Epidemiological Scenario of Anisakidosis in Spain Based on Associated Hospitalizations: The Tip of the Iceberg.

BACKGROUND: The risk of infection with Anisakis has been recognized for some time, but it is now emerging due to major awareness, better diagnostic techniques, and increasing preference for raw or lightly cooked food. Spain has the second-highest reported incidence after Japan, though the real anisakidosis burden is unknown because of the scarcity of epidemiological data. This study provides a 19-year review of anisakidosis-related hospitalizations describing epidemiological trends and patient characteristics. METHODS: We performed a retrospective descriptive study using the Spanish Hospitalization Minimum Data Set from 1997 to 2015. Hospitalization rates were calculated and spatial distribution of cases and their temporal behavior were assessed. Clinical characteristics were described, including related codiagnoses and procedures. RESULTS: A total of 2471 hospital discharges were identified. A continuous increasing trend was observed, with several peaks. Most affected communities were located in the northwest inland part of the country. Almost 54% of hospitalized patients were male, with a mean age of 51.3 years. Median length of stay was 5 days, and the hospitalization median cost around €2900. Fatal outcome occurred in 0.5%. Most frequent codiagnoses were digestive diseases, mainly intestinal obstruction. Urticaria, anaphylactic reaction, and angioneurotic edema were only recorded in 2.2%, 2.4%, and 1.2%, respectively. CONCLUSIONS: Knowing that hospitalization is unusual in anisakidosis, we offer calculations of the real disease burden. Improving disease surveillance in parallel to disease control will be useful both in gaining extended disease knowledge and reducing morbidity and related costs.

Molecular epidemiology of Anisakis spp. in blue whiting Micromesistius poutassou in eastern waters of Spain, western Mediterranean Sea.

The infection of blue whiting Micromesistius poutassou from the western Mediterranean Sea, off the eastern coast of Spain, with larvae of Anisakis spp. was studied. Between April 2016 and April 2017, 140 fish were analyzed. Total epidemiological data showed that the prevalence of Anisakis spp. was 29.3% and the mean intensity 1.8. Of the 74 larvae collected, 61% were type I and the remaining 39%, type II. Of the former, 91% were molecularly identified as Anisakis pegreffii (P = 19.3%; MI = 1.4), 2.2% as Anisakis simplex s.s. (P = 0.7%; MI = 1.0), while the rest (6.7%) showed a recombinant genotype between the two (P = 2.1%; MI = 1.0). All the type II larvae analyzed were molecularly identified as Anisakis physeteris (P = 10.0%; MI = 2.1). Three fish (2.1%) were found to have larvae in the muscle, while two were found with 1 larva of A. pegreffii and one with two larvae (1 A. simplex s.s. and 1 A. pegreffii). Statistical analysis showed that the prevalence of Anisakis spp. in blue whiting was higher in spring than in autumn (P < 0.001), probably due to the greater size (and age) of the fish and related to factors as diet shift, accumulation with age and higher food intake. Analysis of the data suggested that blue whiting were first infected with Anisakis type I (mean age 2.3 years) and later with Anisakis type II (mean age 2.7 years), probably due to the diet changing with age, with the incorporation of the paratenic/intermediate host species of these parasites. In any case, the public health authorities must continue to emphasize the need for suitable thermal treatment (freezing or cooking) of the fish prior to consumption.