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.

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There are strong indicators that the degradation of coral reefs may increase the intensity and frequency of ciguatera fish poisoning (CFP) outbreaks when denuded reef surfaces are colonised by macro algae that are the preferred hosts of toxic dinoflagellates that can cause the disease. Ciguatera field studies have concentrated on the dinoflagellate genus Gambierdiscus, well known to be the producer of ciguatoxin precursors. Moreover the potential of toxins from other dinoflagellate genera such as Prorocentrum and Ostreopsis is less often considered. Whilstit is known that toxic compounds produced by Ostreopsis species include ostreotoxins (OTX) and ostreocins, the potential harmful impacts of Ostreopsis, Prorocentrum and Gambierdiscus species on coral reef organisms (and ecological impacts) are largely unknown. In addition, CFP has historically largely occurred on the oceanic islands of the world’s tropical seas, but has only recently been reported in the major archipelagoes of Indonesia and thePhilippines. In view of their degraded coral reef ecosystems and the potential link between reef health and CFP, this study examined three sites in Bali and Gili Trawangan over one year, to assess the prevalence and distribution of CFP related dinoflagellate species. Beside finding Gambierdiscus, Ostreopsis and Prorocentrum at most sites, water column nitrogen nutrient levels were also found on the average to be 3−4 times higher than that recommended for a healthy coral reef (0.013mg/L). However the maximum abundance of Prorocentrum, Ostreopsis and Gambierdiscus found were low (103, 2,860 and 28 cells per gram of wet weight of host macroalgae, respectively). A factor thatmay play a part in the potential for toxicity at these sites is the abundance of sea grass (and associated micro flora and fauna) which are often present within and adjacent to coral reef ecosystems across the Indonesian archipelago.