When I teach food service folks a certified food protection manager class I often stumble over the pronunciation of ciguatera poisoning (the New York Times says it’s sig-WAH-terra – I’ll go with that). The toxin is produced by a dinoflagellates (usually Gambierdiscus toxicus which lives on algae or dead coral) and is eaten up by sporting fish like barracuda, amber jack and some types of grouper and snapper.

The fish eat the small organisms and overtime bioaccumulate the toxin in their tissue.

Then folks who like fish, eat it and get sick. Even if it’s cooked.

The toxin is pretty heat stable (FAO says that even 20 min of cooking at 158°F/70°C for 20 min was insufficient to fully denature the toxin protein). Ciguatera was responsible for an outbreak aboard a cargo ship earlier this year, leading to a code orange at a Saint John, New Brunswick (that’s in Canada) hospital. Thirteen crew members fell ill within hours of eating toxin-ridden fish.

Elizabeth Radke and colleagues at Florida’s Emerging Pathogens Institute published research earlier this week estimating that ciguatera is a much larger issue than the reported illness disease trackers believe. Public health data show that barracuda, grouper and amberjack caught from subtropical waters in the Bahamas and the Florida Keys are key risk factors.

From the paper:

Our finding that only 7% of diagnosed cases were reported to the FDOH may at first glance be surprising. However, for many notifiable diseases, physicians rely on laboratory reporting of cases, which is not available for ciguatera because of the lack of a diagnostic laboratory test. In addition, because ciguatera is not a communicable disease, physicians may be unaware that it is a notifiable condition in the State of Florida. One survey in Miami-Dade County found that only 47% of physicians knew that ciguatera was notifiable and this is likely to be lower in less endemic parts of the state.

We also found that Hispanics experience the highest rate of ciguatera illness in Florida, possibly due to more frequent consumption of barracuda than non-Hispanics. This may represent an opportunity for targeted, culturally relevant educational messaging after more narrowly identifying high-risk cultural groups.

Know your target audiences, their practices and communicate to them directly.