Globally, Ciguatera Fish Poisoning endemic regions can be superimposed to coral development areas, delimited by intertropical areas, mostly island regions. The Caribbean basin (with an estimated incidence rate between 12-500 cases/ 100,000 inhab.), the Pacific ocean (by far the one with the highest incidence rates, up to 18,000/100,000 inhab.) and the Indian ocean (<10/100,000 inhab.), represent a population of approximately 400 million peoples potentially at risk. If ciguatera preferentially develop in lagoons and reefs areas, it can also be encountered in deep coastal waters, even if there are no coral reefs.
How many people are affected by Ciguatera annually?
Between 25,000 and 50,000 persons worldwide are affected annually; however, these figures are likely to represent only 20% of actual CFP cases. In fact, despite being considered as the most widespread foodborne illness, CFP statistics suffer from a real lack of completeness, partly due to a lack of information and diagnosis issues (often erroneous or delayed). Furthermore, because there is no efficient and specific treatment, many ciguatera poisoned person prefer to treat themselves without consulting a physician. Thus these unreported cases are not taken into account. This loss of data contributes to the strong underestimation of the actual number of CFP cases.
Imported cases of CFP
Tourism and international trade development as well as the increased interest for “exotic foods”, make temperate regions’ seafood consumers, potential new CFP targets. Hence, the numerous so-called “imported” cases that are reported each year in the US, Canada, France, Germany, etc. It could be a tourist who is poisoned during his trip, but whose symptoms appear only when he is back in his country. It could also be a CFP case due to the consumption of a fish imported from an endemic region of ciguatera.
New propagation areas of CFP
Until recently, ciguatera was considered specific of warm waters, island and coral archipelagos. However in the recent years there is a progressive spread of ciguatera to more temperate region, including Europe, Korea, Hong Kong…, which until now were unaffected. Thus, endogenous cases of ciguatera poisoning (i.e. related to consumption of locally caught fish), were reported in Madeira and the Canary Islands since the early 2000s.
Climate changes (global warming) may be the reason underlying this emergence of new areas at risk of ciguatera by promoting, at a global scale, the proliferation of toxins-producer microorganisms and/or the migration of subtropical and tropical toxic fish to more temperate regions.