Tourists visiting Hawaii are being urged to avoid raw food amid a rise in cases of rat lungworm disease, a parasitic infection that can cause severe neurological damage. The disease, also known as neuroangiostrongyliasis, is transmitted through raw snails, slugs, or contaminated produce such as kale and potatoes.
Symptoms mimic the flu, including headaches, nausea, coughing, and fevers, but can escalate to long-term neurological problems and disability. Kay Howe, whose son contracted the disease in 2008 and spent months in a coma, now advocates for awareness. “Don’t eat raw food in Hawaii,” she told SFGate. “This is a tropical place. There’s a parasite, and we advise to cook everything.”
Experts recommend tourists avoid roadside smoothie stops unless produce has been thoroughly washed and dried. Franny Brewer of the Big Island Invasive Species Committee warned: “If you haven’t been able to inspect the kale yourself, I wouldn’t recommend that you include that.”
Diagnosis is difficult, requiring a spinal tap, and many doctors are reluctant to test. Howe noted: “We often have to fight a doctor to get them to deliver the antiparasitic medicine. Once it’s in your brain, it’s in your brain.” Between 2014 and 2023, there were 80 laboratory-confirmed cases in Hawaii, with most on Hawaii Island.
Dr. Sarah Kemble of the Hawaii State Department of Health advised: “Don’t eat raw snails, slugs, freshwater shrimp. Wash fresh fruits and vegetables carefully before consuming.” Howe added: “When you have seven serious cases a year among a small population, that’s not really rare anymore. You should be looking at severity.”
