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    Paralytic Shallfish Poisoning

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    Kyla Barrera Tabungar
    1) An investigation was conducted into an outbreak of Paralytic Shellfish Poisoning among residents in West Samar, Philippines in June-July 2013 that affected 31 people and killed 2. 2) Laboratory testing found high levels of saxitoxin in mussels harvested from Cambatutay Bay, which was not being monitored for harmful algal blooms despite previous outbreaks. 3) Consuming mussel broth and eating mussels from the contaminated bay in multiple meals were identified as risk factors for illness. Improved monitoring and bans on shellfish harvesting and consumption were recommended.

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    Paralytic Shallfish Poisoning

    Uploaded by

    Kyla Barrera Tabungar
    40 views33 pages
    1) An investigation was conducted into an outbreak of Paralytic Shellfish Poisoning among residents in West Samar, Philippines in June-July 2013 that affected 31 people and killed 2. 2) Laboratory testing found high levels of saxitoxin in mussels harvested from Cambatutay Bay, which was not being monitored for harmful algal blooms despite previous outbreaks. 3) Consuming mussel broth and eating mussels from the contaminated bay in multiple meals were identified as risk factors for illness. Improved monitoring and bans on shellfish harvesting and consumption were recommended.

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    1) An investigation was conducted into an outbreak of Paralytic Shellfish Poisoning among residents in West Samar, Philippines in June-July 2013 that affected 31 people and killed 2. 2) Laboratory testing found high levels of saxitoxin in mussels harvested from Cambatutay Bay, which was not being monitored for harmful algal blooms despite previous outbreaks. 3) Consuming mussel broth and eating mussels from the contaminated bay in multiple meals were identified as risk factors for illness. Improved monitoring and bans on shellfish harvesting and consumption were recommended.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    40 views33 pages

    Paralytic Shallfish Poisoning

    Uploaded by

    Kyla Barrera Tabungar
    1) An investigation was conducted into an outbreak of Paralytic Shellfish Poisoning among residents in West Samar, Philippines in June-July 2013 that affected 31 people and killed 2. 2) Laboratory testing found high levels of saxitoxin in mussels harvested from Cambatutay Bay, which was not being monitored for harmful algal blooms despite previous outbreaks. 3) Consuming mussel broth and eating mussels from the contaminated bay in multiple meals were identified as risk factors for illness. Improved monitoring and bans on shellfish harvesting and consumption were recommended.

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    © All Rights Reserved
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    Paralytic Shellfish Poisoning:

    Implications of Absent Red Tide Monitoring


    in a Mussel Farm- Visayas, Philippines, 2013

    Paola Katrina G. Ching, RN, MAN


    Epidemiology Bureau
    Department of Health

    Integrity and Excellence in Field Epidemiology


    Introduction
    • July 2, 2013- report on PSP* among 21
    residents of Gallego & Bahay Village in
    Tarangan, West Samar

    • July 3, 2013- coordinated


    with CHD** Eastern
    Visayas

    • July 8, 2013 - team


    was sent to investigate

    *Paralytic Shellfish Poisoning


    Integrity
    **Center for Health and
    & Development Excellence in Field Epidemiology
    Objectives
    1. To confirm the diagnosis
    2. To determine source & mode of
    transmission
    3. To identify risk factors
    4. To recommend control and
    preventive measures

    Integrity and Excellence in Field Epidemiology


    Background
    Tarangnan

    Villages: 41
    Population: 25, 703
    Samar Bay: Cambatutay
    Industry:
    Agriculture,
    Fishing
    Mussel Farm
    5,000 metric tons
    shellfish production/yr

    Integrity and Excellence in Field Epidemiology


    Red Tide Monitoring Stations
    West Samar

    Cambatutay
    Bay
    Irong-Irong Bay

    Maqueda Bay

    Integrity and Excellence in Field Epidemiology


    Methods
    I. Descriptive Study
    • Review of Records
    • Face to face Interview
    • Key Informant Interview
    • Environmental Survey
    • Laboratory Examination
    Mussel
    Human (Urine & Blood)
    Seawater

    II. Case-Control Study


    1:3 unmatched
    Integrity and Excellence in Field Epidemiology
    Case Definition
    Suspect Case
    Previously well individual from Gallego & Bahay Village in
    Tarangan, Samar who developed any motor, and/or
    sensory with gastrointestinal symptoms after a meal from
    June 29 to July 4, 2013.

    Confirmed Case
    Suspect case with a positive Saxitoxin in blood or urine.

    Control
    Any resident of Gallego Village & Bahay Village in
    Tarangan, Samar who did not develop any sensory, motor
    & gastrointestinal symptoms after a meal.

    Integrity and Excellence in Field Epidemiology


    Fig. 1: PSP Cases by Onset of Illness (N=31)
    Tarangnan, West Samar, June 29-July 4, 2013
    No. of Cases IP: 1 Hr to 23 Hrs (Median= 11 hrs)
    7
    6 Death Cases
    5 CFR= 6%
    4
    3
    2
    1
    0

    28-Jun 29-Jun 30- 1-Jul 2-Jul 3-Jul 4-Jul July


    Jun 5- 8
    Date of Onset of Illness
    Integrity and Excellence in Field Epidemiology
    Fig 2. PSP Attack Rate per Village,
    Tarangnan, West Samar, June 29-July 4, 2013
    Bahay Village
    Population: 710
    No. of Cases: 6
    AR/100: 7
    Bahay
    Gallego

    Gallego Village
    Population: 429
    No. of Cases: 25
    AR/100: 4
    Villages with PSP
    Adjacent Villages

    Integrity and Excellence in Field Epidemiology


    Fig 3. PSP Cases by Age Group & Sex (N=31)
    Tarangnan, West Samar, June 29-July 4, 2013
    Age Group Male Female

    > 60
    51-60
    41-50
    31-40
    21-30
    11-20
    1- 10
    <1

    6 4 2 0 2 4 6
    No. of Cases
    Integrity and Excellence in Field Epidemiology
    Fig 4. Signs & Symptoms of PSP Cases (N=31)*
    Tarangnan, West Samar, June 29-July 4, 2013
    Signs & Symptoms

    Numbness 90

    Dizziness 65

    Lightheadedness 55

    Headache 48

    Burning sensation 32

    Tingling sensation 23

    Others 19

    0 10 20 30 40 50 60 70 80 90 100
    *Multiple responses Percentage

    Integrity and Excellence in Field Epidemiology


    Fig. 5. PSP Cases Most Sources of Food (N=31)
    Tarangnan, West Samar, June 29-July 4, 2013

    Buy from
    Market
    (13, 42%)

    Harvest from
    Bay
    (18,58%)

    Integrity and Excellence in Field Epidemiology


    Fig. 6. Types of Food Consumed by PSP Cases (N=31)*
    Tarangnan, West Samar, June 29-July 4, 2013

    Type of Food

    Mussel 100

    Fish 95

    Vegetables 89

    Oyster 10

    0 20 40 60 80 100
    *Multiple responses Percentage

    Integrity and Excellence in Field Epidemiology


    Fig. 7. Types of Shellfish Preparation by PSP Cases (N=31),
    Tarangnan, West Samar, June 29-July 4, 2013

    Type of Preparation

    Boiled Mussel 35

    Sauteed Mussel, with


    29
    soup

    Sauteed Mussel, dry 23

    Raw Mussel in
    13
    Vinegar

    0 10 20 30 40 50 60
    Percentage
    Integrity and Excellence in Field Epidemiology
    Fig 9. No. of Pieces of Green Mussel Meat Eaten by PSP
    Cases (N=31)
    Tarangnan, West Samar, June 29-July 4, 2013

    6-14 pcs
    Less than 5
    (2, 6%)
    pcs
    (1,4%)

    >15 pcs.
    ( 28,90%)

    Integrity and Excellence in Field Epidemiology


    Laboratory Result
    I. Food Samples
    Sample Site: Cambatutay Bay,
    Gallego Village
    Samples: Green Mussel
    (Perna virides)
    Result: 225 ugSTXeq/100 g
    shellfish meat
    (Normal: < 80 ugSTXeq)

    Source: Bureau of Fisheries & Aquatic Resources

    Integrity and Excellence in Field Epidemiology


    Laboratory Result
    II. Human Serum & Urine Samples
    • No Saxitoxin detected

    III. Water Samples


    • Positive for Pyrodinium bahamense var
    compressum

    Integrity and Excellence in Field Epidemiology


    Key Informant Interview
    • 1983 & 2009- reported PSP
    Case
    • Contaminated bay because
    of a landfill
    • No succeeding monitoring
    • June 2013-
    red discoloration of
    seawater
    • Loss of income for 11
    villages

    Integrity and Excellence in Field Epidemiology


    Environmental Survey

    Coastal areas

    Wastes directly disposed in the shore

    Integrity and Excellence in Field Epidemiology


    Table 5. Risk Factors on Multivariate Analysis,
    Tarangnan, West Samar, June 29-July 4, 2013

    95%
    Confidence
    Factors Odds Ratio Interval p-value
    Consumed atleast 1 cup
    12 2.14-63.15 0.0045
    Broth
    Ate Green Mussel more
    6 1.08-29.45 0.0406
    than one meal

    Integrity and Excellence in Field Epidemiology


    Conclusion
    • Paralytic Shellfish Poisoning outbreak in
    Tarangnan, West Samar
    • High number of cases
    • Case Fatality Rate= 6%
    • Cambatutay Bay-positive for p. bahamense
    var compressum.
    • Green mussel, bivalve shellfish- positive for
    high Saxitoxin level
    • Cases had eaten green mussel & its broth

    Integrity and Excellence in Field Epidemiology


    Discussion
    No Red Tide
    Harvest food
    monitoring

    PSP Cases & Deaths


    Contamination of Seawater Mussel with high
    Saxitoxin
    Consumed atleast 1
    Eat mussel cup of broth
    Near landfill
    Red tide found on More than 1 meal
    surrounding bays
    Integrity and Excellence in Field Epidemiology
    Recommendations
    Bureau of Fisheries & Aquatic Resources

    • To impose a total ban on the harvest, sale &


    consumption of shellfish

    • To assign a permanent point person

    • To include Cambatutay Bay as monitoring


    station
    Integrity and Excellence in Field Epidemiology
    Recommendations
    Local Government Unit of Tarangnan

    • To regulate the total ban of shellfish

    • To create a local task force

    • To conduct coastal clean-up.

    Integrity and Excellence in Field Epidemiology


    Public Health Impact
    35

    30

    25

    20
    No succeeding cases
    15

    10

    0
    June 1-7 8-14 15-21 22-28 29- 4 5-11 12-18 19-25 26- 1 2-8 9-15 16-22 23-29

    July August September

    Integrity and Excellence in Field Epidemiology


    Public Health Impact
    35
    2x a week
    30 monitoring activity

    25

    20

    15

    10

    0
    June 1-7 8-14 15-21 22-28 29- 4 5-11 12-18 19-25 26- 1 2-8 9-15 16-22 23-29

    July August September

    Integrity and Excellence in Field Epidemiology


    Public Health Impact
    35
    Cambatutay bay as a monitoring station
    30 Sampler hired

    25

    20

    15

    10

    0
    June 1-7 8-14 15-21 22-28 29- 4 5-11 12-18 19-25 26- 1 2-8 9-15 16-22 23-29

    July August September

    Integrity and Excellence in Field Epidemiology


    Public Health Impact
    35

    30

    25

    20

    15
    Red Tide Awareness Forum
    10

    0
    June 1-7 8-14 15-21 22-28 29- 4 5-11 12-18 19-25 26- 1 2-8 9-15 16-22 23-29

    July August September

    Integrity and Excellence in Field Epidemiology


    Public Health Impact
    35

    30

    25

    Save Cambatutay Bay Movement


    20

    15 Red Tide Awareness Forum

    10

    0
    June 1-7 8-14 15-21 22-28 29- 4 5-11 12-18 19-25 26- 1 2-8 9-15 16-22 23-29

    July August September

    Integrity and Excellence in Field Epidemiology


    Public Health Impact
    35

    30

    25

    Save Cambatutay Bay Movement


    20

    15 Red Tide Awareness Forum

    10

    5
    Coastal clean-up & Mangrove
    planting
    0
    June 1-7 8-14 15-21 22-28 29- 4 5-11 12-18 19-25 26- 1 2-8 9-15 16-22 23-29

    July August September

    Integrity and Excellence in Field Epidemiology


    Public Health Impact
    35 September
    2x a week 4, 2013-
    30 monitoring activity Ban lifted up
    25

    20

    15

    10

    0
    June 1-7 8-14 15-21 22-28 29- 4 5-11 12-18 19-25 26- 1 2-8 9-15 16-22 23-29

    July August September

    Integrity and Excellence in Field Epidemiology


    Public Health Impact
    35 September
    2x a week 4, 2013-
    30 monitoring activity Ban lifted up
    25

    20
    2x a month
    15 monitoring

    10

    0
    June 1-7 8-14 15-21 22-28 29- 4 5-11 12-18 19-25 26- 1 2-8 9-15 16-22 23-29

    July August September

    Integrity and Excellence in Field Epidemiology


    Paralytic
    Shellfish
    Poisoning

    Integrity and Excellence in Field Epidemiology

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