Hawaii health officials are on alert with 30 states across the nation seeing one of the worst outbreaks of West Nile virus.
There have been 690 cases reported and 26 deaths so far this year.
Hawaii has no reported cases of West Nile virus but it does have the mosquito that carries the disease, so state and city health officials are keeping a close eye out for it.
"Of course, we’re always on alert to see if we do happen to get a case," said Janice Okubo, spokeswoman for the state Department of Health.
The strategy is surveillance -- at the airports and through physician reports. State vector control workers are checking mosquito traps.
Also, with the large number of visitors who come through the islands, ill tourists are carefully monitored.
"People travelling with influenza-like illness like fevers and body aches, are being interviewed and appropriately referred for clinical care," said Dr. Jim Ireland, Emergency Management Services director.
One problem: it takes 2 to 14 days to develop symptoms of West Nile virus.
"About 80 percent of those who may have the virus don’t even know they’re sick. 20 percent get a flu-like illness, but about one percent or less than one percent can actually get the severe form where they can get a very high fever, neck stiffness and severe headache," said Ireland.
The easiest way to avoid the virus is to prevent getting a mosquito bite. So health officials are encouraging people to help reduce the mosquito population by emptying any standing water around your home, where mosquitos can breed.
Health officials also said since birds are susceptible to the disease and recommend notifying health officials if you find a mass number of dead birds.