By Katie Reilly
February 9, 2016

The mayor of Hawaii’s Big Island declared a state of emergency on Monday over the growing dengue fever outbreak that now includes 250 confirmed cases.

The outbreak is the largest in the state since the 1940s, Reuters reported, citing Hawaii County Mayor Billy Kenoi and Hawaii health officials.

Hawaii’s governor said he would not issue a statewide emergency declaration until the outbreak spread to other islands or grew to include other diseases, such as the Zika virus, according to Reuters.

Health officials have been investigating the growing outbreak, which represents the first cluster of locally acquired dengue fever since a 2011 outbreak on Oahu, according to the Centers for Disease Control and Prevention.

Dengue fever, which is spread by mosquitos, has symptoms that include high fever, severe headache, joint pain, rashes and mild bleeding, the CDC reported.

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