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Epidemiology and Impact of Ciguatera in the Pacific: a Review

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Epidemiology and Impact of Ciguatera in the Pacific: A Review NANCY DAVIS LEWIS Introduction hood. The epidemiology ofciguatera in that influence reporting. For example, the Pacific has received considerable at­ sample surveys suggest a wide range Ciguatera, first described in the tention (Banner and Helfrich, 1964; (9-75 percent) in the number of individ­ Caribbean (Martyr, 1555), has a long Halstead, 1978; Bagnis, 1976, 1977; uals who go to a western medical facility recorded history in the Pacific as well. Lewis, 1981, 1984a, b). In this paper, when experiencing ciguatera (Bagnis, Sailors with the Spanish explorer, de the epidemiology is updated through 1973a; Dawson, 1977; Lewis, 1981). Quiros, suffered from ciguatera in 1983-84, and some considerations for There are often considerable differences Vanuatu in 1606 (Dalrymple, 1770), and health, nutrition, and specifically between a country's central register of Anderson (1776) described an intoxica­ marine resource development are pre­ disease and the statistics reported to tion aboard one of Cook's ships, the sented. Banner (1976), Withers (1982), SPEHIS. In Fiji, Naryan (1980) indi­ Resolution, in the same island group. and Baden (1983) have reviewed the cated that there were 791 cases of cigua­ The pantropical distribution ofciguatera etiology, chemistry, pharmacology, and tera reported to the Ministry of Health and the fact that the fish are unaffected ecology. between 1975-78. SPEHIS, based on re­ by the toxin(s) suggest that it has existed ports submitted to it, listed 449. far longer than the historical record Epidemiology The reported annual incidence of indicates. The most consistent, albeit incom­ ciguatera for the 11 years from 1973 to Ciguatera is a significant health and plete, information on the existence of 1983 was 97/100,000 for the region as a resource problem in tropical areas, cigatoxic fish in the Pacific is from mor­ whole. Using the conservative estimate largely because of its erratic and often bidity reports. Intensive investigations that this represents 20 percent ofactual unpredictable spatial and temporal dis­ of the distribution of both Gambier­ incidence, then actual incidence would tribution. The eating of toxic fish re­ discus toxicus and toxic fish have been be 500/100,000. The regional rate has mains a risk for both seafarers and made at specific sites, but these are been quite constant over the ll-year tourists, but it is a much more pro­ limited in both time and extent (Bagnis, period, with 1973, 1979, and 1983 being nounced problem for the inhabitants of 1969, 1973a, 1977; Yasumoto et al., 1979, years with marginally fewer cases re­ tropical islands, who depend on the re­ 1984). Morbidity for selected diseases ported. Lawrence et al. (1980) estimated sources of the seas for food and liveli- for the Pacific Island Region (not that in Miami the actual incidence of including Hawaii and Australia) is ciguatera was 5/10,000 (50/100,000), recorded by the South Pacific Com­ making the estimated incidence for The mission's South Pacific Epidemiologi­ Pacific ten times that of Miami. cal and Health Information Service Looking at the number of cases and (SPEHIS) (South Pacific Commission, mean rates for individual countries for ABSTRACT-For inhabitants ofthe Pacific Islands, the mean reported incidence of 1973-84). Ciguatera incidence for 1973­ the last 5 years of the period (1979-83) ciguaterafrom 1979 to 1983 was 971100,000. 83 is presented in Table 1. The region (Fig. 2), we see that some have reported As a health problem, ciguatera also appears is composed of 21 island states and ter­ annual morbidity rates several times that to be increasing on some Pacific islands that ritories (Fig. 1), and there are a host of of the region. French Polynesia (5851 had formerly experienced lower levels of cultural, economic, and practical factors 100,000) had an average annual rate six endemicity. Ciguatera also has important im­ plications for nutrition and the development times that of the region as a whole, and of inshore fishery resources. The epidem­ Tuvalu (484/100,000), five times. Kiri­ iology of ciguatera in the Pacific is pre­ Nancy Davis Lewis is with the Department of Geography and the Social Science Research bati (462/100,000) also had a mean in­ sented, and viewing ciguatera as a pheno­ Institute, University of Hawaii, Honolulu, HI cidence rate almost five times as high menon to which islanders have had to adapt 96822. Views or opinions expressed or implied as the region as a whole. The reported for centuries, the implications for health, are those of the author and do not necessarily nutrition, and resource development are reflect the position of the National Marine Fish­ rate for Tokelau, 1,338/100,000, was ex­ discussed. eries Service, NOAA. ceptionally high. 6 Marine Fisheries Review 180" 160" 150· 140' 130 120" 150 160" 40' THE PACIFIC ISLANDS , Ryukyu , Islands NORTHERN 20 MARIAN/\ ISLANDS PACIFIC OCEAN GUAM .. MARSHALL 10 BELAU.' ISL,ANDS FEDERATED STATES' OF " Klrilimati IChnstmas Island, -P MICRONESIA f .. o· NAURU KIRIBATI . ~-~~~'~,PAPU: N'~W:- -', i ~,;&'tJ '~'" 'TUVALU MarQucsas ~.. -d i : GUINEA SOLOMON TOKELAU "cP" .. - ~'... !'.~.~, Santa Crul •. Islands ." ",;:-' ~ Islands 10 WEST-ERN WALLIS ISLANDS. SAMOA COOK FRENCH "'" and ~- Coral Sea FUTUN~ b·' VANUATU AMERICAN ISLANDS SO.~lefy , POL YNESIA ~~ SAMOA 'Q':. """.'... .'-OYiJII.Y • ISlar:JdS '" .,' KING'DOM NI UE . ~' FIJI, 20' NEW ~ "'~?o: of ~. ~ TONGA CALEDONIA AUSTRALIA 30 NEW~ Tasman Sea Mercator ProjectIon .O' "\ ZEALAND\.<,V 40 MTasman,a 130" 140" V 150~ 160 180" ,:. 170 160 150 140 130 120 Figure I.-The Pacific Islands, Table 1,-Ciguatera morbidity, South Pacific Region, 1973-83, as reported to South Pacific Epidemiological and Health Information Service. Number of cases Rate per Rate per 100,000 100,000 Country 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 Total Mean 1973-83 1979-83 American Samoa 4 0 0 0 0 0 70 30 31 97 69 301 27.36 87 179 Cook Islands 0 0 0 0 0 0 0 1 2 0 0 3 0.27 1 3 Fiji 6 26 150 29 69 201 131 265 123 71 0 1,071 97.36 16 18 French Polynesia 607 867 625 660 502 821 677 937 1.145 831 789 8,461 769,18 545 585 Guam 0 0 21 16 6 6 9 0 4 3 21 86 7,82 8 7 Kiribati 101 175 187 77 41 38 78 187 286 418 414 2,002 182.00 324 462 Nauru 0 0 0 0 0 0 1 5 0 0 0 6 0,55 7 15 New Caledonia 0 200 518 647 487 488 188 147 107 130 112 3,024 274,91 200 96 Niue 7 1 35 4 0 0 0 3 3 0 0 53 4,82 130 36 Papua New Guinea1 0 0 16 0 0 0 0 0 0 0 0 16 1.45 <1 <1 Solomon Islands 1 7 0 7 6 6 0 4 4 0 2 37 3,36 2 1 Tokelau 0 0 0 8 0 0 14 0 3 17 73 115 10.45 653 1,338 Tonga 11 58 12 17 43 13 8 7 2 29 14 214 19,45 21 12 TIPI 240 264 208 313 326 296 191 217 163 119 120 2,455 223,18 173 114 Tuvalu 0 0 0 49 44 71 21 27 73 47 16 348 31,64 439 484 Vanuatu 0 0 35 28 50 53 67 0 32 12 0 277 25.18 25 19 Wallis and Futuna 0 0 3 7 0 0 0 0 0 0 0 10 0,91 9 0 Western Samoa 65 89 15 17 81 179 62 115 127 98 59 907 82,45 54 59 Total 1,042 1,687 1,825 1,879 1,655 2,172 1,517 1,945 2,105 1,870 1,689 19,386 1,762,36 97.1 96,1 'Papua New Guinea has been excluded from the regional analysis, 48(4), 1986 7 Figure 2.-Mean annual incidence of ciguatera (cases per 100,000), 1979-83. Various patterns emerge in the three French Polynesia in 1982-83 and be­ only 10 krn2 . The incidence rate was subregions of Oceania, Polynesia, cause of the long acknowledged asso­ 1,338/100,000 for the period 1979-83. Micronesia, and Melanesia. Incidence ciation between disruption of marine For 1983 alone the incidence was 4,867/ in French Polynesia has been consistent­ substrate and increases in ciguatera, 100,000 and partial data from 1984 in­ ly high throughout the period with a researchers are monitoring for increases dicate an even higher rate. The serious­ peak in 1981. While the longstanding in the causative organism. Islands to the ness of this, particularly in the last 2 research efforts of Raymond Bagnis and west in Polynesia exhibit a less clear years, which showed a precipitous in­ his colleagues at the Institut Recherches picture; the Cook Islands are in many crease, is obvious for this small popula­ Medicales Louis Malarde in Papeete respects a ciguatera anomaly with very tion. They are isolated and highly may have led to increased reporting, low rates of ciguatera. Tonga also has dependent on the resources of the sea, evidence suggests that ciguatera is a relatively low rates of ciguatera. In and they are also distant from hospital more serious problem in French Poly­ Samoa, toxic fish were reported soon facilities that can treat severe cases. 'TU­ nesia than in some other parts of the after the turn of the 20th century (Jor­ valu is another small Pacific country Pacific. The island groups within dan, 1902; Spear, 1904) and the toxicity with elevated rates of ciguatera, 484/ French Polynesia exhibit different levels has persisted, but not at high levels.
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