A six-year-old girl has been confirmed as the first person to die from dengue fever in the Marshall Islands.
The girl was reported to have been taken to Majuro hospital last Thursday after experiencing a headache, where she was given medicine and sent back home.
But she returned to hospital on Sunday because she was vomiting blood and died on Tuesday.
The Ministry of Health and Human Services confirmed in a statement that the death was caused by dengue.
"This is a tragic event and out of respect to the affected family and friends, further details about this case will not be released," said Health Secretary Jack Niedenthal.
The dengue outbreak, now at the two-month mark, continues to spread with 276 cases of suspected and confirmed dengue reported by the Ministry of Health and Environment.
To date, dengue has been reported only in the two urban centres, Ebeye and Majuro.
The dengue seen in the Marshall Islands is Type-3, the same as reported in ongoing outbreaks in Palau, Federated States of Micronesia and the Philippines.
With a national health emergency established by President Hilda Heine in early August, the ministry shut down passenger travel to remote outer islands in efforts to prevent spread to remote populations that have limited medical care options.
The move has worked so far to contain the spread but has sparked concern among tourism operators who have been forced to halt operations involving taking visitors by boat to remote islands for scuba diving or other activities.
Mr Niedenthal said the Marshall Islands government continues "wide-scale, intensive efforts to stop the spread of the virus and protect the health of affected communities".
"This includes intensive efforts to destroy mosquito breeding sites, including spraying and organizing community clean-up campaigns, and intensifying its health services to support the needs of dengue patients."
He urged people to maintain a high vigilance for the signs and symptoms of dengue, in particular in babies and young children, and if they suspect dengue to report directly to their nearest health center.
Most of the 276 cases have been on Ebeye, where the outbreak started in July. The ministry reported 219 confirmed and suspected cases of dengue on Ebeye, and 57 on Majuro.
One individual, reportedly a Japan volunteer, developed severe dengue symptoms and was evacuated for off-island medical care.
Major cleanup activity around Majuro has been ongoing for 10 days, and government spray teams are spraying schools and community areas around Majuro to reduce mosquito breeding areas.
The ban on travel to the outer islands so far has kept dengue from appearing on islands outside of Majuro and Kwajalein.
But it has also caused problems for local residents and tourist-related operators who take visitors diving and for other activities on outer islands.
The M/V Truk Master, a live aboard vessel that transports visiting scuba divers to Bikini for diving, and Indies Trader, which transports both visitors and local customers to various outer islands, have been among those affected by the passenger travel ban.
Visitors have been stranded after arrival in the Marshall Islands, unable to continue their scheduled scuba dive or related trips to the outer islands, sparking complaints from the companies.
A growing number of Marshall Islanders who traveled into Majuro or Ebeye over the past six weeks are unable to return home as a result of the ban on passenger travel to the outer islands.
There is no restriction on passenger travel between Majuro and Ebeye, or on international travel.