Ciguatera Fish Poisoning in East Asia and Southeast Asia

Abstract

In the coastal countries of East Asia and Southeast Asia, ciguatera should be common because of the extensive tropical and subtropical coral reefs along the coasts and in the neighboring seas with ciguatoxic fishes. An extensive search of journal databases, the Internet and the government websites was performed to identify all reports of ciguatera from the regions. Based on the official data and large published case series, the incidence of ciguatera was higher in the coastal cities (Hong Kong, Foshan, Zhongshan) of southern China than in Japan (Okinawa Prefecture). In Singapore, ciguatera appeared to be almost unknown. In other countries, only isolated cases or small case series were reported, but under-reporting was assumed to be common. Ciguatera may cause severe acute illness and prolonged neurological symptoms. Ciguatera represents an important public health issue for endemic regions, with significant socio-economic impact. Coordinated strategies to improve risk assessment, risk management and risk communication are required. The systematic collection of accurate data on the incidence and epidemiology of ciguatera should enable better assessment and management of its risk. Much more work needs to be done to define the size threshold for important coral reef fish species from different regions, above which the risk of ciguatera significantly increases.

Ciguatoxic Potential of Brown-Marbled Grouper in Relation to Fish Size and Geographical Origin

“…11 Concomitant consumption of alcohol may increase the risk of severe ciguatera. [8][9][10][11] In both the Pacific and Atlantic, it has long been known that fishes most likely to contain CTX include E. fuscoguttatus.…”

“…[4][5][6][7][8] In other coastal countries of East Asia and Southeast Asia, only isolated cases or small case series are identified. 9 CTX in the Pacific (P-CTX) is the most potent. 1 Avoidance of large predatory reef fishes are generally recommended.…”

Characteristic Features and Contributory Factors in Fatal Ciguatera Fish Poisoning—Implications for Prevention and Public Education

“…1,2 However, the public health impact of ciguatera is underestimated due to underreporting and underdiagnosis of the disease. 8,11 Regional variations in the incidence and manifestations of ciguatera are described in detail elsewhere. 1,2,11 Recent reports on ciguatera incidence per 100,000 population are summarized in Table 1.…”

“…[1][2][3][4][5][6] CTXs are lipid soluble and heat stable and are concentrated in the fish head, liver, intestines, roe, and other viscera. 7,8 Large outbreaks of ciguatera and ciguatoxic fishes are mainly found in the tropical and subtropical regions of the Pacific Ocean, Indian Ocean, and Caribbean Sea, between the latitudes 35°N and 35°S. 1,2 With increasing reef fish trade, booming international tourism, and coral reefs disruption 8 and climate changes 9 favoring the growth of the Gambierdiscus species, 10 the global incidence and distribution of ciguatera are expected to increase.…”

“…7,8 Large outbreaks of ciguatera and ciguatoxic fishes are mainly found in the tropical and subtropical regions of the Pacific Ocean, Indian Ocean, and Caribbean Sea, between the latitudes 35°N and 35°S. 1,2 With increasing reef fish trade, booming international tourism, and coral reefs disruption 8 and climate changes 9 favoring the growth of the Gambierdiscus species, 10 the global incidence and distribution of ciguatera are expected to increase. 1,2 However, the public health impact of ciguatera is underestimated due to underreporting and underdiagnosis of the disease.…”