HILO — Hilo Medical Center plans a campaign to raise rat lungworm disease awareness.
HILO — Hilo Medical Center plans a campaign to raise rat lungworm disease awareness.
The hospital serves East Hawaii, where most cases in the state occur.
Rats get infested and their droppings contain larvae. Slugs eat the droppings. Humans can then get rat lungworm by accidentally eating slugs on fresh produce or in fluids. Slug slime trails may also be a cause.
Angiostrongylus cantonensis parasites can cause symptoms like migrating skin pain, headaches, neurological problems and, in rare cases, meningitis and death.
Hilo Medical Center 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 ills, 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 or “locum tenens.”
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, a pathologist, a pharmacist and a physical therapist (who helps patients in long-term recovery).
Hospital spokeswoman Elena Cabatu said prevention information will be shared via public service announcements. They’ll appear soon in radio announcements, 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.
Increased awareness happened after mainland visitors got sick 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 had 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.
Had she, she said, she could have prevented becoming ill or gotten treated faster.
Larson wonders, where is the public-health campaign to alert travelers and residents?
“It’s the Department of Health’s job to educate people,” she said.
But the Hawaii Department of Health says it’s already taking action.
“The health director met with Mayor Kim on Monday and discussed rat lungworm response and public outreach, among other Hawaii Island public-health concerns,” said spokeswoman Janice Okubo. “We are committed to working with the county to raise awareness and prevent disease and injury.”
Medical personnel have privately expressed frustration to the Hawaii Tribune-Herald that the Department of Health hasn’t been more aggressive in warning the public about rat lungworm, which is preventable.
Jarvi and Martell both told the newspaper they prefer to eat cooked food to avoid getting rat lungworm.
Does that concern the Department of Health, which consistently reminds consumers that 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. But it hasn’t been.
The Legislature recently approved money for the Department of Health instead of funding Jarvi’s research. She wishes the public was better informed.
“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 to freeze them for 24 hours.
Jarvi said both the CDC and the Hawaii Department of Health continue to advise that rat lungworm is “a mild, self-limiting disease.”
That might be, she said, but people should also be warned that “it’s potentially devastating.”
Jarvi said people get rat lungworm from food or water. She advises learning symptoms and watching for them, and getting to the ER as soon as possible after symptoms start because patients do best when treated early.
The Department of Health advises controlling rats and slugs/snails, especially on farms and home gardens.
Email Jeff Hansel at jhansel@hawaiitribune-herald.com.