Poisoning due to tutin in honey-a report of an outbreak in New Zealand.

AIM: In autumn 2008, an outbreak of toxic honey poisoning was identified. The outbreak was not recognised initially until three cases from one family group presented to hospital, with a common factor of recent consumption of locally produced honey. The aim of this study was to investigate potential cases of this honey poisoning and determine which toxin was involved. METHOD: The incident was investigated retrospectively by Waikato District Health Board's Population Health unit and the New Zealand Food Safety Authority (NZFSA). Identified patients were followed up by questionnaire to gather case information. HortResearch (now Plant and Food Research) tested honey samples for toxins. RESULTS: The causative agent was identified as tutin, which comes from the New Zealand native plant tutu (Coriaria arborea) which has long been known as a potential source of contamination of honey produced in the warmer parts of New Zealand. Retrospective case investigation identified a total of 22 possible or probable cases, based on a clinical case definition. The spectrum of toxic effects reported were broadly similar to those previously described for tutin, derived either directly from the plant itself or indirectly from honey. There were 13 samples of honey, linked to symptomatic individuals, which were available for testing. Of these, 10 were positive for tutin and its hydroxy metabolite hyenanchin (hydroxytutin) and one was positive for hyenanchin alone. CONCLUSION: Toxic honey production is a significant risk in parts of New Zealand. Beekeepers and health professionals need to be informed of this risk and know how best to manage it. Due to this poisoning incident, public and professional awareness of honey poisoning has been substantially enhanced. This incident led to development of new food safety standards for New Zealand honey.

Talking about TB: multicultural diversity and tuberculosis services in Waikato, New Zealand.

AIM: To explore the diversity of opinion amongst different refugee and minority group representatives about tuberculosis, and to examine the provision of services and their effectiveness in the Waikato Health District, New Zealand. METHODS: Open-ended qualitative interviews with the representatives of seven minority populations were undertaken. The interviews focused on the cultural differences in the approach of minority populations to health issues and on the accessibility of health services to these population groups. Participants expressed their opinions about how health services, and more specifically about how tuberculosis (TB) health services could be improved. RESULTS: Important cultural differences between the minority populations were elucidated by community representatives that may determine the interpretation of symptoms and timing of presentation at medical services, the appropriate cultural processes to be followed in the consultation, and adherence to prescribed treatment. CONCLUSIONS: The absence of health services oriented towards specific minority and refugee groups, and communication difficulties with healthcare providers, are important cultural barriers to TB control in Waikato. Recognition of the diversity of these populations, and the cultural and structural barriers that they face in accessing health services in Waikato and other similar health districts in New Zealand, is needed. The development of strategies is required to reduce barriers to TB treatment so that patients from diverse cultural backgrounds can be diagnosed early and effectively treated.