The Hawaii State Department of Health said another four people were diagnosed with dengue fever on Hawaii’s Big Island, bringing the total number of cases in the state to 19.
Health officials describe them as ‘locally transmitted’ cases.
This is causing some concern as most previous cases of dengue were imported to the islands from overseas via infected foreign travelers.
"Although dengue is not endemic to Hawaii, we do have the mosquito species capable of transmitting the disease," said state epidemiologist Dr. Sarah Park.
"We want the public to be aware of this mosquito-borne disease and the steps they can take to prevent infection," she added.
Park said the outbreak likely started in September on the Big Island and has not been confined to one specific area.
Dengue symptoms include fever, joint or muscle pains, headaches and skin rash.
Hawaii health officials are advising people to use mosquito nets and wear insect repellent.
According to the Centers for Disease Control and Prevention, this is the third outbreak of locally transmitted dengue in the last 14 years although Hawaii gets some dengue cases every year, via visiting foreign travelers.