(BIVN) – During a recent awareness concert held in Puna, a scathing letter gathered numerous signatures, targeting the Hawaii Department of Health, the Department of Agriculture, and Governor David Ige.
“We the undersigned protest the misassignment of $1 million dollars to the Hawaii Department of Health,” read Steven Jacquier from the stage of the Green Lake Rat Lungworm Awareness Concert on August 26.
“There was no opportunity for public input on the last moment amendment which changed the recipient of this funding,” the researcher and retired professor stated before a crowd of Hawaii residents, listening to the speech as it was delivered between musical performances. “This was a dirty trick on the part of politicians in Honolulu to maintain a status quo of which the Hawaii Department of Health is very much a core part of the problem.”
Over the last decade, as concerns over angiostrongyliasis, also known as rat lungworm, grew on Hawaii Island, the University of Hawaii-Hilo Daniel K. Inouye College of Pharmacy has become a world leader in research on the disease that affects the brain and spinal cord.
Rat lungworm is caused by a parasitic nematode, or roundworm parasite, called Angiostrongylus cantonensis. Health officials say the adult form of A. cantonensis is only found in rodents. But the nematode larvae can be passed in rat droppings, which can go on to infect snails and slugs, the intermediate hosts. Health officials say humans can become infected with A. cantonensis if they eat (intentionally or otherwise) a raw or undercooked infected intermediate host, thereby ingesting the parasite.
According to the health department website:
This infection can cause a rare type of meningitis (eosinophilic meningitis). Some infected people don’t have any symptoms or only have mild symptoms; in some other infected people the symptoms can be much more severe. When symptoms are present, they can include severe headache and stiffness of the neck, tingling or painful feelings in the skin or extremities, low-grade fever, nausea, and vomiting. Sometimes, a temporary paralysis of the face may also be present, as well as light sensitivity. The symptoms usually start 1 to 3 weeks after exposure to the parasite, but have been known to range anywhere from 1 day to as long as 6 weeks after exposure. Although it varies from case to case, the symptoms usually last between 2–8 weeks; symptoms have been reported to last for longer periods of time.
UH-Hilo College of Pharmacy professor Dr. Susan Jarvi, who’s lab is home to the Hawaii Island Rat Lungworm Working Group, has a list of research that still needs to be done to better understand the disease. Many in Puna anxiously seek a better understanding themselves, especially since the district has since the most cases of the sickness of any other in the state. They call it ‘ground zero’ for rat lungworm disease, for reasons that are not entirely known.
“We have so much research to do on this disease,” said the Hawaii County Councilwoman representing a portion of the Puna area, Eileen O’Hara. “I’m sorry that the million dollars that the legislature passed through this past year, for a two-year period, was given to the Department of Health alone. They do not do research. The only thing that they can do is launch public education campaigns. And until we know better information about how to prevent rat lungworm disease, we’re not able to give really valid information to the public.”
“For instance,” O’Hara continued, “just washing your vegetables alone, that’s not sufficient. You can easily miss a juvenile semi slug in that process and then ingest it and then acquire the disease. So washing alone is not sufficient.”
Also unknown is the role catchment water systems have in the possible transmission of the nematode to humans. Shannon “Smiley” Burrows, who organized the Green Lake awareness concert, believes her son Phoenix was infected with rat lungworm when he contracted it from water in the family’s catchment system. Although Phoenix is doing well these days, Burrows says he was severely sick for about a year. You can see her interview here.
“We don’t know if a 5 micron level filter is sufficient to keep the disease from passing through catchment water,” councilwoman O’Hara said. “So these are things that we need to know, definitively, how to teach the public to protect themselves.”
While the frightening sickness has been plaguing Hawaii Island for years, in recent months it has become a statewide concern. As Dr. Jarvi hoped to find the money for more research at the legislature this year, lawmakers instead directed an appropriation to the Department of Health. Although suspecting political retribution may have been the motivation for the last minute change (VIDEO: Ruderman Blasts State’s “Outrageous” Political Games), some legislators hoped the health department would voluntarily donate some of that money to fund Jarvi’s research.
Instead, during an August 2 livestream, Governor David Ige and the state health director Virginia Pressler, M.D.. announced the first year of the two-year allocation of money would be going towards an educational campaign, running TV ads and radio spots.
Steven Jacquier was not pleased.
“We demand this funding be redirected to the original recipients for whom it had been requested,” Jacquier read from the letter, “with the benefit of public testimony and approved unanimously in all house and senate committees. We also protest as distortions, misdirection, and ineffective policy the statements presented as substantiate fact and bold initiatives to the public by Governor Ige, Dr. Pressler and Mr. Enright at their press conference. Specifically, that produce is made safe by simply washing. Angiostranguliasus in Hawaii is quote – ‘rare, and there have been quote relatively few incidents’ – unquote.”
“Some some people I know have become very ill,” Jacquier later told us in a video interview. “That, of course, provoked concern and when – year after year – we see a bill for funding be killed.”
“To change the designation of the recipient away from the lab that’s been doing good work through the department of health, against the wishes of the hundreds of people who provided testimony,” Jacquier continued, calling it both unconscionable and treacherous. “A knife in the back,” he said.
“It was upsetting enough to want to do something,” Jacquier said, “and so I came up with this open letter presenting the various issues as I saw them with that press conference. Assertions being made as fact, which in truth are unsupportable. There’s no evidence to support several of the things that were said. There was misdirection on the part of the Governor and Dr. Pressler in downplaying the severity of what’s going on. There there have been mortalities. There have been pediatric mortalities. People have died. Children have died as a result. Was there a word about that in the televised press conference? Zero. None. It’s not right.”
“Some of these patients have devastating outcomes,” Pressler said at the August 2 press conference.
“What’s happened for years is that people in the Department of Health… have been saying that this was a lifestyle disease,” Jacquier said. “And the subtext there is: only if you’re ignorant and poor would you have a problem with this. Well, guess what? Maui and Kauai and Oahu are encountering this disease as well. Because it actually is a function of the ideal intermediate host the semi slug, parmarion martensi, spreading in those areas. And that’s why all the sudden we’re seeing acute cases in those areas.”
“Parmarion martensi came to Hawaii about the same year that the coqui frog did,” Jacquier continued. “The thing is, you can hear coqui frogs. And as their range expands and their population increases it’s very conspicuous. Now the ideal intermediate host for angiostrongylus, the disease, is from China. The slug is from Asia. And it made it to the island at about the same time as the coqui frogs. And it’s range has been expanding and its population has been increasing. But people have not been noticing because they can’t hear it going ‘coquí, coquí’. But we should be paying attention and not covering it up. Not sweeping it under the rug. Not hoping to preserve some sort of imagined status quo that everything’s okay for the sake of the tourism industry. The tourism industry is going to take a hard hit when it all comes out, as it has started to, thanks to some wealthy honeymooners from the bay area getting sick at a five-star resort over on Maui, and all the sudden it’s in the San Francisco Chronicle and the New York Times. Well, that’s not how you want to be dealing with this this issue, you know, retro actively trying to do damage control.”
Jacquier, like O’Hara, takes issue with the state-produced PSA telling people to wash their veggies to get the slime off to make it safe for consumption.
“Where’s the evidence?” Jacquier asked. “In order for that statement to be verified as scientifically accurate, Dr. Pressler and Dr. Park, and the Hawaii State Department of Health would have had to conduct a bioassay, taking Hawaii produce with slime trails of parmarion martensi infected with angiostrongylus cantonensis, and fed that produce to rats, under controlled conditions, where the rats were known to be clean before they ate the infected produce. Then, you wait a certain period of time for the incubation period to proceed, and sacrifice the rats, and look inside them and see: do we have adult worms reproducing in the hearts and lungs of these rats? Do we, when we check the fecal material of these rats, find the first-stage larvae in their fecal material?”
“If you do all that and you find nothing then you can say probably it’s safe to eat produce that has been washed,” he said. “But unless you do that you have no basis, no evidence to be able to say washing simply washing is enough. There’s no basis in evidence for this.”
At the press conference, Dr. Pressler said epidemiology and vector control programs in partnership with the U.S. Centers for Disease Control and Prevention will conduct a targeted, concurrent rat, slug, and snail sample survey that’s guided by current disease data.
The discontented letter also demands an aplogy from Dr. Sarah Park, the Hawaii State Epidemiologist and Chief of the Disease Outbreak Control Division.
“We denounce (Park) for a asserting prophylactic treatment with albendazole in Hawaii is quote ‘medically reprehensible’ unquote. We demand she publicly retract the statement along with delivering a public apology to all who may have been harmed as a result of this profoundly flawed and irresponsible declaration,” Jacquier read.
“I am not a physician, I’m not a clinician, I’m simply a concerned parent, a concerned community member, and farmer,” Jacquier later told Big Island Video News, adding “my understanding regarding albendazole is that its toxicity is very low in humans. Now, what I know from firsthand experience with my friends and neighbors is that the hazard presented by this disease is very high. People can be permanently, neurologically damaged by exposure to this disease. They can be killed by this disease, and have been. So if a parent brings a child in to clinician in Hawaii and says I believe that my child has ingested a slug…. the clinician is faced with a dilemma. The physician can go ahead… and say ‘oh this child has been exposed we need to administer albendazole to clear the possibility of parasite in this child’s system’ and do so. And you may never know whether the parasite was actually there or not, but the parasite was cleared if it was.”
During an information briefing at the state legislature earlier this year, Dr. Park said “I can tell you the treatment using albendazole for parasitic infections is highly controversial for round worms,” for a number of reasons.
“One, it’s thought that … if you treat with albendazole and you’re killing off worms… if you actually achieve … the die off of worms, you may actually worsen the disease and so to treat with just albendazole, you could actually worsen symptoms in the patient,” Park told lawmakers. “But aside from all that, albendazole works in the adult worm. We know that the infection infection occurs from third-stage larvae. So you’re using medication, potentially, that does not work. And then you’re reassuring the patient. In my mind – if I put on my clinical infectious disease hat – it would be reprehensible to do that, and reassure patient. Which is why if I actually were to consult on patient, my recommendation is to monitor that patient very closely, and if there are concerning signs and symptoms, to utilize prednisone steroid and to actually monitor the patient and to follow that patient with appropriate steroid therapy.”
“Just because I’m afraid I got infected, to use albendazole, reassuring a patient, that’s reprehensible from a medical standpoint,” Dr. Park said. “You’re falsely reassuring them. Because you don’t know what you just did.”
“Well, when there are symptoms,” Jacquier argued during our interview at Green Lake, “that means that the larvae are burrowing around in the brain. And doing damage. Potentially permanent, potentially catastrophic damage. So when you look at the risk benefit analysis on this, why wait until there is potentially catastrophic permanent damage or death?”
“The Department of Health has warned us that it’s ‘medically reprehensible’ to use the nematicide in this manner,” Jacquier told us. “I think that that deserves a lot of scrutiny and a retraction.”
Jacquier told those assembled at the awareness concert to “come by the table” and add their names to the almost 200 signatories on the letter. He later said that the proprietor of Jungle Love store in Pahoa invited him to bring the letter to the store and leave it there to gather more names.
“There are over 200 people who have signed this, saying: no, we agree this is really not appropriate,” Jacquier said. “That should be a signal to folks that it’s not just one lone crank who’s upset about what he heard it that that press conference.”
by Big Island Video News
KAPOHO, Hawaii - Some Puna residents are upset with the state's plan to counter the spread of rat lungworm disease.