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https://www.arca.fiocruz.br/handle/icict/50193
HAFF DISEASE IN SALVADOR, BRAZIL, 2016-2021: ATTACK RATE AND DETECTION OF TOXIN IN FISH SAMPLES COLLECTED DURING OUTBREAKS AND DISEASE SURVEILLANCE
Doenças Transmitidas por Alimentos
Saúde pública
Saúde global
Surto da doença
Vigilância
Epidemiologia
Haff disease
Foodborne disease
Palytoxin
Public health
Global health
Outbreak
Surveillance
Epidemiology
Author
Cardoso, Cristiane Wanderley
Silva, Monaise Madalena Oliveira e
Bandeira, Antônio Carlos
Silva, Renan Bispo
Prates, Ana Paula Pitanga Barbuda
Soares, Enio Silva
Silva, Jose Jorge Moreno
Souza, Lazaro Jose Rodrigues de
Souza, Mirela Maisa da Silva
Muhana, Marcela Almeida
Pires, Rosildete Silva Santos
Araujo Neto, Jose Fernando
Santos, Manuela Sampaio Souza
Mafra Junior, Luiz Laureno
Alves, Thiago Pereira
Schramm, Mathias Alberto
Ribeiro, Guilherme Sousa
Silva, Monaise Madalena Oliveira e
Bandeira, Antônio Carlos
Silva, Renan Bispo
Prates, Ana Paula Pitanga Barbuda
Soares, Enio Silva
Silva, Jose Jorge Moreno
Souza, Lazaro Jose Rodrigues de
Souza, Mirela Maisa da Silva
Muhana, Marcela Almeida
Pires, Rosildete Silva Santos
Araujo Neto, Jose Fernando
Santos, Manuela Sampaio Souza
Mafra Junior, Luiz Laureno
Alves, Thiago Pereira
Schramm, Mathias Alberto
Ribeiro, Guilherme Sousa
Affilliation
"Múltipla ver em Notas"
Abstract
Background From late 2016 to early 2021, cases of Haff disease, a rare cause of rhabdomyolysis, possibly due to poisoning
by palytoxin-like compounds in seafood, were detected in Salvador, Brazil. Surveillance was established to
detect additional cases aiming at describing the clinical characteristics of the cases, identifying associated factors,
estimating disease attack rate, and investigating the presence of biotoxins and trace metals in selected fish specimens
obtained from cases.
Method Between December/2016-January/2021, surveillance investigated Haff disease suspected cases, and
obtained clinical and fish samples to test.
Findings Of 65 cases investigated during the 2016-2017 outbreak, 43 (66%) had high creatine phosphokinase (CPK)
levels. Among those with laboratory-confirmed rhabdomyolysis, 38 (88%) were hospitalized, 11 (26%) required
intensive care, and three (7%) dialysis. Ingestion of marine fish 24h before disease onset was reported by 74% of the
cases with elevated CPK and by 41% of those without CPK measurement (P=0¢02). Attack rate for individuals who
ate fish related to the outbreak was 55%. Following this outbreak, surveillance identified 12 suspected cases between
2017-2019, and a second outbreak in 2020-2021, with 16 laboratory-confirmed rhabdomyolysis patients (five
required intensive care; one died). No traces of ciguatoxins and metals were detected in fish specimens obtained in
2016, found to be Seriola rivoliana. Some fish samples from 2020 were screened for palytoxin (PlTX)-like compounds
and contained detectable levels of molecule fragments characteristics of isobaric PlTX, ovatoxin-a (OVTX-a),
OVTX-b and OVTX-d.
Interpretation These findings support the hypothesis that compounds related to PlTX accumulated in marine fish
may be the toxic agent causing the disease. Haff disease is a life-threatening condition, requiring clinical suspicion
for patients with sudden-onset myalgia following fish ingestion. Suspected cases should be reported to health
authorities for investigation.
Keywords in Portuguese
RabdomióliseDoenças Transmitidas por Alimentos
Saúde pública
Saúde global
Surto da doença
Vigilância
Epidemiologia
Keywords
RhabdomyolysisHaff disease
Foodborne disease
Palytoxin
Public health
Global health
Outbreak
Surveillance
Epidemiology
Publisher
Elsevier
Citation
CARDOSO, Cristiane Wanderley et al. Haff Disease in Salvador, Brazil, 2016-2021: Attack rate and detection of toxin in fish samples collected during outbreaks and disease surveillance. The Lancet, 2021.DOI
10.1016/j. lana.2021.100092ISSN
0140-6736Notes
aSecretaria Municipal de Sa ude de Salvador, Salvador, Brazil bInstituto Gon¸calo Moniz, Funda¸c~ao Oswaldo Cruz, Salvador, Brazil cSecretaria de Sa ude do Estado da Bahia, Salvador, Brazil dCentro de Estudos do Mar, Universidade Federal do Paran a, Pontal do Paran a, Brazil eInstituto Federal de Santa Catarina, Campus Itajaí, Itajaí, Brazil fFaculdade de Medicina, Universidade Federal da Bahia, Salvador, BrazilRelated items
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