Social Ecological Analysis of an Outbreak of Pufferfish Egg Poisoning in a Coastal Area of Bangladesh

M. Saiful Islam International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh; Centers for Disease Control and Prevention, Atlanta, Georgia

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Stephen P. Luby International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh; Centers for Disease Control and Prevention, Atlanta, Georgia

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Mahmudur Rahman International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh; Centers for Disease Control and Prevention, Atlanta, Georgia

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Shahana Parveen International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh; Centers for Disease Control and Prevention, Atlanta, Georgia

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Nusrat Homaira International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh; Centers for Disease Control and Prevention, Atlanta, Georgia

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Nur Har Begum International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh; Centers for Disease Control and Prevention, Atlanta, Georgia

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A. K. M. Dawlat Khan International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh; Centers for Disease Control and Prevention, Atlanta, Georgia

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Rebeca Sultana International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh; Centers for Disease Control and Prevention, Atlanta, Georgia

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Shammi Akhter International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh; Centers for Disease Control and Prevention, Atlanta, Georgia

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Emily S. Gurley International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh; Centers for Disease Control and Prevention, Atlanta, Georgia

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Recurrent outbreaks of marine pufferfish poisoning in Bangladesh highlight the need to understand the context in which the outbreaks occurred. In a recent outbreak investigation, a multidisciplinary team conducted a mixed-method study to identify the demography and clinical manifestation of the victims and to explore different uses of pufferfish, and local buying, selling, and processing practices. The outbreak primarily affected a low income household where an elderly woman collected and cooked pufferfish egg curry. Nine persons consumed the curry, and symptoms developed in 6 (67%) of these persons. Symptoms included vomiting, diarrhea, paresis, and tingling sensation; 2 (22%) persons died. The unstable income of the affected family, food crisis, and the public disposal of unsafe pufferfish byproducts all contributed to the outbreak. A multi-level intervention should be developed and disseminated with the participation of target communities to discourage unsafe discarding of pufferfish scraps and to improve the community knowledge about the risk of consuming pufferfish.

Author Notes

*Address correspondence to M. Saiful Islam, Programme on Infectious Disease and Vaccine Sciences, Health System and Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh. E-mail: saiful@icddrb.org

Financial support: This study was supported by the Centers for Disease Control and Prevention through cooperative award number I-U01-C1000298 and by the Government of the People's Republic of Bangladesh.

Disclosure: None of the authors have any conflicts of interest.

Authors' addresses: M. Saiful Islam and Shahana Parveen, Programme on Infectious Disease and Vaccine Sciences, Health System and Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh, E-mails: saiful@icddrb.org and shahana@icddrb.org. Stephen P. Luby, Programme on Infectious Diseases and Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh and Centers for Disease Control and Prevention, U.S. Embassy, Dhaka, Bangladesh, E-mail: sluby@icddrb.org. Mahmudur Rahman, Institute of Epidemiology Disease Control and Research and National Influenza Centre Mohakhali, Dhaka 1212, Bangladesh, E-mail: mrahman@citechco.net. Nusrat Homaira, Influenza Cluster, Programme on Infectious Disease and Vaccine Sciences, Health System and Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mail: nhomaira@icddrb.org. Nur Har Begum and Shammi Akhter, Institute of Epidemiology Disease Control and Research, Mohakhali, Dhaka 1212, Bangladesh, E-mails: dr.nurhar@yahoo.com and bablybd2002@yahoo.com. A. K. M. Dawlat Khan, Rebeca Sultana, and Emily S. Gurley, Programme on Infectious Disease and Vaccine Sciences, Health System and Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mails: dawlat@icddrb.org, rebeca@icddrb.org, and egurley@icddrb.org.

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