ks will reduce this burden, enabling PICT authorities to redistribute their limited resources to other priorities. Management action and prevention do not correlate with ciguatera incidence highlighting the lack of a unified and systematic approach for addressing ciguatera in the region. A clear desire for assistance exists within the PICTs that have high ciguatera incidence, suggesting that PICTs would be highly receptive to an external body aiding in enabling unified and systematic action. In addition to exploring new and better apporaches to detection and treatment, research is needed into the causes of ciguatera outbreaks, including environmental and anthropogenic parameters, to explain the hypotheses raised by this study.
Limitations of study
It is possible that the unusual collaboration of the majority of the PICTs in this project might have contributed to the observed increased reporting of ciguatera (as well as other unidentified infrastructure changes), and thus a possible reporting bias for the more recent 1998–2008 data when compared with the 1973–83. However, these data represent a decade of reporting during a period of competing public health interests and lack of surveillance resources for ciguatera in the PICTs. As with all ciguatera studies where the case definition does not include active confirmation of ciguatoxin in the fish consumed, there is the possibility of the misclassification of reported cases; however, this situation has not changed from the 1970s .
It is also beyond the scope of this study to speculate on the causes of the high spatial and temporal variability of ciguatera . This study, instead, aimed to demonstrate that ciguatera is still of major and possibly growing concern in the region. Addressing ciguatera will require significant investment in research and continuing education campaigns. If the suspected disturbances (including coral bleaching, cyclones, shipwrecks, and port facilities) are major causes of ciguatera outbreaks, then it is likely that the general temporal pattern of increased outbreaks will continue in the region, and be a far more expensive concern in the future, if our understanding of, and response to, ciguatera is not extensively improved.
Despite over 50 years of ciguatera research in the Pacific, no comprehensive region-wide action has occurred to better manage ciguatera. Based on this study, an estimated 500,000 persons might have contracted ciguatera in the last 35 years, corresponding to a lifetime prevalence of 25%. It is remarkable that ciguatera has largely been ignored by the PICT national governments, with only two nations having an ongoing monitoring program and only one nation having a small unit devoted to researching ciguatera (Toxic Micro-algae Unit of the Institut Louis Malarde, French Polynesia). Given the rapidly changing physical environment (including global warming, extreme weather, and coral reef degradation) as well as the dependence of local populations upon fish for their physical and cultural survival, research into improved disease treatment and toxin detection, and a better understanding of the environmental factors contributing to ciguatera, are required to help reduce the likely growing adverse impacts of ciguatera.
Document and questionnaire sent to PICTs requesting questionnaire completion.
The authors would like to thank SPC Fisheries for their support, and the following people for responding to the questionnaire: Teina Rongo, Tearoa Ionangi, Dr Aung (Cook Is.); Andy Tafileichig (F. S. of M.); Solo Qaranivalu (Fiji); Dr Chinain Mireille (F. Poly); J. O'Mallan (Guam); R. Kanenaka, M. Wong, C. Giles, Assoc. Professor Paul Bienfang (Hawaii); Tonana George (Kiribati); F. Hernaez (Marshall Is); Dr Zin (Nauru); O. Segur (N. Caledonia); Dr Viwa Lailai, Vanessa Marsh (Niue); Ed Diaz, R. Brostrom, JohnTagabuel (Northern Mariana Is.); Losii Samsel (Palau); Joyce Samuel, Maria Sapatu (Samoa); Lee Pearce (Tokelau); Dr Siale 'Akau'ola, Poasi Ngaluafe (Tonga); Dr Nese Ituaso-Conway, Avana M. Paelate (Tuvalu); L. Tarivonda, Yvannah Taga (Vanuatu); A