DOH Confirms Ninth Case of Rat Lungworm

January 30, 2020, 4:51 PM HST (Updated January 30, 2020, 4:51 PM)
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Rat lungworm disease is carried by slugs and snails. Hawai‘i Department of Health photo.

A ninth case of rat lungworm disease during the 2019 calendar year has been confirmed, according to state officials.

The Hawai‘i Department of Health (DOH) verified the presence of angiostrongyliasis, or rat lungworm disease, in an adult on the island of Kaua‘i. The nine confirmed cases include eight individuals who likely contracted it on Hawai‘i Island, DOH said in a press release.

The ninth individual was an adult resident of Kaua‘i who had travelled to Hawai‘i Island in mid-December and became ill later that month. The individual experienced symptoms of headaches, nausea, vomiting, neck stiffness and joint pain. The person then sought medical care. The investigation was not able to identify an exact source of infection.

A woman and her family were recently exposed to rat lungworm disease through a slug that made its way into an avocado sandwich served by Island Naturals health food store in Hilo. To this point, none of those exposed have tested positive for the disease.

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“Thoroughly inspecting and rinsing all fresh fruits and vegetables under clean, running water can go a long way in making our food safer to eat, and it is the most effective way to remove pests and other contaminants,” said Dr. Sarah Park, state epidemiologist. “When in doubt, cooking food by boiling for three to five minutes or heating to an internal temperature of 165°F for at least 15 seconds can kill the parasite that causes rat lungworm disease.”

DOH provides the following recommendations to prevent rat lungworm disease:

  • Wash all fruits and vegetables under clean, running water to remove any tiny slugs or snails. Pay close attention to leafy greens.
  • Control snail, slug, and rat populations around homes, gardens and farms. Get rid of 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.

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

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.

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