Medical experts and public health advocates are sounding the alarm about a frightening threat in Hawaii.
Caused by tiny roundworm parasites, neuroangiostrongyliasis—known more commonly as rat lungworm disease—is a serious condition that begins with nausea, abdominal pain, fever, and a cough. The disease can then progress to the brain and spinal cord, causing severe headaches, neurological issues, coma, brain damage, and, in some cases, death.
Rat lungworm disease is "endemic in all of the islands" in Hawaii, according to the state's Department of Health. The Big Island of Hawaii is the "epicenter of the disease for the entire country,” health advocate Kay Howe told SFGate.
Howe's son, then 23, contracted the illness while living in the Big Island's Puna District in 2008. He went into a coma and remains "permanently disabled, with his vision and short-term memory affected," SFGate reports.
Rat Lungworm Disease in Hawaii: How It's Transmitted and How to Prevent It
You can get rat lungworm disease by eating food—usually raw produce—contaminated by parasitic larvae carried by snails, slugs, or other infected creatures (or small parts of them) you might accidentally ingest. The larvae come to snails and slugs via the feces of infected rodents. The whole thing is unpleasant all around.
To prevent rat lungworm disease, Hawaii's Department of Health advises that you should not eat raw or undercooked snails, slugs, freshwater shrimp or prawns, land crabs, and frogs. Don't handle any of those critters with your bare hands, either.
The state's guidance also recommends washing produce thoroughly—including rinsing each leaf of leafy greens under running potable water.
Howe goes even further. "Don't eat raw food in Hawaii," she flatly told SFGate, advising visitors to opt only for cooked vegetables.
Another expert consulted by the outlet warns against roadside smoothies with greens and recommends asking Airbnb hosts how their water is filtered, as "slugs can get into water catchment tanks if they aren’t properly maintained."
As travel news site Beat of Hawaii points out, the parasite is not known to lurk in seafood from the ocean, such as sushi or the ahi in your poke bowl, or in tropical fruits like pineapple and papaya.
The danger is unwashed raw vegetables with leaves—spinach, lettuce, kale, green onions, and so on. Eat your greens cooked or only after you're sure they've been thoroughly rinsed and dried. Beware the farmers market.
Prevalence of Rat Lungworm Disease in Hawaii and How It's Treated
Fortunately, confirmed cases of rat lungworm disease in Hawaii remain rare, with only 80 reported instances across the islands from 2014 to 2023.
The disease may be underreported, however, due to the difficulty of diagnosis, which requires a spinal tap.
Some people with mild cases of the disease don't require treatment and the parasite dies on its own, according to the Centers for Disease Control and Prevention. Antiparasitic medications can be used to address more serious bouts, provided it's not too late.
The reason Hawaii's Big Island has become the "epicenter" for rat lungworm disease in the U.S.: the isle's snail-friendly conditions of a rainforest climate and lush vegetation, along with the presence of an invasive semi-slug that seems to cause more severe cases of the disease.
For more information about rat lungworm disease in Hawaii, go to the website of the state's Department of Health.