Hawai‘i DOH Confirms 2019’s 3rd Rat Lungworm Case on Hawai‘i Island

The rat lungworm parasite under a microscope. PC: Dr. Susan Jarvi

The Hawai‘i Department of Health (DOH) has confirmed a case of rat lungworm disease (angiostrongyliasis) contracted on Hawai‘i Island, the DOH reported on April 25, 2019.

The individual is a resident of East Hawai‘i and is the third person from Hawai‘i County to test positive for angiostrongyliasis in 2019, bringing the statewide total to three laboratory-confirmed cases this year.

Health officials learned recently about the case, although the individual may have been infected as early as February. Laboratory testing though DOH’s State Laboratories Division confirmed the individual’s infection in mid-April. The individual was hospitalized, and the exact source of infection could not be identified.

“Diagnosis and treatment of this disease is incredibly difficult, especially since there is still much we don’t know about the parasite and the disease,” said Health Director Bruce Anderson. “The Governor’s Joint Task Force on Rat Lungworm Disease has done extensive work to develop preliminary clinical guidance for local physicians who may encounter patients with the disease and physician trainings will continue this year. That work, along with immediate reporting by physicians is critical to facilitate prompt, accurate diagnosis and appropriate patient management.”

Last year, the Governor’s Joint Task Force on Rat Lungworm Disease developed new preliminary guidelines and made them available to Hawai‘i physicians immediately, providing clear diagnosis, treatment, and management guidance for timely identification and care for patients who have contracted the disease. The guidelines are available at http://health.hawaii.gov/docd/disease_listing/rat-lungworm-angiostrongyliasis/#info_for_clinicians.

DOH provides the following recommendations to prevent rat lungworm disease:

• Control snail, slug, and rat populations around homes, gardens and farms. Get rid of these vectors safely by clearing debris where they might live, and also using traps and baits. Always wear gloves for safety when working outdoors.
• Inspect, wash and store produce in sealed containers, regardless of whether it came from a local retailer, farmer’s market, or backyard garden.
• Wash all fruits and vegetables under clean, running water to remove any tiny slugs or snails. Pay close attention to leafy greens.

For more information about rat lungworm disease and how to prevent its spread, visit:

DOH website
HDOA website
CTAHR website
CDC website

Angiostrongyliasis, commonly known as rat lungworm disease, is caused by a parasitic roundworm and can have debilitating effects on an infected person’s brain and spinal cord. In Hawai‘i, most people become ill by accidentally ingesting a snail or slug infected with the parasite Angiostrongylus cantonensis (A. cantonensis). Symptoms vary widely between cases, and the most common ones include severe headaches and neck stiffness. The most serious cases experience neurological problems, severe pain and long-term disability.