Fourteen months after an outbreak of dengue fever hit the Marshall Islands, the country cannot shake the mosquito-borne illness.
It raised the question of whether dengue was becoming an endemic illness for the first time.
After averaging over 200 cases per week in the January and February period, the number of cases dropped significantly, hitting single digits per week for most of the May through July period. But an uptick in the number of cases is apparent in recent weeks.
Four of the past five weeks have produced double-digit numbers at Majuro hospital. Though still small in comparison to earlier this year, the rise in dengue numbers are concerning health authorities who have called on the government to resume promoting prevention protocols to reduce dengue fever spread.
An emergency medical situation involving a patient from an outer atoll with dengue fever the first week of September has increased concern at the ministry of about a possible resurgence of the illness on remote outer islands - which have seen almost no cases for the past two months.
Dengue fever started in July 2019 on Ebeye Island, and spread to Majuro in late August a year ago and over the following two months, high numbers were reported in the capital and hospitalizations skyrocketed.
The numbers dropped off toward the end of the year. But Christmas gatherings appeared to fuel a resurgence of the problem, which hit hard again starting with the new year. Meanwhile, Ebeye was able to get control of its dengue problem within three months and has recorded only a couple of cases since late 2019.
The most recent previous outbreak of dengue fever, in 2011, lasted for only three months before it was brought under control.
After a travel ban to remote outer islands was lifted by the government's Cabinet in December last year, dengue soon spread to remote islands.
At one point early this year, Majuro hospital was averaging close to 30 cases per day, as dengue patients jammed the emergency room and the dengue ward overflowed.
In February, dengue cases peaked at nearly 200 in one week, before starting a decline. Then, by April, the case load dropped off.
But over a year since the first case showed up in Majuro, dengue won't let go. Unlike Ebeye, which managed to eradicate the sickness in less than three months from the initial case in June 2019, Majuro has not seen a week with zero dengue cases reported to the hospital. In a 10-week period from the end of May through the beginning of August, eight of the 10 weeks showed single digit numbers.
But three of the four weeks that ended August showed over 10 cases each, with the week ending August 23 numbers rising to 20. Ministry of Health officials expressed concern that with the nation concerned about Covid-19 and other issues, people may have forgotten about dengue fever.
"We still have dengue," said Health Secretary Jack Niedenthal.
Prior to the emergency dengue case from Mili Atoll earlier this month, the last reported dengue case was in Jaluit Atoll in mid-June.
The ministry is urging government offices and the public to not be complacent about the extended dengue outbreak.
The ministry, said Niedenthal is "concerned that it could get out of hand again."
From June 2019 through the end of August this year, the Ministry of Health has recorded 3,572 dengue-like illnesses.
Most of these have been in Majuro, with 3,129 recorded at Majuro hospital. Of the Marshall Islands-wide total, 1,706 were confirmed by laboratory testing to be dengue.