The Centre for Food Safety (CFS) received in April 2023 a referral from the Centre for Health Protection of a suspected case of diarrhoetic shellfish poisoning in which the affected persons developed diarrhoea, nausea, vomiting and abdominal pain within an hour after consuming venus clams at a restaurant. This article gives a brief introduction on shellfish poisoning.
What is Shellfish Poisoning?
Shellfish poisoning is caused by shellfish toxins produced by certain species of algae. When shellfish eat toxin-producing algae, the toxins can accumulate in their tissue. Consumption of shellfish containing shellfish toxins by humans can cause a variety of gastrointestinal and neurological illnesses, known as shellfish poisoning. Examples of shellfish that have been involved in shellfish poisoning include mussels, clams, oysters, scallops and geoducks.
Numerous shellfish toxins have been discovered around the world; they could cause different types of shellfish poisoning. Five major types of shellfish poisoning are discussed below:
(i) Paralytic shellfish poisoning (PSP) --- caused by paralytic shellfish toxins (PSTs), which are a group of water-soluble alkaloid neurotoxins, including saxitoxins (STXs).
(ii) Diarrhoetic shellfish poisoning (DSP) --- caused by diarrhoetic shellfish toxins (DSTs), which are a group of lipid-soluble polyether toxins, including okadaic acid (OA).
(iii) Neurotoxic shellfish poisoning (NSP) --- caused by neurotoxic shellfish toxins (NSTs), which are a group of lipid-soluble polyether toxins, including brevetoxins (BTXs).
(iv) Amnesic shellfish poisoning (ASP) --- caused by amnesic shellfish toxins (ASTs), including the water-soluble amino acid domoic acid (DA).
(v) Azaspiracid shellfish poisoning (AZP) --- caused by azaspiracid shellfish toxins (AZTs), including the lipid-soluble toxin azaspiracid (AZA).
Characteristics of Shellfish Toxins
Different groups of shellfish toxins display multifarious chemical structures, which can be broadly classified into amino acids (DA), alkaloids (STXs) and polyketides (OA, BTXs and AZA).
The reasons why some algae produce shellfish toxins remain unknown. These toxins are secondary metabolites with no explicit function for the algae. They are probably used by the algae to compete for space, defence against predators or prevent the overgrowth of other organisms.
In general, shellfish toxins are heat stable, odourless, tasteless and not destroyed by cooking, freezing or other food preparation procedures. It is hard to distinguish between toxic and non-toxic shellfish visually.
Bioaccumulation of Shellfish Toxins in Bivalve Molluscs
Algae are part of the natural diet of bivalve molluscs. After shellfish has ingested shellfish toxin-producing algae, shellfish toxins will accumulate and concentrate in their internal organs, such as hepatopancreas of bivalves (Figure 1). Generally speaking, the adductor muscle contains only a low level of shellfish toxins.
Figure 1: Internal parts of a scallop
Symptoms of Shellfish Poisoning
Shellfish toxins can cause a wide variety of symptoms in humans, depending on the type and amount of toxins ingested. Symptoms of different types of shellfish poisoning are summarised below:
Safety Levels of Shellfish Toxins
The toxicity of various shellfish toxins was evaluated by a joint expert working group of the Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO) and the Intergovernmental Oceanographic Commission of UNESCO in 2004. Acute reference doses (ARfDs) (i.e. the amount of toxins that can be ingested in a period of 24 hours or less without appreciable health risk) have been established for these shellfish toxins. In addition, the Codex Alimentarius Commission (Codex) has established the maximum levels (MLs) for shellfish toxins in edible parts (the whole or any part intended to be eaten separately) of live bivalve molluscs. While the ARfDs are critical in assessing the safety of food in terms of the level of shellfish toxins contained, Codex MLs are the levels recommended by Codex to be permitted in shellfish.
*An estimate of toxicity of the toxin made by mouse bioassay.
Key Points to Note
- Shellfish toxins are heat stable, odourless, tasteless and not destroyed by cooking, freezing or other food preparation procedures.
- It is hard to distinguish between toxic and non-toxic shellfish visually.
- In general, shellfish toxins accumulate and concentrate in the internal organs of bivalves.
Advice to Food Businesses
- Source shellfish from places where monitoring programmes for shellfish toxins have been established.
- Do not accept shellfish from dubious sources.
Mascot ON in Lesson
Food Safety Concern over Radioactive Contamination
Recently, the media has been voicing concerns over the discharge of treated nuclear-contaminated water from the Fukushima nuclear power station (FNPS) and its possible contamination of the marine environment and seafood. It is the Hong Kong SAR Government's prime consideration to ensure food safety. In response to the FNPS incident in 2011, the Administration has imposed import control measures on Japanese food and has been reviewing these measures on food products imported from Japan in light of the latest test results and developments.
Japan's Discharge Plan
The Government of Japan discharged the nuclear-contaminated water generated in the process of cooling the nuclear reactors at the FNPS into the ocean after treatment in the summer of 2023. The nuclear-contaminated water had direct contact with the active raw materials of the nuclear reactors and thus contained a high concentration of radioactive substances. The discharge plan will last for 30 years. During this long period of time, if the purification system fails to operate effectively, it may pose significant risks to food safety and marine ecology. The plan has aroused concern from the international community and the public.
International Atomic Energy Agency’s Review
The International Atomic Energy Agency (IAEA) has set up a Task Force to review Japan's discharge plan. The Task Force has conducted visits to Japan and published review reports to make suggestions on some technical and regulatory aspects of the discharge plan to the Japanese authorities. In July 2023, the IAEA released a report on its review work conducted prior to the discharge, and indicated that its review work would continue during the discharge phase.
Enhanced Testing on Imported Japanese Aquatic Products
According to a report issued by Tokyo Electric Power Company Holdings (TEPCO) earlier, a fish sampled from the port area of the FNPS was found to contain 18 times the guideline level of the radioactive substance Caesium adopted by Codex (Codex guideline level). Caesium can be taken into the body by eating food or drinking water. After ingestion, it is absorbed into the bloodstream and distributed throughout the body. It tends to concentrate in muscles. The consumption of the fish in question may pose a risk to health and increase the likelihood of inducing cancer.
In view of the report concerning the fish sampled in Fukushima containing Caesium exceeding the Codex guideline level, the CFS has adjusted its corresponding monitoring work and enhanced its testing on imported Japanese aquatic products. The fish in question was caught in May 2023, and the laboratory report was uploaded onto TEPCO's website on 5 June 2023. In fact, the CFS has since mid-June expanded the scope of testing to cover all Japanese aquatic products.
Myth 1: Consumption of iodine-rich foods, such as iodised salt, as a prophylactic measure
In previous nuclear emergencies where radioactive iodine might have been involved, iodide tablets would be distributed by health authorities as protection against radiation by preventing the uptake of radioactive iodine by the thyroid gland.
However, there is no scientific evidence to suggest that iodine-rich foods and iodised salt have a similar radiation protective effect to iodide tablets. For iodised salt, its iodine content is relatively low. One has to take about 2.5 to 5 kg of iodised salt a day in order to absorb the equivalent dose of iodine contained in an iodide tablet. Excessive consumption of salt is harmful to health, especially for those with high blood pressure, heart disease or kidney disease.
Myth 2: Measurement of radiation with self-purchased portable radiation detectors
Ionising radiation detectors (commonly known as nuclear radiation detectors) for professional uses have to comply with the requirements on accuracy and sensitivity and need to be calibrated regularly by professional bodies to make sure that they give accurate and reliable results. Self-purchased portable radiation detectors may not have the required measurement capability nor relevant professional certification and calibration, and thus cannot replace radiation monitoring and assessment by professional equipment and personnel. Therefore, self-purchased nuclear radiation detectors may not have the capability to determine the radiation levels in food.
Advice to Trade
- The CFS will continue to maintain close liaison with local importers of Japanese food products and the catering sector to enable their better grasp of the latest position of the discharge plan and the import control measures that may be implemented, so that early arrangements such as for sourcing ingredients can be made.
Robotics in Food Service - Ensuring Hygiene and Food Safety
With advancement in technology, the use of food serving robots by food businesses to deliver food from the kitchen to dining tables is increasingly popular. These robots usually serve a number of dining tables. Consumers may have to collect foods from the same shelf, which could increase the risk of cross-contamination of foods by unhygienic hands. Moreover, some consumers may return finished plates or used cutlery to the robots, which could also lead to contamination of other food items carried by the robots.
To ensure food safety, food business operators should maintain a high standard of hygiene for the robots and implement measures to remind consumers not to return finished plates to the food serving robots. Food carried by the robots should be covered properly and kept unadulterated during delivery. Consumers should follow the meal collection instructions and should not return finished plates or used cutlery to the robots.
Safe Preparation of Siu Mei and Lo Mei
Siu mei and lo mei are popular dishes. They are intrinsically high-risk, as they are usually prepared in advance and require post-cooking handling. Morever, they are often stored at room temperature after cooking with no further or insufficient heat treatment to eradicate disease-causing bacteria. If hygiene practices are not observed in handling ready-to-eat foods, “superbugs”, i.e. microbes that have developed antimicrobial resistance (AMR) Note 1, may spread.
Food handlers should maintain good personal, environmental and food hygiene in the preparation of siu mei and lo mei. Plan production schedules well to prevent over-production and prolonged storage at room temperature. Wash hands before handling food and use gloves properly. Hooks and pliers should be used for displaying and handling siu mei and lo mei to minimise bare-hand contact. As bacteria may grow faster on cut siu mei displayed in plastic wrap, siu mei shops should only chop up siu mei upon orders. Follow the “2-hour/4-hour rule” Note 2 if siu mei and lo mei are displayed at room temperature, or refrigerate them within two hours after production.
For details of safe production of siu mei and lo mei, please click this link or scan the QR code:
Note1:To learn more about AMR microorganisms, please click this link or scan the QR code:
Note2:To learn more about the “2-hour/4-hour rule”, please click this link or scan the QR code:
Glutamates in Your Kitchens
In 1908, Kikunae Ikeda, a Japanese professor, extracted glutamates from a seaweed broth and concluded that glutamates provided a savoury taste to the broth. He also noticed that the taste of the broth was distinct from sweet, sour, bitter and salty, and named it umami, the fifth taste. Glutamate has since been commercially produced, generally in the form of monosodium glutamate (MSG), and used by chefs and home cooks frequently to enhance the flavour of their dishes.
What are MSG and Glutamates?
MSG is a white crystallised, odourless sodium salt of glutamic acid, one of the most abundant amino acids found in nature and produced by living organisms including humans. At present, various salts (e.g. potassium, calcium, magnesium and sodium) of glutamic acid (collectively known as “glutamates”) are added to food as flavour enhancers. Various foods, such as seasonings and condiments, may also contain natural or artificial glutamates. In the commercial production process of MSG, fermentation technology is used to convert sugars from different sources into glutamates (Figure 2).
Given that glutamates are ubiquitous in foods, the dietary exposure to glutamates in adults through natural or man-made sources is extensive:
(1) Natural sources: (i) “bound” glutamates that occur as proteins in almost all food (for example milk, meat, poultry, fish, vegetables and mushrooms); and (ii) “free” glutamates (i.e. not bound to proteins) present in tomatoes, mushrooms, yeast extracts, fermented fish sauce and fermented/hydrolysed protein products (for example soy sauce), which account for the savoury flavour of these foods; and
(2) Man-made sources: “free” glutamates added to food as salts of glutamic acid (for example MSG).
Free glutamates can attach to specific receptors on the tongue and induce the umami flavour, while bound glutamates cannot. Natural glutamates and those artificially produced are chemically indistinguishable. Both sources of glutamates are metabolised in the same way in our bodies.
Figure 2. MSG is produced by fermentation of sugars from different sources
According to the U.S. Food and Drug Administration (USFDA), an average adult in the U.S. consumes approximately 13 grams of glutamates each day from the protein in food, while the daily intake of added MSG is estimated at around 0.55 gram. Other studies show that among the European population, average MSG consumption represents between 6% and 12% of total glutamate intake. In summary, the intake of free glutamate from food additives only constitutes a small proportion of our total intake of glutamates from different sources.
Safety of MSG
The Joint FAO/WHO Expert Committee on Food Additives (JECFA) has allocated an acceptable daily intake (ADI) of “not specified” to glutamic acid and its salts, meaning that their use as food additives does not represent a health concern. The USFDA considers the addition of MSG to foods to be “generally recognised as safe”. According to the Codex, MSG can be used in foods in general if used in accordance with the principles of Good Manufacturing Practice (GMP), that is, the quantity of MSG added to food shall be limited to the lowest possible level necessary to accomplish the desired effect.
Since the late 1960s, MSG has been claimed to be the cause of a range of adverse reactions in people who had eaten foods containing the additive. However, international scientific assessments have concluded that the evidence available does not establish a causal relationship between the consumption of MSG and the development of symptoms such as headache, numbness or tingling in the back of the neck and flushing.
Like table salt, MSG contains sodium. While sodium is an essential nutrient necessary for the maintenance of plasma volume, acid-base balance, transmission of nerve impulses and normal cell function, excessive sodium intake is linked to non-communicable diseases such as elevated blood pressure. In general, salt consumption can be reduced by using less table salt and sodium-containing food additives.
How Can I Tell If MSG is Present in My Food?
Under the local labelling regulation, prepackaged foods with added MSG shall indicate its specific name (i.e. monosodium glutamate) or identification number under the International Numbering System (i.e. 621) and its functional class (i.e. flavour enhancer) in the ingredient list on the food label. The requirements on ingredient labelling also apply to other added glutamates (i.e. additives designated 620 to 625).
Advice to the Trade
- If MSG is to be added to food, limit its quantity to the lowest level for flavour enhancement in accordance with GMP principles.
- Observe the labelling requirement of food additives (including MSG).
Safe Kitchen/Food Safety Guidelines
Introduction to “Safe Kitchen” Scheme
To facilitate the adoption of Five Keys to Food Safety and Good Hygiene Practices (GHPs) by trade members, and enhance food safety in their daily operation, the Centre for Food Safety (CFS) has integrated the existing channels of risk communication and launched a new platform, namely “Safe Kitchen”, to communicate with the trade. The platform provides food safety information of greater practical importance to meet the operational needs of catering outlets.
The “Safe Kitchen” platform disseminates up-to-date food safety information (including food safety guidelines and relevant legislative amendments) to the trade through a host of channels including WhatsApp, emails and dedicated websites. In response to food poisoning outbreaks in restaurants, the platform will also issue food alerts to remind the trade of the points to note in preventing future occurrences so that the risk of food poisoning can be minimised.
New dedicated websites and risk information exchange platforms will be rolled out under the “Safe Kitchen” Scheme. In addition, training materials tailor-made for the trade and workshops for kitchen staff will be provided to enhance food safety and hygiene awareness among them. Members of the trade are welcome to scan the relevant QR code below to download the registration form for the “Safe Kitchen” Scheme in order to receive the latest food safety information in a timely manner.
Food Safety Guidelines
Food Safety Advice on Packed Meals
Packing meals is a common way for us to enjoy homemade dishes at workplaces or schools. However, these packed meals may be stored or transported at unsafe temperatures for some time before consumption, making them susceptible to contamination and harmful bacterial growth. If these meals are not stored properly, disease-causing bacteria can multiply to dangerous levels or produce toxins, leading to food poisoning.
However, refrigeration or reheating devices may not be available at certain venues, such as schools. Therefore, it is important to adopt appropriate measures based on the setting where the meal is consumed to ensure food safety. To learn more, please click this link or scan the QR code:
Chicken Dishes with Post-cooking Handling (Applicable to Poached Chicken and Shredded Chicken) – Food Safety Guidelines for the Trade
Poached chicken and shredded chicken are popular local dishes. They are prepared by immersing the raw chicken into hot water until it is cooked. The cooked chicken may be chopped or shredded for preparing different dishes which require manual handling. Such processing practices may make the chicken susceptible to microbial growth and post-processing contamination.
Therefore, the CFS has compiled food safety guidelines on “Chicken Dishes with Post-cooking Handling”, which provides advice to the trade on the food safety measures that should be adopted in the three main steps, namely purchase and transportation of raw materials/ingredients, cooking of chicken, and holding and display of the products. Food handlers, especially those who need to handle dishes such as poached chicken and shredded chicken, could browse or download the guidelines by clicking this link or scanning the QR code:
News on CFS
1. CFS's New Exhibition Boards
Recently, two sets of new exhibition boards are on display in the exhibition room of the Communication Resource Unit of the CFS. Centred around the themes of “Understanding Trans Fats” and “5 Keys to Food Safety”, the exhibition boards provide information such as what the differences between trans fats and saturated fats are, why trans fats are harmful to our health, and what foodborne diseases and “5 Keys to Food Safety” are.
- “Understanding Trans Fats”
- “5 Keys to Food Safety”
The exhibition room is freshened up with new exhibition boards.
For persons concerned with food safety, if they have any questions mentioned above and want to learn more, they are welcome to visit the exhibition room, where relevant leaflets are also available for free. The address and opening hours of the exhibition room of the Communication Resource Unit are as follows:
Address: Room 401, 4/F, Food and Environmental Hygiene Department Nam Cheong Offices and Vehicle Depot, 87 Yen Chow Street West, Sham Shui Po, Kowloon
Monday to Friday: 8:45 am to 1:00 pm; 2:00 pm to 5:30 pm
Saturday, Sunday and Public Holiday: closed
2. 1st Technical Meeting with Trade on Proposed Amendments to the Preservatives in Food Regulation (Cap. 132BD)
The technical meeting with trade is chaired by Dr. Cheung Yung Yan, Consultant (Community Medicine) (Risk Assessment & Communication) (second left).
The public consultation on the proposed amendments to the Preservatives in Food Regulation (Cap. 132BD) ended on 28 August 2023. To enhance the trade’s and the public’s understanding of the proposed amendments to the Preservatives in Food Regulation (Cap. 132BD), the CFS held the 1st technical meeting with trade on 23 August. For details, please visit the following thematic webpage:
3. The 82nd Meeting of the Trade Consultation Forum
The 82nd meeting of the Trade Consultation Forum was held on 20 September 2023. The CFS and the trade exchanged their views on topics including “Regulation of Partially Hydrogenated Oils (PHOs)”, “Harmful Substances in Food (Amendment) Regulation 2021”, “Safety of Aspartame”, “Proposed Amendments to the Preservatives in Food Regulation (Cap. 132BD)”, “Food Safety Advice for Handling Eggs and Egg Products”, “Risk Assessment Study on Microbiological Quality of Non-hot Served Dishes with Chicken Meat” and “Import Control Measures on Japanese Food”. For details of the event, please visit:
4. Press Briefing on Risk Assessment Study on Microbiological Quality of Non-hot Served Dishes with Chicken Meat
The press briefing was hosted by Dr. Chow Chor Yiu, Principal Medical Officer (Risk Assessment & Communication) (left) and Dr. Chong Tsz Kit, Scientific Officer (Microbiology) (right).
The CFS held a press briefing on 20 September for the publication of the report on the risk assessment study on microbiological quality of non-hot served dishes with chicken meat.
Chicken meat is a common ingredient in many local non-hot served ready-to-eat dishes, and there are quite a number of shops selling takeaway shredded chicken and chopped chicken in recent years. The preparation process of chicken meat for non-hot served dishes may result in greater microbiological risks, due to the potential risk of insufficient cooking and involvement of manual handling. Furthermore, cooling is usually required before serving, and improper temperature control during storage of the dishes may allow the growth of pathogens. In view of this, 100 samples of non-hot served chicken meat dishes were collected by the CFS from various takeaway shops or stalls and restaurants for study. The results showed that all samples complied with the microbiological food safety criteria for pathogenic bacteria (i.e. Salmonella spp., Listeria monocytogenes and Staphylococcus aureus). The overall microbiological quality was found satisfactory. While no unsatisfactory samples were found in the study, the CFS would like to remind food businesses to follow Good Hygiene Practices at all times for preventing contamination of food. Food businesses also have the responsibility to provide sufficient ongoing food safety and hygiene training to their staff.
For details, please visit the thematic webpage on “Microbiological Quality of Non-hot Served Dishes with Chicken Meat”:
Ask Our Mascots
Iodised Salt Cannot Protect against Radiation
There are rumours that iodised salt can provide protection against radiation, which have triggered panic buying of iodised salt. Our mascots have to clarify: Iodised salt cannot protect against radiation.
Currently, there is no scientific evidence to suggest that consumption of salt can effectively prevent damage to the body from radiation. For iodised salt, its iodine content is low. One has to take about 2.5 to 5 kg of iodised salt a day in order to absorb the equivalent dose of iodine contained in an iodide tablet. On the contrary, excessive consumption of iodine and sodium (salt) is harmful to the body. Moreover, iodide tablets are not “radiation antidotes”, nor can they protect against any other radioactive substances besides radioactive iodine.
Iodide Tablets Must Not be Taken Casually
In case of a nuclear emergency, radioactive iodine may be released to the environment. For people exposed to radioactive iodine, such as staff at the nuclear plant and the rescue team, taking iodide tablets before or shortly after the exposure can reduce the uptake of radioactive iodine by the thyroid gland. However, such tablets must only be taken under emergency circumstances and on the medical advice of a doctor or a public health professional.
Harmful Rather than Beneficial
Indiscriminate use or excessive intake of iodine are detrimental to health, including causing thyroid disorders such as hypothyroidism and hyperthyroidism. Moreover, many studies revealed that excessive intake of salt would also increase the risk of hypertension and cardiovascular disease.
Mascot ON would like to remind everyone to never panic-buy salt. For more information, please visit:
- Shellfish toxins are heat stable, odourless, tasteless and not be destroyed by cooking, freezing or other food preparation procedures. To reduce the health risk of shellfish poisoning, remove and discard all __________________ of shellfish where possible before consumption.
- If the power at home has gone out for more than four hours, what should we do with the food in the refrigerator?
- To avoid MSG, we could consider using more herbs and __________, and glutamate-rich ingredients (e.g. tomato, mushroom) during cooking to enhance the flavour of food, thereby reducing sodium intake.
Diary of Mascot ON
Food Safety Lesson on Power Cut
Typhoons and heavy rain are common in summer. In case of a power cut at home, what should we do with our food in the refrigerator?
Do Not Open the Refrigerator Door Unless Necessary
During a power cut, bear in mind that the refrigerator door should be kept closed. In this way, food can be stored for 2 to 4 hours in the fridge; 48 hours in a full freezer; and 24 hours in a half-full freezer.
Keeping Time after Power Restoration
After the power has been restored, for any potentially hazardous foods such as meat, seafood, eggs, milk, dairy products, cut fruits and cooked dishes that have been at temperatures between 4°C and 60°C:
- Refrigerate or consume immediately if kept for less than two hours;
- Consume immediately if longer than two hours but less than four hours; and
- Toss away if more than four hours.
Be Fully-prepared before a Power Cut
We should keep the refrigerator in good order in normal times, and place appliance thermometers inside to ensure that the temperature of the fridge is at 4°C or below, and the freezer at -18°C or below. Always keep some ice cubes and frozen gel packs in the freezer. They can keep the freezer full to help maintain the temperature, and keep foods cold should they be transferred to other locations.
Now that you are well trained in food safety, there is no need to worry when power goes out during a typhoon! For more comprehensive information, please visit: