{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T03:16:09Z","timestamp":1791515769607,"version":"4.3.4"},"reference-count":28,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T00:00:00Z","timestamp":1581292800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["NU50CK000415 - Epidemiology and Laboratory Capacit"],"award-info":[{"award-number":["NU50CK000415 - Epidemiology and Laboratory Capacit"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>From September 2015 through March 2016, Hawaii had the largest outbreak of locally transmitted dengue since 1944. We report on the Hawaii Department of Health\u2019s (HDOH\u2019s) investigation, findings, and response to the outbreak.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We defined cases of dengue using a modified version of the Council of State and Territorial Epidemiologists\u2019 case definition for dengue virus infections. We conducted epidemiologic investigations, including interviews with case-persons, review of medical records, laboratory testing, genetic sequencing of specimens, and geographic information system (GIS) data analysis. Outbreak response included community outreach and vector-control activities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We identified 264 confirmed cases of dengue; illness onset dates ranged from September 11, 2015, to March 17, 2016, all with reported travel to or residence on the Island of Hawaii. Of 264 persons with confirmed dengue, 238 (90.2%) were Hawaii residents. Thirty-seven (14.0%) persons required hospitalization; no cases of severe dengue or death were reported. GIS hot-spot analysis identified a cluster of cases on the western side of the island. Established risk factors for dengue exposure included holes in window or door screens, presence of standing water, and not using insect repellent or wearing protective clothing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>To prevent or mitigate the spread of future arboviral introductions and outbreaks, the public health response should focus on behavioral and cultural attitudes, emphasizing personal mosquito protection and mosquito control at the community level. Outbreak responses can also be enhanced through the use of advanced GIS techniques, such as hot-spot analysis, to provide situational awareness and guide response efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0033354920904068","type":"journal-article","created":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T17:22:37Z","timestamp":1581355357000},"page":"230-237","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":14,"title":["Investigation and Response to an Outbreak of Dengue: Island of Hawaii, 2015-2016"],"prefix":"10.1177","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8866-2118","authenticated-orcid":false,"given":"David I.","family":"Johnston","sequence":"first","affiliation":[{"name":"Disease Outbreak Control Division, Hawaii State Department of Health, Honolulu, HI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa A.","family":"Viray","sequence":"additional","affiliation":[{"name":"Disease Outbreak Control Division, Hawaii State Department of Health, Honolulu, HI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny M.","family":"Ushiroda","sequence":"additional","affiliation":[{"name":"Disease Investigation Branch, Hawaii State Department of Health, Honolulu, HI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"He","sequence":"additional","affiliation":[{"name":"Disease Investigation Branch, Hawaii State Department of Health, Honolulu, HI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Christian","family":"Whelen","sequence":"additional","affiliation":[{"name":"State Laboratories Division, Hawaii State Department of Health, Honolulu, HI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca H.","family":"Sciulli","sequence":"additional","affiliation":[{"name":"State Laboratories Division, Hawaii State Department of Health, Honolulu, HI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail Y.","family":"Kunimoto","sequence":"additional","affiliation":[{"name":"Medical Microbiology Branch, State Laboratories Division, Hawaii State Department of Health, Honolulu, HI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Y. Park","sequence":"additional","affiliation":[{"name":"Disease Outbreak Control Division, Hawaii State Department of Health, Honolulu, HI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,2,10]]},"reference":[{"key":"bibr1-0033354920904068","doi-asserted-by":"publisher","DOI":"10.3201\/eid1105.041063"},{"key":"bibr2-0033354920904068","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-83"},{"key":"bibr3-0033354920904068","doi-asserted-by":"publisher","DOI":"10.3201\/eid1504.080664"},{"key":"bibr4-0033354920904068","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2007.76.1182"},{"key":"bibr5-0033354920904068","doi-asserted-by":"publisher","DOI":"10.3201\/eid1604.091582"},{"key":"bibr6-0033354920904068","first-page":"299","volume":"5","author":"Murray NE","year":"2013","journal-title":"Clin Epidemiol"},{"key":"bibr7-0033354920904068","volume-title":"Dengue Guidelines for Diagnosis, Treatment, Prevention and Control","author":"World Health Organization","year":"2009"},{"key":"bibr8-0033354920904068","first-page":"67","volume":"19","author":"Wilson GW","year":"1904","journal-title":"Public Health Rep"},{"key":"bibr9-0033354920904068","doi-asserted-by":"publisher","DOI":"10.2307\/4584829"},{"key":"bibr10-0033354920904068","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.35.3.261"},{"key":"bibr11-0033354920904068","doi-asserted-by":"publisher","DOI":"10.2987\/12-6292R.1"},{"key":"bibr12-0033354920904068","unstructured":"Hawaii State Department of Health. 10-year summary of reported cases of notifiable diseases, statewide: 2005-2014. http:\/\/health.hawaii.gov\/docd\/resources\/reports\/summary-of-reported-cases-of-notifiable-diseases. 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