Hawaii teachers tackle a slimy subject: rat lungworm disease

Kay Howe wore a beige T-shirt with a catchy message to the workshop she led for public and private school teachers at ‘Iolani School: A drawing of a slug with the words “Let’s Talk About It” adorned the front, and a warning about “Hawaii’s STD,” or slug-transmitted disease, aka rat lungworm, was on the back.

“Instead of thinking this is a shameful thing and we don’t want to talk about it, we need to be learning about it,” said Howe, a curriculum development specialist with the University of Hawaii-Hilo College of Pharmacy.

Rat lungworm, a parasitic disease that affects the brain and spinal cord, is a deadly serious issue for Howe. She learned about it firsthand when her 24-year-old son came down with a debilitating case in 2008 on Hawaii island and lapsed into a coma. He eventually recovered but still suffers from aftereffects, including vision and memory problems, she said.

Today Howe is doing all she can to educate people and stop the spread of the disease, formally known as angiostrongyliasis. On Tuesday she debuted the new curriculum she developed, “Engaging Students in Citizen Science Through the Prevention of Rat Lungworm Disease.”

The daylong professional development workshop for teachers was funded by the Department of Health, ‘Iolani School, Oahu Farm to School Network and Hawaii Farm to School Hui. A longer course is anticipated for teachers on the Big Island this fall.

The workshop filled up quickly with 32 participants with more having to be turned away, according to Debbie Millikan, sustainability specialist at ‘Iolani School and a presenter at the session. Participants came from all over, including Waialua High & Intermediate School, Hau‘ula Elementary School and Kualapuu School on Molokai, as well as ‘Iolani School, St. Andrew’s Priory and Le Jardin Academy.

Linda Higashi, a fifth-grade teacher at Kalihi Elementary, said she is eager to help her students understand that “No. 1, there is a concern, and No. 2, I can do something about it even though I’m only a fifth-grader.”

“My hope, and please take this the right way,” she said, “my hope is to infect our students not with rat lungworm disease, but to infect them with this desire to learn to develop skills that will allow them to impact our community.”

The workshop covered the life cycle of the rat lungworm, a parasitic roundworm, as well as its global spread, pest management techniques, identification and data collection. The parasites grow inside rats, which pass the larvae in their droppings, which are eaten by snails and slugs. Humans can fall ill when they unwittingly ingest the parasite in tiny slugs or snails on unwashed, raw produce or by eating undercooked snails, slugs, frogs or crabs.

The disease has been in Hawaii since 1959. Last year there were 18 laboratory­-confirmed cases and three probable cases, mostly on Hawaii island and Maui, according to the Health Department. Over the previous decade there had been between one and 11 cases confirmed by laboratory testing.

So far this year there have been four confirmed cases, including a toddler from Central Oahu, a Maui resident and a resident and visiting adolescent on the Big Island.

Symptoms of rat lungworm can include severe headaches and neck stiffness, tingling and pain in the extremities, and nausea. Serious cases can lead to neurological problems, lasting pain and long-term disability. There is no specific treatment for the disease. Sometimes steroids are used to reduce inflammation.

As part of the workshop, the teachers headed out to ‘Iolani’s garden on a slug hunt, wearing purple waterproof gloves. Afterward they got some training on identifying the slimy creatures and learned about disposing of them in “slug jugs,” large-mouthed jars filled with one part salt to seven parts water.

Moanalua High School’s Sandra Nakagawa-­Saito said she intends to incorporate parts of the rat lungworm curriculum into her AP Environmental Science course, to make it more relevant to Hawaii.

“Education is one of the crucial components of prevention, so we are always looking for creative ways to reach people, and what better way to reach people than students in school?” said Anna Koethe, public health information coordinator with the Health Department. “We’re excited to support this program and teach the teachers the knowledge they need to bring back to their students, that the students will take home to their families.”