The Emergence and Epidemiology of Haff Disease in China

Abstract

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.

Clinical characteristics of patients with Haff disease after eating crayfish

“…Haff disease was firstly reported in Beijing in 2000, and there has since been an obvious increase in the number of reports from other cities. [1] The epidemiological characteristics of the patients with Haff disease in our reports include the following: i) common onset in summer (July to September); ii) a previous history of eating crayfish before the onset of disease; iii) myalgia accompanied by fatigue, dizziness and palpitation; and iv) laboratory findings of an elevation of CK and myohemoglobin. These characteristics are similar to previous reports.…”

“…Examples of these include buffalo fish, crayfish and carp fish. [1] Haff disease is named after the Königsberg Haff (or lagoon) that borders the Baltic coasts of Russia and Poland. This lagoon is the site at which the disease was fi rstly reported in 1924.…”

“…Serious complications included renal failure, multi-organ failure and death, though these are rare. [1] Nonetheless, all suspected cases of Haff disease are requested to report to public health authorities. [1] Haff disease targets and damages striated muscle and causes rhabdomyolysis with through the release of myoglobin, creatinine kinase (CK) and other muscle cell enzymes.…”

“…[1] Nonetheless, all suspected cases of Haff disease are requested to report to public health authorities. [1] Haff disease targets and damages striated muscle and causes rhabdomyolysis with through the release of myoglobin, creatinine kinase (CK) and other muscle cell enzymes. [7] The U.S. Centers for Disease Control and Prevention (CDC) defines Haff disease as a painful myotoxic condition that meets the following criteria: i) a positive cooked seafood ingestion history within 24 hours; ii) a markedly elevated (specifically a 5-fold or greater rise over normal) serum CK level; and iii) a CKmuscle/brain (MB) fraction <5%.…”

A cluster of patients with rhabdomyolysis after eating crayfish

“…In fact, crayfish accounts for most cases in China. 5 As crayfish have become a popular seafood dish, leading to their increased consumption, Haff disease may be considered an emerging crustacean-borne illness. 6 Haff disease is a clinical syndrome characterized by myalgia and rhabdomyolysis that develops within 24 hours of the ingestion of cooked seafood.…”