Epidemiology
Due to the limited habitats of ciguatoxin-producing microorganisms, ciguatera is common in only subtropical and tropical waters, particularly the Pacific and Caribbean, and usually is associated with fish caught in tropical reef waters. Ciguatoxin is found in over 400 species of reef fish. Avoiding consumption of all reef fish (any fish living in warm tropical waters) is the only sure way to avoid exposure. Imported fish served in restaurants may contain the toxin and produce illness which often goes unexplained by physicians unfamiliar with the symptoms of a tropical toxin. Ciguatoxin can also occur in farm-raised salmon. Furthermore, species substitution, labeling a reef fish as a non-reef fish at restaurants and retail, can complicate efforts by consumers to avoid ciguatera.
In 2007, ten people in St. Louis, Missouri developed the disease after eating imported fish.
In February 2008, the U.S. Food and Drug Administration (FDA) traced several outbreaks to the Flower Garden Banks National Marine Sanctuary in the northern Gulf of Mexico, near the Texas–Louisiana shoreline. The FDA advised seafood processors that ciguatera poisoning was "reasonably likely" to occur from eating several species of fish caught as far as 50 miles (80 km) from the sanctuary.
In Q1 2012, two restaurants in Lanzarote are thought to have been the source of ciguatera poisoning, leading to new fishing regulations issued 18 April 2012. The first outbreak was reported after eating amberjack in February 2012. The diners suffered with vomiting, diarrhoea and abdominal pain several hours later. The second case was in early April affecting six people who live in Lanzarote and had all eaten amberjack at a local restaurant.
Read more about this topic: Ciguatera