The death toll from dengue fever in American Samoa is now three with confirmation that the death last week of a woman in her early 20's was due to the mosquito borne virus.
A fourth suspected case is being investigated by doctors at the LBJ Hospital.
In May a ten month old baby and a 23 year old man died from dengue.
The hospital's assistant chief medical officer Annie Fuavai says the outbreak is turning into an epidemic.
"The dengue is caused by a virus that is not the same as a disease caused by a bacteria where we can easily treat it with anti-biotics. Unfortunately we have a dengue hemorrhagic fever which can be fatal."
Dr. Fuavai said all of the cases presented with flu like symptoms, such as fever, vomiting, dehydration and body aches.