Bill would fund rat lungworm battle

State lawmakers are considering pouring hundreds of thousands of dollars into research and prevention efforts aimed at combating rat lungworm disease, a condition in which parasitic worm larvae infect people’s brains. The growing larvae can cause neurological damage, a potentially painful and debilitating type of meningitis, and possibly death.

With cases of the disease expected to increase in coming years, some lawmakers expressed frustration during a joint Senate and House informational briefing at the state Capitol on Wednesday that there isn’t more information on how the disease is being transmitted and the best way to prevent and treat it.

For instance, health officials are urging people to be sure to thoroughly wash their produce, especially leafy greens. However, it’s possible that the larvae could be introduced through water catchment systems, which are prevalent in rural areas of the state. Health officials clarified at the hearing that the water used to wash produce should be potable.

There also seems to be confusion about the best way to treat people who have contracted the disease, which is transmitted by snails and slugs.

“Right now, I don’t even see a standardized protocol for treating this in our state,” said Rep. Richard Creagan (D, Naalehu-Captain Cook-Keauhou), who is a physician.

Sue Jarvi, a leading rat lungworm researcher at the University of Hawaii at Hilo and a professor of pharmaceutical sciences, said her understanding was that prescribing albendazole, which can kill the parasites, was generally considered the best practice, though she added that she is not a doctor.

However, Sarah Park, the state epidemiologist, expressed alarm at such advice, telling lawmakers that it could worsen a patient’s symptoms. She called such treatment “reprehensible from a medical standpoint.”

“You are using a medication that potentially does not work, and then you are reassuring the patient,” she said.

Park said that she would instead recommend close monitoring of a patient and possibly steroid therapy.

Creagan told Park that regardless of what the best practice is, health officials need to be much better apprised of it.

“I think our front-line physicians need to know much, much better how to respond to potential cases and then know what to do immediately,” he said.

State lawmakers are currently debating Senate Bill 272, which would appropriate a yet-to-be-determined amount of funding to UH-Hilo to hire staff to conduct research and spearhead prevention activities, as well as partner with state agencies. Jarvi told lawmakers Wednesday that she hopes to hire three to four people to assist her in her work on the disease, which she estimated would cost between $350,000 and $400,000.

There have been 58 recorded cases of isle residents contracting the disease in the past decade, according to state Department of Health data, but health officials told lawmakers that the numbers are likely higher.

“It’s way under-reported based on the number of cases who call us,” Jarvi said.

She said her team gets an email or call from someone who believes they may have contracted the disease at least once a week. Jarvi estimated that there have been about five deaths in Hawaii from the disease in recent years.

There have also been several cases of visitors to Hawaii contracting the disease that are not included in the state data.

While the Puna district of Hawaii island has experienced the most cases, there have also been cases on Maui, Oahu and Kauai, and health officials are stressing that the disease is a statewide problem.

The disease gets its name because the larvae are transmitted between rats and snails and slugs. In rats, the larvae develop into worms, which invade the heart and lungs. However, in humans the larvae is believed to usually die after reaching the brain.

“Clearly outreach and education is what’s needed and it’s not just for the Big Island, it needs to be statewide,” Department of Health Director Virginia Pressler told lawmakers. “This is probably going to be a growing issue and we aren’t going to be able to totally eradicate slugs or the rats.”