Researchers report that 28 cases of ciguatera fish poisoning occurred in New York City during 2010-2011, a greater number than were reported during the preceding 10-year period.
Addressing this type of food poisoning can be difficult, as it does not occur as a result of poor food preparation, hygiene, or procurement, explain the investigators in a paper published in the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report.
John Hustedt (CDC, Atlanta, Georgia, USA) and colleagues comment: "Until the time when premarket testing of fish becomes practical, additional outreach and education to industry and health-care providers is warranted.
"New York City's experience from these outbreaks highlights the importance of industry adherence to approved hazard analysis and critical control points plans to reduce the risk for ciguatoxic fish entering the market."
Ciguatoxins are naturally occurring and can accumulate in any commonly consumed coral reef fish, including barracuda, grouper, snapper, surgeonfish, or wrasse. Fish become contaminated by the toxins through primary or secondary consumption of dinoflagellates - for example, Gambierdiscus toxicus - that live on tropical or subtropical reefs.
During August and September 2010, two outbreaks and a single case of ciguatera fish poisoning were reported in New York City, affecting 13 people in total. A health alert released by the New York City Department of Health and Mental Hygiene in November 2010 resulted in 11 more cases being reported that month and a further four in July 2011.
Of those who were affected, 13 people had eaten barracuda and 15 grouper. The most common symptoms exhibited were cramps, diarrhea, and nausea in 71%, 71%, and 61%, respectively. Numbness, tingling, or itching were experienced by 57%, and 21% had cardiac symptoms such as heart palpitation, bradycardia, and hypotension. Four of the 28 people affected were hospitalized.
Hustedt and co-authors emphasize the importance of educating the general public and seafood suppliers and distributers about areas that are endemic for ciguatera fish poisoning and high-risk fish species, as "although specific and highly sensitive laboratory analyses can detect and confirm ciguatoxin in fish, no practical field tests are available for fish monitoring programs."
They conclude: "This study also illustrates the importance of accurate diagnosis and consistent reporting to public health agencies to ensure the prevention of additional cases through traceback investigations, product embargoes, and regulatory enforcement."
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