title: A past Haff disease outbreak associated with eating freshwater pomfret in South China.
abstract: BACKGROUND
  Haff disease is unexplained rhabdomyolysis caused by consumption of fishery products in the previous 24 h. It was first identified in Europe in 1924 but the condition is extremely rare in China. Here we describe a past outbreak of acute food borne muscle poisoning that occurred in Guangdong Province (South China) in 2009.
  
  
  METHODS
  The first full outbreak of Haff disease reported in Jiangsu Province (East China) in 2010, indicated that the incidence of the disease may be increasing in China. We, therefore first retrospectively reviewed epidemiologic, trace-back, environmental studies, and laboratory analyses, including oral toxicity testing to ascertain risk and chemical analysis to identify toxin(s), from the 2009 Guangdong outbreak. Then we compared data from the 2009 outbreak with data from all other Haff disease outbreaks that were available.
  
  
  RESULTS
  Clinical symptoms and laboratory findings indicated that the 2009 Guangdong outbreak disease was consistent with rhabdomyolysis. Epidemiologic, trace-back, environmental studies and laboratory analyses implied that the disease was caused by freshwater Pomfrets consumed prior to the onset of symptoms. We also identified common factors between the 2009 Guangdong outbreak and previous Haff disease outbreaks reported around the world, while as with other similar outbreaks, the exact etiological factor(s) of the disease remains unknown.
  
  
  CONCLUSIONS
  The 2009 Guangdong outbreak of 'muscle poisoning' was retrospectively identified as an outbreak of Haff disease. This comprised the highest number of cases reported in China thus far. Food borne diseases emerging in this unusual form and the irregular pattern of outbreaks present an ongoing public health risk, highlighting the need for improved surveillance and diagnostic methodology.
authors: Xi
authors: X
authors: Huang
authors: Yipeng
authors: Y
authors: Li
authors: Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China. huangqiong18@yahoo.com.cn.
authors: Qiong
authors: Q
authors: Huang
authors: Junhua
authors: J
authors: Liang
authors: Chunsui
authors: C
authors: Liang
authors: Bifeng
authors: B
authors: Chen
authors: Lingling
authors: L
authors: Lu
authors: Xiaoling
authors: X
authors: Deng
authors: Zihui
authors: Z
authors: Chen
authors: Yonghui
authors: Y
authors: Zhang
authors: Yongning
authors: Y
authors: Wu
authors: Bing
authors: B
authors: Shao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D005399:Fishes; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000209:etiology; D005618:Fresh Water; D006801:Humans; D008875:Middle Aged; D012206:Rhabdomyolysis / Q000453:epidemiology* / Q000209:etiology
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