CDC Report on Ciguatera Fish Poisoning in NY - 2010 to 2011

Wen discussing chemicals hazards in food, we often mention ciquatoxin, a natural toxin found in tropical predator fish such as grouper and barracuda. CDC’s MMWR (Feb 1, 2013), Ciguatera Fish Poisoning - New York, 2010-2011, is a case study that looks at 28 cases of ciguatera fish poisoning (CFP) in 28 individuals that occurred in a one year period, from August, 2010 to July 2011. 13 people became ill after eating barracuda, and 15 after eating grouper.

 

The toxin originates as a precursor in dinoflagellates (microalgae) which live in coral reef areas. These algae are eaten by smaller fish and the precursor toxin is converted to the toxic form. Predator fish such as barracuda, grouper, snapper, amberjack and surgeonfish eat these small fish, and over time, this toxin accumulates in the larger fish’s body. People eat these larger fish and then suffer the symptoms of CFP. “CFP is characterized by various gastrointestinal, cardiovascular, and neurologic symptoms. A prolonged period of acute illness can result, and the neurologic symptoms can last months, with variable asymptomatic and symptomatic periods.” Typical symptoms include diarrhea, abdominal cramps, dizziness, headache, faintness, nausea, vomiting and tingling in the extremities (fingers and toes).

Two interesting points made in this report:

• “CFP is considered a highly underreported illness, with only an estimated 10% of cases reported to health authorities (7). Increasing awareness among health-care providers might improve reporting and investigation. However, CFP prevention is complicated by difficulty in identifying high-risk fishing grounds and inadequate industry knowledge and compliance with the FDA seafood Hazard Analysis and Critical Control Point (HACCP) regulations.† Premarket testing of fish for CTX is not feasible because of the lack of rapid field methods and the sporadic distribution of toxic fish, even in endemic areas. Coordinated tracebacks of implicated fish by federal and state agencies to specific fishing grounds remains the primary strategy for managing CFP.”

• “This investigation demonstrates the value of CFP-implicated fish traceback along with updated information on emerging CFP risks, including new harvest areas and species. Prevention through education alone might be limited by seafood mislabeling.”

 

Ciguatera Fish Poisoning — New York City, 2010–2011

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6204a1.htm?s_cid=mm6204a1_x

Weekly

February 1, 2013 / 62(04);61-65

During August 2010–July 2011, the New York City Department of Health and Mental Hygiene (DOHMH) received reports of six outbreaks and one single case of ciguatera fish poisoning (CFP), involving a total of 28 persons. CFP results from consumption of certain large, predatory, tropical reef fish that have bioaccumulated ciguatoxins (CTX). CFP is characterized by various gastrointestinal, cardiovascular, and neurologic symptoms. A prolonged period of acute illness can result, and the neurologic symptoms can last months, with variable asymptomatic and symptomatic periods. The first two outbreaks and the single case, involving 13 persons, were reported during August 6–September 13, 2010. DOHMH distributed a health alert in November 2010 requesting health-care providers be alert for CFP signs and symptoms. The health alert resulted in identification of 11 more cases that month and an additional two outbreaks involving four persons in July 2011. In comparison, only four CFP outbreaks, involving 21 persons total, had been reported in New York City (NYC) during the preceding 10 years (2000–2009). DOHMH's investigation revealed that 13 persons became ill after eating barracuda, and 15 became ill after eating grouper. Although specific and highly sensitive laboratory analyses can detect and confirm CTX in fish, no practical field tests are available for fish monitoring programs. CFP prevention depends on educating the public, seafood suppliers, and distributors about known CFP endemic areas and high-risk fish species. Traceback investigations of fish associated with outbreaks provide valuable information regarding fishing areas associated with CFP. Not all fish from CFP endemic areas are ciguatoxic, but persons who eat fish from endemic regions are at higher risk for CFP. If an illness is suspected to be CFP, public health authorities should be notified and informed of the case history for possible investigation and intervention measures.

Black licorice recalled due to high lead content

American Licorice company is recalling black licorice due to elevated levels of lead. The product was found to have 0.33 ppm of lead which could lead to ingestion of  13.2 micrograms of lead per serving. (And those of us who enjoy black licorice...much higher).  The issue was discovered by the California Dept of Public Health.  There have been no reported cases.

Lead Intoxication
An early symptom of mild lead intoxication lead is anemia, or lack of red blood cells.  In higher levels of intoxication, anemia becomes worse and effects begin on the central nervous system including hyperactivity, impulsive behavior, and slowed learning.  With increased levels, people become irritable and restless, and suffer headaches, tremors, and memory loss.  Acute toxicity can lead to kidney failure, convulsions, coma, and death.

There is a long history of lead intoxication.  It is believed that the Romans, from the year 30 to 200 or so, suffered the effects of lead toxicity from drinking wine stored in lead-containing containers.  This probably accounted for the erratic behavior of the emperors at that time.  More recently, moonshiners who used equipment with lead solder (radiators) often suffered the consequences of lead poisoning.  Because of this, they tested their 'shine' by taking a small teaspoon full of shine and lighting it on fire.  A blue flame was good, and a red flame 'makes you dead'.

In the early days of canned food when the cans were soldered with lead, products could contain lead as high as 0.5ppm.  The industry and FDA instituted the use of non-soldered cans which resulted in a marked decrease in lead levels within the population.



FDA News Relasea
American Licorice Company Announces Recall of 16 oz. Red Vines® Black Licorice Twists
 http://www.fda.gov/Safety/Recalls/ucm316850.htm?source=govdelivery
Contact:
Consumer:
886-442-2783
Media:
Michael Kelly
831-359-1839

FOR IMMEDIATE RELEASE - August 21, 2012 - American Licorice Company of Union City, CA is recalling 16 oz. Red Vines® Black Licorice Twists due to elevated levels of lead. Only the one pound bag (16 oz.) of Red Vines® Black Licorice Twists containing "Best Before Date" of 020413 are affected by this recall. American Licorice is notifying consumers and customers not to consume this candy.

American Licorice learned from the California Department of Public Health (CDPH), that some Red Vines® Black Licorice Twists contain levels of lead that could potentially cause health problems to consumers, particularly infants, small children, and pregnant women. American Licorice immediately segregated its entire inventory of 16 oz. Red Vines® Black Licorice Twists.

Red Vines® Black Licorice Twists is a black licorice candy made from molasses, wheat flour, corn syrup, caramel coloring, licorice extract, salt, and anise flavor. The 16 oz. bag is red and white in color with a window in the package to display the black licorice twists.

Recent analysis of Red Vines® Black Licorice Twists by CDPH found that the candy contained lead levels as high as .33 parts per million (ppm). This concentration of lead could provide up to 13.2 micrograms of lead per serving and children under 6 years of age should not consume more than 6.0 micrograms of lead per day from all dietary sources. Therefore, the CDPH's position is that the sale of this lot of the 16 oz. Red Vines® Black Licorice Twists is in violation of California statutes.
American Licorice wants to ensure its products are safe. Consequently, in addition to its ongoing cooperation with the CDPH, American Licorice is voluntarily recalling all 16 oz. Red Vines® Black Licorice Twists from all of its customers with affected product. Consumers in possession of Red Vines® Black Licorice Twists with the "Best Before Date" of 020413 should not eat the candy and should return it to their place of purchase for a full refund. The "Best Before Date" is located in black ink on the rear of the package.

Pregnant women and parents of children who may have consumed any candy should consult with their physician or health care provider to determine whether further medical testing is required. For more information about lead poisoning, parents and caretakers should contact their local childhood lead poisoning prevention program or local public health department.

American Licorice will be sending recall notices to all of its affected customers. Please contact American Licorice Consumer Support at 886-442-2783 for further information.