title: Chelonitoxism outbreak caused from consuming turtle, Eastern Samar, Philippines, August 2013.
abstract: BACKGROUND
  On 21 August 2013, the Event-based Surveillance and Response system of the Department of Health, Philippines captured a foodborne illness event among residents of a coastal village in Eastern Samar, Philippines. The suspected cause was the consumption of a sea turtle found near the village. A team from the Department of Health was sent to conduct an outbreak investigation.
  
  
  METHODS
  A case was defined as any person in Arteche, Eastern Samar, who developed dry mouth and burning sensation in the throat from 15 August to 27 August, 2013. Severity of the disease was classified as mild, moderate or severe. We conducted records review, environmental investigation, interviews of key informants and a retrospective cohort study.
  
  
  RESULTS
  Sixty-eight cases were identified; four died (case fatality rate = 6%). All cases had a history of turtle meat consumption. Dose-dependent relationship was noted between amount of turtle meat consumed and the risk of illness. In the cohort study, consumption of turtle meat and turtle meat soup were associated with illness.
  
  
  CONCLUSIONS
  This study identified turtle meat as the source of this foodborne outbreak and emphasized the dangers of consuming turtle meat. Other reported cases of turtle meat poisoning in the Philippines suggest that turtle consumption is an ongoing practice in the country. By publishing information about sea turtle poisoning outbreaks in the Philippines, we hope to raise awareness of the potential severe health effects from ingesting these endangered sea creatures.
authors: Field Epidemiology Training Program, National Epidemiology Center, Department of Health, Sta Cruz, Manila, Philippines . ; Department of Health, Sta Cruz, Manila, Philippines .
authors: Ray Justin
authors: RJ
authors: Ventura
authors: Field Epidemiology Training Program, National Epidemiology Center, Department of Health, Sta Cruz, Manila, Philippines . ; Department of Health, Sta Cruz, Manila, Philippines .
authors: Paola Katrina
authors: PK
authors: Ching
authors: Department of Health, Sta Cruz, Manila, Philippines .
authors: Vikki Carr
authors: VC
authors: de los Reyes
authors: Department of Health, Sta Cruz, Manila, Philippines .
authors: Ma Nemia
authors: MN
authors: Sucaldito
authors: Department of Health, Sta Cruz, Manila, Philippines .
authors: Enrique
authors: E
authors: Tayag
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004196:Disease Outbreaks; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008297:Male; D008460:Meat / Q000506:poisoning*; D008875:Middle Aged; D010679:Philippines / Q000453:epidemiology; D012189:Retrospective Studies; D014426:Turtles; D055815:Young Adult