The current estimated global incidence annually is 20,000 to 50,000 people, though a large number of cases are believed to go unreported. Due to the limited habitats of ciguatoxin-producing microorganisms,<unk>  is common only in subtropical and tropical waters, particularly the Pacific and Caribbean, and usually is associated with fish caught in tropical reef waters. Exportation of reef fish, as well as tourism, often account for cases that develop in other regions. Ciguatoxin is found in over 400 species of reef fish. Avoiding consumption of all reef fish 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<unk> . 20th and 21st centuries *In 1994, Nobel-Prize winning novelist Saul Bellow nearly died from<unk>  after eating red snapper on vacation in St. Martin, fictionalized in his last novel Ravelstein. *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<unk>  poisoning was reasonably likely to occur from eating several species of fish caught as far as from the sanctuary. *From August 2010 to July 2011, there were eight outbreaks of<unk>  in New York City. Outbreaks were linked to barracuda and grouper purchased at a fish market in Queens, New York. *In the first quarter of 2012, two restaurants in Lanzarote, Canary Islands are thought to have been the source of<unk>  poisoning, leading to new fishing regulations issued 18 April 2012. The first outbreak was reported in February 2012. Diners suffered with vomiting, diarrhoea and abdominal pain several hours after eating amberjack. The second case was in early April affecting six people who live in Lanzarote and had all eaten amberjack at a local restaurant. *In March 2014, nine people were hospitalised near Macksville, New South Wales, Australia after a recreational fisherman caught a 55 lb Spanish mackerel (Scomberomorus commersoni) off Scott's Head (NSW) and then shared it among his friends and family. *In April 2015, fourteen crew members of a potash ship were hospitalized in Saint John, New Brunswick, Canada after consuming tropical fish obtained from international waters. After the incident, Marine Catering Services issued a reminder to seafarers that the UK Food Act makes it illegal for crews to fish for food from their vessels. *In September 2016, a British holidaymaker died while on honeymoon in Mexico after consuming fish contaminated with the algae that causes<unk>  poisoning. *During October 2016, more than 100 people suffered from<unk>  poisoning after eating fish heads supplied by an export firm in Mangalore, India.
Ciguatera fish poisoning
Scombroid food poisoning
Shellfish poisoning
Tin poisoning
Sulfuric acid poisoning
Chinese alchemical elixir poisoning
Strychnine poisoning
Ethylene glycol poisoning