Outbreak of Haff Disease along the Yangtze River, Anhui Province, China, 2016.

Huilai Ma,Qi Chen,Tichao Zhou,Yan Ma,Jian Chen,Qun Li,Chao Lin,Shicong Li,Jiabing Wu,Wanwan Ma,Wei Qin,Zhouxiang Cheng,Lei Gong,Bing Zha,Dafang Ge,Dan Li

doi:10.3201/eid2612.191186

Abstract

We investigated a large outbreak of Haff disease that occurred along the Yangtze River in Anhui Province, China, in 2016. Of the 672 cases identified during the outbreak, 83.3% (560/672) occurred in Wuhu and Ma’anshan. Patients experienced myalgia (100%) and muscle weakness (54.7%). The mean value of myoglobin was 330 + 121.2 ng/mL and of serum creatine kinase 5,439.2 + 4,765.1 U/L. Eating crayfish was the only common exposure among all cases; 96.8% (240/248) of implicated crayfish were caught on the shores of the Yangtze River or its connected ditches. Mean incubation period was 6.2 + 3.8 hours. This case–control study demonstrated that eating the liver of crayfish and eating a large quantity of crayfish were associated with an increased risk for Haff disease. The seasonal increases in crayfish population along the Yangtze River might explain the seasonal outbreaks of Haff disease.

Highlights

We investigated a large outbreak of Haff disease that occurred along the Yangtze River in Anhui Province, China, in 2016
In July 2016, the number of rhabdomyolysis cases reported to the National Foodborne Disease Surveillance System (NFDSS) in China dramatically increased in Anhui Province compared with previous years
Case Definition and Finding We defined a case of rhabdomyolysis as any person with elevation in creatine kinase (CK) value plus clinical manifestations of myalgia or limb weakness [10,11]

Summary

Introduction

We investigated a large outbreak of Haff disease that occurred along the Yangtze River in Anhui Province, China, in 2016. Mean incubation period was 6.2 + 3.8 hours This case–control study demonstrated that eating the liver of crayfish and eating a large quantity of crayfish were associated with an increased risk for Haff disease. Haff disease is an unexplained rhabdomyolysis that occurs within 24 hours after consumption of certain types of freshwater or saltwater fish [1,2]. It was first reported in 1924 in the vicinity of Königsberg along the Baltic coast near Frisches Haff [1,2,3]. The objectives of the investigation were to describe the epidemiologic and clinical characteristics, trace back the implicated vectors, identify possible risk factors, and recommend control measures

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Conclusion