Rise in Infections Prompts a New County Warning on Seafood Risks

An increase in serious infections linked to consumption of raw oysters in 1995 has prompted Los Angeles County health officials to reissue a warning about the dangers of eating raw or undercooked seafood.

There were at least five cases of Vibrio vulnificus, including two deaths, from individuals reporting recent raw oyster consumption in the county last year.

V. vulnificus is rare compared to other food-borne illness, but its high fatality rate--about 50%--and severe symptoms have made it a public health concern.

“V. vulnificus is characterized by primary septicemia [blood poisoning] that often leads to cellulitis [inflamed muscle tissue], shock and death in over half of cases,” the county’s “Public Health Letter” reported. “Among those who survive, surgical amputation of gangrenous limbs is often required.”

California is one of the few states that requires a warning label wherever oysters from the Gulf of Mexico are sold. The regulation, in place since 1991, is directed at Gulf oysters because V. vulnificus is a naturally occurring bacteria in the region, especially during warm weather months.

“Gulf oysters have been associated with the most notorious cases of V. vulnificus,” said Dr. Shirley Fannin, director of disease control programs for the county’s Health Services Department.

All the 1995 victims reported eating Gulf oysters 24 to 48 hours before the onset of illness. In one case, a Pasadena woman with hepatitis C became ill two days after consuming raw oysters. She died two weeks later of liver and kidney failure despite treatment with antibiotics.

California’s strict labeling requirement may not have been enough in the most recent infections. Between 1993 and 1995, there have been 11 cases of V. vulnificus in Los Angeles County. In 10 of those incidents the victims were Hispanic and spoke Spanish as their primary language. “It is possible that [the state required warning] posters in English may not have been read or understood,” the newsletter said.

As a follow-up to the recent illness, county health officials surveyed 103 restaurants serving Gulf oysters and found that 56 did not have the required warning sign or placed it where it was not readily visible to consumers. Health inspectors provided signs where none were posted and will fine offenders on subsequent inspections.

“This is not a law or regulation that is being followed very well,” Fannin said.

Nationally, there are an estimated 24 deaths annually from V. vulnificus, according to the U.S. Food and Drug Administration.

“[Los Angeles County officials] are right on target in reissuing this warning,” said Caroline Smith DeWaal, food safety director for the Center for Science in the Public Interest in Washington. “This is an unusual situation where we have a legal food product that kills a certain number of people each year. The FDA has entirely failed in their responsibility to protect the public. [L.A. County’s] warning shows that other government agencies have to step in when the FDA refuses to act.”

Chronic contamination of Gulf oysters has been a controversial issue for some time. The FDA last year proposed a ban on sales of the region’s most popular shellfish during warm weather months. However, the agency was rebuffed last month by the Interstate Shellfish Sanitation Conference, a task force of government and industry representatives. Instead, the shellfish conference will implement an interim proposal requiring that all Gulf oysters be refrigerated within six hours after harvest if the water temperature reaches 84 degrees.

An estimated 30 million pounds of shucked oyster meat is harvested annually from states bordering the Gulf of Mexico. Seafood interests believe that an FDA proposal to ban warm-weather oyster harvesting would place an onerous financial burden on the $200-million industry.

L.A. County’s warning was directed at individuals classified as high risk, including those with:

*Liver disease from either excessive alcohol intake, viral hepatitis or other causes.

*Diabetes, cancer or hemochromatosis.

*Immune disorders including HIV infection and long-term steroid use.

*Stomach problems involving surgery or medicines taken to lower stomach acid.

Health officials recommend that physicians advise patients with any of these conditions about the risk of “V. vulnificus and other diseases that can be acquired from raw or partially cooked shellfish and seafood.”

An FDA consumer-oriented booklet titled “If You Eat Oysters, You Need to Know . . . “ explains the V. vulnificus threat, lists those at particular risk and provides handling and cooking instructions. To obtain a copy, call the FDA Seafood Hotline at (800) 332-4010.