Health Advisory: Ciguatera Fish Poisoning (CFP)

11 July, 2019

The Epidemiology and Surveillance Unit (ESU) of the Ministry of Health and the Department of Environment and Natural Resources (DENR) would like to advise the public on how to reduce their risk of Ciguatera Fish Poisoning (CFP). This is in response to an investigation into one case of suspected CFP in the community. The fish implicated in this case is a portion of a large amberjack that was consumed during the week of June 30th to July 5th 2019. Large amberjacks, large yellow jacks (larger than 20lbs), barracuda and Cubera snapper have been implicated in  past cases of CFP in Bermuda. This case isthe first report of CFP received in 2019, however,  the ESU have received reports of CFP every year since 2016. Prior to 2016, CFP was considered a rare occurrence in Bermuda.

Ciguatera fish poisoning (CFP) is caused by toxins (or poisonous substances) from microscopic marine plants, which build-up in large predatory fish. An older or larger predatory fish that has eaten many herbivorous fishes over a period of time has a greater risk of carrying CFP toxins than a younger or smaller fish of the same species.

The fish themselves are not affected by the toxin, and the handling of the fish (i.e. how it was processed and stored post-catch) does not affect the presence of the toxin. CFP does not change the appearance, taste or smell of a fish, and it is not affected by cooking or freezing. There is no simple detection test.

However, when the poisoned fish is eaten, it can cause symptoms in persons that include: diarrhea, itchy skin, numbness, burning skin, nausea, vomiting, pain to limbs and fatigue or weakness. The reversal of cold and hot sensations (that is, hot items “feel” cold and cold items “feel” hot) is a telltale sign of CFP because it is absent in other types of fish-related food poisoning. Symptoms can appear between 1 to 72 hours after eating the suspect fish and can persist for an extended period of time. CFP is unpleasant, but most people that are affected recover fully over time.

The ESU and the DENR will continue to investigate any new reports of CFP and will provide an update if there are any ongoing concerns.

If you or someone you know is experiencing or has experienced the symptoms listed above after eating fish, please contact your physician. Your physician will contact the Epidemiology and Surveillance Unit. Prompt reporting of CFP makes it easier for the Epidemiology and Surveillance Unit to track down the source and can help prevent further cases.

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