Health Protection

Communicable Disease Control

Dengue

Te Marae Ora declared an outbreak of Dengue Type 1 (DENV-1) on 27 February 2019. To date, there have been over 300 cases since 2019, with over 190 new cases reported since January 2020. There have been no deaths related to dengue.

A range of programmes have been put in place to mitigate against dengue including:

Operation Namu – an environmental health programme led by Te Marae Ora to mobilise government agency representatives, community members and the Puna to clean up and get rid of mosquito breeding and resting sites in our communities. This work involves picking up rubbish, trimming overgrown hedges, slashing overgrown sections, removing containers that hold water, drilling holes or covering with tarpaulin any discarded tyres that hold water.
Vector control programme – involves block spraying most homes and public places with pesticides. The block spraying programme is organised by Te Marae Ora at scheduled times free of charge. Otherwise, only homes of those diagnosed with dengue fever are sprayed, while fees apply to requests for spraying outside scheduled times.

What is dengue?

Dengue is a mosquito-borne disease caused by the dengue virus. It is transmitted to humans from the daytime bite of an infected female Aedes aegypti mosquito. The same mosquito also spreads other common mosquito-borne diseases such as chikungunya and zika. It is recognised by white markings on its legs. Dengue fever is common in tropical and sub-tropical climates such as the Cook Islands and the wider Pacific region.

How do I know if I have dengue?

The common signs and symptoms of dengue include:

Fever
Headache
Muscle and joint pains
Nausea
Vomiting
Swollen glands
Pain behind the eyes

If you feel one or more of these symptoms, you should call the Healthline and arrange to see a health professional.

Severe dengue symptoms include rash, mild bleeding in the nose or gums, and easy bruising. If left untreated, severe dengue can cause internal bleeding or even death.

What treatment is available for dengue?

There is no specific treatment for dengue but early detection and seeking proper medical care lowers chances of death or severe illness.

The female Aedes mosquitoes spends their lifetime in and around houses, and when they emerge as adults, fly an average of 400 metres. As a result, home owners and occupants are advised to clean around their homes and pay attention to any mosquito breeding sites or adult mosquitoes present in their homes. Mosquitoes tend to breed in stagnant water, such as empty containers, flower vases, discarded tyres hence it is important to empty or drain the water.

How are we protecting the Pa Enua from dengue?

Most of the dengue cases, up to 97%, are based on Rarotonga. Te Marae Ora currently implements exit screening processes requiring travellers to obtain medical clearance prior to travel to the Pa Enua. Click here for more information.

What are the common pesticides used for dengue spraying?

The common pesticides used are:

Key Delta Aqua
Recruit
Strike out

These pesticides have two basic ingredients, pyrethrum and deltamethrin. These come in a concentrated liquid form and when mixed with the right amount of water (up to 5L), it is safe to use against a wide range of pests including mosquitoes and flies.

Advice for families and communities

Clean in and around your home
Empty out anything that holds stagnant water
Wear long sleeved clothing when outdoors wherever possible
Use mosquito repellent
Use mosquito netting over your bed if your bedroom is not air conditioned or screened

Food Safety

Food safety refers to the handling, preparation and storage of food to prevent individuals from becoming sick from a food borne illness. Unsafe and contaminated food contains harmful bacteria, viruses, parasites and chemical substances and can cause poisoning or diseases such as diarrheal illness and cancer.

Licensing

The importation, supply and sale of food is legislated through the Food Act 1992-1993. Any person or establishment selling, producing or supplying food is required to obtain a food licence. The Public Health directorate are required to protect the health and wellbeing of consumers and set and monitor food standards. All food handlers selling food to the public are required to apply for an annual food licence from the Public Health office. An application for a food license will require food handlers to obtain a medical certificate from a clinician at Te Marae Ora and undertake a written test on food safety. Download the annual Food Licensing application form

Food establishment	Rarotonga	Pa Enua
Retail shops	$40	$20
Wholesale shops	$100	$50
Cafe	$80	$40
Restaurant	$80	$40
Bakery	$60	$30
Mobile/caravan	$60	$30
Takeaway/fast food outlet	$60	$25
Manufacturing and packaging	$120	$60
Seasonal (all food products including fish)	$20	$10
Special inspection (case or further investigation)	$50	$50
Market owner fee	$100	No charge
Club houses/bar	$50	No charge

Tips for safe food

Wash your hands before preparing food

Use soap and running water to wash your hands for 20 seconds, and dry well. You should wash your hands after:

Handling raw meat and poultry
Going to the toilet or changing nappies
Handling pets or animals
Gardening
Any activities that make your hands dirty

Clean your tools, utensils and cooking area

Wash surfaces such as countertops before and after use. Ensure the cloths you use for washing dishes, wiping the bench and wiping the floor are different and separate. Ensure you keep raw meat away from cooked foods, fruit and vegetable.

Cook your food thoroughly to kill harmful bacteria

Keep raw and cooked foods separate from each other – including utensils. Ensure meat such as chicken is cooked right through. It is important to check the expiry date on packaged foods and avoid eating this once the use-by date has passed.

Environmental Health

Water and Sanitation

The provision of good quality drinking water is essential to prevent a wide range of gastrointestinal diseases in the Cook Islands. The regulation of water supply, treatment and disposal is legislated through the Public Health Act 2004 and Ministry of Health Act 2013. Under the Public Health Act, this includes water in reticulated supplies and water in public swimming pools and swimming places.

The implementation of the Te Mato Vai project provides the opportunity to improve the provision of drinking water on Rarotonga. The establishment of a dedicated government water entity, To Tatou Vai ensures routine monitoring and quality control continues for water supplies. Te Marae Ora will maintain oversight in a surveillance and test capacity, with a focus on compliance and overall quality assurance for the public.

Drinking water standards

The Cook Islands Drinking Water Standards (CIDWS) are still in development. The CIDWS draws upon a broad range of public health and scientific research from other countries and jurisdictions, enabling Te Marae Ora to draft and tailor standards to suit our needs and expectations. The CIDWS will require water suppliers to develop and implement a drinking water safety plan to guide the safe management of water supplies, and prescribe maximum allowable concentrations of potentially harmful contaminants. Standards of bottled/packaged water are covered in the Food Act 1993.

Sanitation in the Cook Islands

Sanitation is the process of removing waste from water. It is essential to prevent the spread of water-borne diseases. Good sanitation requires a sewage system that can properly and safely remove human waste and other harmful products from the water, so it is safe to drink.

The Public Health (Sewage and Wastewater Treatment and Disposal) Regulations 2014 set outs the requirements for sanitation system upgrades and compliance. As at March 2020, more than 10% of residential and commercial properties on Rarotonga comply with the Regulations. However, many properties are yet to upgrade their sewage systems to comply with the Regulations. This is a concern, as poor water and sanitation is linked to transmission of water borne diseases such as cholera, diarrhoea, and typhoid which can cause death.

Tutaka

The annual Tutaka programme involves inspecting homes and properties around the Cook Islands to minimise health issues related to poor hygiene, sanitation, mosquito breeding places and other pests around the home. It is a long running public health programme since the 1930s. Te Marae Ora conduct the Tutaka four times a year.

Liquor Licensing

The sale and supply of liquor is legislated through the Sale of Liquor Act 1991-1992 and requires the seller of alcohol to the public to have a licence. The conditions of the liquor licence are determined by the Liquor Licensing Authority. The conditions of the licence cover things such as:

Suitability of applicant to hold a licence
Days and hours alcohol can be sold
Designated areas on the premises that are restricted or supervised
Alcohol is not sold or provided to any person who is underage or intoxicated
Range of food, non-alcohol and low-alcohol drinks to be provided
Proximity of premises to schools, places of worship and other community institutions

Click here for information on applying for a liquor licence