Ciguatera Fish Poisoning in the Pacific Islands (1998 to 2008)

Abstract

BackgroundCiguatera is a type of fish poisoning that occurs throughout the tropics, particularly in vulnerable island communities such as the developing Pacific Island Countries and Territories (PICTs). After consuming ciguatoxin-contaminated fish, people report a range of acute neurologic, gastrointestinal, and cardiac symptoms, with some experiencing chronic neurologic symptoms lasting weeks to months. Unfortunately, the true extent of illness and its impact on human communities and ecosystem health are still poorly understood.MethodsA questionnaire was emailed to the Health and Fisheries Authorities of the PICTs to quantify the extent of ciguatera. The data were analyzed using t-test, incidence rate ratios, ranked correlation, and regression analysis.ResultsThere were 39,677 reported cases from 17 PICTs, with a mean annual incidence of 194 cases per 100,000 people across the region from 1998–2008 compared to the reported annual incidence of 104/100,000 from 1973–1983. There has been a 60% increase in the annual incidence of ciguatera between the two time periods based on PICTs that reported for both time periods. Taking into account under-reporting, in the last 35 years an estimated 500,000 Pacific islanders might have suffered from ciguatera.ConclusionsThis level of incidence exceeds prior ciguatera estimates locally and globally, and raises the status of ciguatera to an acute and chronic illness with major public health significance. To address this significant public health problem, which is expected to increase in parallel with environmental change, well-funded multidisciplinary research teams are needed to translate research advances into practical management solutions.

Ciguatera Incidence in the US Virgin Islands Has Not Increased over a 30-Year Time Period Despite Rising Seawater Temperatures

“…7,[17][18][19] A threshold was also suggested by Llewellyn 6 based on data in the South Pacific. However, the threshold suggested in the past is approximately 30 C, which St. Thomas does not typically exceed; the average Table 4 Demographics of US Virgin Islands, 1980 and 2000 16,20 Our findings support the idea that other factors, including demographic and behavioral, are associated with changes in ciguatera incidence over time, with lower socioeconomic status (particularly education), fish consumption three times a week or more, being born in the Caribbean (outside the US Virgin Islands), and previous ciguatera episodes associated with illness. [21][22][23] Lower socioeconomic status presumably increases risk of ciguatera, because lower income individuals may have few affordable protein alternatives to locally caught fish.…”

“…The findings are consistent with a recent estimate of 11 per 1,000 for Culebra, Puerto Rico 15 and higher than an estimated average for the South Pacific of 2-10 per 1,000. 16 Given the potential for chronic, debilitating symptoms, there is a need to understand risk factors for ciguatera. Climate change (i.e., global warming) has been recently introduced as a potential contributor to increased disease rates in some areas.…”

Ciguatoxic Potential of Brown-Marbled Grouper in Relation to Fish Size and Geographical Origin

“…[4][5][6][7][8] In other coastal countries of East Asia and Southeast Asia, only isolated cases or small case series are identified. 9 CTX in the Pacific (P-CTX) is the most potent.…”

Characteristic Features and Contributory Factors in Fatal Ciguatera Fish Poisoning—Implications for Prevention and Public Education

“…1,2,11 Recent reports on ciguatera incidence per 100,000 population are summarized in Table 1. 8,[12][13][14][15][16][17][18][19][20] In the South Pacific and Caribbean Islands, ciguatera is endemic [14][15][16][17][18][19] and has become more common than decades ago. 16,19 The manifestations of ciguatera can be variable depending on the types and quantities of CTX present, individuals' susceptibility, and other factors.…”