MEDIA RELEASE

Five months ago, Kona Community Hospital (KCH) established a Trauma Program Committee to develop policies and procedures in order for Kona Community Hospital to function and be designated as a Level III Trauma Center (a facility that is able to provide resources for emergency resuscitation, stabilization, emergency surgery and intensive care of most trauma patients).

After months of collaboration and input by the trauma committee members, as well as four mock trauma activation drills – as of Jan. 1, 2010, Kona Community Hospital’s “Multi-Tier Trauma Team Activation Protocol” went into effect making the hospital the first hospital on the Big Island to function as a Level III Trauma Center.

“We are proud to be the first hospital on the Big Island to treat patients as a Level III Trauma Center,” stated Rich McDowell, MD, KCH’s Chief of Emergency Medicine. “We are also excited to be part of the development of a state-wide trauma system which is going to be of a great benefit to the care of trauma patients throughout the state”

According to a 2005 study by the American College of Surgeons, 50 percent of all deaths in Hawaii (ages 1 to 44) are trauma-related. Since the policy’s implementation, fourteen Emergency Room cases have been activated through the new Trauma Program.

The purpose of this new program is to streamline the process for trauma cases, and decrease the time needed for emergency care.

Wendi Wagner, RN, KCH’s Trauma Program Coordinator commented, “We are excited to have initiated the Trauma Team Activation protocol as of Jan. 1, 2010. Trauma Team Activations are called when patient injuries meet specific critical criteria established by the American College of Surgeons. When criteria are met, the multidisciplinary trauma team is activated and the members report immediately to the emergency department.”

This response allows for the initial evaluation and stabilization to occur in the most efficient and expedient manner. The early detection and determination that the patient’s injuries require the need to transfer to a more definitive Trauma Care Facility can take place while the patient is receiving appropriate and timely resuscitation measures.

This organized response will improve efficiency in direct patient care, as well as improve transfer times to definitive care facilities. The primary goal is to improve outcomes for trauma patients.

Mandatory requirements to be designated as a Level III Trauma Center include having a Multi-Disciplinary Trauma Committee Meeting and monthly emergency department and surgery department peer review meetings of all trauma activations. These have all been scheduled at Kona Community Hospital.

The Department of Health expects to receive a year of national registry data, as well as a year of required meetings documentation in order to complete the designation process.

Kona Community Hospital anticipates to be designated as a Levell III Trauma Center in 2011.

MEDIA RELEASE

Today (Jan. 29) marks the official first step in improving trauma care on the island. The inaugural meeting of the Big Island Trauma Advisory Council (BITAC), consisting of hospital leadership, physicians and emergency first responders from all regions of the island, is 9:30-11:30 a.m. at North Hawaii Community Hospital in the Mauna Kea conference room.

In 2005, the American College of Surgeons Trauma Systems Consultation Program reviewed Hawaii’s statewide system and provided recommendations for improvement for each hospital, service, and resource, including forming a regional trauma advisory council to address specific local issues.

In 2007, the Hawaii State legislature released funding through the Department of Health to organize the statewide trauma system, which facilitated the creation of the Big Island Trauma Advisory Council.

The council is charged with developing a systems approach for trauma care providers on the island. Funding from the Department of Health allows the council to help island hospitals pursue official trauma designation that is specific to each facility’s level of care.

The focus of the council includes:
* Improving and standardizing trauma care
* Improving transport times for trauma cases both on and off the island
* Optimizing specialty coverage such as orthopedics, neurology, surgery
* Educating youth and raising community awareness on preventative measures to avoid trauma

Hilo Medical Center has been designated at the lead facility in this initiative. In 2009, Hilo Medical Center established a Trauma Program, which includes:

* Program Administrator: Dan Brinkman – Hawaii Health Systems Corporation East Hawaii Regional Chief Nurse Executive

* Program Manager: Arthur Sampaga, Jr., RN, BSN, CCRN – Hilo Medical Center Cardiovascular/Emergency Service Nursing Supervisor

* Program Coordinator: Louise Fincher, RN, BSN, CCRN – Hilo Medical Center Emergency Department nurse for 10 years

In addition, program medical directors include Dr. Peter Matsuura for orthopedics, Dr. Daniel Hudak for surgery and Dr. Joseph Pollard for emergency medicine.

“Trauma is an equal opportunity injury,” said Dan Brinkman, Chief Nurse Executive for the East Hawaii Region. “It doesn’t matter if you are the richest or poorest; live in east or west Hawaii. Everyone is cared for in the same trauma system, which is why we must strengthen the current system and ramp up prevention and education efforts.”

MEDIA RELEASE

Public advised to prepare for a smoke-filled New Year’s Eve

HONOLULU – The Hawai‘i State Department of Health’s (DOH) Clean Air Branch will be monitoring Hawai’i’s air quality during New Year’s and comparing it with national ambient air quality standards. The heavy use of fireworks during the annual holiday celebration can significantly increase the amount of particulates in the air, especially on Oahu.

The Clean Air Branch is encouraging the public to be properly informed and prepared for the upcoming New Year’s fireworks celebrations as well as possible temporary increases in vog levels.

Firework smoke consists primarily of particulate matter that can aggravate conditions such as asthma, emphysema, and chronic bronchitis. Those who suffer from any of these lung conditions may want to take certain precautionary measures. The DOH offers some of the following guidelines:

• On New Year’s Eve, stay indoors and close your windows and doors.
• Check that your air conditioner or air purifier is working properly, change filters if necessary.
• Do not smoke and avoid second-hand smoke.
• If you take medication, make sure you have an adequate supply and use them as directed by your physician.
• Contact your physician if you need more medication and get clear instructions of what to do if your lung condition suddenly worsens.
• Avoid people who have colds and other lung infections and wash your hands thoroughly.
• Drink plenty of fluids to loosen mucus. Warm beverages work best.
• Get plenty of rest and limit physical exertion.

While these suggestions are intended primarily for persons with respiratory or chronic lung disease, they are also useful for healthy persons during air pollution episodes such as particulates dust, brush fires, firework smoke, or volcanic haze.

For further information regarding air quality, contact the Clean Air Branch at 586-4200. To obtain additional information on respiratory health and the New Year’s fireworks, contact the American Lung Association of Hawai’i at 537-5966 or visit their website at www.ala-hawaii.org

MEDIA RELEASE

The state Department of Health has begun placing orders with the U.S. Centers for Disease Control and Prevention for 2009 Novel H1N1 Influenza vaccine.  

The CDC has approximately 3 million initial doses of nasal-spray flu vaccine LAIV (FluMist®) available to the nation in this first series of shipments to all states that place orders.  

Shipments are expected to arrive during the week of Oct. 5. 

“These initial shipments of H1N1 vaccine will be used to protect emergency medical service personnel, first responders and healthcare workers,” said Health Director Chiyome Fukino, M.D. “The state will follow CDC guidance and give first priority to high-risk groups that may be more vulnerable to serious complications from the H1N1 flu.”

In accordance with CDC guidelines, the DOH will give first priority to the following high-risk groups for H1N1 vaccination: 

* Healthcare and emergency medical services personnel with direct patient contact; 

* Pregnant women; 

* Household contacts and caregivers for children younger than age 6 months; 

* All people from age 6 months through 24 years; 

* Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza. 

Hospital facilities will be some of the first to receive the novel H1N1 vaccine to immunize their healthcare workers. 

The DOH is also working on other avenues of distribution that will include pre-registered primary care physicians; community vaccinators such as retail pharmacy chains and community health clinics; and school-located vaccination clinics scheduled to begin in November. 

According to the CDC, the first H1N1 vaccine doses received by all states will be the nasal spray live attenuated influenza vaccine (LAIV) or FluMist®.  This form of vaccine is recommended for children two years of age or older and adults up to 49 years of age.  

It is not recommended for pregnant women or individuals with underlying medical conditions such as asthma. In addition to LAIV, injectable vaccine doses will be available in weekly shipments to states beginning in mid-October.   

The CDC estimates 10 million to 20 million doses of both forms of vaccine will be available for distribution nationwide each week after the first week in October.  

Hawaii was allocated 14,400 doses of vaccine to be able to draw from with its first order. H1N1 vaccine allocations can and most likely will come multiple times during the course of a week, so H1N1 allocation numbers will change frequently. 

Beyond the high-risk groups who will be targeted initially to receive the H1N1 vaccine, the DOH will be encouraging everyone to get vaccinated as it becomes more widely available. 

Meanwhile, everyone can continue to help stop the spread of influenza by getting their seasonal flu vaccination and through simple yet effective methods like covering your cough, washing your hands frequently, and staying home if you are sick. 

New influenza Web site

The DOH has launched a new website dedicated solely to information on influenza and the H1N1 vaccine in Hawaii.  

The Web site is accessible at www.hawaii.gov/health/about/H1N1.html and will include the latest information available on the H1N1 vaccine, when and where it will be available.  

The public may also receive the updates on H1N1 vaccine availability by following the DOH on Twitter, at twitter.com/HIgov_Health.  

Information on 2009 Novel H1N1 influenza is also available by calling Aloha United Way’s 2-1-1 helpline.

Media releases compiled by Karin Stanton/Hawaii247.org Contributing Editor

The state Department of Health has confirmed the state’s third and the first neighbor island swine-flu related death.

The woman, who died July 7 at Kona Community Hospital, has been identified at Donna Altamirano, 51, of Kealakekua.

The Big Island resident is one of 263 swine flu-related deaths nationwide.

“Although flu was the primary cause of death for this individual, she had serious underlying medical conditions that exacerbated her condition and contributed to her decline and death,” said Dr. Sarah Park, chief of the Disease Outbreak Control Division and state epidemiologist. “We all need to take care of ourselves and be as healthy as we can be to maximize our ability to fight off infection.”

More than 1,000 reported cases of swine flu in the islands have been identified since May. Nationwide, there have been more than 40,000.

MEDIA RELEASE

The state Department of Health has confirmed novel H1N1 influenza infection likely contributed to underlying medical conditions that caused the death of an adult in her late 60’s on June 19 at Tripler Army Medical Center.  

The Oahu resident is the first death in Hawaii associated with the new flu strain and one of more than 100 reported nationwide during the last two months. No further information about the patient’s medical condition before death or identification will be released due to patient privacy considerations and federal law.   

The first hospitalization of an adult with novel H1N1 influenza within the state was confirmed June 27. The Oahu resident with underlying health issues developed pneumonia as a 

complication of their H1N1 infection. The individual is responding to treatment and recovering in the hospital. 

“These two new severe cases of novel H1N1 are a sad reminder of the seriousness of influenza, particularly for those at-risk for complications,” said Dr. Sarah Park, chief of the DOH Disease Outbreak Control Division. “Unfortunately, we knew this would happen eventually, as we have flu-related deaths and hospitalizations every year from regular seasonal influenza.” 

Park added, ”The influenza infection itself was not the primary cause of death in this case, it was a contributing factor to the patient’s already declining condition due to multiple serious health issues.” 

Cases of novel H1N1 influenza have been identified on the islands of Oahu, Maui, Hawaii, Kauai, and Molokai with the majority of cases confirmed on Oahu.  

Most recently, the DOH confirmed an outbreak of novel H1N1 among firefighters on Molokai with reportedly 20 workers or more than half of the staff becoming ill.  

The DOH has been working with local organizations to provide information to the community on prevention measures, and Tuesday will be sending public health staff to Molokai to conduct additional education and outreach efforts due to this new outbreak. 

“The situation on Molokai shows how influenza can affect basic central services and cripple limited resources,” Park said. “It is so important that we all continue to consider and plan for the impact a flu pandemic can have on our workplaces, schools, and communities.” 

The DOH has confirmed a total of 545 cases of novel H1N1 since May 5. Of these cases, all but three have recovered or are recovering at home with no complications. One adult resident is hospitalized on Oahu; one adult that resides on Maui became ill after traveling to Washington state in May, was hospitalized and recovered in Washington before returning home; and one death occurred on Oahu as a result of complications from the flu. 

— Find out more:

State Department of Health: hawaii.gov/health/about/H1N1.html

Centers for Disease Control: www.cdc.gov/h1n1flu/

World Health Organization: www.who.int/en/

MEDIA RELEASE

HONOLULU – Tuesday, May 19, 2009 is World Hepatitis Day in Hawai’i. The Hawai’i State Department of Health (DOH) is joining others across the nation and world to help raise awareness and support for improvements in prevention, diagnosis and treatment for people living with chronic viral hepatitis B and C.

DOH health centers and other community-based sites are offering free screenings to the public on Tuesday, May 19 to encourage people to find out their hepatitis B and C status. Individuals can call Aloha United Way 211 to find the free screening location nearest them (flyer attached). 

“Often called the silent epidemic, most people with hepatitis B or C don’t have symptoms for many years,” stated Heather Lusk, DOH hepatitis C coordinator. “People with hepatitis B and C shouldn’t wait until they feel sick to be tested because there are many things, including treatment, they can do to take care of themselves before they become ill. The earlier people know they have hepatitis, the better the outcome.” 

According to DOH Immunization Branch estimates, 1 percent to 3 percent of people in Hawai’i have hepatitis B, and approximately 23,000 are living with hepatitis C. Hepatitis B and C are the most common known causes of liver cancer in Hawai’i, and Hawaii has the highest rate of liver cancer in the U.S. 

“Many people with hepatitis B and C get liver damage or cirrhosis from the disease, which can be minimized by making healthy choices such as not drinking alcohol,” said Lusk. 

Hepatitis B and C are spread through contact with blood and body fluids. The Centers for Disease Control and Prevention (CDC) recommend that anyone who has been exposed to blood through needle use, blood transfusion, non-sterile equipment or tattooing should be tested for both hepatitis B and C. Anyone born in a country with high rates of hepatitis B, such as countries in Asia and the Pacific, should be screened for hepatitis B. Hepatitis B is easily spread from mother to child through contact with blood and other body fluids. Infants born to mothers who have hepatitis B infection warrant special treatment at birth. 

More information on hepatitis B and C is available from the Centers for Disease Control and Prevention at www.cdc.gov/hepatitis, or by calling 1-888-443-7232. For more information about World Hepatitis Day, go to www.aminumber12.org.

What is H1N1 Flu (swine flu)?

H1N1 Flu (swine flu) is caused by type A influenza viruses that cause regular infection outbreaks among pigs. People do not normally get swine flu, but human infections can and do happen. Swine flu viruses have been reported to spread from person-to-person but usually not more than a chain of three people.

Are there human infections with swine flu in the United States?

In late March and early April 2009, cases of human infection with a new H1N1 Flu (swine flu) were first reported in California and Texas. Around the same time, cases were being reported in Mexico. Other U.S. states have reported cases of H1N1 Flu (swine flu) infection in humans, and cases have been reported internationally as well. For the most updated case count of laboratory confirmed swine flu infections in the United States, visit the CDC website, http://www.cdc.gov/swineflu/.

Is there H1N1 Flu (swine flu) in Hawai‘i?

No H1N1 Flu (swine flu) cases have been reported yet in Hawai‘i. The Hawai‘i Department of Health is working hard to keep this H1N1 Flu (swine flu) from spreading in Hawai‘i by screening passengers arriving at airports, investigating and testing people with illnesses and recent travel to affected areas, giving the latest information to doctors, making sure an extra supply of flu-specific medicines for our state, and by helping people learn what they can do to stay healthy.

Is this H1N1 Flu (swine flu) virus contagious?

Yes, this H1N1 Flu (swine flu) virus seems able to spread from person-to-person, like regular human influenza viruses. However, you can protect yourself from getting sick by avoiding contact with sick people and washing your hands often.

What are the signs and symptoms of H1N1 Flu (swine flu) in people?

The symptoms of this H1N1 Flu (swine flu) in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and tiredness. Some people with this new infection have also had diarrhea and vomiting. As with the seasonal flu that occurs every year, severe illnesses and even deaths can occur, especially in persons with some medical condition and in the young or old.

How does H1N1 Flu (swine flu) spread?

This H1N1 Flu (swine flu) virus appears to be spread the same way as our regular seasonal flu viruses. Flu viruses are spread from person-to-person through coughing or sneezing or by touching infected droplets. People may also become infected by touching something with flu viruses on it and then touching their mouth, nose, or eyes.

How long is a person with H1N1 Flu (swine flu) contagious?

An adult with H1N1 Flu (swine flu) may be contagious to others from a day before they get sick until 7 days after becoming sick. Children may be contagious for 10 days after getting sick with H1N1 Flu (swine flu).

Are there medicines to treat H1N1 Flu (swine flu)?

Medicines such as acetaminophen (e.g. Tylenol) and ibuprofen (e.g. Motrin, Advil) can help make people with flu feel better. If you have a medical condition such as liver, stomach, or kidney problems or take certain medicines (such as blood thinners like coumadin) you should talk with your doctor before using these medicines. Antiviral medications are available to treat H1N1 Flu (swine flu), but most illnesses seen in the United States have so far been mild and not everyone may need to be treated with these antiviral medicines. It will be important to use these medicines to treat hospitalized patients and patients who may be at risk for more severe illness because of their age or health conditions. Your doctor will be able to help decide if you should take these medicines.

Is there a vaccine against H1N1 Flu (swine flu)?

Scientists are working on making a vaccine for this H1N1 Flu (swine flu), but it may not be ready for several months. In the meantime you can protect yourself by avoiding contact with sick people and washing your hands frequently.

What can I do to protect myself from getting sick?

Protect yourself and others from diseases like flu by taking these simple steps:

• Cover your nose and mouth with a tissue when you cough or sneeze.   Throw the tissue in the trash after you use it.
• If you don’t have a tissue, cough or sneeze into your sleeve or the inside   of your upper arm or elbow, away from your hands.
• Wash your hands often with soap and water, especially after you cough or   sneeze. Alcohol-based hand cleaners are also effective. Avoid touching   your eyes, nose, or mouth.
• Try to avoid close contact with sick people.
• If you get sick, stay home from work or school and limit contact with others   to keep from infecting them.
• Get plenty of sleep, exercise, and eat healthy foods.

Is it safe for children to attend school?

Right now children should attend school if they are healthy. Children who are sick with a fever and cough or sore throat should stay home from school until they have recovered. If cases of this H1N1 Flu (swine flu) are seen in Hawai‘i, the Department of Education may decide, based on the Department of Health recommendations, to close schools for a time until no more cases are seen.

It is safe for adults to go to work?

Right now you should not be at risk for H1N1 Flu (swine flu) at work. If cases of H1N1 Flu (swine flu) are seen in Hawai‘i, your employer may have plans for you to change your work schedule. If you become sick, especially with a fever with cough or sore throat, you should stay home from work until you have recovered. If your doctor suspects that you may havH1N1 Flu (swine flu) you will be asked to stay home for at least 7 days.

What should I do if I get sick?

If you become ill with flu-like symptoms, such as fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you should contact your doctor. Your doctor will help decide if you need flu testing or treatment. Call your doctor’s office before you arrive, and let them know you are worried about having flu and why. They may give you a mask to wear and have you avoid the waiting room. If you are sick, you should stay home and avoid contact with other people as much as possible to keep from spreading your illness to others. You should seek immediate medical care or call 911 if you have any of the following:

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting

What should I do to prepare for an outbreak of H1N1 Flu (swine flu) in Hawai‘i?

If there is a reported case of this H1N1 Flu (swine flu) in Hawai‘i, efforts will be made to contain the spread of this infection. Such efforts may include closing schools and encouraging people to stay at home. Each home should be prepared with an emergency preparedness kit that contains at least 3 days supply of water, food, a can opener, clothes, flashlight, hygiene items, first aid basics, and a radio. You should make sure that all members of your family keep at least a 2 week supply of any necessary medicines in the house. You should make plans for childcare at home if schools are closed.

Can I get swine influenza, including this new H1N1 Flu (swine flu), from eating or preparing pork?

No. Swine influenza viruses, including this new H1N1 Flu (swine flu), are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe.

MEDIA RELEASE 

The state Department of Health has recommended consumers not eat raw alfalfa sprouts, including sprout blends containing alfalfa sprouts, until further notice because the product has been linked to Salmonella serotype Saintpaul contamination. 

Other types of sprouts have not been implicated at this time. This follows the recommendation issued by the U.S Food and Drug Administration and the Centers for Disease Control and Prevention.  

Although there have been no confirmed salmonella cases attributable to alfalfa sprouts in Hawaii, the DOH Food and Drug Branch will be pulling samples from local alfalfa sprout growers for testing. There are local sprout growers on every island in Hawaii. 

“While there are no salmonella cases in our state stemming from alfalfa sprouts, we are taking a proactive and precautionary approach and will be sampling product from local growers even  though they do already disinfect seeds prior to growing,” said Lynn Nakasone, program manager for the DOH Environmental Health Administration. 

The DOH recommends people at high risk for complications, such as the elderly, young children, and those with compromised immune systems, not eat raw sprouts because of the risk of contamination with Salmonella or other bacteria.  

Salmonella is an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. 

Healthy individuals infected with Salmonella often experience fever, diarrhea, nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses, such as meningitis and bone infections. 

The FDA Web site contains detailed information on reducing microbial safety hazards for sprouted seeds.

— Find out more:

Food and Drug Administration: www.cfsan.fda.gov/~dms/sprougd1.html  

Big Island Sanitation Office: 933-0917

MEDIA RELEASE

HONOLULU – The Hawai‛i State of Hawaii Department of Health (DOH) is warning all restaurants and food establishment owners to beware of a letter alerting them of a requirement to purchase and post hand washing signs. The scam involves an official looking citation with a State of Hawai‛i Logo that claims that a new law was passed mandating the display of hand washing posters, and threatening fines if not in compliance. This scam may be an attempt to gain credit card and other personal information.

The DOH has passed no such requirement for mandatory hand wash signage, and owners or managers of food establishments should disregard the notice. Numerous posters are available free online by searching under the key word “hand wash posters”. The DOH also has hand wash posters that are available for free upon request for food establishments and the public.

The Department does require that all food establishment owners and managers have their employees wash their hands frequently, especially prior to beginning work, before handling food, after using the restroom, and anytime they contaminate their hands. Food establishments in Hawai‛i are required to have readily accessible sinks restricted for hand washing only, and must always have an adequate supply of soap and single use towels available for employee use.

For more information, food establishments can contact the Department of Health at the following numbers: Hilo (808) 933-0917; Kona (808) 322-1507; Kaua‘i (808) 241-3323; Maui and Lana‘i (808) 984-8230; Moloka‘i (808) 553-3208; and O‘ahu (808) 586-8000.

MEDIA RELEASE

The state Department of Health is advising the public not to eat peanut products or feed them to their pets if they are unsure whether the product has been recalled by the U.S. Food and Drug Administration.

A total of five cases linked with the nationwide outbreak of salmonellosis have been identified in Hawaii. Although none of the known Hawaii cases of Salmonella Typhimurium has had a verifiable exposure to any of the peanut products identified on the U.S. Food and Drug Administration’s recall list, the DOH is advising consumers to take precautions.

“If you have a peanut product on the recall list we recommend the product be discarded,” said Lynn Nakasone, chief of the DOH Food and Drug Branch. “We also advise that you refrain from eating other peanut products such as cookies, crackers, cereal, candy and ice cream until you are sure those products are not part of this nationwide recall. DOH is concerned that consumers are not aware how broad the recall of peanut products has become and urges everyone to check the product recall list thoroughly and often.”

A list of recalled peanut products can be found on the DOH Web site at www.hawaii.gov/health by clicking on the FDA search tool on the right side of the page. Or, visit the FDA Web site at www.fda.gov or the Centers for Disease Control Web site at www.cdc.gov for more information.

Consumers also may call FDA’s information line at 1-888-SAFEFOOD (1-888-7233-3663) or CDC’s consumer information hotline staffed 24 hours a day, seven days a week at 1-800-CDC-INFO (1-800-232-4636).

An outbreak of more than 600 illnesses of salmonellosis nationwide has led to a recall of many peanut-containing products. To date, more than 2,100 products in 17 categories have been voluntarily recalled by more than 200 companies, and the list continues to grow. Health inspectors are visually checking store shelves to ensure recalled products are removed from sale.

Salmonellosis is the illness caused by various strains of Salmonella bacteria. Persons infected with Salmonella may develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts 4 to 7 days and most persons recover without treatment. However, the diarrhea may be so severe that the patient needs to be hospitalized. The elderly, infants, and those with impaired immune systems are more likely to have a severe illness. People who think they may have become ill from eating peanut products are advised to contact their physician.

Karin Stanton/Hawaii247.org
 
The state Department of Health now is advising Big Island residents to wash produce thoroughly to help prevent exposure to pesticides, bacteria, and parasites such as angiostrongylus, or rat lung worm, which has sickened at least six people.  

The DOH reports it has identified one-half dozen probable cases of illness caused by angiostongylus in 2008, including two that have resulted in comas. The cases are centered in and around the Puna district and have been traced to eating fresh raw vegetables from backyard gardens.

A USDA report in 2007 found the culprit – a semi-slug known as Parmarion martensi - across the eastern part of the Big Island and Kailua-Kona. More than 3/4 were infected with the rat lung worm parasite.

The Angiostrongylus cantonensis parasite can cause a rare form of meningitis called eosinophilic meningitis or angiostrongyliasis. The condition is also referred to as “rat lung worm” because rats are part of the life cycle of the parasite.  

The parasite is found in snails, slugs, and freshwater prawns, crabs fish, and possibly the flatworm in Hawaii. Eating uncooked snails, slugs, freshwater prawns and fish can cause the rare infection, which can lead to serious illness.  

“It’s important to always wash raw vegetables and fruits thoroughly before eating them to remove insects, parasites, bacteria and other possibly harmful contaminants,” said Dr. Sarah Park, DOH State Epidemiologist and Chief of the Disease Outbreak Control Division. 

Signs of rat lung worm disease, which can affect the brain and spinal cord as the larvae travel through those tissues, can include severe headaches, nausea, vomiting, neck stiffness, and back, tingling skin, and hallucinations. Some infected people don’t have exhibit symptoms, or experience mild symptoms for a short time. 

Most patients recover without treatment, however anyone who believes they may be suffering from angiostrongyliasis is urged to seek medical attention.

To prevent infection:

* Do not eat raw or undercooked snails or slugs. Handle snails or slugs while wearing gloves and wash hands thoroughly.

* Do not eat raw foods contaminated with snails or slugs. Boil snails, prawns, fish, and crabs for at least 3-5 minutes.

* Keep home gardens free of rodents, snails and slugs.

* Wash produce thoroughly. 

A 2007 study published in the journal Pacific Science reported “a new species of semi-slug was discovered on the island of Hawaii in 2004. The species has been tentatively identified as Parmarion martensi. This species is very common in some areas of eastern Hawaii island, and it may be out-competing the Cuban slug, Veronicella cubensis, which is usually the most common large slug species on the island at lower elevations. A survey in the summer of 2005 showed that semi-slugs are present primarily at lower elevations in the Puna area of Hawaii island. We found an isolated population in Kailua-Kona.”

The same type of semi-slug was first discovered on Oahu in 1996.

The study’s authors, including Hilo-based research biologist Robert G. Hollingsworth, found 77.5 percent of semi-slugs collected at survey sites were infected with A. cantonensis, compared to 24.3 percent for Cuban slugs sampled from the same areas.  

The probability that semi-slugs will transmit rat lung worm disease to humans may be higher than for other slug and snail species because a high percentage of semi-slugs are infected, and the habits of semi-slugs increase the chance of contact with humans, the researchers concluded.

— Find out more:
Marlena Dixon, communicable disease specialist, DOH East Hawaii District Health Office: 933-0912 
DOH West Hawaii District Health Office: 322-4877
Dr. Jacqueline Hahn (ND), Hilo Naturopathic Clinic: 969-7848 
Centers for Disease Control and Prevention: www.dpd.cdc.gov/DPDx/HTML/Angiostrongyliasis.htm
USDA Agricultural Research Service: http://www.ars.usda.gov/research/publications/publications.htm?seq_no_115=200247