Outbreak of ciguatera fish poisoning on a cargo ship in the port of hamburg.

BACKGROUND: Ciguatera fish poisoning is a travel-related illness characterized by a combination of gastrointestinal and neurological symptoms in persons who eat ciguatoxic seafood in endemic areas. METHODS: In 2009, an outbreak of the disease on a refrigerator vessel in the port of Hamburg was investigated. The ship's crew fell ill after they ate fish from a catch in the Caribbean 2 weeks earlier. All 15 sailors on board were examined by port medical officers. Samples of blood and stool specimens were taken from symptomatic sailors. The frozen fish was secured for the prevention of further disease spreading and additional diagnostic tests. RESULTS: All but one sailor ate the fish. The intoxication resulted in gastrointestinal or neurological symptoms in all 14 sailors who consumed the fish and persisted in varying degrees in 93% of sailors over at least 14 days. No fatality occurred, but two seamen were "unfit for duty" on the ship due to severity of symptoms. The diagnosis was supported by the fact that all seafarers who consumed the same reef fish, experienced typical signs, symptoms, and time course consistent with ciguatera fish poisoning. The fish from the catch in the Caribbean was identified as Caranx sexfasciatus (Bigeye Trevally) and Cephalopholis miniata (Red Grouper). An experimental assay later confirmed presence of the ciguatoxin in the fish. CONCLUSIONS: Sailors are an occupational group at risk for ciguatera fish poisoning due to potentially unsafe food sources during international travel. Even if no fatality occurred, the disease affected marine operations due to high attack rates and chronicity of symptoms. Medical doctors must be aware that ciguatera fish poisoning is a risk for seafarers traveling in tropical and subtropical areas. Stocking of food in affected ports from safe sources, adequate training of ship cooks, and informing sailors about the risk of fishing are needed to prevent disease occurrence in seafarers in international trade and traffic.

Public health significance of chickenpox on ships - conclusions drawn from a case series in the port of Hamburg.

BACKGROUND: Despite international notification requirements, the magnitude of disease transmission on board ships remains undetermined. This case series aims to exemplify that varicella aboard ships is a topic of interest for maritime medicine and of public health significance. MATERIAL AND METHODS: Systematic presentation of cases of chickenpox reported to the Hamburg Port Health Authority between November 2007 and April 2008. A systematic literature search on 'ships and chickenpox' was performed. RESULTS: Five crew cases of chickenpox were reported from two passenger ships and two cargo ships. The cases originated from Indonesia (2), the Philippines (1), and Sri Lanka (2). Three cases were notified by the shipmaster, one by a general practitioner, and one by the immigration service. Sources of infection were other crewmembers, passengers, and persons in the home countries. CONCLUSIONS: This description of five varicella cases aboard ships points to the significance of the disease among seafarers. Many seafarers originate from tropical countries where seroconversion to varicella zoster virus generally occurs in late adolescents and adults. Thus, a substantial portion of the crew may be non-immune and have the potential to introduce the disease from their home country to the ship, or are at risk for infection on the ship. Port health authorities, shipmasters, and doctors need to be well informed about the relevance of chickenpox on ships and the recommended control measures. Travellers should be advised to report to the ship doctor with any signs of infectious disease.