Outbreak of Haff Disease caused by consumption of crayfish (Procambarus clarkii), Nanjing, Jiangsu Province, China

Chen, Yan; Bao, Yuan; Xie, Gary; Zhen, Shiqi; Zhou, Yijing; Shao, Bing; Zhang, Jing; Ji, Hua; Wu, Yongning

doi:10.1016/j.foodcont.2015.06.031

Cited by 13 publications

(19 citation statements)

References 12 publications

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“…As can be seen in Figure 1 and Table 1, both the geographical distribution and the number of reports of Haff disease had increased during 2009–2016 since the first outbreak in Beijing in 2000 [9]. Subsequent outbreaks mostly occurred in the Jiangsu Province [16,17,18,19,28], an eastern coastal province, and recurred in its capital, Nanjing [12,13,14,15,16,17,27,28]. Isolated cases and small outbreaks have occurred in other cities since 2010 [20,21,22,23,24,25,26].…”

Section: Discussionmentioning

confidence: 99%

“…Myalgia usually involved could be severe, moderate or mild, involving muscles of the back, shoulder, neck, chest, upper limbs, and lower limbs [27]. Initial presenting symptoms after eating crayfish were very similar between the cases in China and the U.S. [2].…”

Section: Discussionmentioning

confidence: 99%

“…Subsequent outbreaks mostly occurred in the Jiangsu Province—Nanjing in 2010 [12,13,14,15,27,28], 2012 [16], and 2014 [17], Yangzhou in 2012 [18], Huai’an in 2013 [17], and Yancheng in 2015 [19]. Isolated outbreaks occurred in other cities since 2010—Shijiazhuang, Hebei Province, in 2010 [20], Yueyang, Hunan Province, in 2010 [22], Shanghai in 2013 [23], Wuhu, Anhui Province, in 2014 [24], Shenzhen in 2016 [25], and Hong Kong (two imported cases from Shenzhen) in 2016 [26].…”

Section: Reports Of Haff Disease From Chinamentioning

confidence: 99%

“…Nine reports were from the national [27], provincial [11,16,19], or local [13,17,25,26] food safety [27] and health [11,13,16,17,19,25,26] authorities, including two with additional epidemiology data on the 2010 outbreaks in Nanjing [27,28]. Ten reports were from the local hospitals [9,12,13,14,15,20,21,22,23,24].…”

Section: Reports Of Haff Disease From Chinamentioning

confidence: 99%

“…The attack rates among the subjects at different risk levels [11,17,27,28] will be analyzed in detail (see Section 4). …”

Section: Reports Of Haff Disease From Chinamentioning

confidence: 99%

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The Emergence and Epidemiology of Haff Disease in China

Chan

2016

Toxins

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Haff disease is a rare syndrome of unexplained myalgia and rhabdomyolysis occurring within 24 h of consumption of certain types of cooked freshwater fish or crustacean. It is caused by a yet unidentified heat-stable toxin. In the present review of published case studies and official press releases, the main objective is to report the emergence and epidemiology of Haff disease in China. Haff disease first occurred in Beijing in 2000 and in Lianzhou and Liannan, Guangdong Province in 2009. Subsequent outbreaks mostly occurred in the Jiangsu Province—Nanjing, Yangzhou, Huai’an, and Yancheng. Isolated outbreaks occurred in other cities since 2010—Shijiazhuang, Yueyang, Shanghai, Wuhu, Baoding, Shenzhen, and Hong Kong (imported cases from Shenzhen). Outbreaks occurred predominately in the summer. Crayfish accounted for almost all the outbreaks. Two large outbreaks occurred in Lianzhou and Liannan in 2009 (n = 54) after eating pomfrets and in Nanjing in 2010 (n = 42) after eating crayfish. Other reports or outbreaks involved only 1–9 subjects (median 2 subjects). Variability in individual susceptibility and attack rates were noted, with many subjects remaining asymptomatic despite sharing the same seafood meal as the index cases. Adults were predominately involved. Symptoms occurred within 3–20 h of seafood ingestion, including myalgia, weakness, and, less frequently, nausea, vomiting, abdominal pain, and diarrhea. Myalgia and muscle weakness should normally subside within 2–3 days. Serum creatine phosphokinase became normal within 5–6 days. Abnormal renal function was uncommon. Serious complications (renal failure, multi-organ failure, and prolonged myopathy) and death were rare. In any subjects with unexplained myalgia and rhabdomyolysis, seafood consumption should be included in the history. All suspected cases of Haff disease, including milder presentations, should be reported to public health authorities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Reports Of Haff Disease From Chinamentioning

confidence: 99%

Section: Reports Of Haff Disease From Chinamentioning

confidence: 99%

“…The attack rates among the subjects at different risk levels [11,17,27,28] will be analyzed in detail (see Section 4). …”

Section: Reports Of Haff Disease From Chinamentioning

confidence: 99%

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The Emergence and Epidemiology of Haff Disease in China

Chan

2016

Toxins

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Clinical features of Haff disease and myositis after the consumption of boiled brackish water crayfish: a retrospective study of 96 cases at a single centre

Huang

et al. 2018

Intern Emerg Med

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The present study describes the difference in clinical features between the patients with Haff disease and crayfish-related myositis (CRM) after crayfish consumption. This was a single-centre, retrospective analysis at the Emergency Department of the Drum Tower Hospital of Nanjing University School of Medicine from July to August of 2016. The baseline information came from the Electronic Medical Record System at the institution. Totally 96 patients were included, of whom 52 patients were confirmed to have Haff disease and 44 patients were CRM. The illness predominately occurs in summer and most of them (55/96) are female. The primary clinical features are myalgia, muscle allodynia and back and body pain. Statistical differences in the baseline CK, CK-MB, myoglobin, and the WBC count exist between the Haff disease and CRM groups (P < 0.05). The serum levels of CK and CK-MB increase in the second (a median time 29.2 ± 7.4 h) or third day (a median time 54.8 ± 9.3 h) of disease course, and then rapidly decreased to normal levels, while the levels of myoglobin peak at the admission (a median time 7.7 ± 6.4 h) and became normal after admission. There were no fatalities or complications during this study. All 96 patients recovered in a week. Of them, 75 were followed-up within 1 month and none had recurrence. The Haff disease and CRM after boiled crayfish consumption reflect a different severity of muscle injury, and reveal similar clinical characteristics and most of the laboratory values. The overall prognosis of both is good.

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Food safety monitoring and surveillance in China: Past, present and future

Chen

2018

Food Control

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Outbreak of Haff Disease caused by consumption of crayfish (Procambarus clarkii), Nanjing, Jiangsu Province, China

Cited by 13 publications

References 12 publications

The Emergence and Epidemiology of Haff Disease in China

The Emergence and Epidemiology of Haff Disease in China

Clinical features of Haff disease and myositis after the consumption of boiled brackish water crayfish: a retrospective study of 96 cases at a single centre

Food safety monitoring and surveillance in China: Past, present and future

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