The Hawaii Department of Health (DOH) has been conducting detailed investigations of two additional cases of angiostrongyliasis, or rat lungworm disease, contracted in the state. The two cases are unrelated and were confirmed by laboratory tests conducted by the DOH State Laboratories Division in March. This brings the statewide total of confirmed cases of the disease to three individuals to date in 2018.


The second case of rat lungworm disease confirmed this year was an adult resident of Maui who became ill in mid-February and was briefly hospitalized. The DOH investigation determined the individual was most likely infected in Maui but had a history of travel to Oahu and Hawaii Island during the time when the infection may have occurred.

The third case of rat lungworm disease in 2018 was a visiting adolescent, who traveled with their family to Hawaii Island in January. A resident of New York state, the individual was hospitalized after returning home in late January. Laboratory testing confirmed angiostrongyliasis infection in mid-March. DOH and its local partners have been in close communication with the clinicians providing treatment to the individual as well as public health colleagues in New York. After careful investigation, no clear risk factor causing the visitor’s infection could be determined.

“These recent cases are a reminder that the risk of rat lungworm disease exists statewide and we all need to take precautions to prevent infection,” said Dr. Sarah Park, DOH’s state epidemiologist. “We can all do our part to eliminate risks around our homes, gardens, and farms by controlling rats, slugs and snails, especially during the rainy season. Inspecting and thoroughly washing produce under clean, running water can go a long way in preventing rat lungworm disease.”

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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 Hawaii, most people become ill by accidentally ingesting a snail or slug infected with the parasite Angiostrongylus cantonensis (A. cantonensis). Symptoms vary widely between cases, but 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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In 2017, there was a total of 18 laboratory-confirmed cases of angiostrongyliasis in the state. The first case confirmed in 2018 was an adult West Hawaii resident.