Open Access Research article

A past Haff disease outbreak associated with eating freshwater pomfret in South China

Xi Huang12, Yipeng Li3, Qiong Huang1*, Junhua Liang1, Chunsui Liang1, Bifeng Chen1, Lingling Lu1, Xiaoling Deng1, Zihui Chen4, Yonghui Zhang1*, Yongning Wu5 and Bing Shao6

Author Affiliations

1 Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China

2 School of Public Health, Sun Yat-sen University, Guangzhou, China

3 Jiangmen Prefectural Centre for Disease Control and Prevention, Jiangmen, China

4 Guangdong Provincial Institute of Public Health, Guangzhou, China

5 National Centre for Food Safety Risk Assessment, Beijing, China

6 Beijing Centre for Disease Control and Prevention, Beijing, China

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BMC Public Health 2013, 13:447  doi:10.1186/1471-2458-13-447

Published: 6 May 2013



Haff disease is unexplained rhabdomyolysis caused by consumption of fishery products in the previous 24 h. It was first identified in Europe in 1924 but the condition is extremely rare in China. Here we describe a past outbreak of acute food borne muscle poisoning that occurred in Guangdong Province (South China) in 2009.


The first full outbreak of Haff disease reported in Jiangsu Province (East China) in 2010, indicated that the incidence of the disease may be increasing in China. We, therefore first retrospectively reviewed epidemiologic, trace-back, environmental studies, and laboratory analyses, including oral toxicity testing to ascertain risk and chemical analysis to identify toxin(s), from the 2009 Guangdong outbreak. Then we compared data from the 2009 outbreak with data from all other Haff disease outbreaks that were available.


Clinical symptoms and laboratory findings indicated that the 2009 Guangdong outbreak disease was consistent with rhabdomyolysis. Epidemiologic, trace-back, environmental studies and laboratory analyses implied that the disease was caused by freshwater Pomfrets consumed prior to the onset of symptoms. We also identified common factors between the 2009 Guangdong outbreak and previous Haff disease outbreaks reported around the world, while as with other similar outbreaks, the exact etiological factor(s) of the disease remains unknown.


The 2009 Guangdong outbreak of ‘muscle poisoning’ was retrospectively identified as an outbreak of Haff disease. This comprised the highest number of cases reported in China thus far. Food borne diseases emerging in this unusual form and the irregular pattern of outbreaks present an ongoing public health risk, highlighting the need for improved surveillance and diagnostic methodology.