FISH-ASSOCIATED FOODBORNE DISEASE OUTBREAKS IN THE UNITED STATES, 1998-2008 Public

Abstract

ABSTRACT

Background: The United States is the third largest consumer of seafood in the world. Consumption of seafood has many health benefits, but there are also associated risks. Seafood has the potential to carry chemical and biological toxins that can result in severe cases of foodborne illness and even death. In fact, fish is one of the top 3 food commodities implicated in foodborne disease outbreaks each year. In this paper, we describe the epidemiological traits of fish-associated outbreaks from 1998-2008, as well as seek to elucidate associations between fish type, method of preparation, setting, and geographic location.

Methods: Fish-associated outbreak data from CDC's Foodborne Disease Outbreak Surveillance System were analyzed in this report and included number of illnesses, hospitalizations and deaths, age groups, gender, reporting state, etiology, fish type, setting, and method of preparation. Univariate and multivariate logistic regression were used to identify risk factors for outbreaks and predictors of severe illness.

Results: Hawaii (207/607 outbreaks) and Florida (136/607) reported the most outbreaks with numbers declining overall during the 11-year period. Chemical etiologies, primarily scombroid toxin (317/550) and ciguatoxin (173/550) poisoning, contributed to more outbreaks than other causes, although Clostridium botulinum cases showed the highest risk for hospitalization (21 of 32 cases were hospitalized). Tuna (199/607) and mahi mahi (78/607) were the main fish types associated with outbreaks, and more outbreaks occurred from fish prepared in a commercial (339/572) versus home (186/572) setting, with cooking the most common method of preparation (206/368).

Conclusions: The decline in number of outbreaks is largely the result of a decrease in outbreaks in Hawaii, particularly in scombroid toxin poisoning in tuna and mahi mahi fish types. This trend may be attributed to better adherence to food handling guidelines, although consumer education about fishing and observing algal bloom warnings is needed to mitigate the slight rise in illnesses related to naturally occurring algal toxins.

Table of Contents

TABLE OF CONTENTS

Introduction …………………………………………………………………………….................. 1
Methods ……………………………………………………………………………………................. 3
Results …………………………………………………………………………………............…….... 5
General epidemiological characteristics …………………………………………....…….. 5
Etiologic agents and fish types …………………………………………………….......…….. 7
Outbreak setting and method of preparation …………………………………………. 12
Discussion ………………………………………………………………………………............…… 17
Tables and Figures …………………………………………………………………......……...... 24
References ………………………………………………………………………..........…...………. 35
Appendices ………………………………………………………………………..........…………... 37

About this Master's Thesis

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School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Mot-clé	scombroid toxin seafood outbreak ciguatoxin foodborne fish
Committee Chair / Thesis Advisor	Brachman, Philip S, Emory University
Committee Members	Sullivan, Kevin M, Emory University Gould, Lydia H, Emory University Alperin, Melissa, Emory University
Partnering Agencies	CDC

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