Scombrotoxin fish poisoning (SFP) is caused by the ingestion of certain fish species with elevated levels of histamine due to decomposition. In the fall of 2019, the Food and Drug Administration (FDA) was notified of 51 SFP illnesses including two hospitalizations from 11 states through consumer complaints received by FDA’s Consumer Complaint System or directly from state partners. A case was defined as an individual who experienced a histamine-type reaction after consumption of tuna imported from Vietnam and an illness onset between August 14, 2019 and November 24, 2019. A traceback investigation was initiated at 19 points-of-service (POS) to identify a common tuna source. FDA and state partners collected a total of 34 product samples throughout the distribution chain including from a case patient’s home, POS, distributors, or at the port of entry. Samples were analyzed by sensory evaluation and/or chemical testing for the presence of histamine. Cases reported exposure to tuna imported from Vietnam. The traceback investigation identified two Vietnamese firms as the sources of the tuna. Twenty-nine samples were confirmed as decomposed by sensory evaluation and/or positive for the presence of elevated levels of histamine by chemical testing. Both Vietnamese firms were placed on Import Alert. Seven U.S. firms and one Vietnamese firm initiated voluntary recalls. FDA released public communication naming the U.S. importers to help suppliers and distributors to identify the product and as a result, effectuate the foreign firm’s recall. This SFP outbreak investigation highlights the complexities of the federal outbreak response, specifically related to imported food. Imported foods present cultural considerations that need to be addressed during outbreak response when timing is critical. Furthermore, collaborating with countries where confidentiality agreements are not in place can limit information sharing and the speed of public health response efforts.
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Research Article|
January 11 2021
An Outbreak Investigation of Scombrotoxin Fish Poisoning Illnesses in the United States Linked to Yellowfin Tuna Imported from Vietnam – 2019
Evelyn Pereira;
Evelyn Pereira
US Food and Drug Administration
4300 River Rd
UNITED STATES
College Park
MD
20740
2405067375
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Elisa L. Elliot;
Elisa L. Elliot
Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland 20740
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Lauren Shade Singleton;
Lauren Shade Singleton
Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland 20740
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Mark Otto;
Mark Otto
Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland 20740
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Adiam Tesfai;
Adiam Tesfai
Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland 20740
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Matthew Doyle;
Matthew Doyle
Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland 20740
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Heather Hawk;
Heather Hawk
Office of Regulatory Affairs, Food and Drug Administration, Jefferson, Arkansas 72079
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Steven Bloodgood;
Steven Bloodgood
Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland 20740
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Ronald A. Benner;
Ronald A. Benner
Center for Food Safety and Applied Nutrition, Food and Drug Administration, Dauphin Island, Alabama 36528
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Mary P. Ross;
Mary P. Ross
Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland 20740
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Allison Scott;
Allison Scott
Office of Regulatory Affairs, Food and Drug Administration, Rockville, Maryland 20857
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Matthew C. Kristof;
Matthew C. Kristof
Office of Regulatory Affairs, Food and Drug Administration, Long Beach, California 90831
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Teresa Fox;
Teresa Fox
Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland 20740
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Brandon Bridgman;
Brandon Bridgman
Center for Food Safety and Applied Nutrition, Food and Drug Administration, Alameda, California 94502
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Nicholas Long;
Nicholas Long
Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland 20740
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Kimberly Livsey;
Kimberly Livsey
Office of Regulatory Affairs, Food and Drug Administration, Atlanta, Georgia 30309
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Alister Rubenstein;
Alister Rubenstein
Office of the Commissioner, Food and Drug Administration, White Oak, Maryland 20993
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Kimberly Garner;
Kimberly Garner
Office of the Commissioner, Food and Drug Administration, White Oak, Maryland 20993
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David Nicholas;
David Nicholas
Bureau of Community Environmental Health and Food Protection, New York State Department of Health, Albany, New York 12237
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Yayu Chuang;
Yayu Chuang
Public Health Laboratory, New York City Department of Health and Mental Hygiene, New York, New York 10016
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Brendalee Viveiros;
Brendalee Viveiros
Center for Food Protection, Rhode Island Department of Health, Providence Rhode Island 02908
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Christopher Waggener;
Christopher Waggener
Division of Consolidated Laboratory Services, Virginia Department of General Services, Richmond, Virginia 23219
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Karl Klontz;
Karl Klontz
Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland 20740
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Stelios Viazis
Stelios Viazis
Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland 20740
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J Food Prot (2021)
Article history
Received:
November 16 2020
Revision Received:
January 04 2021
Accepted:
January 06 2021
Citation
Evelyn Pereira, Elisa L. Elliot, Lauren Shade Singleton, Mark Otto, Adiam Tesfai, Matthew Doyle, Heather Hawk, Steven Bloodgood, Ronald A. Benner, Mary P. Ross, Allison Scott, Matthew C. Kristof, Teresa Fox, Brandon Bridgman, Nicholas Long, Kimberly Livsey, Alister Rubenstein, Kimberly Garner, David Nicholas, Yayu Chuang, Brendalee Viveiros, Christopher Waggener, Karl Klontz, Stelios Viazis; An Outbreak Investigation of Scombrotoxin Fish Poisoning Illnesses in the United States Linked to Yellowfin Tuna Imported from Vietnam – 2019. J Food Prot 2021; doi: https://doi.org/10.4315/JFP-20-456
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