The Hawai‘i Department of Health (DOH) has confirmed a case of neuroangiostrongyliasis, also known as rat lungworm disease, in an adult on Kaua‘i. According to the department, the disease is considered endemic on all islands in Hawai‘i. The individual affected had not traveled to other islands, or outside the state or country.
Symptoms reported by the individual included headaches, nausea, vomiting, neck stiffness, and sensitivity to bright light. The diagnosis was confirmed using a new, more sensitive test at the DOH State Laboratories Division. The investigation did not determine the specific source of infection.
Over the past decade, from January 1, 2014 to the present, 102 cases of rat lungworm disease have been reported across Hawai‘i. Of these, 78 occurred in Hawai‘i County, 13 in Maui County, seven in Honolulu County, and four in Kaua‘i County (including the current case). Residents of Hawai‘i made up 84% of these cases, while visitors accounted for the remaining 16%. Seventy-three percent of laboratory-confirmed cases required hospitalization. The previous case on Kauaʻi was reported in 2019.
“Thoroughly inspecting and washing all fresh fruits and vegetables under clean, running water is the most effective way to reduce the risk of rat lungworm disease,” said Dr. Sarah Kemble, state epidemiologist. “Small slugs and snails on produce can be difficult to see. Cooking food thoroughly also kills the parasite that causes rat lungworm disease.”
The DOH recommends washing all fruits and vegetables under clean running water to remove small slugs or snails—especially leafy greens—regardless of where the produce is purchased or grown. It also advises controlling snail, slug, and rat populations around homes and gardens by clearing debris and using traps or baits. For those with water catchment systems, regular maintenance and filter replacement are encouraged to prevent contamination.
Early diagnosis can help guide treatment to reduce long-term effects from the disease. The department urges individuals experiencing symptoms to seek medical attention promptly to rule out other serious illnesses.
Further information about rat lungworm disease and prevention methods can be found at the Hawai‘i Department of Health website: https://health.hawaii.gov/docd/disease_listing/rat-lungworm-neuroangiostrongyliasis/
Rat lungworm disease is caused by a parasitic roundworm that can affect the brain and spinal cord. In Hawai‘i, most people contract the disease by accidentally eating snails or slugs carrying Angiostrongylus cantonensis. Symptoms vary but often include severe headaches and neck stiffness; some cases can lead to neurological problems or long-term disability.
