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The Newest Threat to Sports Events in Hawaii: Rat Lungworm Disease

3 May, 2017

By: Mary Helen Sprecher

Zika. Ebola. They’re words that raise enormous red flags for sports event planners. But brace yourself for the newest plague – and this one has a name that results in instant heebie-jebbies without even having to look up the symptoms: Rat lungworm disease.

And yes, it's OK to take a moment to shudder before reading on.

Rat lungworm disease, an infectious parasite that can cause a form of meningitis, is on the increase in Hawai’i, and as might be expected, has elicited a firestorm of media attention.

However, according to an article in Travel Weekly, the number of cases is still relatively low and the disease has only been contracted on two of the Hawai’ian islands this year. A little more good news: there are plenty of precautions individuals can take to prevent infection.

The article notes,

The disease, which has the formal name of 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 Hawai’i Island occurred when a group of people 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 are 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, making 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.

While Hawai’i has long been a popular destination for tourism, it has made serious inroads into the sports tourism market, with events like IRONMAN triathlon and the Sony Open golf tournament . Another area of sports growth in Hawai’i is XTERRA, the off-road sports syndicate, with mountain biking, trail running and triathlon events. The XTERRA World Championship, in fact, were held on Maui in October.

Still, the islands have suffered a bit, both from losing the Pro Bowl and in December 2016, from the late cancellation of a USWNT soccer victory tour match because of unsuitable field conditions.

In September 2016, Hawai’i announced a sports tourism marketing deal with the Ascendent Sports Group, with the intention of publicizing the islands as a desirable destination.

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 non-resident in both 2015 and 2016, and has recorded two nonresident cases this year.

The Travel Weekly article also notes, "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."

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