Ciguatera Poisoning (CP) is the most prevalent, phycotoxin related seafood poisoning across the globe, affecting between 10,000 and 50,000 people annually. This illness results from the consumption of seafood contaminated with lipid soluble toxins known as ciguatoxins (CTXs) that are produced by benthic dinoflagellates in the genera Gambierdiscus and Fukuyoa. The present work reviews the global occurrence of CP events and outbreaks, based on both scientific and gray literature.

Ciguatera prevalence is significantly underestimated due to a lack of recognition of ciguatera symptoms, limited collection of epidemiological data on a global level, and reticence to report ciguatera in CP-endemic regions. Analysis of the time-series data available for a limited number of countries indicates the highest incidence rates are consistently reported from two historical CP-endemic areas i.e., the Pacific and Caribbean regions, a situation due in part to the strong reliance of local communities on marine resources. Ciguatera-related fatalities are rare (<0.1% of reported cases). The vast majority of outbreaks involve carnivorous fish including snappers, groupers, wrasses, and barracudas. Since 2000, an expansion of the geographical range of CP has been observed in several areas like Macaronesia and east and southeast Asia. In some of these locales, random surveys confirmed the presence of CTXs in locally sourced fish, consistent with the concurrent report of novel CP incidents (e.g., Canary Islands, Madeira, Selvagens Islands, New South Wales). One characteristic of outbreaks occurring in Asia is that they often present as large disease clusters due to group consumption of a single contaminated fish. Similar observations are reported from the Indian Ocean in the form of shark poisoning outbreaks which often lead to singular types of CP characterized by a high fatality rate. Other atypical forms of CP linked to the consumption of marine invertebrates also have been documented recently. Owing to the significant health, socioeconomic and socio-cultural impacts of ciguatera, there is an urgent need for increased, standardized, coordinated efforts in ciguatera education, monitoring and research programs. Several regional and international initiatives have emerged recently, that may help improve patients' care, data collection at a global scale, and risk monitoring and management capabilities in countries most vulnerable to CP's toxic threat.

Ciguatera Poisoning（CP）是全球最普遍的与植物毒素有关的海鲜中毒，每年影响10,000至50,000人。这种疾病是由食用被脂溶性毒素污染的海产品引起的，该脂溶性毒素被称为古瓜毒素（CTX），由古比亚鞭毛虫和福冈属的底鞭毛鞭毛藻产生。本工作根据科学和灰色文献综述了全球CP事件和爆发的发生。

由于缺乏对卡瓜特尔症状的认识，在全球范围内流行病学数据的收集有限以及在CP流行地区不愿报告卡瓜特尔，因此严重低估了卡瓜特尔的患病率。对可用于少数几个国家的时间序列数据进行的分析表明，两个历史性CP流行地区（即太平洋和加勒比地区）一致报告了最高的发病率，部分原因是当地社区强烈依赖海洋资源。与Ciguatera有关的死亡很少见（<报道病例的0.1％）。绝大多数暴发涉及食肉鱼类，包括鲷鱼，石斑鱼，濑鱼和梭子鱼。自2000年以来，在马卡罗尼西亚以及东亚和东南亚等几个地区发现了CP的地理范围的扩大。在其中一些地区，随机调查证实了本地采购的鱼类中存在CTX，这与同时发生的新型CP事件（如加那利群岛，马德拉群岛，塞尔瓦根群岛，新南威尔士州）的报道一致。亚洲爆发的特征之一是，由于成群食用一条受污染的鱼类，它们通常以大型疾病群的形式出现。来自印度洋的类似报告也以鲨鱼中毒暴发的形式报道，鲨鱼中毒暴发通常导致特征性CP的高死亡率。最近还记录了与海洋无脊椎动物消费有关的其他非典型形式的CP。由于Ciguatera对健康，社会经济和社会文化产生重大影响，因此迫切需要在Ciguatera教育中加大力度，标准化和协调一致的努力，监测和研究计划。最近出现了一些区域和国际举措，这些举措可能有助于改善患者护理，在全球范围内收集数据以及在最容易遭受CP毒性威胁的国家中进行风险监测和管理的能力。