18 cases of the mosquito-borne chikungunya disease have been confirmed in the Cook Islands.
The cases included two travellers returning from French Polynesia and one from Samoa.
The Cook Islands News reports all confirmed cases involved Rarotonga residents.
Public Health Officials are continuing its risk assessment campaign, and is carrying out aerial spraying to kill adult mosquitoes at the homes of those who have been confirmed with the disease.
The department is also urging travellers to take precautionary measures if travelling within the Pacific region as outbreaks of chikungunya are continuing in American Samoa, Samoa, French Polynesia, New Caledonia and Kiribati.
Symptoms of chikungunya include fever and joint pains, while many victims also suffer headache, muscle pain, nausea, fatigue and rash.