The environmental and social factors of the 2001 dengue outbreak in Hawaii

Abstract

This dissertation is comprised of three papers that address broad theoretical issues surrounding the prevention and control of dengue outbreaks through the study of the 2001-2002 dengue outbreak in Hawaii, centered on Maui, and spread by Aedes albopictus. In the first paper, sub-island precipitation variability is examined, and the relationship between Hawaiian precipitation and the El Nino-Southern Oscillation is explored. The results are applied to the second paper, a study of mosquito habitat across the islands that addresses mosquito control and dengue prevention. The prevention of an outbreak is strongly influenced by the control of mosquitoes particularly near homes, and the more thorough understanding of dengue-climate relationships elucidated in this study outlines areas in which mosquito control efforts should be concentrated. Also, the development of an improved conceptual model for the examination of the relationship between climate conditions and mosquitoes will serve to improve future studies. The third paper explores stigmatization that may occur during a dengue outbreak. The stigmatization of those with dengue or those living in an outbreak area can undermine disease control efforts if the ill are hesitant to seek medical care out of the fear of negative repercussions from uninformed residents. The results of this dissertation contribute to the overall understanding of dengue prevention and control, and are applicable to Hawaii as well as other potential outbreak locations in which the Aedes mosquito is present but the virus has not yet been introduced. These areas include the southeastern and southwestern United States, and tropical and sub-tropical locations around the world.