OHE August 4, 1997

Gene Robinson (gene@lava.net) sends in the following:
I was going through a pile of old mail this weekend and found the May/June 1997 issue of the Communicable Disease Report put out by the Hawaii Department of Health. An article titled "1996 Leptospirosis Summary" caught my eye, and I thought I should summarize it for the OHE gang.

52 cases of leptospirosis were diagnosed in Hawaii in 1996, the largest number of cases since 1971, and double the number reported in 1995. 11 cases were from Oahu, the highest number ever reported for this island. Quoting the article: "Three cases on Oahu were exposed at Maunawili stream and falls. Earlier last year, the Sierra Club received permission from the land owner to make trail improvements, making the falls more accessible. Although cases had occasionally been previously reported from that site, the number of cases increased sharply in 1996." There is no information in the article on where the other eight cases were exposed on Oahu. Through May of this year, 14 leptospirosis cases have been reported for the state.

I noticed that the Sierra Club had a "family hike" up the Maunawili trail last weekend. I hope nobody went swimming. I've never been to Maunawili falls, but if I go, I don't think I'll jump in. The first case of leptospirosis I saw after practicing here for about a year was an older man in the ICU with liver and kidney failure. This is one extreme of the disease, but if you are exposed, it's not clear who will get simple flu-like symptoms and who will get much sicker.

So, be safe, and keep your mucous membranes and skin abrasions ouit of the mud and water, especially if you're going to Maunawili falls. If anybody would like a fax of the "1996 Leptospirosis Summary" or of a medical journal article on leptospirosis, send me your number.

Reply from Art Neilson (artn@aloha.net):

Thanks for the info, Gene!! Maybe it would be a good idea to keep a list of swimming holes known to have Leptospirosis and post the list on Dayles hiking page.

Reply from Pete Caldwell (pekelo@LAVA.NET):

Gene -

Altho it's true leptospirosis can spoil your day if you're really unlucky, I wouldn't say it has reached epidemic proportions unlike the headlines that we've been seeing. Kind of reminds me of the "flesh-eating bacteria " story or the giardia stuff which is way overblown especially in my familiar High Sierras. Common sense counts for a lot. When it comes to Hawaii and Oahu in particular, there are some definite problem areas like Nuuanu Stream etc. to avoid especially like da man says if your skin isn't quite intact. Knowing about a questionable exposure area in advance or just to be on the safe side, a little doxycycline in advance and afterwards is good for your piece of mind to be on the safe side.

Dr. Pete

Reply from Mae Moriwaki (mae@hawaii.edu):

Yep, the water at Kaau crater (organic tea) looks suspicious. My friends were hiking from Nature Center (Makiki) to Olympus. They missed the Olympus trail and ended up coming down Palolo. The water was long gone. One of them took a sip & ended up w/lepto. Good thing the doctor caught it--he thought he had the flu.

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