The Hawaii Department of Health (DOH) has confirmed 15 cases of the illness in Hawaii for 2017, including nine (9) from Hawaii Island, four (4) Maui residents and two (2) Maui visitors.
This is the highest number of cases reported in the state over the last decade.
On Wednesday, Gov. David Y. Ige, together with the DOH and the Hawai‘i Department of Agriculture (HDOA) announced the state’s plans to place a stronger emphasis on the prevention of rat lungworm disease.
“We are bringing together local experts from relevant fields to increase public awareness, improve our response activities, and explore ways to control and treat the disease,” said Gov. Ige. “They will work together with the Joint Task Force we established last year to step up prevention efforts beyond Hawai‘i Island, where the first cases were reported.”
Dr. Kenton Kramer, Associate Professor of the Department of Tropical Medicine, Medical Microbiology and Pharmacology with the University of Hawai‘i John A. Burns School of Medicine (UH-JABSOM), who is serving as Joint Task Force chair said, “The Joint Task Force to combat rat lungworm disease will reconvene in August. Experts from the medical, scientific, environmental, and public health communities will collaborate to develop guidelines for schools, farms, food establishments, physicians and other groups on best practices to prevent, control, and treat 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 Kaua‘i, Vector Control Branch, Safe Drinking Water Branch, Disease Outbreak Control Division, and Sanitation Branch.
Because of rising concerns over the recent increase in confirmed cases this year, the 2017 Hawai‘i State Legislature appropriated $1 million ($500,000 over two years) to the DOH 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 Hawai‘i Association of Broadcasters to build public awareness of ways to prevent the spread of the parasitic disease.
Health Director Dr. Virginia Pressler said, “We appreciate the Legislature’s support in allowing the state to accelerate our efforts on this important initiative. The funds will provide much needed resources for our public health communications efforts as well as strengthen our disease investigation and vector control measures for rat lungworm disease.”
In addition to a statewide public awareness campaign, the DOH will work in partnership with the U.S. Centers for Disease Control and Prevention, the University of Hawai‘i, HDOA, 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.
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.
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, Hawai‘i 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.
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