The Island Resort That Was Hit With A Bacterial Disease | Diagnosis Unknown | Real Responders

An

island

in Hawaii is invaded by a terrifying virus Entire communities are infected and the

disease

is on the move It is transmitted by mosquitoes that feed on human blood There is no vaccine or cure No one is safe from the potentially deadly threat Now health officials must eradicate the source before the virus threatens the entire

island

. Maui is one of the most popular tourist destinations in the United States. Each year, more than 2 million people from around the world visit the island to enjoy luxury

resort

s and pristine beaches, but tourists only experience a small part. Of the islands' beauty, more than 700 square miles of Maui are covered in untamed jungle.

There, warm temperatures and frequent rains have created a tropical paradise. It's also the perfect breeding ground for a deadly

disease

in September 2001. Maui health officials responded to an emergency call for doctors. On the remote east side of the island, several cases of a strange disease had been reported. I think this is a little higher. Any idea where we are on the map? Yes, I think we're right here, dr. Lauren Pang heads Maui's district health office, and he and Chris Mills, an epidemiology specialist, made the two-and-a-half-hour drive from his office to the isolated village of Nahiku. The doctors who first treated the sick patients had never seen these symptoms before and could not make a decision.

diagnosis

, but since epidemiologists are trained to investigate mysterious infectious diseases, if this disease was spreading, they needed to see the patients and their symptoms firsthand.

Debbi Stoner first contacted public health officials when her entire family became ill. health department are here mr. Stoner now her husband and her daughter were sick and Debbie was worried, what do you have today? Beaver, so words don't describe how I feel. Bruce Stoner suffered from blinding headaches, extreme muscle pain, and exhaustion. His fever had risen to 104 degrees. The men went to check. about the stoner's daughter while dr. Pang examined Bruce, so this is unusual for you, though Makena for Mahina. I'm Chris and with the health department, how are you feeling? I don't feel very well, no, but the feeling through me is that 16-year-old Mahina was so weak that she could.

She was barely moving like her father, she was experiencing extreme headaches, joint pain and fever. Mills took a medical history and a blood sample, maybe the lab could figure out what was making the mckenas family so sick, for my whole family to get sick, it was very scary because it was a strange disease and I was the first one to be sick for six days. I was in bed for six days. Well, now Makena and Bruce were sick too. Health officials also took blood samples from the entire family. As Mills examined Debbie, he encountered an alarming situation. symptom press this for about a minute yes, baby rash Owen, we need to turn it on Debbie's arms were covered in a strange rash.

It feels like I've been boiled and it was so itchy I could barely stand it. I came in at night and felt it. Like pins and needles when I first got it, like your hands had been asleep and were waking up and then it was so itchy and there was nothing I could do to stop the itching, yeah you see nothing on the face, I don't HE. The rash was concerning, but what Debbie said after paying alarmed him. Well, I had heard from my neighbor rumors of sick people in the neighborhood and she told me that she is leaving, Debbie.

I've been so sick that she disappeared for two weeks and she hadn't. I hadn't seen her and she told me Debbie, she had been so sick it was very strange. Mills and PEG still didn't know what they were dealing with, but they knew it could be contagious. The stoner's neighbor lived less than a mile away. We'll draw blood first and then talk a little later. She had gotten sick two weeks ago. She still felt weak and tired. We interviewed her and collected all the information from her about her illness. She also got sick and we took her blood.

Gelda's symptoms were identical to those of stoners, but she had not been in contact with them for more than a month. Someone else was sick from the heat that you know of. Oh yeah, like you're sick or not. In the case of the flu, the pattern was an ominous twinge, and Mills feared they were seeing the beginning of an outbreak by the end of the day. They had seen four cases of the mysterious disease. They agreed that no symptoms pointed to a specific illness. They all contracted the same thing, but the combination of symptoms worries the doctor paying for the minutes of fever associated with a rash when you don't know what is worrying you because it could be many things that could mean a thought following the protocol dr.

Pang sent his detailed case notes to the State Department of Health in Honolulu, on the island of Oahu. Michelle Nakata received the information as a state epidemiology specialist; Her job is to monitor disease outbreaks on the seven main Hawaiian islands. Nakata reviewed the case notes. with the state health director dr. Bruce Anderson Hi Paul, come here for a second, let me know what you think. She also consulted dr. Paul kit sued Thani, an infectious disease expert, while reporting on the lawsuit. Chris Mills called from Maui Mills had assembled the small staff of the Maui health office and they were eager to hear Nakata's opinion on the cases, well, we hadn't thought it would be like that. easy to make spyro sis is also a never possibility i was worried about dengue fever the maui team was surprised is there anything we can do to help you call me again no i definitely will Thank you dengue is a human disease that In the 1980s it was a gym mosquito, but in the 1950s this species had been eradicated from the island.

A dengue outbreak seemed impossible and unthinkable. Historically, dengue outbreaks are massive and unstoppable. Thousands can die when the disease attacks, dengue. It is caused by a virus that attacks the body's immune system. There is no vaccine and there is no cure. It is often known as breakbone fever because patients experience pain similar to that of their broken bones. Brusatte Quindi suffered with the disease. I'd say this would easily be a hundred times worse than then, the worst headache you can imagine, you know, right behind your eyes, your head is pounding, your eyes feel like they're going to pop out of your head for a moment.

Week after becoming infected, patients develop a painful rash, a condition caused by veins bleeding underneath. the skin after two more weeks the symptoms disappear if dengue spreads uncontrollably victims with repeated infection can develop dengue hemorrhagic fever, with this patients bleed internally and from the eyes, nose and mouth the disease can be fatal if dengue would have invaded Maui Nakata had to determine To find out the extent of the outbreak, he sent a medical alert to hospitals and health care officials across the state. He advised them to watch out for patients with rashes, headaches, joint pain and high fever.

The main reason we asked you to do this was to receive immediate notification of new cases. In some cases, at the Maui District Health Department, the small laboratory was not equipped to test blood for dengue. A technician prepared blood samples collected in the remote village of Nahiku for shipment. He would send them to a specialized laboratory at the Centers for Disease Control and Prevention in Maui. The Puerto Rico tragedy occurred in New York City this morning. Two planes crashed into the World Trade Center towers. A third plane crashed into the Pentagon in Washington DC. We will keep you informed.

Terrorists attacked on September 11 for the first time in history. Air traffic was closed. Across the country, all outbound flights are suspended indefinitely. Passengers should stay home if they are local residents or if they are tourists, they should not leave their hotel. Maui was isolated and it affected us in the sense that we couldn't. send samples to be tested for dengue fever, but it was a big challenge for the CDC to retain it, they were distributors of the potentially deadly outbreak and had to deal with it alone without laboratory testing. Mills and Peng returned to Nahiku to examine further.

The residents first checked out the stoners. Bruce was starting to feel better but his daughter Mahina was still weak. Her fever had gone down but she ate well. There was very little her family could do for her except give her fluids and some pain medications. City ward Chris Mills questioned more residents and believed he could be seeing up to 20 new cases. It was more than the small staff could handle now that we had an epidemic on our hands with the possibility of dengue coming to Maui. He

real

ly overwhelmed his office, so we

real

ly needed a lot of help.

Mills asked the State Department of Health to send him more personnel to deal with the epidemic while flights out of Hawaii were grounded, flights between the islands were still operating dr. Paul Kazoo Taani and a team of epidemiologists arrived from Honolulu, they needed to examine each suspected case and quickly an outbreak was unthinkable if the virus was dengue, no one knew where it came from or where it would strike next with a supposed dengue epidemic in the The officials The island of Maui's public health officials were perplexed and overwhelmed, they asked the state health department for help.

A team of epidemiologists arrived on the island while heading to the hot zone. Maui Health Officer Chris Mills briefed epidemiologists, but like I said, we sat down. at the municipal meeting so quickly that there could be many more in the community than even those twenty, there are between 150 and 200 people in the community, so the population of nahiku was small and in a remote place, far from the most Officials in such a small community hoped they could locate the source of the disease and stop it before it spread. Upon reaching Nahiku, they set up a temporary medical station.

Worried residents were already waiting. The district health team needed to get a better idea of ​​the number of people. who had been ill, most residents had overcome the debilitating stage of the illness, but all had suffered fever, muscle aches, and a persistent painful rash. Volunteers at the local clinic took medical histories and drew blood samples; In a few hours they documented more than a dozen suspects. Male cases entered patient information into a database. All symptoms continue to point to dengue fever. In Hawaii it is not unusual to see isolated cases of the disease, but the victims are always travelers who contracted the virus in another country, other tropical areas such as Tahiti.

Samoa, Philippines, was experiencing an increase in dengue rates as of the interview. So far no one had traveled outside of Maui and they headed to the town church to meet with residents, for now the outbreak was isolated to the small town of nahiku dr. Pang explained that his blood could not be sent for testing the 9/11 terrorist attack had stopped all air traffic without laboratory analysis they could not confirm dengue fever they were still paying they recommended a massive spring campaign to protect residents from the virus with so much at stake they couldn't afford to wait for lab results no pesticide no DDT but residents knew mosquitoes were everywhere the response was overwhelmingly negative nahiku residents lived simply and close to nature they didn't want them pesticides contaminated their tropical paradise the anguish was fighting a defeated battle despite the risk that the townspeople wanted confirmation before allowing the Health Department to act, they are very opposed to spraying any type of pesticide in their town and really We were trying to respect their wishes, but at the same time and the outbreak Bruce and Debbie The stoners were the only residents who allowed spraying outside their home.

They were terrified for their family. If any of them became infected with the virus again, it could cause dengue hemorrhagic fever, a painful and potentially fatal form of the disease. The risk was too great. These donors. hope that spring will protect them health officials went to the most remote corners of nahiku during their interviews they learned that many more people were sick in a home medical kit cassock found a woman who said her daughter had contracted a case severe flu two weeks earlier still felt weak from the illness her symptoms were fever, headache, joint pain and rash the girl was too weak to walk to the car a week after the first case was reported, the team received unexpected good news that, according totransportation officials will return home on September 19 the US air travel ban had finally been lifted blood samples could be sent to the CDC lab it would still take several days to identify the virus Chris Mills sent samples on the first available flight to Puerto Rico Maui health officials would finally get the answers they needed and could call for reinforcements from the mainland at the CDC laboratory in Puerto Rico blood samples from the nahiku received top priority scientists specializing in the dengue The quickest way to test for dengue is to inject the patient's blood into the most common carrier of the disease, ETA, while mosquito samples of the species are kept frozen for testing purposes, if dengue is present, the virus will multiply inside the mosquito, the insect tissue is very sensitive to the virus tissue.

The samples are then removed from the carrier and combined with a reagent under an ultraviolet light. Infected blood cells will glow. Scientists finally had their answer. They were facing a full-blown epidemic. It was the worst case scenario. Nahiku's blood samples had tested positive for dengue. Given the number of mosquitoes we have here and the history of other countries in tropical areas never being able to get rid of them, it was a big problem, the situation was urgent, there were now 30 documented cases of the disease in Nahiku, the Department of Health. The Department was losing the fight.

The CDC told us that no one can control the dengue epidemic once it starts. The CDC told us that generally every time it detects a case in its system, there are two or three hundred more undetected, according to the CDC's estimates, the toll could now be in the thousands and they still had no idea. How the virus was spreading The species of mosquito that transmits dengue had been eradicated from the island in the 1950s If the eighties at that time mosquitoes had returned To answer that question Maui health officials brought in an entomologist , a scientist who specializes in insects needed to catch mosquitoes and examine them to see if another species was spreading the disease dr.

Paul Reader works for the CDC and is an expert on Maui's number one public health enemy, the mosquito. The first thing we were interested in knowing was what mosquitoes are around here and, of course, before coming here we knew that ADE is albopictus, which is another species. actually now known as the Asian tiger mosquito, it was actually common and we didn't expect to see how common it was until we got here in Naha ku. The reader and his colleague carried out an experiment to measure the population of mosquitoes, the best way to measure the number of mosquitoes is to collect them in a vacuum cleaner.

The reader used himself as bait. In minutes they had collected dozens of insects in the laboratory they only found The eighties albopictus or Asian tiger mosquito, this species carries the dengue virus but does not feed exclusively on humans and is rarely the cause of an outbreak this year. The breeding conditions had been ideal. The mosquito population increased with so much competition. for food Asian tiger mosquitoes were now biting more humans there were millions of Asian tiger mosquitoes across the island carrying a deadly disease in the fall of 2001 Maui health officials struggled to contain a dengue outbreak millions of mosquitoes were carrying the virus the entire island was at risk the dengue outbreak is larger than we originally thought state health director dr.

Bruce Anderson and held a press conference announcing the outbreak. Hundreds of calls flooded the Health Department. Retired nurses were recruited to help with the workload. The phone just went off the hook. Calls from tourists from the mainland US who had been here and we are. Worried about me getting sick or the tourists coming and then our local people being really upset. Few people on Maui had heard of dengue. Panic spread through the community. The Health Department distributed pamphlets explaining the symptoms of the disease and its dangers. They asked residents and tourists to call the health department if they experienced the characteristic dengue x pain, fever and rash.

The effect on Maui was immediate and devastating. The island's hotels were cleared. Reservations were cancelled. Hawaii's tourism industry was already suffering the effects of the terrorist attacks. On September 11, now also dealing with an epidemic, officials once again returned to Nahiku and pleaded with residents to allow them to spray. Some people were still very opposed to pesticides and a property, but a lot more people were much more open and thought I'd rather have the pesticides and help prevent other people from getting sick. Technicians sprayed pesticides around the homes of infected residents. They sprayed the tropical flowers with soap and water.

The solution killed the larvae without harming the environment. There was no way they could spray enough to kill. all mosquitoes, but if they could reduce the insect population they could prevent mosquitoes from spreading the virus when news of the outbreak reached the island insecticides ran out the Health Department received an emergency shipment to keep residents and tourists protected The public health nurses opened a stand where tourists and also many local people who live here passed by and they handed out information and also wipes or spray if people didn't have insect repellent, but Mills knew they would have to fight them at the source. . puddles of water surrounded nahiku insect larvae the next wave of mosquitoes was visible on the surface stagnant streams were caused by a reservoir that diverted Maui's water supply to tourist areas district health officials requested it be released the water if they flooded the streams that could destroy the mosquito breeding ground, the reservoir opened, the water ran into nahiku a few hours later, a pang and Mills surveyed the streams, the water level had barely risen, their attempt to destroy the hatcheries had failed, mosquitoes were multiplying and the virus was still spreading, health officials.

They were outnumbered and surrounded ten miles from Nahiku, in the city of Hana, doctors were called to examine a group of sick high school students, the disease had spread outside the hot zone in Nahiku, dengue was on the move for the epidemiologists who provided the high school students. An important clue is that the students had recently visited Tahiti, a country that was also suffering from a dengue outbreak. Paul KITT in a suit wondered if high school students had been infected with dengue in Tahiti and then brought it back to Hawaii. Blood samples were sent to the CDC, where they could compare the strain found in Hana to the Tahiti strain while they waited.

To see the results, students like Kara Henderson were scared. Everyone in Hana was really worried. There were a lot of people getting sick, so everyone was trying to take care of each other. The outbreak had already spread from Nahiku to Hana and neighboring communities on Maui's east coast. I wasn't surprised to hear more cases outside of our community because it spread so quickly in our community. I was a little sad for the people there and wanted to warn them to be careful, use mosquito repellent and wear long sleeves and pants and don't come down here the health department was fighting a losing battle the roadblocks would keep residents and tourists away from high-risk areas but as the CDC had told them, it would be almost impossible to contain the mosquitoes the swarm of hungry insects Threatened both human life and tourism, the main source of the state's economy, state health official Michelle Nakata Hawaii, because it's still part of the United States, is considered a nice exotic tropical place and I think with the onset of dengue, the impact was that he lost some of that security.

Nakata flew to Maui to help the team, but the number of cases continues to multiply by the time I arrived on Maui we were fighting an uphill battle, they were receiving a lot of phone calls about possible cases and there was only There was a lot of work to do on September 21, two weeks into the outbreak, dr. pang received devastating news another suspected case of dengue had appeared outside the hot zone the virus seemed to be moving towards a more populated area to a town called haiku East Maui is quite isolated and we kind of drew a line on our drawing of a line on the sand and we said that if you crossed into this area called haiku park it was very humid, there were a lot of mosquitoes and the population was about four times that of the other side.

I said if he crossed this to here, where did he do that? I mean, it would be us. Like a fire out of control, researchers drove several hours north to see the haiku. Chris Mills and his team had to stop this latest outbreak. Vector control technicians armed with pesticides had already arrived at the patient's house once they got confirmation that it was dengue. A telltale rash on his arm would come into action. The sunny weather confirmed his worst fears. Once again, dengue had spread to another area. Technicians began fumigating around the house. Mills gave the family detailed information on how to prevent further infection.

He told them to wear long pants and long pants with sleeves outside and using insect repellent was important to reduce the mosquito population around the house, but Mills wondered if it was doing any good when dengue cases began to occur in other parts of Maui, like it really spread all over the island and we're going to live with this forever and that's a scary thought not only as a healthcare worker but also as a resident as the disease raged through haiku village. Reports of dengue fever came faster than ever. The team was frustrated. and worried at the end of September they had 60 suspected cases that Maui officials refused to reveal they knew if they didn't stop the virus it could become deadly in October 2001 dengue was spreading across the island of Maui the mosquito-borne disease had been confined to three small villages on the island was now spreading westward and threatening more populated areas not only which, very well, began to have cases, but also far away in Lahaina, with a population double of 17,000, double the the cool thing, now you have a lot of people, but it's not as humid and you wonder how it got there, located on the western side of the island, Lahaina is where tourists vacation and has the highest concentration of people due to Maui's fragile tropical environment , they could not carry out aerial fumigation, the officials would have done it. to combat mosquitoes house to house their mass eradication effort was not working, new cases were reported every hour if dr. pang and Chris Mills hope to combat the epidemic they needed to map where it was spreading.

We called the Pacific disaster center to help with GPS mapping so we could have a good view of where all the possible and confirmed dengue cases were living. In the Nahiku and Han area, most of these houses don't actually have physical addresses. Medics met with Mike Napier at the Pacific disaster center. Napier monitors earthquakes, volcanoes, tsunamis and severe storm activity in the Pacific and Indian Ocean regions for health officials. This outbreak could be alone. As it was devastating, with Napier's help, the team would use satellite images to get an overview of the epidemic, but first they had work to do on the ground.

The team assembled at Nahiku Napier equipped them with portable global positioning systems or GPS units working in pairs. The goal was to map every household that had confirmed or even suspected cases of dengue. This overview would help health officials visualize where climate and vegetation could support concentrations of mosquitoes in the field. The teams interviewed each patient presenting with dengue symptoms they used. GPS units to record their geographic position, the State Department of Health used the points to show where exactly the outbreak was occurring and, to some extent, limit travel to those areas at the end of a day, Napier downloaded data from each equipment on your computer.

Health officials would eventually see their enemies swarms of mosquitoes all over the island. They set up a perimeter around the houses and outlined critical areas or points for mosquito control. We created two hundred meter circles around each hot case and the reason we did that is that because the albopictus mosquito has a range of 200 yards, now that the teams knew exactly where the mosquitoes were, they targeted areas around houses of any suspected cases, there were already one hundred documented suspected cases covering a 70 mile area across theisland, each area had to be sprayed by hand to prevent further infection they needed to find more resources and quickly in October 2001, Maui scientists and health officials had identified the source of a mosquito epidemic, millions of them, were confirmed almost a hundred cases of dengue, thousands were suspected to be dr .

Lauren Pang and her team were in a race against time, they had to stop the mosquitoes or people might die. The outbreak along with the events of 9/11 threatened to destroy the main source of Maui's economy, tourism, many workers lost their jobs, others faced the outbreak of a deadly disease Maui was in trouble the Hawaiian government responded with a solution bold and practical Hawaiian State Senate Representative Kalani English we took unemployed people who lost their jobs to 9-1-1 and other unemployed people we skipped civil service roles We allowed them to come directly, we hired them directly, we trained them and We went out to eradicate mosquito breeding grounds, so we created what is known as an emergency environmental workforce.

The newly formed work group was grateful for the work and highly motivated. Their own families were at risk day after day they cut the weeds eliminating mosquito breeding grounds pesticide spraying intensified but the infection rate also increased there were now more than a hundred confirmed cases of dengue Chris Mills was worried because it was scary as a health worker We just didn't know if we were going to be able to handle it or even get rid of it. A dengue epidemic had never been successfully contained, but residents across the island pitched in to help. A new series of public service announcements educated them about the dangers of dengue.

A clogged rain gutter. 1,000 mosquitoes an open wheelbarrow 10,000 mosquitoes most importantly they learned how to prevent mosquitoes from breeding residents checked their homes for stagnant water where mosquitoes lay their eggs those who had been sick were particularly worried they were terrified of being reinfected After months of work the number of dengue cases on Maui decreased and then stopped, at one point we were projecting literally hundreds of thousands of cases which would have been the worst case scenario as it turned out we had just over hundred cases and the problem was largely kept under control since the first case in nahiku, CDC scientists analyzed hundreds of blood samples and found the source of the outbreak.

In this case we discovered that the Hawaiian dengue virus was more closely related to the Tahitian virus that we obtained from the same year and more distantly related to the Samoan dengue from the previous year so our conclusion is that the most likely origin of the Hawaiian virus It was Tahiti for the people who had been infected the recovery was long and difficult but the quick action of the Health Department averted a disaster as soon as they found out, they acted immediately, they came out the next day and they were very interested and very detailed, They gave us a lot of personalized attention and started community meetings right away. really made me feel more confident about the whole thingeight months after Debby Stoner reported the first case of dengue on Maui, the outbreak was contained, we declared the outbreak officially over in April, about two months since the last case was reported , we assumed that since the mosquitoes lived for about a month if they were no longer circulating among the mosquito population, then there would no longer be any risk of transmission.

Miraculously, there were no deaths. I think we were able to stop it or have an effect because of the early response and I think we had an early response. because we were educated and people told us that we knew where it was and we could respond very quickly, so a lot of people said how can I personally help in controlling the breeding sites and all that, so we had a very motivated medical community, health officials educated. Scientists and the public had achieved the impossible by working together. They contained an epidemic, defeated a disease, and restored Hawaii as a safe tropical paradise for the first time in history.

Hawaiian public health officials had stopped a dengue outbreak.