Epidemiology of Pufferfish Poisoning in Japan: Trends and Insights from 2004 to 2023.

Introduction: Pufferfish poisoning caused by tetrodotoxin remains a serious and potentially fatal public health concern in Japan, despite stringent regulations governing its traditional consumption. Methods: Epidemiological trends in pufferfish poisoning over the past two decades were retrospectively analyzed using data from the Ministry of Health's "Foodborne Illness Statistical Data" reports between January 2004 and December 2023. Trends in poisoning incidents, affected patients, and fatalities were assessed as primary outcomes. The regional distribution, seasonal patterns, and contributory risk factors, particularly domestic preparation, were also investigated. Results: Between 2004 and 2023, Japan documented 450 incidents of pufferfish poisoning, involving 622 individuals and resulting in 17 deaths. The annual incidence rates for pufferfish poisoning events and affected patients declined by 5% and 8%, respectively. Poisonings occurred more frequently during winter, though summer incidents-including fatalities-were also documented. The majority of incidents, affected individuals, and deaths were linked to domestic preparation. Western Japan reported the highest number of events and incidence rates per 1,000,000 population. Conclusions: Although pufferfish poisoning events declined over the past two decades, fatal outcomes persisted, primarily because of improper handling during domestic preparation. Enhancing awareness of the risks associated with home preparation remains essential to mitigate tetrodotoxin-related poisonings.