Recent media reports quickly caught our attention, as they may have yours. They highlighted something that’s a genuine health concern in Hawaii—rat lungworm disease. However, these reports took a sensationalized approach, using dramatic headlines that could lead one to believe there is some unavoidable or widespread risk for Hawaii visitors. While the disease is rare and has the potential to be severe, its typically simple prevention is something that we have incorporated into our daily lives for years; the reality is far less alarming when placed in a good context.
Most cases of rat lungworm are preventable with basic food safety.
Travelers can continue to enjoy Hawaii’s beauty and cuisine without unnecessary concern by understanding how the disease spreads and then taking the simple steps that significantly reduce exposure. That’s what we and other Hawaii residents have done since this first came to our attention years ago. Taking these small steps ensures you can safely enjoy Hawaii’s diverse produce and culinary offerings without much concern.
Thoroughly inspect and wash produce thoroughly.
This simple step removes snails, slugs, and their slime from produce. It’s especially important for locally grown leafy greens like lettuce, basil, and kale, whether bought from farmers’ markets, roadside stands or stores. For residents, this becomes second nature—starting with checking for signs of slug or snail damage. Visitors should adopt the same habit for added safety.
Rat lungworm disease (angiostrongyliasis) is a parasitic infection.
The parasite’s life cycle begins in rats, with snails and slugs acting as intermediate hosts. Humans become infected when they accidentally consume raw or undercooked snails, slugs, or perhaps most importantly to visitors, products that have been contaminated with droppings and slime. The disease is neither transmitted between humans nor linked to ocean waters or casual exposure.
The symptoms of rat lungworm disease range from mild to severe.
Early signs often include nausea, headaches, stomach pain, and fatigue. However, neurological symptoms such as tingling sensations, burning pain, and neck stiffness can develop in rare and severe cases that may lead to meningitis. While there is no direct cure, doctors treat patients by managing symptoms with pain relievers and anti-inflammatory medications.
Notably, the disease is rare in Hawaii, with annual cases averaging up to a dozen across all islands. While the condition is monitored closely, officials emphasize that the risk remains low, especially for those who take proper precautions.
Why is Hawaii affected?
Hawaii’s lush, tropical environment creates ideal conditions for hosts like snails and slugs to thrive. This makes the islands well suited to outbreaks compared to more temperate regions. However, even in Hawaii, most cases can be traced back to specific exposures involving unwashed produce or raw food.
The Big Island has historically reported the highest number of cases, though instances have also been documented on other islands, including Maui, Kauai, and Oahu. Leafy greens, especially those from home gardens or farmers markets, are sometimes linked to transmission when thorough washing is overlooked. Despite this, people consume fresh produce in Hawaii every year without ever having an issue issue.
Hawaii’s Department of Health actively monitors rat lungworm disease and keeps the public informed. Thanks to ongoing education efforts and heightened awareness, especially among residents (and now hopefully visitors), cases have remained consistently low relative to the population.
Cutting through the media sensationalism.
Recent headlines have overstated rat lungworm disease. It is being overhyped as an urgent and widespread threat, which is not the case. This portrayal lacks the understanding of the actual risks. Some stories imply that anyone visiting Hawaii is automatically at risk; this is not true. The disease is not airborne and cannot be contracted from casual contact or activities like swimming, hiking, or enjoying outdoor spaces.
Another typical exaggeration is that all foods in Hawaii, especially local produce, are dangerous to eat. This claim is not supported by evidence. While unwashed greens can carry risks, most restaurants, grocery stores, and markets in Hawaii adhere to strict safety standards, making their produce safe for consumption. Visitors who practice basic food hygiene virtually eliminate their exposure to the parasite.
Reports also tend to highlight extreme cases, focusing almost entirely on severe symptoms and long-term complications. While these outcomes are possible, they represent a minority of cases. The majority of infections involve mild symptoms that resolve with appropriate medical attention.
What to do if you suspect exposure.
For those worried about potential exposure, staying calm and monitoring for symptoms is key. Contacting a medical professional early is vital if symptoms like persistent headaches, tingling sensations, or neck stiffness develop. Hawaii’s healthcare providers are experienced in identifying and treating rat lungworm disease, and they can offer tailored care to address individual cases.
Though cases are rare, local health systems are prepared to manage the disease effectively. Many cases involve mild symptoms and resolve easily without long-term issues when caught and treated early.
A look at historical perspectives.
Hawaii has dealt with rat lungworm disease for decades, yet the highest-reported cases remain in the single digits annually per island. Historical events, such as cluster cases, sparked essential changes in how the community approaches food safety. Increased public health campaigns and inspections of farm produce have become standard.
Farmers, retailers, and residents alike have embraced best practices like cleaning produce more thoroughly before it reaches consumers. These efforts ensure that most locally grown produce is entirely safe to enjoy.
Enjoying Hawaii without any unnecessary worry.
Hawaii offers an unmatched experience filled with vibrant farmers markets, unparalleled landscapes, and fresh, local food. With basic precautions, visitors can enjoy these highlights without worrying about rat lungworm disease.
Washing produce, keeping an eye out for snail damage, droppings and slime, avoiding raw, risky foods, and staying informed are all simple steps to minimize an already low risk further. By focusing on practical safety measures rather than sensationalized fears, travelers can confidently explore the islands.
Final thoughts.
Rat lungworm disease is a rare but real health issue in Hawaii that can be approached with confidence and good practices. While media reports like this may overstate the risks, the danger is small and preventable. Awareness, not fear, is the best way to address this concern.
We welcome your comments.
Beat of Hawaii © photo at KCC Farmers Market Honolulu.
Get Breaking Hawaii Travel News
I would typically wash my produce quite well and finish rinse with vinegar. What I’m worried about is restaurants and the possibility of employees not caring! How strict are restaurants with washing produce, especially greens with lots of crevices?
Definitely the truth. Hawaii has had historical problems with things that are green,leafy, and cause brain problems. Rats demand this and it’s in your wallet. Sorry just had to laugh.
It’s not all hype. Rat lungworm disease can be fatal. Because of this fact, I’ve totally eliminated lettuce from my salads & used mainland spinach instead, which I thoroughly wash: despite being “prewashed”, mainland spinach wash always leaves dirty water, and an occasional rare worm behind! If family insists upon lettuce on a burger, I’ll use only hydroponically-grown lettuce from a reputable source that uses a greenhouse. Otherwise, why risk this? Hawaii is totally infested with rats and slugs. From a local physician & 40+ year resident,
Totally Infested. Wow. From that I would have thought you were talking about a third world country or place. Thanks for the heads up. I know rats can carry tons of bad diseases too. Hantavirus, Plague, etc. With 40+ years on the islands it sounds like you are well educated and telling from experience. Aloha and thanks again.
About two years ago I had a salad at a local restaurant on the Big Island. Halfway through eating the salad I noticed a slug crawling amongst the lettuce. I informed the manager and she just blew it off telling me that the produce comes from a local organic farm so bugs and “things” can’t be avoided??? She didn’t charge me for the salad….. how nice.
Please Please lets clean the produce. What does that help. Why don’t Hawaii clean up the garbage, demand better cleaner hotels, and get rid of all the areas the rats harbor and make homes in. What guarantee does a visitor have in knowing some fast food worker or sit down restaurant employee washed your lettuce prior to it being served to you in a salad or burger? Answer is None. Somehow Hawaii just reacts to it’s problems and never acts or is proactive to it’s problems. I would solve the rat problem and do some extreme cleaning. Get rid of all the rats,mice and such even in the sewer system. All I have heard is Hawaii is getting dirtier and dirtier and now I know why. Nobody cares and to be clean costs more money.
No statistics?
Ivermectum kills parasites. Try get some
Ivermectin has not been proven clinically effective for the treatment of rat lungworm disease. The addition of albendazole, an anthelminthic drug, may provide additional benefits, although there is limited evidence of this in humans.
If albendazole is used, it should be combined with corticosteroids to blunt any possible increase in the inflammatory response to dying worms.
We washed everything growing up – rice, veggies, meat, seafood. fruit, stray puppies… Everything went into the giant Liberty House colander (which I still have)for a spritz. My Mom spared nothing. “You wash dose J”??? No Rat Lung Disease. Lord I miss that woman…
Best Regards
A far more dangerous parasite plagues the Hawaiian islands. The scientific name for this parasite is called, “Hawaii State Legislature.” This parasite transmits highly virulent infections via taxes, fees, and emergency proclamations.
We were just saying the politicians are the parasites🤣🤣
“Humans become infected when they accidentally consume raw or undercooked snails, slugs, or perhaps most importantly to visitors, products that have been contaminated with their slime.”
It is not known for certain whether the slime left by infected snails and slugs are able to cause infection.
Source: health.hawaii.gov/docd/disease_listing/rat-lungworm-angiostrongyliasis/
My husband and I have been coming to Hawaii for 20 years and this problem. I appreciate this information. I don’t think it is something I will lose sleep over.
We have lived in an area of the United States that has brown recluse spiders for 50 years now. Situation is similar.
You learn to take precautions and stay alert. Most of the time all is well. You usually hear about the extreme cases. Most spider interactions are far from life threatening. More of a nuisance. But we don’t let our guard down.
I’ve lived in Hawaii forever, and it’s crazy how often this issue gets overhyped in the media. As long as you follow a few simple steps, it’s not something to stress over. People should stop making it sound like everyone’s at risk.
I’ve generally cautious about produce, but I never realized how much of a difference simple washing makes.
I always wash my produce no matter where I travel, but I never thought about snails or slugs being a factor. Good to know, especially for farmers’ market finds.
It freaked me out when I read that news about this! Clearly this is a reminder why it’s so important to dig deeper. I’d forgotten all about this since it has not really been in the news for years.
Sure, there’s a risk, but it’s manageable with basic hygiene. Kind of like sunscreen—it’s about being prepared, not panicking. Love the level-headed approach here.
Thanks for the article. I wasn’t even aware of it, but good to know.
I have always washed produce before eating – for 50 years … not just in Hawaii. I even wash melons. It’s just a good habit.