Epidemiology Shellfish-Associated Hepatitis a In 1961 Rippey,

¶ … Epidemiology Shellfish-associated hepatitis a in 1961 Rippey, S.R. (1994). Infectious disease associated with molluscan shellfish consumption. Clinical Microbiology Review. 7(4):419. DOI: 10.1128/CMR.7.4.419. http://cmr.asm.org/content/7/4/419.full.pdf This article provides a historical overview of the shift to the dominance of different disease pathologies associated with consuming tainted shellfish. Prior to the 1950s, the most common disease associated with eating tainted shellfish was typhoid fever. However, improved sanitation has changed this and the last case of shellfish-derived typhoid fever was reported in 1954.

Hepatitis A, in contrast to typhoid, is on the rise: the first case was reported in 1956 in Sweden. In 1961, there were a number of outbreaks reported in Mississippi and Alabama of consumers of raw oysters and of raw clams in New Jersey and Connecticut. Diseases associated with shellfish consumption can be difficult to track: in many healthy individuals they present themselves only as mild gastrointestinal distress and are not reported to health authorities.

In the case of Hepatitis A, given the long incubation period of 2-4 weeks of the illness, this can present additional complications for epidemiologists and even today the 'tagging' system of original shellfish harvest sites can be extremely unreliable. This is troubling given that as mollusks are 'filter feeders' and are often consumed raw, they are uniquely advantageous agents for transmitting foodborne diseases, even though the type of illness may have changed over time. Investigation of L-tryptophan-associated Eosinophilia Myalgia Syndrome (EMS) in 1990 Crofford, L.J. (et al. 1990).

L-tryptophan implicated in human eosinophilia-myalgia syndrome causes fasciitis and perimyositis in the Lewis rat. Journal of Clinical Investigation, 86(5): 1757 -- 1763. doi: 10.1172/JCI114902. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC296930/ Epidemiologically speaking, tryptophan-associated eosinophilia-myalgia syndrome (L-TRP-EMS) is a relatively new disease but reached epidemic proportions in the U.S. In 1989. Epidemiologic data was able to connect the dots and link the syndrome to intake of L-tryptophan (L-TRP) to a specific manufacturer (Crofford 1990).

Symptoms appeared in patients who were ingesting the amino acid L-tryptophan (L-TRP) for a variety of minor problems, including insomnia and depression. However, the 'treatment' soon was revealed to be worse than the disease L-TRP-EMS.