The latest report from American Samoa's Health Department on dengue fever says the number of suspected cases has climbed to 414.
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The September the 6th report includes those seen at the LBJ Hospital Emergency Room and clinics, and the Community Health Centres.
137 have been admitted to hospital.
Since the dengue fever outbreak in May, four people have died from the mosquito-borne disease.
Manu'a is still dengue-free.
