title: Outbreak of ciguatera fish poisoning on a cargo ship in the port of hamburg.
abstract: BACKGROUND
  Ciguatera fish poisoning is a travel-related illness characterized by a combination of gastrointestinal and neurological symptoms in persons who eat ciguatoxic seafood in endemic areas.
  
  
  METHODS
  In 2009, an outbreak of the disease on a refrigerator vessel in the port of Hamburg was investigated. The ship's crew fell ill after they ate fish from a catch in the Caribbean 2 weeks earlier. All 15 sailors on board were examined by port medical officers. Samples of blood and stool specimens were taken from symptomatic sailors. The frozen fish was secured for the prevention of further disease spreading and additional diagnostic tests.
  
  
  RESULTS
  All but one sailor ate the fish. The intoxication resulted in gastrointestinal or neurological symptoms in all 14 sailors who consumed the fish and persisted in varying degrees in 93% of sailors over at least 14 days. No fatality occurred, but two seamen were "unfit for duty" on the ship due to severity of symptoms. The diagnosis was supported by the fact that all seafarers who consumed the same reef fish, experienced typical signs, symptoms, and time course consistent with ciguatera fish poisoning. The fish from the catch in the Caribbean was identified as Caranx sexfasciatus (Bigeye Trevally) and Cephalopholis miniata (Red Grouper). An experimental assay later confirmed presence of the ciguatoxin in the fish.
  
  
  CONCLUSIONS
  Sailors are an occupational group at risk for ciguatera fish poisoning due to potentially unsafe food sources during international travel. Even if no fatality occurred, the disease affected marine operations due to high attack rates and chronicity of symptoms. Medical doctors must be aware that ciguatera fish poisoning is a risk for seafarers traveling in tropical and subtropical areas. Stocking of food in affected ports from safe sources, adequate training of ship cooks, and informing sailors about the risk of fishing are needed to prevent disease occurrence in seafarers in international trade and traffic.
authors: Hamburg Port Health Center, Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Seewartenstraße 10, Hamburg, Germany. Clara.Schlaich@jhu.edu
authors: Clara
authors: C
authors: Schlaich
authors: Jan-Gerd
authors: JG
authors: Hagelstein
authors: Gerd-Dieter
authors: GD
authors: Burchard
authors: Stefan
authors: S
authors: Schmiedel
mesh_terms: D000328:Adult; D000818:Animals; D036841:Ciguatera Poisoning / Q000175:diagnosis / Q000453:epidemiology*; D002922:Ciguatoxins / Q000097:blood*; D004196:Disease Outbreaks; D005517:Foodborne Diseases; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009326:Naval Medicine; D012767:Ships; D014195:Travel
chemical_list: D002922:Ciguatoxins