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Hawaii’s tally of rat lungworm disease cases in 2017 spiked Wednesday to surpass the state’s annual average less than five months into the year.
However, state Department of Health officials said the two new confirmed cases of the debilitating parasitic disease and another four probable cases all stem from one incident on Hawaii island. They used the occasion of the latest surge to caution the public to use proper hygiene and common sense when handling produce and while outdoors.
Hawaii health officials advise the public to:
>> Inspect and wash produce thoroughly, especially leafy greens.
>> Store food in covered containers.
>> Supervise young children outdoors to prevent them from putting snails or slugs into their mouths.
>> Take precautions to control slugs, snails and rats around properties, and especially around gardens.
Source: State Department of Health
The new cases stem from Keaau where six people drank kava, which is made from the piper methysticum plant and is used to promote relaxation. After downing the homemade brew, which had been sitting outside all night, they discovered a slug at the bottom of the large bowl. Slugs and snails are intermediate hosts for the parasitic roundworm.
The six adults were hospitalized and their illnesses reported to the Health Department over the weekend, said health officials, who announced the new cases at a news conference Wednesday afternoon at the department’s headquarters on Punchbowl Street. The two patients with confirmed rat lungworm disease are Hawaii island residents; the four probable cases involve three Hawaii island residents and one Maui resident.
“The department is continuing to monitor this serious illness spread to individuals by infected slugs and snails,” said Dr. Virginia Pressler, the state health director. “Cases like this recent cluster are especially concerning because they can be prevented with basic precautions such as storing food in covered containers and properly inspecting and washing food before eating. These healthy habits can protect against food contamination and prevent serious illnesses.”
Officials said the two confirmed cases bring this year’s total of rat lungworm to 11 confirmed cases in Hawaii. Although rat lungworm has been endemic to Hawaii for 50 years, the state normally averages nine cases annually.
Dr. Sarah Park, Hawaii’s state epidemiologist and chief of the Disease Outbreak Control Division of the Health Department, stressed that the higher counts don’t represent an “epidemic” and that the risk isn’t limited to Maui and Hawaii island.
“We’ve had this risk statewide for many, many years. There have been past cases on Kauai and Oahu,” said Park, who attributes the increases mostly to increased awareness. “Many diseases have a wide spectrum of symptoms. If people aren’t aware, they won’t present (their symptoms) to doctors.”
This latest incident brings the count of confirmed cases on Hawaii island to five in the last three months. There have been six confirmed cases on Maui this year. All but two of the cases involved residents. The other two cases — California newlyweds who contracted the disease after visiting Hana in January — recently generated nationwide negative publicity for the state’s visitor industry.
“Hawaii continues to be the safest, cleanest, most welcome visitor destination in the world,” said George Szigeti, president of the Hawaii Tourism Authority. “Only two of Hawaii’s 8.9 million expected annual visitors have developed rat lungworm this year. Of course that’s two too many.”
Szigeti said HTA is working with health officials and other visitor industry groups, including the Hawaii Lodging & Tourism Association, the Hawaii Restaurant Association and food wholesalers, to mitigate risks. “Visitors don’t do their own food so it’s really important that we do proper preparation for them,” he said.
Peter Oshiro, state environmental health program manager, said if existing restaurant and retail rules and regulations are followed, consumers have nothing to fear. Pest management and hygiene will keep farm and home garden products safe, too, said Brian Miyamoto, Hawaii Farm Bureau executive director.
“We are encouraging the public to thoroughly wash their produce,” Miyamoto said. “We want to ensure that it’s safe to continue to buy local.”
Park said the department hasn’t identified the cause in two of this year’s cases, but the rest could have been prevented with better hygiene and by ensuring that food was thoroughly washed and appropriately prepared and stored.
“In one case, he admitted to picking leaves off and popping them in his mouth,” she said.
Rat lungworm is typically prevalent in Southeast Asia and the Pacific islands. Victims most often contract the disease by consuming produce that contains a raw or undercooked slug or snail that has been infected with the Angiostrongylus cantonensis parasite, which was carried to Hawaii by rats. The adult parasite is found only in rodents. But snails, slugs, freshwater shrimp, land crabs and frogs can become infected by ingesting their feces, which contain the worm larvae.
Most of the victims infected during this cycle have required hospitalization as the disease affects the brain and spinal cord and can cause a rare type of meningitis. According to state health officials, symptoms start one to three weeks after exposure and can last for up to eight weeks.
They said symptoms of rat lungworm can vary but include severe headaches and neck stiffness, while the most severe cases can involve neurological problems, pain and disability. Anyone who suffers headaches, fever, stiff neck, tingling or painful feelings in the skin or extremities should seek medical attention, health officials advise.
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