CDC Report on Foodborne Illness Associated with Fish

Each year people become ill from eating contaminated fish.  CDC issued a report on data from their surveillance system on the agents and the types of fish in the period 1998 to 2015.  Table 2 from that report (ref below) provides a nice summary of those findings that link agent and the source of fish:

Scombrotoxin is the leading agent of foodborne illness associated with fish and it is found in tuna and mahi-mahi.  Scombrotoxin is due to histamine formation as a byproduct of microbial activity as that fish meat spoils when it is temperature abused.   The symptoms are similar to what you would have during an allergic reaction.  This toxin is not destroyed by heating.

Ciquatoxin is found associated with tropical predator fish such as grouper and barracuda when those fish eat smaller fish that have eaten a particular types of dinoflagellate (type of plankton).  The toxin bioaccumulates in the predator fish.  There are gastrointestinal issues, but the biggest issue are the neurological affects  that include headaches, muscle aches, numbness, and cold allodynia -  a burning sensation on contact with cold.  These symptoms can persist for weeks to months.  The toxin is heat stable.

Foodborne Pathog Dis. 2017 Jul 6. doi: 10.1089/fpd.2017.2286. [Epub ahead of print]
Fish-Associated Foodborne Disease Outbreaks: United States, 1998-2015.
Barrett KA1, Nakao JH1, Taylor EV2, Eggers C3, Gould LH1.

Author information
11 Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia .22 Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention , Atlanta, Georgia .33 Division of Global Health, Center for Global Health, Centers for Disease Control and Prevention , Atlanta, Georgia .

Abstract

Each year in the United States, ∼260,000 people get sick from contaminated fish. Fish is also the most commonly implicated food category in outbreaks. We reviewed the Centers for Disease Control and Prevention Foodborne Disease Outbreak Surveillance System for outbreaks resulting from consumption of fish during the period 1998-2015. We found 857 outbreaks associated with fish, resulting in 4815 illnesses, 359 hospitalizations, and 4 deaths. The median number of illnesses per outbreak was three (range: 2-425). The annual number of fish-associated outbreaks declined from an average of 62 per year during the period 1998-2006 to 34 per year during the period 2007-2015. Hawaii (221 outbreaks [26%]) and Florida (203 [24%]) reported the most outbreaks. Among 637 outbreaks (74%) with a confirmed etiology, scombrotoxin (349 [55%]) and ciguatoxin (227 [36%]) were by far most common. Most outbreak-associated illnesses were caused by scombrotoxin (1299 [34%]), Salmonella (978 [26%]), and ciguatoxin (894 [23%]). Most hospitalizations were caused by Salmonella (97 [31%]) and ciguatoxin (96 [31%]). Norovirus (105 average illnesses; range: [6-380]) and Salmonella (54 [3-425]) caused the largest outbreaks. Fish types implicated most often were tuna (37%), mahi-mahi (10%), and grouper (9%). The etiology-fish pairs responsible for the most outbreaks were scombrotoxin and tuna (223 outbreaks), scombrotoxin and mahi-mahi (64), and ciguatoxin and grouper (54). The pairs responsible for the most illnesses were scombrotoxin and tuna (720 illnesses) and Salmonella and tuna (660). Of the 840 outbreaks (98%) with a single location of food preparation, 52% were associated with fish prepared in a restaurant and 33% with fish prepared in a private home. Upstream control measures targeted to the most common etiologies and controls during processing and preparation could further reduce outbreaks caused by fish.

KEYWORDS:

disease outbreaks; fish; foodborne diseases; public health surveillance
PMID: 28682115 DOI: 10.1089/fpd.2017.2286



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