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, Oct. 15. 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. 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 percent 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.
