Blowfish/pufferfish caught in/near Indian River lagoon (Titusville Pier), Brevard County cause saxitoxin poisoning

(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.

This week (July 29, 2002), FWC extended the ban on catching and eating puffer fish caught in the waters of the above-mentioned Florida counties into October and expanded the ban to include Martin County as a precautionary measure. The extension of the five-county ban until Oct. 23 comes following a recent case in which a Brevard County fisherman was sickened by eating a poisonous blowfish.