(compiled from EpiX reports)
The Sparta (New Jersey) Health Department notified the New
Jersey Department of Health and Senior Services (NJDHSS) in mid-March of two
cases of neurotoxin poisoning in elderly persons who had consumed blowfish (pufferfish)
which had been given to them by a family member. The family member had caught
the blowfish in the area of Titusville, Florida (Indian River Lagoon) in late
February 2002; the fish were gutted, cleaned, filleted and frozen by the
fisherman and later transported in a frozen state to the family members in New
Jersey. The two ill persons had consumed the fish on March 18, developed
immediate symptoms (including tingling around the mouth and chest discomfort)
and were subsequently hospitalized later that day; one person had respiratory
failure and was placed on mechanical ventilation. No other family members had
consumed the fish.
Remaining fish samples were sent immediately to a marine
biotoxin lab in Nova Scotia, Canada, and the U.S. Food and Drug Administration
(FDA) lab in Jamaica, Queens. Both labs confimed the presence of saxitoxin in
the fish samples, and the Nova Scotia lab found quantified levels of saxitoxin
at 20,000 micrograms/kg.
The source of the saxitoxin in the blowfish is under
investigation. Saxitoxin has not previously been detected in blowfish from
Florida waters.
The NJDHSS is working closely with Florida state and local
officials, the New Jersey Poison Information and Education System, as well as
the US FDA in the investigation. Florida officials, in consultation with the
FDA, will be taking samples of fish and shellfish (clams) for marine biotoxin
analysis
The blowfish were recreationally caught and
not purchased in a marketplace
The Florida Department of Health (FDOH) investigated nine
suspected cases of saxitoxin poisoning that in Florida from the consumption of
puffer fish (blowfish). The cases occurred from January to March of 2002.
Following the reports of four cases occurring in other states (three in New
Jersey and one in Virginia), FDOH heightened surveillance for similar cases. As
a result of the surveillance, FDOH identified nine cases: five cases were
identified by the Florida Poison Information Network, three cases were elicited
by investigators from interviews, and one case (which occurred in January) was
identified by checking foodborne illness complaint logs.
Florida county health departments have been alerted to
implement heightened surveillance for additional cases. A statement issued by
the State Health Officer, Dr. Agwunobi warned of health risks associated with
consumption of puffer fish. Ten species of puffer fish are found in Florida
waters. The only regulation of the harvest of puffer fish pertains to commercial
and recreational harvest of certain species for live display in aquaria (Rule
68B-42, Florida Administrative Code).
On April 15, 2002, The Food and Drug
Administration (FDA) issued a health advisory warning consumers not to eat
puffer fish, also know as blowfish or sea squab, harvested from the Titusville,
Florida, area because these fish might contain a naturally occurring toxin that
can cause serious illness or death.
The Florida Department of Health completed investigations into
nine cases of suspected saxitoxin poisoning possibly linked to puffer fish
consumption. A total of 17 interviews have been conducted using a standardized
questionnaire. Interviews also included persons who consumed food with the
suspected cases. Case information was collected by interview and medical record
review.
Nine persons experienced neurological symptoms following the
consumption of puffer fish. All had eaten puffer fish prior to symptom onset.
Eight persons who consumed puffer fish did not experience any symptoms. No other
foods were common to the nine ill persons. The only seafood consumed by all
cases was the puffer fish. The majority of the cases prepared the puffer fish by
frying. One person boiled the fish. The illnesses occurred during the months of
January (1 case), February (5 cases), and March (3 cases). Seven cases went to
emergency rooms and 4 were hospitalized. The age of the cases ranged from 32 to
84 years with a median of 69 and a mean of 63.7 years.
Predominant symptoms described (number of cases with the
symptom in parenthesis) were numbness in the face (6), numbness in lips (6),
numbness in legs (6), tingling in arms (5), numbness in arms (5), tingle in lips
(5), drowsiness (5), breathing difficulty (3), speech difficulty (3), tingling
in face (3), nausea (3), and vomiting (3). Other symptoms included respiratory
paralysis, blisters in facial area, dizziness, seizures, lightheadedness,
confusion, headache, muscle aches and hypoglycemia. The latent period after
consuming the fish ranged from 30 minutes to approximately 8 hours, with a
median of 2 hours and a mean of 2.2 hours. Duration ranged from 10 hours to 45
days with a mean of 6.2 days and median of 24 hours.
There does not appear to be a relationship between the
quantity of fish consumed and latent period or whether illness occurred. All
fish were caught in waters of the Indian River. All fish consumed by all cases
except one were caught recreationally at the Titusville Pier. The fish in the
other case were caught by a recreational fisherman at the Pineda Causeway,
approximately 35 miles south of the Titusville Pier. The harvest dates were in
the months of December of 2001 (1), and January (1), February (3) and March (2)
of 2002.