Rat lungworm disease symptoms may be underrecognized

LIHUE — State epidemiologist Dr. Sarah Park told Kauai council members Wednesday the rat lungworm disease may be underrecognized on some Hawaiian islands

The Hawaii Department of Health has confirmed 14 people this year have been contracted with the disease that can be damaging to the brain and spinal cord. The figure is three more from last year. No deaths have been reported.

“As you look at the understanding that we have, although there are quite common symptoms for severely infected persons, such as headache, neck pain, vomiting,” she said, “for some individuals, it’s possible they have milder symptoms — severe headaches — that may not actually bring them into position.”

Park and Scott Enright, Hawaii Department of Agriculture chair, visited Kauai to update the council on efforts to protect the public from the disease at the request of councilman Mason Chock.

Dr. Janet Berreman, Kauai district health officer, said there have been two cases of the disease on island in the last two years. A visitor was confirmed with the parasite in 2015 and a probable case, which was not confirmed, was reported in 2016.

Rat lungworm disease is caused by a parasite found in rats and passed on to snails, slugs and some freshwater animals like prawns, shrimp and fish.

Victims are infected after ingesting the parasite. Rats excrete the larvae which is ingested by the slug or snail.

Produce — such as green, leafy plants — attract snails and slugs and the infected veggies or animals are consumed by victims.

Councilman Derek Kawakami said council members have received complaints from constituents about people piling trash and hoarding, which attracts rats.

“The culprit is rats,” he said. “What’s the suggestion to the public, so we can all coexist peacefully without these diseases being a big epidemic?”

Park said the solution involves a community effort.

“It requires all of us — state agencies, county agencies, the community — come together and come up with solutions,” she said. “And it’s also a cultural shift to change. Rather than accepting this is occurring, that we actually be proactive and do something in the community to address this ourselves.”

Chock said the public should be wary of produce — local and imported.

“Everything should be considered as carriers and approached cautiously as well,” he said.

Berreman and Park said exercising hygiene and thoroughly washing produce is key to preventing the disease.

“Take your produce and inspect it leaf by leaf and wash it very carefully. Just running your produce under running water is not necessarily going to get rid of it,” Park said. “I think that’s the biggest issue that we’re trying to get across.”

Councilwoman JoAnn Yukimura had concerns about keiki crawling on surfaces with slug or snail trails.

Park, however, said there’s no data to demonstrate the slime itself is infectious, but added researchers have no data to disprove it either.

Park said the disease cannot be transmitted from human to human.

Enright said agricultural practice dictates the control of snails and slugs.

“There will be audits of farms to make sure that farmers maintain these cultural practices that keep these vectors at bay,” he said. “The recommendations that you heard today are practical.”

Park said there aren’t known treatments for the disease.

“This worm will eventually die. We are considered dead-end hosts,” she said. “It will survive until it starves to death. No one knows how long that takes.”

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