d in reef fish through the marine food chain. Unfortunately, the true extent of illness and its impact on human communities and ecosystems are still not well understood. Using data gathered from Health and Fisheries Authorities of the Pacific Island Countries and Territories we identified a 60% increase in the annual incidence of ciguatera from 1988–2008 to 1973–1983 and estimate over 500,000 Pacific islanders might have suffered from ciguatera in their lifetime. The incidence of ciguatera is expected to continue to rise in conjunction with continued reef degradation and global warming, with greatest impact likely to be experienced in the developing PICTs and potentially the archipelagoes of southeast Asia. Despite this threat, little funding is available for research that might lead to better management of the problem either locally, regionally or globally.
Citation: Skinner MP, Brewer TD, Johnstone R, Fleming LE, Lewis RJ (2011) Ciguatera Fish Poisoning in the Pacific Islands (1998 to 2008). PLoS Negl Trop Dis 5(12): e1416. doi:10.1371/journal.pntd.0001416
Editor: Charles H. King, Case Western Reserve University School of Medicine, United States of America
Received: July 7, 2011; Accepted: October 22, 2011; Published: December 13, 2011
Copyright: © 2011 Skinner et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This study was funded in part by the Australian Research Council Centre of Excellence for Coral Reef Studies (Tom Brewer) and the European Union Convergence Funding to the European Centre of Environment and Human Health (Lora Fleming), Peninsula College of Medicine and Dentistry, University of Exeter, Truro, Cornwall, UK. Richard Lewis is an NHMRC (www.nhmrc.gov.au) Research Fellow. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
The developing Pacific Island Countries and Territories (PICTs) are under increasing threat from both acute and chronic diseases ranging from HIV/AIDS to obesity. In addition, people residing in PICTs are highly vulnerable to environmental impacts from the sea level rise and extreme weather events associated with global warming. Ciguatera is a prevalent tropical and subtropical disease that has been an under-appreciated cause of acute and chronic disease in island communities and might be increasing in incidence due to increasing vulnerabilities (i.e. poverty, global warming, eutrophication) in these populations –.
Ciguatera is caused by the consumption of coral reef fish contaminated by ciguatoxin and related toxins from dinoflagellates (microalgae) and cyanobacteria , . The ciguatoxin bioaccumulates up the food web, either directly from incidental uptake by herbivorous fish or indirectly by carnivorous fish . After the consumption of coral reef fish contaminated with ciguatoxin, people experience potentially severe acute neurologic, gastrointestinal and cardiac symptoms as well as, in some cases, chronic neurologic symptoms lasting weeks to months , . Ciguatera occurs globally, in coastal tropical waters, and is particularly prevalent across the PICTs. Cases of ciguatera have also been reported in temperate regions of the world due to travel and coral reef fish export. Ciguatera poisoning is often under-diagnosed and under-reported, with only 2 to 10% of cases reported to health authorities (Friedman et al 2008). Estimates of the incidence of ciguatera in Oceania have ranged from 0.5/10,000/year in Hawaii to 5,850/10,000/year in French Polynesia . Fish is the staple protein source in many PICT communities, with many islands in the region suffering ongoing outbreaks of ciguatera leading to potentially significant impacts on large portions of the population of small island communities when toxic fish are consumed .
Dinoflagellates o