Nearly 30 people in New York City were sickened by ciguatera fish poisoning between August of 2011 and July of 2012, marking a sharp increase in recorded cases for the area, according to a new government report. Ciguatera fish poisoning, or CFP, arises from eating tropical reef fish that have accumulated ciguatoxins. CFP can cause an array of problems, from gastrointestinal symptoms such as nausea, vomiting and diarrhea to cardiovascular symptoms such as irregular heartbeat and dizziness to neurological symptoms, including numbness or tingling and difficulty walking. In the 10 years before the time period covered by this study, only 21 CFP illnesses were reported in the city. Then, over the course of the year included in this analysis, 28 cases were reported to the New York City Department of Health and Mental Hygiene. This spike might have been due to better reporting and investigative capabilities, say the authors, or it may have been due to a change in the diversity of species marketed in the city. The majority of the patients who fell ill during this time (15) were sickened after eating grouper, while 13 had eaten barracuda before their illnesses. The cases were linked to six different outbreaks, with one person experiencing a spontaneous illness. Because ciguatoxins are difficult to detect in the field, health officials recommend education as the best prevention. Seafood distributors and suppliers should be which areas are more likely to harbor fish carrying ciguatoxins, while consumers should know what fish carry a higher risk of CFM, and know where the fish they eat was harvested, recommend the authors. How do consumers know to identify a fish that is more likely to be contaminated with ciguatoxins? “[CFP] occurrence is sporadic in reef areas, so you have to rely on local knowledge of areas that have a history of problems.” said Ken Gall, a seafood technology specialist for the New York Sea Grant at Cornell University Extension, in an emailed statement to Food Safety News. In 2008, the U.S. Food and Drug Administration issued an advisory about an area of the Northern Gulf of Mexico after fish harvested from that region was linked to several CFP cases. Gall said similar warnings have been issued about certain areas of Hawaii. But other than knowing what species of fish are more likely to harbor ciguatoxins, the responsibility of CFP safety lies mainly with harvesters and suppliers, Gall noted. “Consumers must rely on purchasing fish from commercial sources and be wary of fish caught recreationally or from questionable sources when visiting the tropics. Larger predatory fish (like barracuda) are more likely to accumulate high levels of this toxin.” When illnesses do occur, the authors recommend that doctors be alerted immediately so that they are on the lookout for other cases that might be part of the outbreak. After 16 cases of CFP had been identified in New York City between August and September of 2010, the city health department issued a warning to doctors to be on the lookout for symptoms of this type of poisoning. It was that health alert that led a doctor to detect another outbreak that sickened 11 people in November of that year. “This report reflects the importance of surveillance and outreach networks in responding to patients’ histories, including food consumption, that are indicative of CFP,” note the authors. “Reports made to the NYC PCC (poison control center) allowed expeditious and effective action when the first cases of CFP were reported.” The study appears in the February 1 issue of the Morbidity and Mortality Weekly Report.