Confirmed cases of dengue fever on Hawaii island has climbed to 88, increasing by nine since Thursday.

The state Department of Health reported today that there are now 21 children and 67 adults, who have fallen ill — including 13 visitors — in an outbreak that could continue for months and spread into new areas.

The disease is transmitted by mosquitoes, and symptoms include fever, severe headaches, pain behind the eyes, joint and/or muscle pain and rash.

To contain the Hawaii island outbreak, the health department has been conducting assessments for mosquito activity and sprayed pesticide.

The most recent onset of the illness is now Nov. 15; the earliest was Sept. 11.

The health department says 131 potential cases have been ruled out by negative tests or because of not meeting the criteria.