A warning for holiday travelers to tropical respites

Here’s a buzz-kill alert: Although I’m wishing all the very best for the season, for those headed to vacation in sunny, tropical climes, I’m also hoping to put a tiny bug in your ear — be aware of local health conditions and protect yourself from tiny nipping critters, because tropical diseases continue to surge in new ways.

If you’re headed to Hawaii, the Big Island in particular, you should know the 50th state is coping with an unusual outbreak of dengue fever, with 157 cases confirmed already of an illness that is not endemic and is believed to have been spread by a visitor to local mosquitoes that have carried the disease further.

Dengue afflicts its victims with fever, sweats, headache, and a wracking, deep pain in the eyes and joints that gives rise to its nickname as a “bone fever.” It also is a hemorrhagic disease, meaning in its more severe instances it can cause capillaries to leak, leading to circulatory failure. Although a dengue vaccine has won regulatory approval in Mexico, there are no effective treatments for the illness, which typically runs its course in a week or two, after which the fever and pain subside and patients usually fully recover. There are four strains of dengue and those who recover from one do not necessarily get immunity from the others.

In Hawaii, a recent traveler there reports, local authorities have moved quickly to try to contain the small outbreak, though cases also have cropped up in surrounding islands, including Maui. Authorities are spraying areas of the Big Island aggressively, especially around schools and in known problem areas, to try to kill the aedes aegypti and aedes albopictus mosquitoes that carry and spread dengue. Meantime, civil defense authorities are broadcasting hourly updates to worried parents and residents and these reports offer an odd counterpoint to the sunny weather forecasts that typically precede them.

Experts from the U.S. Centers for Disease Control and Prevention have just visited to check in on the local response, with local media reporting that the feds have raised concerns about the spare number of epidemiologists available to deal with the situation, as well as the potential for fatigue among healthcare staff in general, as they have been laboring with this outbreak for weeks and may need to do so for months.

As disease outbreaks go, the Hawaii dengue cases, thus far, are concerning but they haven’t yet reached the alarming stage, authorities insist. But they provide a reminder, members of the scientific community say, of the impacts on American health of climate change and a global population on the move as it never has been before.

Californians, even in the midst of drought, have been challenged by outbreaks of mosquito-borne West Nile; Texas and Louisiana have battled not only West Nile but also chagas disease, spread by beetle-like, so-called “kissing bugs.” And in Florida, eyebrows went up and residents have learned about and to say the name of an illness that has proved deadly and debilitating in Asia and Africa: chikungunya fever. That last virus, by the way, has become a nationally notifiable disease, with more than 600 reported cases across the U.S.

The increasing incidence of tropical, insect-borne diseases might lead some to want to tighten borders and restrict global flows of people. That, of course, doesn’t make sense in the times we live in with our globally interconnected economies.

It is true that we need to muster a sustained vigilance and response to infectious diseases, tropical or otherwise: Sickness festers in poverty, squalor, and neglect so the more we lift up our collective condition, the better our likely health outcomes will be. We’ve successfully battled some pretty bad bugs before (in case you don’t know why the CDC itself is headquartered in Atlanta, read up on its history and malaria.) We also need to continue to support public health, which gets a tiny slice of the total healthcare budget but produces a big bang for it, and, yes, we need to stop seeing infectious disease specialists (physicians and epidemiologists) as second-class practitioners, as noted MD-author Abraham Verghese, now at Stanford, has described in his books.

As for you lucky travelers, drink lots of water during your airline time, carry lots of disinfecting wipes so you don’t get wiped out by sneezing, coughing cold or flu carriers on your likely packed flights, and, in general, don’t over-do the fun while you’re away. And if you want to arm yourself with the best, latest information on the health conditions in the area you’ll be sojourning to, you might want to start by checking out this online resource from the CDC.