Rat Lungworm Disease Task Force Issues New Guidelines

The rat lungworm parasite under a microscope. Photo courtesy of Dr. Susan Jarvi.

Gov. David Ige’s Joint Task Force on Rat Lungworm Disease is announcing new preliminary guidelines for the clinical management of angiostrongyliasis, more commonly known as rat lungworm disease. The new guidelines may be used by Hawai‘i physicians immediately and provide clear diagnosis, treatment and management guidance for timely identification and care for patients who have contracted the disease.

“One of the top priorities of the Joint Task Force has been to develop sound, evidence-based guidelines for physicians to use in diagnosing and treating angiostrongyliasis,” said Kenton Kramer, Ph.D., chair of the Joint Task Force and associate professor of the Department of Tropical Medicine, Medical Microbiology and Pharmacology with the University of Hawai‘i John A. Burns School of Medicine (UH-JABSOM). “The Clinical Subcommittee, made up of expert physicians and specialists from across the state, spent the last year researching and consulting with national and international specialists on the disease to carefully craft the new guidelines.”

Vernon Ansdell, M.D., an associate professor at UH-JABSOM and physician with more than 45 years of experience specializing in internal and tropical medicine, spearheaded the effort and chaired the Clinical Subcommittee.

“Prior to the extensive work completed by the subcommittee, there were no clear, reliable diagnosis and treatment protocols available to Hawai‘i physicians for this potentially serious and debilitating disease,” said Dr. Ansdell. “Diagnosing angiostrongyliasis can be problematic because patients infected with the parasite do not always present the same symptoms. These preliminary guidelines provide critical guidance to physicians to help them make timely and accurate diagnoses and give their patients the best possible treatment available. Our next step is to offer physician training in all counties to increase awareness and understanding of this complex disease.”

Members of the Clinical Subcommittee will be offering Continuing Medical Education (CME) courses through UH-JABSOM in all counties, starting in Hilo on Hawai‘i Island on Oct. 10. CME courses will also be offered on Maui, Kaua‘i, and in Honolulu in early 2019 with the schedule and more details to be announced later this year. For information on the CME courses, go to http://manoa.hawaii.edu/tropicalmedicine/?page_id=3783.

“Updating and improving the guidelines for physicians to better diagnose and treat rat lungworm disease is a major accomplishment for the Joint Task Force,” said Health Director Dr. Bruce Anderson. “We are excited to be a partner in this process and look forward to supporting this project as the guidelines move toward publication and national recognition.”

The preliminary guidelines will be presented to a national audience during the Annual Meeting of the American Society of Tropical Medicine and Hygiene in November. Clinical Subcommittee members will also be working to undergo the rigorous academic process to expand the preliminary guidelines and submit for scientific peer review and official publication.

The Joint Task Force was established in May 2016 and consists of members from the medical, scientific, environmental, and public health communities including the following organizations: UH-JABSOM, Pacific Biosciences Research Center; The Daniel K. Inouye College of Pharmacy at UH Hilo; Hawai‘i Department of Agriculture; USDA Agricultural Research Service; Kaiser Permanente Hawai‘i; Hilo Medical Center; Kapi‘olani Medical Center for Women and Children; Hawai‘i County; and DOH’s Disease Outbreak Control Division, State Laboratories Division, District Health Offices of Hawai‘i Island, Maui, and Kaua‘i, Vector Control Branch, and Safe Drinking Water Branch.

The preliminary guidelines are posted on the Hawai‘i Department of Health website at http://health.hawaii.gov/docd/for-healthcare-providers/news-updates/ and http://health.hawaii.gov/docd/disease_listing/rat-lungworm-angiostrongyliasis/#info_for_clinicians. It is also posted on the UH-JABSOM website.