Five people in the Netherlands have been affected by ciguatera poisoning likely caused by frozen red snapper steaks from India.

Those sick had a meal together in mid-May and developed symptoms including gastroenteritis and neurological complaints within three hours. None of them needed hospital treatment.

Tjitte Mastenbroek, a press officer at the Netherlands Food and Consumer Product Safety Authority (NVWA), said probable ciguatoxin poisoning was established.

“One original sealed package of the fish was still available in the household and is currently being analyzed for neurotoxins. Outcome of this analysis of the red snapper fish is expected next week. Currently it is unknown if this case is related to a point source (e.g. a single fish) within the batch, which could have been contaminated with ciguatoxins,” he said.

“The batch concerned has been recalled from sale and consumers in the Netherlands. The product was only offered for sale in the Netherlands in a limited number of toko’s. These small stores have warned their customers through posters and shelf cards in the shops.”

In the Netherlands, the name for an Asian food store is a Toko.

Wide distribution; no other cases reported
Ciguatera is an illness caused by eating fish containing certain toxins. The toxins come from a type of algae, and get into the fish either through it eating the algae, or eating fish that ate the algae.

The frozen red snapper steaks from India and via France were also distributed to Austria, Belgium, Finland, Germany, Italy, Luxembourg, Sweden, Switzerland and the United Kingdom.

Experts from the European Centre for Disease Prevention and Control (ECDC) said they had not seen any reports of ciguatera fish poisoning in the system used for early detection and assessment of multi-country clusters and outbreaks.

The INFOSAN Secretariat said it hasn’t been informed of any additional cases of illness in other countries linked to consumption of the implicated frozen red snapper steaks.

“We have not followed up with India regarding this food safety incident since the concerned product had already long passed its best before date. We will keep following this incident through RASFF,” he said.

An alert from authorities in Luxembourg shows the brand of the affected product is Seapro and it has lot number 85205-2217.

Possible symptoms of poisoning include nausea, vomiting, diarrhea, muscle pain followed by neurological symptoms including headache, temperature reversal (hot things feel cold and cold things feel hot), dizziness, tingling, muscular weakness and irregular heartbeat.

onset of symptoms usually occur within six hours of eating the contaminated product and last a few days or weeks. Ciguatera toxin does not affect the appearance, odor or taste of fish. Freezing or cooking fish once it has been contaminated will not kill the toxin.

Outcome of Ciguatera expert meeting
Meanwhile, the Food and Agriculture Organization (FAO) and World Health Organization (WHO) have published a report on ciguatera.

More than 20 experts met in November 2018 to discuss ciguatera fish poisoning and develop scientific advice for the Codex Committee on Contaminants in Food. They included Ann Abraham and James M Hungerford, of the U.S. Food and Drug Administration, Miriam Friedemann from the German Federal Institute for Risk Assessment (BfR) and Nathalie Arnich, of the French Agency for Food, Environmental and Occupational Health and Safety (ANSES).

Existing data gaps meant it was not possible to complete a full risk assessment but the meeting covered analytical challenges, hazard identification, exposure assessment and risk management considerations.

Ciguatera is a growing worldwide problem because of reasons including climate change. Due to world trade, and consumption of imported fish there are poisoning reports in many countries, such as Canada, Germany, France and the United States. Epidemiological data suggest ciguatoxin poisoning is vastly under‑reported.

Many countries impose fish size restrictions as a ciguatera risk management action, but toxicity of some species is associated to seasonal variations and for most there is no proven correlation between toxicity of fish and their size or weight.