Author | Cardoso, Cristiane Wanderley | |
Author | Silva, Monaise Madalena Oliveira e | |
Author | Bandeira, Antônio Carlos | |
Author | Silva, Renan Bispo | |
Author | Prates, Ana Paula Pitanga Barbuda | |
Author | Soares, Enio Silva | |
Author | Silva, Jose Jorge Moreno | |
Author | Souza, Lazaro Jose Rodrigues de | |
Author | Souza, Mirela Maisa da Silva | |
Author | Muhana, Marcela Almeida | |
Author | Pires, Rosildete Silva Santos | |
Author | Araujo Neto, Jose Fernando | |
Author | Santos, Manuela Sampaio Souza | |
Author | Mafra Junior, Luiz Laureno | |
Author | Alves, Thiago Pereira | |
Author | Schramm, Mathias Alberto | |
Author | Ribeiro, Guilherme Sousa | |
Access date | 2021-12-07T11:47:39Z | |
Available date | 2021-12-07T11:47:39Z | |
Document date | 2021 | |
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. | pt_BR |
ISSN | 0140-6736 | pt_BR |
URI | https://www.arca.fiocruz.br/handle/icict/50193 | |
Description | 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, Brazil | pt_BR |
Sponsorship | Brazilian Ministry of Health for providing
fish analysis, and the Central Laboratory of Bahia
(LACEN, Salvador, Brazil), Oswaldo Cruz Foundation
(FIOCRUZ, Salvador, Brazil), Adolf Lutz Institute (S~ao
Paulo, Brazil), Federal University Institute of ABC
(Santo Andr e, Brazil), Federal Institute of Santa Catarina
(Itaja ı, Brazil), and Food and Drugs Administration
(FDA, Alabama, USA) for all laboratory analysis. We
also thank the health professionals of Salvador and all
patients for providing important information during
our epidemiological investigations. This study was supported
by the Centre for Strategic Information and
Health Surveillance (CIEVS), Secretary of Health of Salvador;
the Oswaldo Cruz Foundation; and the Federal
University of Bahia. Guilherme Ribeiro receives a
research scholarship from Brazilian National Council
for Scientific and Technological Development (CNPq). | pt_BR |
Language | eng | pt_BR |
Publisher | Elsevier | pt_BR |
Rights | open access | pt_BR |
Subject in Portuguese | Rabdomiólise | pt_BR |
Subject in Portuguese | Doenças Transmitidas por Alimentos | pt_BR |
Subject in Portuguese | Saúde pública | pt_BR |
Subject in Portuguese | Saúde global | pt_BR |
Subject in Portuguese | Surto da doença | pt_BR |
Subject in Portuguese | Vigilância | pt_BR |
Subject in Portuguese | Epidemiologia | pt_BR |
Title | Haff Disease in Salvador, Brazil, 2016-2021: Attack rate and detection of toxin in fish samples collected during outbreaks and disease surveillance | pt_BR |
Type | Article | pt_BR |
DOI | 10.1016/j. lana.2021.100092 | |
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. | pt_BR |
Affilliation | "Múltipla ver em Notas" | pt_BR |
Subject | Rhabdomyolysis | pt_BR |
Subject | Haff disease | pt_BR |
Subject | Foodborne disease | pt_BR |
Subject | Palytoxin | pt_BR |
Subject | Public health | pt_BR |
Subject | Global health | pt_BR |
Subject | Outbreak | pt_BR |
Subject | Surveillance | pt_BR |
Subject | Epidemiology | pt_BR |