State to step up prevention, education in fight against rat lungworm disease

Photo: Susan Jarvi

The state is stepping up efforts to combat rat lungworm disease in Hawaii.

So far this year, 15 cases of the parasitic infection have been confirmed in Hawaii — the highest number reported over the last decade. Nine were on Hawaii island, and six were on Maui.

There have been no new cases in Hawaii since May, and health officials want to keep it that way.

“The reason rat lungworm disease is getting so much attention now is not just because of the number of cases that have increased, but because some of these patients have devastating outcomes. We want to acknowledge the angst felt by our Puna and our Hana communities particularly, and we also want to assure you that we take this disease very seriously,” said Dr. Virginia Pressler, Department of Health director.

Starting this month, a Joint Task Force will collaborate with local experts to increase public awareness, improve response, and explore ways to control and treat the disease.

That includes developing guidelines for schools, farms, food establishments, physicians, and other groups.

The 2017 Hawaii State Legislature appropriated $1 million ($500,000 over two years) to the Hawaii Department of Health to increase public education and improve control and prevention of rat lungworm disease. The funding will make possible a statewide media campaign in partnership with the Hawaii Association of Broadcasters to build public awareness of ways to prevent the spread of the parasitic disease.

Funding from the Legislature will also support two temporary full-time staff positions to coordinate prevention efforts between county, state, federal, and private sector partners.

The DOH will also work in partnership with the U.S. Centers for Disease Control and Prevention, the University of Hawaii, the state Department of Agriculture, and other agencies to conduct a targeted rat, slug and snail study to identify disease routes and provide data on disease risks from these vectors. A statewide study of this kind has never been conducted in Hawaii before because of limited resources. Findings from the study will guide vector control activities for rat lungworm prevention.

“We hope to gather information on the disease risk of not only rat lungworm, but also diseases like leptospirosis and murine typhus, which we know are also carried by rats in Hawaii. We hope to learn the extent of these diseases among rats in our state and the related risk factors,” Pressler said.

Currently, the DOH’s food safety inspectors and vector control staff are collaborating with HDOA to investigate any reports of produce shipments from any farmer or vendor (local or mainland) with an infestation of slugs or snails. If the shipment is traced to a local farm, inspectors work with the farmer to ensure proper pest reduction measures are implemented.

Rat lungworm disease is caused by a parasitic roundworm called Angiostrongylus cantonensis. The parasite can be passed from the feces of infected rodents to snails, slugs and certain other animals, which become intermediate hosts for the parasite. People can become infected when they consume infected raw or undercooked intermediate hosts (slugs, snails, freshwater prawns, frogs, crayfish, and crabs).

Although the rat lungworm parasite has been found in slugs and snails throughout the state, Hawaii island has experienced the majority of the confirmed cases. Some infected people don’t show any symptoms or have mild symptoms. For others, the symptoms can be much more severe and debilitating, and can include headaches, stiffness of the neck, tingling or pain on the skin or in extremities, low-grade fever, nausea, and vomiting. Sometimes, a temporary paralysis of the face may occur, as well as light sensitivity.

This infection can also cause a rare and serious type of meningitis (eosinophilic meningitis).

To prevent the spread of rat lungworm infection, the public is urged to take these important steps:

  • Always practice safe eating habits by inspecting, thoroughly washing, and properly storing raw produce, especially leafy greens, regardless of where it came from, and/or cooking it properly to kill any parasites. Washing raw vegetables and fruits thoroughly under running water before eating not only prevents rat lungworm, but also rinses off other contaminants.
  • Eliminate snails, slugs and rats — all of which are potential vectors for the disease — both around residential home gardens and agricultural operations of all scales.
  • Prevent the consumption of snails and slugs by covering all containers, from water catchment tanks to drink and food dishes. Supervise young children while playing outdoors to prevent them from putting a slug or snail in their mouths.

Click here for more information on preventing rat lungworm disease.

The Joint Task Force, established in May 2016, consists of members from UH-JABSOM, Pacific Biosciences Research Center; The Daniel K. Inouye College of Pharmacy at UH Hilo; HDOA’s Plant Industry and Quality Assurance Divisions; USDA Agriculture Research Service; Kaiser Permanente Hawaii; Hilo Medical Center; Kapiolani Medical Center for Women and Children; Hawaii County; and the DOH’s State Laboratories Division, District Health Offices of Hawaii Island, Maui, and Kauai, Vector Control Branch, Safe Drinking Water Branch, Disease Outbreak Control Division, and Sanitation Branch.

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