Epidemiologic Trends of Dengue in U.S. Territories, 2010-2020.

Problem/Condition: Dengue is one of the most common vectorborne flaviviral infections globally, with frequent outbreaks in tropical regions. In 2019 and 2020, the Pan American Health Organization reported approximately 5.5 million dengue cases from the Americas, the highest number on record. In the United States, local dengue virus (DENV) transmission has been reported from all U.S. territories, which are characterized by tropical climates that are highly suitable for Aedes species of mosquitoes, the vector that transmits dengue. Dengue is endemic in the U.S. territories of American Samoa, Puerto Rico, and the U.S. Virgin Islands (USVI). Dengue risk in Guam and the Commonwealth of the Northern Mariana Islands is considered sporadic or uncertain. Despite all U.S. territories reporting local dengue transmission, epidemiologic trends over time have not been well described. Reporting Period: 2010-2020. Description of System: State and territorial health departments report dengue cases to CDC through ArboNET, the national arboviral surveillance system, which was developed in 2000 to monitor West Nile virus infections. Dengue became nationally notifiable in ArboNET in 2010. Dengue cases reported to ArboNET are categorized using the 2015 Council of State and Territorial Epidemiologists case definition. In addition, DENV serotyping is performed at CDC's Dengue Branch Laboratory in a subset of specimens to support identification of circulating DENV serotypes. Results: During 2010-2020, a total of 30,903 dengue cases were reported from four U.S. territories to ArboNET. Puerto Rico reported the highest number of dengue cases (29,862 [96.6%]), followed by American Samoa (660 [2.1%]), USVI (353 [1.1%]), and Guam (28 [0.1%]). However, annual incidence rates were highest in American Samoa with 10.2 cases per 1,000 population in 2017, followed by Puerto Rico with 2.9 in 2010 and USVI with 1.6 in 2013. Approximately one half (50.6%) of cases occurred among persons aged <20 years. The proportion of persons with dengue who were hospitalized was high in three of the four territories: 45.5% in American Samoa, 32.6% in Puerto Rico, and 32.1% in Guam. In Puerto Rico and USVI, approximately 2% of reported cases were categorized as severe dengue. Of all dengue-associated deaths, 68 (0.2%) were reported from Puerto Rico; no deaths were reported from the other territories. During 2010-2020, DENV-1 and DENV-4 were the predominant serotypes in Puerto Rico and USVI. Interpretation: U.S. territories experienced a high prevalence of dengue during 2010-2020, with approximately 30,000 cases reported, and a high incidence during outbreak years. Children and adolescents aged <20 years were disproportionately affected, highlighting the need for interventions tailored for this population. Ongoing education about dengue clinical management for health care providers in U.S. territories is important because of the high hospitalization rates reported. Dengue case surveillance and serotyping can be used to guide future control and prevention measures in these areas. Public Health Action: The Advisory Committee on Immunization Practices recommends vaccination with Dengvaxia for children aged 9-16 years with evidence of previous dengue infection and living in areas where dengue is endemic. The recommendation for the dengue vaccine offers public health professionals and health care providers a new intervention for preventing illness and hospitalization in the age group with the highest burden of disease in the four territories (Paz Bailey G, Adams L, Wong JM, et al. Dengue Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021. MMWR Recomm Rep 2021;70[No. RR-6]). American Samoa, Puerto Rico, and USVI are all considered endemic areas and persons residing in these areas are eligible for the new dengue vaccine. Persons aged 9-16 years in those jurisdictions with laboratory evidence of previous dengue infection can receive the dengue vaccine and benefit from a reduced risk for symptomatic disease, hospitalization, or severe dengue. Health care providers in these areas should be familiar with the eligibility criteria and recommendations for vaccination to reduce the burden of dengue among the group at highest risk for symptomatic illness. Educating health care providers about identification and management of dengue cases can improve patient outcomes and improve surveillance and reporting of dengue cases.

Emergence of influenza B/Victoria in the Micronesian US-affiliated Pacific Islands, spring 2019.

Data collected through routine syndromic surveillance for influenza-like illness in the Micronesian United States-affiliated Pacific Islands highlighted out-of-season influenza outbreaks in the spring of 2019. This report describes the data collected through the World Health Organization's Pacific Syndromic Surveillance System for the Commonwealth of the Northern Mariana Islands (CNMI), Guam, the Federated States of Micronesia (FSM) and the Republic of the Marshall Islands (RMI). Compared with historical data, more cases of influenza-like illness were observed in all four islands described here, with the highest number reported in Guam in week 9, CNMI and FSM in week 15, and RMI in week 19. The outbreaks predominantly affected those aged < 20 years, with evidence from CNMI and RMI suggesting higher attack rates among those who were unvaccinated. Cases confirmed by laboratory testing suggested that influenza B was predominant, with 83% (99/120) of subtyped specimens classified as influenza B/Victoria during January-May 2019. These outbreaks occurred after the usual influenza season and were consistent with transmission patterns in Eastern Asia rather than those in Oceania or the United States of America, the areas typically associated with the United States-affiliated Pacific Islands due to their geographical proximity to Oceania and political affiliation with the United States of America. A plausible epidemiological route of introduction may be the high levels of international tourism from Eastern Asian countries recorded during these periods of increased influenza B/Victoria circulation. This report demonstrates the value of year-round surveillance for communicable diseases and underscores the importance of seasonal influenza vaccination, particularly among younger age groups.

Investigating Measures of Social Context on 2 Population-Based Health Surveys, Hawaii, 2010-2012.

Measures from the Social Context Module of the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System were used on 2 population-based health surveys in Hawaii to explicate the role of the nonmedical and social determinants of health; these measures were also compared with conventional socioeconomic status (SES) variables. Results showed that the self-reported SES vulnerabilities of food and housing insecurity are both linked to demographic factors and physical and mental health status and significant when controlling for the conventional measures of SES. The social context module indicators should be increasingly used so results can inform appropriate interventions for vulnerable populations.

Weight reduction among people with severe and persistent mental illness after health behavior counseling and monitoring.

The high prevalence of obesity and associated chronic conditions in persons with severe and persistent mental illness has contributed to a mortality rate that is nearly two times higher than the overall population. In 2008, the Central O'ahu Community Mental Health Center of the Hawai'i State Department of Health, Adult Mental Health Division began an unfunded, health counseling intervention pilot project to address such concerns for the health of persons with severe and persistent mental illness. This article reviews the results of this intervention. Forty-seven persons with schizophrenia or related disorders were included in the intervention which involved health counseling and monitoring of weight as a risk factor for chronic disease. After five years of counseling and monitoring, medical chart reviews were conducted for each person for data on weight change. Analysis showed weight loss and improvements in body mass index. The results of this project show potential for long-term counseling and monitoring as an intervention for obesity in persons with severe and persistent mental illness.

An exploration of ethnic, immigration and acculturation differences on tobacco smoking among public high school girls in Hawai'i.

This cross-sectional study explores the differences in ethnicity, sex, immigration (place of birth of student and parents), and acculturation (based on language spoken at home) on current cigarette smoking among public high school students in Hawai'i, and especially examine if this affected smoking among girls. Previous behavior risk surveys of youth in Hawai'i showed higher smoking rates among girls, although these were not found to be statistically significant differences. Multiple years of data were compiled from the Hawai'i Youth Tobacco Survey (YTS) for years 2005, 2007, 2009, and 2011, for a total sample size of N=5,527. Multivariate logistic regression analysis was conducted to evaluate the likelihood of current cigarette smoking (in the past 30 days) in relation to a variety of factors. The analysis revealed that Hawai'i-specific ethnicity, grade, and sex were all significant predictors of smoking. Girls whose mothers were born in Hawai'i or in another United States state were more likely to smoke than those whose mothers were born in a foreign country. The model showed girls were more likely to smoke than boys. Eleventh and twelfth graders were more likely to smoke than ninth graders. Whites, Filipinos, Native Hawaiians, Pacific Islanders, and Other ethnic groups were more likely to smoke than those who identified themselves as Japanese.

Results from the Hawaii domestic violence fatality review, 2000-2009.

BACKGROUND: Patterns of domestic violence fatalities and agency responses in Hawaii have not been explicated. METHODS: Retrospective reviews of events leading up to domestic violence related fatalities in Hawaii were assessed from 45 adjudicated cases that resulted in 62 fatalities for the ten year period from 2000-2009. RESULTS: Almost one-half of the fatalities were homicide/suicide combinations. Females were disproportionately more likely to be fatal victims of domestic violence relative to their proportion in the population. Those aged 21-40 years and those over 80 years were more likely to be fatal victims of domestic violence, relative to their proportion in the population. Filipinas and 'Other" ethnic groups are disproportionately more likely to be fatal victims of domestic violence while Native Hawaiians and Japanese are less likely to be fatal victims, relative to their proportions in the population. In more than two-thirds of the cases, the victim had made some attempt to leave the relationship prior to the fatality. CONCLUSIONS: In the majority of cases there was agency involvement in some form: either the victim alone or the perpetrator alone, or both. However, less than one-third (31.1%) of the cases over the past ten years had documentation of prior violence from medical reports, so this may be an area to further document and address domestic violence.

Overweight and obesity among Hawai'i children aged 4 to 5 years enrolled in public schools in 2007-2008 and comparison with a similar 2002-2003 cohort.

This assessment provides the most recent estimates of overweight and obesity among children 4 to 5 years old who were enrolled in public schools in the 2007-2008 school year, using data obtained from Student Health Records for 12,823 children, which represents 91% of the 14,070 children who were enrolled in kindergarten in 2007-2008. This assessment is a census of 4 to 5 year olds that entered public schools in Hawai'i in 2007-2008 and represents approximately 38% of the total Hawai'i population for those aged 4 to 5 years, since kindergarten is not a requirement. A limited data set with data on age, sex, height, and weight was used to calculate BMI (body mass index) percentiles. We compare this data with age and sex-specific BMI obtained from Student Health Records from 10,199 children aged 4 to 5 years entering public schools during 2002-2003. The results illustrate that like the 2002-2003 data (28.5%), over one in four (28.6%) of the children aged 4 to 5 years entering Hawai'i public schools in 2007-2008 were either overweight or obese. Total proportions overweight and obese were persistently higher (32.5% or more in both 2002-2003 and 2007-2008) in some specific school complexes on O'ahu as well as in some rural and Neighbor Island school complexes. Physicians, public health and school health professionals, advocates, schools, and communities should be vigilant about this persistent problem and seek to implement practices to combat overweight and obesity. In addition, the use of Student Health Records for on-going pediatric obesity surveillance should be explored more fully.

Betel nut chewing in Hawai'i: is it becoming a public health problem? Historical and socio-cultural considerations.

This article examines the socio-cultural significance of betel nut use among Micronesians, in light of the recent migration of Micronesians to Hawai'i. The different ways of chewing betel nut are the result of historical changes within Micronesia over time due to Spanish and US colonialism as well as the introduction of tobacco. These divergent ways of chewing may have different risks or impacts on health and it remains to be seen whether or not betel nut will become a significant public health problem in Hawai'i.

Preview of Hawaii Cancer Facts and Figures 2010.

Each year, nearly 6,700 Hawaii residents are diagnosed with cancer and more than 2,000 die from the disease. Detailed data on the burden of cancer in Hawaii, including cancer incidence and mortality rates, are available in Hawaii Cancer Facts & Figures 2010 (CF&F). A collaborative effort of the Cancer Research Center of Hawaii, the American Cancer Society and the Hawaii Department of Health, this update of the original version published in 2003 is intended as a tool for public health education, research, and planning. The following are highlights of years 2000-2006 (a 6-year period) data as featured in Hawaii Cancer Facts & Figures 2010.

Hawai'i air quality monitoring assessment: some effects of Hawai'i's smoke-free work and public places law.

In November 2006, the Smoke-Free Work and Public Places Law passed to protect people from secondhand smoke in Hawai'i. An air-quality monitoring assessment to determine the difference this law made in air quality was conducted at 15 bars/restaurants. Levels of particulate matter (PM2.5) at enclosed (indoor) venues fell 90% after implementation of the law while partially enclosed restaurants/bars were all below the EPA 24 hour average limit both before and after the law.

Overweight and at-risk for overweight among Hawai'i public school students entering kindergarten, 2002-2003.

Recent studies have pointed to an increasing problem of overweight and obesity in children in Hawai'i, but all of these studies have been conducted in specific communities or special population groups. No broad population-based studies have been conducted to document the extent of overweight in the general population of children in Hawai'i. To provide a population based estimate of overweight in Hawai'i's children, this study examined Student Health Records for 10, 199 children entering kindergarten in public schools during 2002-2003. Data on age, gender, height, and weight were used to calculate BMI (body mass index) scores. Because records for all students entering public school kindergarten were available for analysis, the data presented here represents the broadest estimates of overweight and at risk for overweight in Hawai'i's children published to date. The results illustrate that almost one-third of the children aged 4-6 years old entering Hawai'i public schools are either overweight or at risk for overweight. Rates are higher in rural school complexes than urban ones. Compared to a 1984 study that found 'no significant under or over nutrition' in Hawai'i's school children, our results suggest that almost one-third of children aged 4-6 entering Hawai'i public schools are either overweight or at risk for overweight. Physicians should be aware of this growing problem, and seek to implement practices to combat overweight among their pediatric patients and families.

Community based participatory approaches to address health disparities in Hawai'i: recent applications in cancer prevention, detection and treatment programs.

Assessment of recent trends in the prevalence and incidence of cancer, and its associated risk and protective factors in the State of Hawai'i illustrate that there are definite ethnic, socio-economic, and geographic health disparities. Disparities in access to health care are reflected in decreased and under utilization of all types of preventive cancer screening tests and decreased proportions of people with health insurance coverage. Increases in obesity mirror U.S. national trends and disproportionately affect certain ethnic groups and those with low income. Tobacco use has increased among at-risk populations including: certain ethnic groups, those with low-income and/or low education and those in rural areas. Data that reveal continuing or worsening health disparities imply that either the old methods have not been effective and/or resources are not available or are not being applied to address such disparities. Promising methodologies and programmatic focuses to reduce health disparities are needed as mechanisms for improving the circumstances of at-risk populations. Community based participatory approaches are described here for cancer prevention, detection, and treatment programs that utilize culturally appropriate methods.