An American Samoa doctor has encouraged residents to watch for early signs of dengue fever, after four people died.
An epidemiologist from the Department of Health, Scott Anesi, says early detection of dengue fever can help prevent a person from developing the severe stages of the disease.
Following two earlier cases, the Department of Health has confirmed a male in his 40s and a woman in her early 20s have also died.
The outbreak began six weeks ago.
Dr Anesi says there needs to be engagement from the community to help stop the spread of dengue.
