The state Health Department has received confirmation from the U.S. Centers for Disease Control and Prevention of three unrelated cases of rat lungworm disease diagnosed in visitors to Hawaii island.

All three were adults from the U.S. mainland visiting Hawaii between now and last year when they were infected with the parasitic roundworm causing rat lungworm disease. The disease can have debilitating effects on an infected person’s brain and spinal cord.

One of the individuals visited East Hawaii in December 2018 and became infected after eating a slug on a dare. The other two individuals traveled to Hawaii island’s west side, and the exact source of their infections remains unknown, but one consumed homemade salads and the other ate unwashed fruits and vegetables.

In chronological order:

>> The first individual became ill after eating a slug in Hawaii in late December but was not hospitalized for his or her symptoms. That individual was the eighth person infected on Hawaii island to test positive for rat lungworm in 2018, bringing the statewide total to 10 confirmed cases last year.

>> The second individual became ill in early January of this year, and an investigation failed to find out how he or she was infected. However, the individual remembers having eaten many homemade salads while on vacation.

>> The third individual became ill in late February of this year and was hospitalized for a short time. The investigation was not able to identify an exact source of infection, but the individual likely became infected while “grazing,” or eating unwashed raw fruits, vegetables and other plants straight from the land.

This brings the statewide total of confirmed cases to five this year, all of which were contracted on Hawaii island.

“It’s important that we ensure our visitors know the precautions to take to prevent rat lungworm disease, which can have severe long-term effects,” said Health Director Bruce Anderson in a news release. “Getting information to visitors about the disease is just as critical as raising awareness amongst our residents.”

While the state Health Department provides information about rat lungworm on signs at local airports and shopping centers, Anderson acknowledged more needs to be done.

“We recognize that there is more work to be done in educating residents and visitors and making sure they know how to prevent the spread of this disease,” he said.

The state recommends the following to prevent rat lungworm disease:

>> Wash all fruits and vegetables under clean, running water to remove any tiny slugs or snails. Pay close attention to leafy greens.

>> Control snail, slug, and rat populations around homes, gardens and farms by clearing debris where they might live, and using traps and baits.

>> Always wear gloves for safety when working outdoors.

>> Inspect, wash and store produce in sealed containers, regardless of whether it came from a local retailer, farmer’s market, or backyard garden.

More information about the prevention of rat lungworm disease is available from the state Health Department and the state Agriculture Department.