Issue link: https://www.epageflip.net/i/647232
ByCathyBussewitz TheAssociatedPress CAPTAIN COOK, HAWAII On a farm in the heart of Ha- waii's ongoing dengue out- break, coffee grows wild among the ferns, and va- nilla vines climb guava trees. It's hard to know where nature ends and the farm begins, and that's the way organic farmers there like it. But state efforts to com- bat the outbreak — and pre- vent the related Zika virus from making inroads on the island — could put these farmers out of business. Posting "no spray" signs on their properties, they're pushing back on the use of pesticides to kill the mos- quitoes that transmit both infections. Global health officials have identified mosquito eradication as the key to curtailing the Zika out- break that has taken hold in Latin America and been linked to birth defects in Brazil, as well as preventing it from taking hold in other areas where the Aedes ae- gypti mosquito is prevalent, including the southern U.S. "Any place a dengue out- break can occur, a Zika out- break could occur," Lyle Pe- terson, director of CDC's division of vector-borne dis- eases, said in an interview with The Associated Press. "Given the fact that many affected travelers could be coming to Hawaii as out- breaks occur around the Pacific, there is always the possibility of infecting local mosquitoes." But mosquito control is highly variable around the U.S., and a chunk of the $1.8 billion in emer- gency funding the Obama administration is seeking for Zika would go to shor- ing up those capabilities, Dr. Anne Schuchat, CDC's principle deputy director, told a Senate committee Wednesday. "In many areas, there are big holes," she said. Plus, this mosquito spe- cies is particularly hard to deal with, an aggressive daytime biter that can live not just in the yard but in- side the house. A little water left in a flower pot is enough for its eggs to hatch; they even can survive drought until rain returns. Hawaii has had four cases of Zika, all in travel- ers to countries with ongo- ing transmission, according to the Centers for Disease Control and Prevention. But local mosquitoes have infected 260 on the Big Is- land with dengue fever. And the CDC reported active lo- cal Zika transmissions in Pacific islands that have a fair amount of traffic to Hawaii, including Samoa, American Samoa, the Mar- shall Islands and Tonga. In a report, Peterson said staff shortages in the state Health Department and conditions on the is- land make it difficult to fight mosquito-borne dis- eases. The report cited abundant mosquito breed- ing grounds, dense vegeta- tion, unoccupied homes and widespread use of cisterns to provide water to house- holds. On Old Ways Farm, or- ganic farmer Steve Mann tends to his herbs with mosquito netting dangling from his straw hat. Neigh- bors have been infected with dengue, but Mann wouldn't allow his home or farm to be sprayed with pesticides. "It's not organic, and that would cancel our certifica- tion for a period of three years," Mann said. "That might well put us out of business." Organic farmers aren't the only ones pushing back. Hundreds of residents flock to the Legislature annually decrying their use. Steve Okoji, supervising sanitarian for the state De- partment of Health, said his teams ask permission be- fore spraying at homes and work with farmers on pos- sible alternatives. But they have reached only a quar- ter of households in den- gue-affected areas, instead of the recommended 90 per- cent, the CDC report said. Okoji says repeated visits have helped improve that number. Hawaii slashed its mos- quito control and entomol- ogy staff from 56 employ- ees in 2009 to 25 in 2016. The state has redirected workers who usually per- form sanitation and radio- logical health roles to help fight dengue. "We actually have an ad- equate amount of people and resources to meet this response ... but what we're doing is we're just pretty much treading water," Okoji said. "We need to actually try and get ahead of the dis- ease." After new cases of den- gue cropped up in tour- isty Kailua-Kona, volun- teers fanned out to edu- cate the community and a team searched for mos- quito breeding grounds at the Courtyard Marriott King Kamehameha's Kona Beach Hotel, dumping out buckets of water that had been set out for feral cats. "It's not a question of if, it's a question of when Zika comes here to this island, and we have a very unique opportunity right now to squash it," said Karen An- derson, a Big Island resi- dent who started a Face- book page to share infor- mation about the outbreak. Anderson and other res- idents distributed thou- sands of mosquito traps in their neighborhoods. "We work three jobs, and now we've added this, be- cause nobody else is doing it," said Krista Johnson, 49, a commercial fisherman, estate caretaker and re- searcher on the Big Island. In a previous dengue fe- ver outbreak in 2001 that sickened 122 people, the state hired more than 200 workers to fight mosquitoes and other pests. This time, 10 new staffers will be hired with money the governor released in an emergency proclamation that also allows the state to spray without a land own- er's permission, said Vir- ginia Pressler, director of the state Health Depart- ment. Meanwhile, the state is advising residents to re- move standing water, fix leaky faucets and repair screens to keep mosqui- toes out. The public has been responsive, but their sense of urgency wears off over time, said Rep. Nicole Lowen, who represents part of the Big Island. "If we're not proactive about preventing these things coming to Hawaii, we're going to lose tourists, and it will be devastating not only for public health, but also for Hawaii's econ- omy," Lowen said. Dengue victim BreeLyn DuPertuis, a South Kona massage therapist and or- ganic farmer, allowed crews to spray her property with pesticide to reduce the threat for others. "I think if there was more resources put toward it, it would have been handled in a more effective way," DuP- ertuis said. "Of all the times to act, and act aggressively, it's now." Follow Cathy Bussewitz on Twitter: https://twitter. com/cbussewitz. Her work can be found at http:// bigstory.ap.org/journalist/ cathy-bussewitz. ZIKA OUTBREAK Hawaiifacessmallstaff,pesticidefears ASSOCIATEDPRESSPHOTOS "No Spray" signs are posted along the roadway in a neighborhood with many organic farms in Captain Cook, Hawaii. Hawaii's strong anti-pesticide sentiment, tropical conditions, under-staffing in the Department of Health and an island culture where many live off the grid are part of the many challenges facing the teams that fight dengue fever. Those same issues would confront Hawaii if the Zika virus were to arrive on the islands. BreeLyn DuPertuis, a South Kona massage therapist and organic farmer, describes her harrowing experience with dengue fever in Kealakeku, Hawaii. By Andrew Welsh- Huggins The Associated Press COLUMBUS, OHIO Authori- ties are sounding the alarm about a new and deadly twist in the country's drug- addiction crisis in the form of a potent painkiller dis- guised as other medica- tions. Tennessee officials say they've seen two dozen cases in recent months of pills marked as the less po- tent opiates oxycodone or Percocet that turned out to contain fentanyl, a far more powerful drug. One official likened the danger to users playing Russian roulette each time they buy a pill on the street. In San Francisco, the health department blamed several overdoses last sum- mer on lookalike Xanax containing fentanyl, while Canada has issued warn- ings about multiple recent cases of lookalike oxyco- done pills containing fen- tanyl. And in suburban Cleve- land, federal agents ar- rested a man this month af- ter seizing more than 900 fentanyl pills marked like oxycodone tablets. "These pills are truly a fatal overdose waiting to happen," said Carole Ren- don, acting U.S. attorney in Cleveland. Because fentanyl is cheap to manufacture illic- itly, dealers see a chance to make more money by dis- guising it as oxycodone, which typically can sell for more, she said. Lookalike pills were likely to blame for some of the county's 19 fentanyl- related overdose deaths in January alone, said Dr. Thomas Gilson, the Cuyahoga County medical examiner. "People might otherwise say, 'I know I can abuse this much of oxycodone,' and they may be in for a really, really bad surprise when they find out that's fen- tanyl and not oxycodone," said Gilson. The drug, typically used for treatment of chronic pain in end-stage cancer patients, is 25 to 40 times more powerful than heroin. Properly prescribed, it's of- ten applied through a skin patch. Fentanyl produced for the illegal street market comes from Mexico, while chemically similar compo- nents have been traced to China, according to the U.S. Drug Enforcement Admin- istration. In a second Ohio indict- ment, federal authorities have charged a man with obtaining fentanyl from China that killed an addict to whom it was sold in Ak- ron. The DEA says fentanyl- related overdoses killed more than 700 people na- tionwide between late 2013 and early 2015. Mimicry of other drugs is one way fentanyl is now being illicitly marketed, the agency said. "The fact that fentanyl has been found in this form should hopefully make peo- ple nervous that do abuse these types of opiate pills, that they could be getting their hands on something even more lethal," said DEA spokesman Rich Isaacson. China announced in Oc- tober it would regulate the sale and distribution of 116 chemical compounds used in the production of syn- thetic drugs, including ace- tyl-fentanyl. The problem of looka- like fentanyl comes as the country struggles to con- tain a drug overdose epi- demic that began with ille- gal use of prescription pain- killers and developed into a heroin crisis. Ohio experienced 502 fentanyl-related deaths in 2014, up from 84 the year before. In all, 2,482 people in Ohio died from acciden- tal overdoses in 2014, an 18 percent increase over the previous year. Nationally, the Centers for Disease Control and Prevention says drug over- doses rose again in 2014, driven by surges in deaths from heroin and prescrip- tion painkillers. Overdose deaths in the U.S. surpassed 47,000 — up 7 percent from the previous year. Heroin deaths also con- tinued to climb, by 28 per- cent to about 10,500. Despite these statistics and the danger of lookalike pills, addicts aren't always deterred, said Rendon, the acting U.S. attorney. "When there is an over- dose death, users do tend to flock to that drug dealer, because they think that he or she must have incredi- bly potent — either heroin or fentanyl or a combina- tion thereof," she said. PILLS New twist in addiction crisis: Deadly painkiller impostors "Any place a dengue outbreak can occur, a Zika outbreak could occur. 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