BACKGROUND: Marine turtles of all species are capable of being toxic. On 17 October 2010, health authorities in the Federated States of Micronesia were notified of the sudden death of three children and the sickening of approximately 20 other people on Murilo Atoll in Chuuk State. The illnesses were suspected to be the result of mass consumption of a hawksbill turtle (Eretmochelys imbricata). An investigation team was assembled to confirm the cause of the outbreak, describe the epidemiology of cases and provide recommendations for control. METHODS: We conducted chart reviews, interviewed key informants, collected samples for laboratory analysis, performed environmental investigations and conducted a cohort study. RESULTS: Four children and two adults died in the outbreak and 95 others were sickened; 84% of those who ate the turtle became ill (n = 101). The relative risk for developing illness after consuming the turtle was 11.1 (95% confidence inteval: 4.8–25.9); there was a dose-dependent relationship between amount of turtle meat consumed and risk of illness. Environmental and epidemiological investigations revealed no alternative explanation for the mass illness. Laboratory testing failed to identify a causative agent. CONCLUSION: We concluded that turtle poisoning (also called chelonitoxism) was the cause of the outbreak on Murilo. The range of illness described in this investigation is consistent with previously reported cases of chelonitoxism. This devastating incident highlights the dangers, particularly to children, of consuming turtle meat. Future incidents are certain to occur unless action is taken to alter turtle-eating behaviour in coastal communities throughout the world.

Objective：To assess the public health risk posed by the ongoing Ebola virus disease (EVD) epidemic in West Africa to Pacific island countries and areas and to highlight priority risk management actions for preparedness and response.Method：The likelihood of EVD importation and the magnitude of public health impact in Pacific island countries and areas were assessed to determine overall risk. Literature about the hazard, epidemiology, exposure and contextual factors associated with EVD was collected and reviewed. Epidemiological information from the current EVD outbreak was assessed.Results：As of 11 March 2015, there have been more than 24 200 reported cases of EVD and at least 9976 deaths in six West African countries. Three EVD cases have been infected outside of the West African region, and all have epidemiological links to the outbreak in West Africa. Pacific island countries’ and areas’ relative geographic isolation and lack of travel or trade links between countries with transmission means that EVD importation is very unlikely. However, should a case be imported, the health and non-health consequences would be major. The capacity of Pacific island countries and areas to respond adequately varies greatly between (and within) states but in general is limited.Discussion：This risk assessment highlights the needs to enhance preparedness for EVD in the Pacific by strengthening the capacities outlined in the World Health Organization Framework for Action on Ebola. Priority areas include the ability to detect and respond to suspected EVD cases quickly, isolation and management of cases in appropriately resourced facilities and the prevention of further cases through infection prevention and control. These efforts for Ebola should enhance all-hazards public health preparedness in line with the International Health Regulations (2005).

West Africa is currently experiencing the largest outbreak of Ebola virus disease (EVD) in history with intense transmission in several affected countries. For non-affected countries, the best protective measures are adequate levels of preparedness including vigilant surveillance to detect cases early and well-prepared health systems to ensure rapid containment of the virus and to avoid further spread. The World Health Organization Regional Office for the Western Pacific recently conducted two activities: a web-based EVD preparedness survey and an EVD simulation exercise to determine the overall level of EVD preparedness in the Region. The survey and exercise together demonstrate there is a good overall level of preparedness for a potential imported case of EVD in the Western Pacific Region. However, a number of areas still require further strengthening before the Region can efficiently and effectively respond to potential EVD events, including laboratory testing arrangements; clinical management and infection prevention and control; and public health intervention measures, particularly at points of entry. Importantly, the survey and exercise also highlight the unique situation in Pacific island countries and emphasize that special considerations are needed to better support these countries in EVD preparedness.