A 38-year-old woman recovering from dengue fever says her symptoms have been more difficult and longer-lasting this time around, years after she first had the disease.

Cook Islander Poaurii Tanner is one of four confirmed cases of dengue fever in Rarotonga this year. Tanner believes the dengue virus affected her more severely this time than when she first had it about five years ago, before her Covid-19 vaccination.

Her latest bout began over a week ago, with symptoms similar to the first time – aches, nausea and intense sweating.

“You just sort of sweat it out,” Tanner said. “I knew I had dengue and that was about over a week ago.”

Tanner said she stayed home to manage her symptoms, knowing from experience that there wasn’t much doctors could offer beyond pain relief.

But after the initial symptoms eased, she was left struggling with lingering discomfort and unexpected complications.

“I was at the hospital just the other day because I was like, oh, I had dengue a week ago, but I can’t, you know, like my breathing or the aches in my back,” she explained. “And the doctor's like, ‘no, no, you haven’t really recovered from dengue yet.’”

Te Marae Ora Ministry of Health is stepping up its surveillance and control measures following the detection of four confirmed cases, with evidence pointing to potential local transmission.

The acting Secretary of Health, Dr Deacon Teapa, explained that the first case, identified on February 22, involved a person who had travelled to Fiji and was confirmed to have contracted Dengue serotype 2.

However, in a concerning development, three more cases were confirmed between April 20 and 24. While one of these individuals had recently travelled through Tahiti, the other two cases had no travel history, raising concerns about local transmission.

Although none of the affected individuals have been hospitalised, Dr Teapa said they are being “monitored and advised on appropriate care at home”.

The health ministry has not identified any complications so far, but health officials are maintaining close contact with the patients.

Te Marae Ora has also launched contact tracing in response to the new cases. “Contact tracing efforts have been initiated, and samples have been sent to NZ LabPlus for serology confirmation,” said Dr Teapa.

These efforts are part of TMO’s attempt to prevent a potential outbreak by identifying any additional infected individuals as early as possible.

“Our current number is four. There are no other cases. As per dengue outbreak definition, if there is five or more cases within 15 days then it’s an outbreak. We are on day nine from the last diagnosed case (i.e. on the 23/04/25),” Dr Teapa explained.

“There have been no reported disruptions to schools, workplaces, or public events as a result of the confirmed cases.”

Tanner described her recovery as more difficult and longer than before. The same four to five days of acute symptoms were followed this time by continued fatigue, pain and difficulty breathing.

“Last time when that was over, you’re pretty much on the mend after a week or so. But this time, no, not the case,” she said. “You’re kind of left with, like I said, aches in the back of my lungs, like my breathing and stuff like that.”

Tanner said it was surprising to experience such intense after-effects, adding: “As an adult, when you experience that level of discomfort in your body, you kind of wouldn’t wish it on somebody small, like it’s not very nice.”

Tanner said she isn’t sure whether the Covid-19 vaccination she received since her last bout has impacted her recovery, but noted: “I just know I had dengue before I got vaccinated. And then I had it after and my body appears to be struggling to repair itself.”

She said she was shocked to learn how severe dengue can be, especially the risk of internal bleeding and other complications.

That concern has heightened her awareness about how little some in the community understand about the virus and how it’s transmitted.

“Can I give dengue to someone else? How would I do that? Do we know? How come I've lived here for this long and I don't even know?” she said. “So more education around that could be useful.”

To limit further spread, the Ministry of Health has activated its vector control protocols.

“Perifocal spraying within a 200-metre radius has been completed in affected areas per TMO dengue protocols,” Dr Teapa explained.

He added that TMO’s ongoing larvae control programmes are also active, including “the Tutaka programme and Larvicidal eradication programme,” which are designed to reduce the Aedes mosquito population – the known carrier of the dengue virus.

Dr Teapa also pointed to recent preventative actions through community engagement. “The recent TMO Tutaka Programme has provided proactive vector control measures,” he said.

A proposed island-wide cleaning campaign is set for discussion at the upcoming meeting to further enhance preventative measures.

While there are currently no travel advisories in place, TMO is urging both locals and visitors to take precautions.

“Travellers are encouraged to take precautions such as using mosquito repellents and reducing exposure to mosquito-prone areas,” said Dr Teapa.

As part of its preparedness measures, TMO is also reviewing its resources.

“The TMO is conducting a risk assessment to ensure clinical readiness. Medical teams remain alert for possible ongoing cases and are equipped to manage potential cases through standard clinical protocols,” Dr Teapa said.

He added that Lab readiness is in place to send confirmation tests to NZ LabPlus.

In terms of protection, Dr Teapa urged the public to take simple but effective actions.

“Residents are advised to take precautionary measures, including: eliminating mosquito resting places and breeding grounds, such as stagnant water around homes; wearing long-sleeved clothing outdoors; using mosquito repellent regularly; [and] ensuring mosquito netting is in place where needed,” he said.

TMO is also working with regional agencies.

“Te Marae Ora reports to regional health organisations and monitor dengue prevalence trends at a broader level from regional office and ensure effective response coordination.”

Tanner encouraged the community to take their own health into their hands when symptoms strike – isolating, managing symptoms, and using traditional remedies to aid recovery.

“If you feel like you’ve got it, then take precautions,” she said. “I didn’t want to get bitten by mosquitoes and pass it on to my loved ones.”

She recommended one remedy that could help: “If you can’t make it into a juice, boil it into a tea and add something sweet that’s quite bitter. That helps to improve our platelet count.

Reflecting on the wider outbreak and her own experience, Tanner said it’s important to stay calm and look after one another.

“Your body is intelligent and will do what it needs to do. So just give it all the things that it needs to do the job of healing,” she said.

“Ask your neighbours if you need help. And if you know anyone who has that, I don’t know, make them a meal or whatever and let’s just make this whole thing easier for everybody.”