Thursday, November 11, 2010

Turtle Poisoning in Chuuk

This message was originally distributed on the CTURTLE listserve
on Nov. 12, 2010. I is posted here on behalf of Dr. Vita A. Skilling,
Secretary of the Department of Health and Social Affairs, FSM National
Government, Palikir Pohnpei.

Turtle Poisoning in Murilo Atoll, Chuuk State, Federated States of
Micronesia (FSM).

On Sunday, October 17th, 2010, the Federated States of Micronesia
(FSM) Department of Health and Social Affairs (DHSA) and the World
Health Organization (WHO) were notified of the sudden death of three
children and the sickening of approximately 20 other persons on
Murilo Island, Chuuk State. The illness was suspected to be the
result of mass consumption of a hawksbill turtle (Eretmochelys
imbricata) which had been prepared and served on the afternoon of
Friday, October 15th. Upon receipt of the reports of sudden illness,
an emergency response team was dispatched to Murilo to set up a field
hospital for treatment of victims. Concurrently, an investigation
team was assembled to confirm the cause of the outbreak, describe the
epidemiology of cases, and provide recommendations for control.

The investigative team conducted interviews with key members of the
community in order to determine the cause of the outbreak, conducted
environmental investigation, and questioned all sick persons and a
large proportion of healthy community members.

Four children and two adults died in the outbreak, and approximately
91 others were sickened; approximately 80% of those who ate turtle
became ill. A variety of samples were collected for analysis, though
no autopsies were performed. No laboratory results are available at this time.

The investigators concluded that turtle poisoning (also called
chelonitoxism) was the cause of the mass illness on Murilo; there
does not appear to be any other significant explanation for the mass
illness. Persons from Murilo affected by the illness are not a risk
to others. Because all of the tissue from the turtle has been
consumed or otherwise disposed of, there is no remaining turtle meat
which could lead to further illness. There is no reason to suspect
that reef fish around Murilo are toxic.

The range of illness described in the investigation is consistent
with previously reported cases of chelonitoxism. There is no antidote
or other medicine that can specifically treat chelonitoxism. Children
are expected to be more severely affected. It is not clear why the
two adult males developed serious disease and died, though they may
have consumed a larger amount of turtle than other victims.

All turtles, but particularly hawksbill turtles, are known to be
capable of being poisonous. There is no way to determine which
individual turtles are or are not poisonous. Because there is nothing
unique about Murilo that would result in only Murilo turtles being
toxic, there is no justification for continuing to single out Murilo
(or the Hall Islands) as being at increased risk for chelonitoxism.
Instead, it should be emphasized that any turtles or their eggs,
anywhere, may be toxic.

Since all turtles and their eggs are capable of being toxic, the only
way to insure public health is to avoid consuming any turtles or
their eggs. The FSM DHSA therefore recommends a complete ban on the
consumption of all species of turtles and their eggs in Chuuk and the
rest of FSM. The health sector will be working with lawmakers and
other relevant stakeholders to update turtle management policies.

Though this incident has come to an end, future incidents are certain
to occur unless action is taken to alter turtle-eating behavior in
Chuuk and the rest of FSM.

Boris Pavlin MD MPH
Medical Officer / Country Liaison Officer
Country Liaison Office for Northern Micronesia
World Health Organization

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