The state Department of Health confirmed four more cases of mumps in the islands today, bringing the year’s total to 20, as well as one additional case of rat lungworm, which brings that disease total to 14 cases.

Janice Okubo, DOH spokeswoman, said that while two of the new mumps cases are related to two previously announced clusters, the other two are not related to previously announced cases.

The new tally is the highest number of mumps cases recorded in at least a decade.

As for rat lungworm, the new case is one of the adults who drank kava and was previously reported as a highly probable case on April 19. Lab test results for this case came in positive this week to confirm the illness, Okubo said.

Rat lungworm disease, so far linked to the Big Island and Maui, is caused by a parasite found in rodents, which can pass the parasite to snails, slugs, crabs and other creatures. It can cause damage to the brain and spinal cord and bring nausea, severe pain and temporary paralysis.