Hilo Medical Center plans a campaign to raise awareness of rat lungworm disease.
Hilo Medical Center plans a campaign to raise awareness of rat lungworm disease.
The hospital serves East Hawaii, where most cases in the state occur.
Rats get infected and their droppings can contain worm larvae. Slugs eat the droppings. Humans can then get rat lungworm by accidentally eating fresh produce or drinking fluids carrying the parasite. Slug slime trails also can be a cause.
Angiostrongylus cantonensis parasites can cause symptoms such as migrating skin pain, headaches, neurological problems and, in rare cases, meningitis and death.
HMC Quality Director Tandy Newsome said a rat lungworm planning meeting there Wednesday focused on the lack of a conclusive diagnostic test.
Symptoms mimic many other illnesses, she said, so the parasite isn’t always considered.
The planning group decided hospital pathology will now alert key personnel if certain unusual lab readings occur. And pharmacy will alert them if anti-inflammatory drugs get prescribed unexpectedly (when there’s no arthritis, for example).
The hospital’s electronic system now automatically asks staff about rat lungworm when those drugs are prescribed.
Medical Director Dr. Jon Martell plans training for ER doctors, new physicians and temporary fill-in providers. Initially, the efforts are solely for the hospital, but the team plans outreach.
“Dr. Martell is open to anybody who is willing to join us in this effort,” Newsome said.
A multidisciplinary group of experts will include Martell, an ER physician, pathologist, pharmacist and physical therapist.
Hospital spokeswoman Elena Cabatu said prevention information will be shared via public service announcements. They’ll be heard soon in radio announcements and appear in newspaper ads and on a PBS television program on which Martell will appear. University of Hawaii at Hilo Department of Pharmaceutical Sciences professor Susan Jarvi, a leading rat lungworm researcher, also plans to appear.
Awareness of rat lungworm increased after mainland visitors became sick following a two-week honeymoon on Maui and national news took note.
Tatum Larson, for example, moved to Maui a year ago, had a job and was ready to stay long term. But she got ill with strange itching feelings on her feet and legs and mobile skin pain.
Larson said her Maui medical team was dismissive and rude, as if her symptoms were imaginary. They offered pain drugs but she declined — because she isn’t a fan of opioids.
After three hours, she asked a nurse if the doctor assessed her symptoms.
“Oh, so you want the pain medicine now?” was how she remembers the nurse responding.
Larson said she was diagnosed in Washington state, where she now lives, with meningitis caused by rat lungworm disease. Her doctor there didn’t know what rat lungworm was but learned after she mentioned a friend’s suggestion.
Larson is frustrated she never saw any public notices or fliers from the Hawaii Department of Health about rat lungworm — at a farmers market, a grocery store or the hospital. If informed, she said she could have prevented becoming ill or gotten treated faster.
Larson wonders why there is no public health campaign to alert travelers and residents.
“It’s the Department of Health’s job to educate people,” she said.
But the Health Department says it’s already taking action.
“The health director met with Mayor (Harry) Kim on Monday and discussed rat lungworm response and public outreach, among other Hawaii Island public health concerns,” said DOH spokeswoman Janice Okubo. “We are committed to working with the county to raise awareness and prevent disease and injury.”
Medical personnel privately expressed frustration to the Hawaii Tribune-Herald that the department hasn’t been more aggressive in warning the public about rat lungworm, which is preventable.
Jarvi and Martell told the newspaper they prefer to eat cooked food to avoid getting rat lungworm.
Does that concern the DOH, which consistently reminds consumers it’s safe to eat fresh produce that’s well-cleaned?
“Fresh vegetables and fruits are part of a healthy diet and the Department of Health will continue to encourage people to eat fresh produce that is appropriately inspected, stored and washed,” Okubo said.
But Jarvi said Wednesday that she knows of no study that demonstrates that even thoroughly washed produce is freed of parasites.
That study “should be done,” she said.
To help stem the spread of rat lungworm disease, state lawmakers gave $1 million to the Health Department in the two-year, $28 billion budget they approved Tuesday, but did not include funding for Jarvi’s research.
Jarvi wishes the public was better informed about the disease.
“I’ve lived on Hawaii Island for 22 years now,” Jarvi said, “and I’ve never seen any notification from the state, any notification from the Department of Health. I’ve never seen anything in the stores, at the airport, at the farmers market. I hope that with the million dollars they got that they do some of that.”
Jarvi said education is key to prevention.
Her advice is to cook all foods well or freeze them for 24 hours.
Jarvi said the U.S. Centers for Disease Control and Prevention and the state DOH continue to advise that rat lungworm is “a mild, self-limiting disease.”
That might be, she said, but people also should be warned that “it’s potentially devastating.”
Email Jeff Hansel at jhansel@hawaiitribune-herald.com.