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Toxicon xxx (2009) 1–14

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Toxicon
journal homepage: www.elsevier.com/locate/toxicon

Ciguatera: A public health perspective
Robert W. Dickey*, Steven M. Plakas
U.S. FDA Center for Food Safety and Applied Nutrition, Office of Food Safety, Division of Seafood Science and Technology, Gulf Coast Seafood Laboratory, 1 Iberville Drive,Dauphin Island, AL 36528, USA

a r t i c l e i n f o
Article history: Received 10 January 2009 Received in revised form 15 September 2009 Accepted 18 September 2009 Available online xxxx Keywords: Ciguatera Ciguatoxins

a b s t r a c t
Ciguatera fish poisoning is a seafood-borne illness caused by consumption of fish that have accumulated lipid-soluble ciguatoxins. In the United States,ciguatera is responsible for the highest reported incidence of food-borne illness outbreaks attributed to finfish, and it is reported to hold this distinction globally. Ciguatoxins traverse the marine food web from primary producers, Gambierdiscus spp., to commonly consumed fish in tropical and subtropical regions of the world. Ciguatoxins comprise 12 known congeners among Caribbean and tropical Atlanticfish and 29 reported congeners among Pacific fish. Expanding trade in fisheries from ciguatera-endemic regions contributes to wider distribution and increasing frequency of disease among seafood consumers in non-endemic regions. Ciguatoxins produce a complex array of gastrointestinal, neurological and cardiological symptoms. Treatment options are very limited and supportive in nature. Information derivedfrom the study of ciguatera outbreaks has improved clinical recognition, confirmation, and timely treatment. Such studies are equally important for the differentiation of ciguatoxin profiles in fish from one region to the next, the determination of toxicity thresholds in humans, and the formulation of safety limits. Analytical information from case and outbreak investigations was used to derivePacific and Caribbean ciguatoxin threshold contamination rates for adverse effects in seafood consumers. To these threshold estimates 10-fold safety factors were applied to address individual human risk factors; uncertainty in the amount of fish consumed; and analytical accuracy. The studies may serve as the basis for industry and consumer advisory levels of 0.10 ppb C-CTX-1 equivalent toxicity in fishfrom the tropical Atlantic, Gulf of Mexico, Caribbean, and 0.01 ppb P-CTX-1 equivalent toxicity in fish from Pacific regions. Published by Elsevier Ltd.

1. Introduction Ciguatera fish poisoning is a food-borne disease endemic to tropical and subtropical coral reef regions of the world. It is contracted by consumption of finfish that have accumulated lipid-soluble toxins produced by microalgae(dinoflagellates) of the genus Gambierdiscus. The vectors and symptoms of this disease in the Caribbean and South Pacific have been described in the literature since the 18th century, with mentions of illness consistent with ciguatera

* Corresponding author. Tel.: þ1 251 690 3368; fax: þ1 251 694 4477 E-mail address: robert.dickey@fda.hhs.gov (R.W. Dickey). 0041-0101/$ – see front matter Published byElsevier Ltd. doi:10.1016/j.toxicon.2009.09.008

dating back to the 16th century (e.g. Halstead, 1967). Current estimates of ciguatera prevalence in endemic regions range from less than 0.1% of populations of continental land masses (e.g., Queensland, Australia; Florida, USA) to greater than 50% of populations of small islands of the South Pacific and Caribbean (see reviews by Lewis, 1986a; Lange,1994; Fleming et al., 1998, 2001). Ciguatera has over time become a hazard to consumers in nonendemic regions because of expanding international trade in seafood from tropical fisheries. In 2007, the European Union and the United States imported greater than 80% of their fishery products to meet consumer demand. In the U.S., approximately 2.4% of fishery imports originated from the islands of...