Thawed tuna steaks, poisoning cases in Italy

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The Ministry of Health today registered in the European Rapid Alert System on Food Safety reports of several cases of poisoning from yellowfin tuna steaks thawed with added water. (1)

Pending firm news on affected operators and at-risk batches, food service and food delivery operators are advised to suspend use of this type of product unless written assurances are received from suppliers.

Poisoning from adulterated tuna, cases reported by Pavia Poison Control Center

The Pavia Poison Control Center(CAV) has identified seven cases of severe nitrite/histamine poisoning related to consumption of fresh tuna as of 1.6.21. Clinically established cases occurred at:

– Lavagna (GE), 1.6.21, 1 adult

– Brindisi, 3.6.21, 2 adults and 2 children,

– Benevento, 3.6.21, 2 adults.

Other cases of food poisoning following consumption of tuna steaks have also been reported in Tuscany. (2) Despite the severe clinical condition (methemoglobinemia), immediate administration of the antidote (methylene blue) prevented lethal outcomes. The cases were reported to the relevant ASL veterinary offices for inspection and control.

Tuna poisoning. Symptoms and diagnosis

The Poison Control Center’s recommendations to the national health care system:

– Immediately consider suspicion of intoxication when accessing pale and/or cyanotic patients with rapid-onset symptoms unrelated to previous illness. Gastrointestinal complaints and altered consciousness (e.g., syncope) may also be present,

– Make immediate determination of methemoglobinemia (including on venous sampling) by hemogasanalysis or specific pulse oximeters (if available),

– Evaluate each case with syncope due to intoxication with methemoglobinemia before starting different diagnostic routes.

Treatment with antidote

The CAV (Poison Control Center) therefore recommends:

– Check the availability of the antidote (methylene blue) in emergency hospital services and equip territorial emergency vehicles (medical cars) with vials of methylene blue, (2)

– Report immediately to the CAV for any suspected case, for information on antidotal therapy (dose, mode and time of administration, contraindications), other investigations and treatment,

– Collect samples for specific analytical diagnosis (causative agent) in any other cases.

Ittica Zu Pietru, defective alert

On 4.6.21 , the Ministry of Health published a recall of a single batch of ‘thawed tuna steak with added water‘ produced by Ittica Zu Pietro Srl based in Bisceglie (BA). (4) The recall notice refers to FAO fishing area 77 (Central Eastern Pacific Ocean) and an unacceptable reason for recall, which the authorities should have corrected. Not ‘anoxic syndrome‘ (the effect) but ‘histamine contamination,’ or perhaps ‘nitrite adulteration‘ (the cause). (5,6)

On 7.6.21, the ministry itself notified in RASFF(Rapid Alert System on Food and Feed) theserious food safety risk on slices of yellowfin tuna thawed in Italy, ‘raw material origin Spain‘. (1) Pending clarification on the actual extent of the crisis-all the more so in the face of an untimely recall that followed rather than preventing dangerous food poisoning-operators are advised to exercise caution.

Dario Dongo

Notes

(1)RASFF (Rapid Alert System on Food and Feed). Notification 2021.2933. Foodborne outbreak suspected to be caused by thawed yellowfin tuna steaks (Thunnus albacares) with added water from Italy, with raw material from Spain. 7.6.21, https://webgate.ec.europa.eu/rasff-window/screen/notification/481311

(2) Florence, nine people end up in hospital after eating fresh tuna at two restaurants. Asl investigations. The Daily Fact. 4.6.21, https://www.ilfattoquotidiano.it/2021/06/04/firenze-nove-persone-finiscono-in-ospedale-dopo-aver-mangiato-tonno-fresco-in-due-ristoranti-indagini-dellasl/6220209/

(3) Emergency services are required to update data on the availability of methylene blue by accessing the National Antidote Database on the Pavia CAV website(http://www9.unipv.it/reumatologia-tossicologia/cav/CAV/index.php?c=2&op=5&cosa=1 ) in order to facilitate its rapid availability where it is lacking

(4) Manufacturer’s identification mark IT 2830 CE, lot 2008217/21, expiration 7.6.21. V. https://www.salute.gov.it/imgs/C_17_PubblicazioneRichiami_1224_azione_itemAzione0_files_itemFiles0_fileAzione.pdf

(5) Ittica Zu Pietro Srl on the page dedicated to yellowfin tuna proclaims that ‘inside the factory, processing is done flawlessly!(https://www.itticazupietro.com/tonno-spada). Without even referring to the current recall

(6) For further discussion, see Dario Dongo’sebook ‘Food Security. Mandatory Rules and Voluntary Standards’. https://www.greatitalianfoodtrade.it/libri/sicurezza-alimentare-regole-cogenti-e-norme-volontarie-il-nuovo-libro-di-dario-dongo