Title : The largest histamine poisoning outbreak in Brazil: An experience report from a one health perspective in Fernando de Noronha
Abstract:
Background: Histamine poisoning is a foodborne illness associated with the consumption of improperly preserved fish and represents a major public health concern, particularly in island territories that rely heavily on artisanal fisheries and tourism. The One Health approach provides an integrated framework to understand this condition by addressing the interactions among human health, food safety, environmental factors, and fish production practices.
Objective: To report the investigation and response to the largest documented histamine poisoning outbreak in Brazil, which occurred in Fernando de Noronha (Pernambuco State), highlighting the integrated surveillance and health education actions developed under a One Health perspective.
Case Report: Between 2015 and 2016, 37 confirmed cases of histamine poisoning were identified across eight epidemiological clusters. Laboratory analyses detected histamine concentrations far exceeding the limits established by Brazilian legislation. Sanitary inspections revealed critical failures throughout the fish production chain, including inadequate refrigeration, insufficient use of ice during fishing and transportation, and poor food handling practices. An integrated intervention involving Health Surveillance, Epidemiological Surveillance, laboratory monitoring and health education targeted fishermen, food handlers, restaurant owners and the local community, enabling identification of outbreak determinants and implementation of preventive measures.
Conclusion: Coordinated actions integrating surveillance, food safety, health education and community engagement were essential to interrupt the outbreak and prevent new cases. This experience reinforces the value of the One Health approach for preventing and responding to foodborne diseases in vulnerable island territories.
