The name makes your skin crawl, there is no cure or vaccine, and one honeymooning couple returned from their trip to Hawaii with matching cases. It is called rat lungworm disease, an infectious parasite that can cause a form of meningitis.
A spike in cases in Hawaii has drawn media attention, and the specter of coming home from vacation with a debilitating disease can certainly sour the anticipation of an upcoming trip. The number of cases is still relatively low, the disease has only been contracted on two of the Hawaiian islands this year, and there are precautions one can take to help prevent infection.
In 2016, there were 11 confirmed cases, all originating on Hawaii Island and just one was a visitor to the island. This year the state has already hit 11 confirmed cases of rat lungworm, six originating on Maui and five on Hawaii Island, according to the Hawaii Department of Health. Two of the cases were nonresidents. In addition to those confirmed numbers, there are four more people who are believed to have contracted the disease, and are related to the latest case on Hawaii Island, which are as of yet unconfirmed.
Rat lungworm disease, which has the formal name Angiostrongyliasis cantonensis, is a type of parasitic roundworm that as an adult is only found in rodents. The larvae, however, can be found in rodent feces which then infect snails, slugs and some other animals, such as freshwater shrimp, when ingested. Humans can then be infected if they consume a raw or undercooked infected host of the larvae, such as a snail hitching a ride on a piece of lettuce that was not thoroughly washed.
The most recent cluster of two known and four suspected cases on Hawaii Island occurred when a group drank homemade kava, only to find a slug sitting at the bottom of the bowl when they were mostly done, according to the state Department of Health.
The most common symptoms of rat lungworm include severe headache and neck stiffness, but the severity and symptoms in each case can vary widely. The most serious cases can result in neurological problems, pain and severe disability. There is no blood test, and the disease is hard to diagnose. There is no formal treatment, but patients are often prescribed pain killers. It usually resolves on its own, but can be fatal in some cases.
In one case receiving wide media attention, a couple from the Bay Area of California contracted the disease while honeymooning for two weeks in the Hana area of Maui. Both experienced severe pain, and they are still unsure of how they were infected.
Some researchers have criticized the state's response, and argue that more cases would be reported if people were more aware of the disease and its symptoms. Susan Jarvi, a professor of pharmaceutical sciences at the University of Hawaii at Hilo, told the San Francisco Chronicle that more needs to be done to inform the public and health care providers.
"It appears to me that they've been trying to sweep this under the rug for a number of years now," Jarvi said to the Chronicle. "I would guess they don't want to hurt the tourism industry."
Janice Okubo, spokeswoman for the Hawaii Department of Health, said the state has focused its resources on Hawaii Island, where most of the cases in recent years have occurred, and they have collaborated with the Centers for Disease Control and Prevention on a number of programs to address the issue.
"Rat lungworm disease has been a concern for the Hawaii Department of Health for some time and a great deal of work has gone into searching for answers to this rare and difficult-to-track disease, as well as educating the public on precautions," Okubo said in an email.
The Department of Health has held public meetings, distributed flyers, worked with the food industry, notified physicians, improved testing and reporting protocols, and distributed information at farmers markets, among other preventative measures, according to Okubo.
"There is no reason to feel differently about Hawaii or to fear getting this disease as long you follow the advice of the Department of Health and use good common sense when eating and storing food in the Hawaiian Islands," she said.
To help avoid the parasite, inspect and wash produce, particularly leafy greens, store food in covered containers, and supervise young children playing outdoors, the state Department of Health recommends. The state is also urging farmers and consumers alike to be extra vigilant in controlling snails, slugs and rats around their properties.
Hawaii sees few cases of the disease each year, ranging between one and 11 cases annually over the last decade. The state welcomes more than 8 million visitors each year, and reported one case of rat lungworm in a nonresident in both 2015 and 2016, and has recorded two nonresident cases this year.
Rat lungworm disease was originally identified in Taiwan in 1945, and the majority of cases have occurred in China, Thailand, other parts of Southeast Asia and the Caribbean. The disease is spreading, however, and has been found in Florida and Oklahoma in recent years, according to a study published in the Journal of Parasitology in 2015. Scientists believe humans have aided in the spread of the disease via rats, snails and other carriers unintentionally transported on ships, and through other human interventions.