabbard called on the governor to declare a state of emergency in response to the ongoing health threat.

Gov. David Ige praised Hawaii County's management of the dengue outbreak on Tuesday, but acknowledged that state resources are stretched.

Gov. David Ige praised Hawaii County’s management of the dengue outbreak on Tuesday, but acknowledged that state resources are stretched.

Cory Lum / Civil Beat

As of Tuesday there had been 246 confirmed cases of dengue on Hawaii Island since the outbreak started. Three cases are deemed active — up from one case at the end of last month.

Ige said the state had written a first draft of an emergency declaration in November and there have been ongoing conversations between the state and Hawaii County about whether such a declaration is appropriate or needed.

Although the state and federal agencies are assisting in the outbreak, the efforts are being led by Hawaii County, Ige said, and the state is taking on a supporting role.

Hawaii County is getting close to making a request for an emergency proclamation, said Darryl Oliveira, administrator of Hawaii County’s Civil Defense Agency.

“It’s not because we don’t have control of the situation or a shortage of resources currently,” Oliveira said. “We’d like to stay ahead of the response.”

There is no estimate on how long the dengue outbreak might last.

The Aedes aegypti is one of two mosquitos in Hawaii capable of transmitting Dengue.

The Aedes aegypti is one of two mosquitos in Hawaii capable of transmitting Dengue.

Graham Snodgrass / Courtesy of Army Medical

In addition to pulling Department of Health staff from other islands to address the outbreak, three quarters of the state’s backpack sprayers — equipment used by vector control workers to eradicate mosquitos — are currently on Hawaii Island.

State officials said that if a situation arose and additional sprayers and equipment was needed on Maui — where the Department of Health just confirmed a case of dengue — they could be quickly delivered using commercial flights or the National Guard.

The Maui dengue patient recently traveled to Asia, and health officials do not currently believe that the dengue virus was acquired locally.

But the health department has limited staffing, so the agency could face serious challenges addressing an additional outbreak.

The Centers for Disease Control and Prevention warned Hawaii in a written assessment in December that the Hawaii Department of Health was facing “critical deficiencies,” particularly in the number of entomologists the agency employs.

“Longer term, 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,” Lyle R. Petersen, director of the CDC’s Division of Vector-Borne Diseases, wrote.

The department has less than half as many vector control positions as it had before its budget was slashed seven years ago — and seven of the 25 positions allocated to it now are not filled.

There are currently two entomologists — scientists who study insects and play a vital role in tracking and assessing possible outbreaks — at the Department of Health, and one is set to retire soon, said Keith Kawaoka, deputy directory of environmental health.

Lawmakers have introduced several bills this session to increase vector control staffing and create an emergency fund for addressing outbreaks.

“That really is the next step,” Ige said. “What can we do to ensure and restore the capacity within the Department of Health so we are better prepared and can get ahead of the next outbreak wherever it happens.”  

Kawaoka said he is hopeful that lawmakers will come up with long term solutions. In the meantime, he’s looking at a variety of ways to hire vector control workers and an addition entomologist soon.

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