Hawaii Pushes Rat Lungworm Education, But Research Wanted

(BIVN) – Governor David Ige livestreamed a press conference on rat lungworm disease from his office on Oahu Wednesday. The frightening sickness has been plaguing Hawaii Island for years, and in recent months has become a statewide concern.

“In January and May of this year,” said State Health Director Dr. Virginia Pressler, who stood beside the governor at the podium. “We’ve had 15 confirmed cases of rat lungworm disease in Hawaii. 9 of these cases were on Hawaii Island and 6 were on Maui.”

“Some of these patients have devastating outcomes,” Pressler said.

The governor was also joined by state agriculture officials and 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). Kramer is the chair of the Joint Task Force to combat rat lungworm disease, which will reconvene in August.

“We want to acknowledge the angst felt by our Puna and our Hana communities, particularly,” Pressler said.

The state explained the disease in a media release issued the same day:

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).

The officials explained to the press and those watching on Facebook what it is they plan to do with the funds allocated by the state legislature in this years budget. The emphasis is on prevention.

“The Department of Health is working together with the governor’s joint task force and will spearhead a targeted approach to responding to and preventing rat lungworm disease in Hawaii,” Pressler said.

The health director later turned everyone’s attention to a TV screen, saying “we now have a PSA that we wanted to share with you that we will be seeing soon on television.”

“The good news is you can prevent (the disease) by simply washing your produce thoroughly,” the PSA stated as video showed hands scrubbing vegetables in a sink under running water.

“We’ll air a series of public service announcements on television and radio stations statewide throughout the year,” Pressler said. “In addition, our epidemiology and vector control programs, in partnership with the US Centers for Disease Control and Prevention, will conduct a targeted, concurrent rat, slug and snail sample survey that’s guided by our current disease data. The survey findings will provide a foundation to guide more effective public health measures in the second year of the Legislature’s funding.”

“A statewide survey of this kind has never been conducted in Hawaii before,” the health director said.

Questions from the media focused on the involvement of the Daniel K Inouye College Of Pharmacy at the University of Hawaii – Hilo, where Dr. Susan Jarvi has been leading the research on the disease. Jarvis was not a speaker at the governor’s press conference.

“Well, they are very much included,” Pressler answered after one reporter inquired about Jarvi’s role in the effort. “Dr. Jarvi is on the governor’s rat lungworm task force, and I have worked together with her Dean of the School of Pharmacy in Hilo, as well as with the Chancellor there, and we are all working together on this now.”

Jarvi says they need funding to finish important studies on diagnostics, water treatment, vegetable rinsing, deworming rats (of which 90% of those caught in Hilo are infected with the disease) and identifyinh RLW hotspots. She hoped to find the money at the legislature this year. But the state’s appropriation instead went to the Department of Health.

Puna State Senator Russell Ruderman said recently that the switch was the result of bitter politics. “I think playing that kind of game with this kind of issue is outrageous,” Ruderman said at a recent town hall meeting. “If we were all adults in the room, we would say Department of Health – you got all this money you don’t even know what to do it. Let’s share it with the rat lungworm lab and all work together to solve this problem. Because we need vector control and we need research.”

During the governor’s press conference, media pressed the state health officials on why none of the $1 million allocated ($500,000 over two years) was going to the UH-Hilo lab.

“The serological tests,” Pressler began, “we’re aware of specimens being sent to the Centers for Disease Control and are working together with those experts there. There is yet to be a validated serological test. There’s research going on throughout the University by multiple faculty.”

Jarvi has not given up She keeps making public appearance when called upon, including a Hawaii County Council Committee meeting held August 1 in Hilo, the day before the governor’s press conference.

During the committee meeting, state health officials presented their plans for an increased educational campaign. But, like Jarvi, Puna councilwoman Eileen O’Hara sees a need for expanded research, in particular as it relates to catchment water systems.

The following is a transcript taken from select portions of the meeting, as seen in the edited video above:

JARVI: Education is no doubt very, very, important. But this problem is bigger than that… “Safe eating is healthy eating, and wash your veggies”. Very, very good advice. But washing your veggies with water does not make them safe, it makes them safer. These larvae, these rat lungworm organisms, live in water. We’ve had them in our lab, in the infectious stage, out to three weeks growing just in water. We now have a culture that when you give them a little food we’re out to four months we can keep these guys alive. So, just washing your vegetables in water – especially in an area where you have such high, widespread, unregulated catchment use, where a lot of people do not have fresh potable water to wash their vegetables in. So that’s a very big problem.

COUNCILWOMAN O’HARA: To me that’s not sufficient… where we’re passing out information that is not well researched, documented, firmly identifies ways to avoid transmission of this disease. We’re not doing enough.

It suggests that people use as small as a 5 micron filter. Most of the filters that are commonly used are 10 or 20 microns. So it was suggested that the use of a 5 micron may protect you from a rat lungworm disease. But to me, that’s not sufficient.

JARVI: We need research on catchment systems – best design for catchment systems, to try to block the larvae from entering into household water supplies as well as agricultural water supplies. We know people can get infected by ingesting contaminated water. We’ve lost a baby – at least one child – that there’s no way this baby could have gotten rat lungworm other than in the bathtub. So, the water issue is a really big issue and we need to have research on that.

JASON DELA CRUZ, Hawaii Health Department: For us you know that primary transmission route still appears to be that accidental or intended ingestion of a either raw or undercooked snail or slug. So, you know… certainly when the investigations start pointing to that, I do think that it’s going to, you know… certainly look into that little bit more. But it’s really hard to pinpoint that exact exposure. So, from a theoretical perspective: yes it is possible and, you know, the Department of Health is not really set up to be a research organization per se. We do look for … the best researchers from around the world to really drive that kind of… our guidelines and our thoughts.

COUNCILWOMAN JEN RUGGLES: So if I heard you correctly… are you saying that rat lungworm … that it’s questionable if it does transfer through water?

CRUZ: To my knowledge, I don’t believe there’s been one confirmed case from the Department of Health that has been directly attributed to exposure (from water) … some of the people that I think have reported have claimed that ‘yes, it was my catchment’ but like I said, it’s extremely hard to know that exactly where that exposure occurred. We do know that – as mentioned – that it can live in water for some time….

Catchment very well could be a transmission route, considering how many people are on catchment here. If it was, there might be other factors that are associated with that in terms of how much maintenance they have, what they use it for, how they use it… We have a lot of people that are maintaining it well and so, I assume, some people that aren’t.

O’HARA: I’m just concerned that if that’s all we’re doing is passing out educational materials where we still don’t know the answers, it’s just not enough. We need to be putting money into research. So, I would like to know of the $500,000 that the Department of Health was given for the each of the next two years, how do we – the County Council on the Big Island, where we are seeing the greatest negative health impacts from this disease… and data being what it is, I don’t think that we have collected data on all the affected cases. A lot of people never got tested. A lot of people are out there who have rat lungworm disease who were never positively tested for it because we don’t have a really good test, yet. So there’s so much research that needs to be done. I would like to know what we, the County Council, can do to encourage expenditure of some of that funds for research. It’s not enough just to spend it on public education. Can we pass a resolution to encourage? Or do you want to hear individually from us, as council members? How is it best to push that point, because I’m very concerned about the lack of research dollars being directed at this problem.

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