What every travel medicine practitioner needs to know about Sargassum weed: five key points

We are writing to communicate what we believe to be an important and under-recognized topical issue in travel medicine, which is Sargassum toxicity. Given the volume of international tourist travel, the frequency of travel-acquired illness1 and the current gaps in knowledge around many such illnesses related to travel, we feel that communication of five key points around Sargassum toxicity in the Caribbean is timely and needed. We herein illuminate the major aspects of Sargassum weed with which travel medicine practitioners should be familiar and highlight some practical communication points for the pre-travel and post-travel setting (Box 1). Sargassum is a drifting seaweed that has accumulated dramatically in the Caribbean. Beginning in 2011, large rafts of Sargassum—a brown, drifting seaweed—began washing up on shores throughout the Caribbean (Figures 1A and 1B; Box 1), its origin tracing back to the north-east coast of Brazil.2 Reasons for the large proliferation remain speculative, but may relate to excess nutrient (e.g. nitrogen) discharge into the ocean, as well as climatologic factors.2 The phenomenon also occurs in the Yellow Sea of China, where it is known as ‘Golden Tide’. Decomposing Sargassum releases hydrogen sulfide (H2S) and ammonia (NH3), which cause respiratory, skin and neurocognitive symptoms in local and travelling populations. H2S is a broad-spectrum poison. Acute H2S inhalation causes cardiovascular, respiratory and neurologic symptoms in a dose-dependent manner and can lead to severe hypoxemic respiratory failure.3,4 Over an 8-month period in 2018, health officials in Guadeloupe and Martinique reported 11 000 such cases.3,4 More chronic exposure to these gasses can lead to conjunctival and neurocognitive symptoms such as memory loss and impaired balance, as well as non-specific symptoms such as headache, nausea and fatigue.3,4 Treatment of Sargassum toxicity is supportive. No specific treatment for Sargassum toxicity exists; supportive medical care may be needed.3 Measures should be taken to stop exposure. The diagnosis is one of exclusion. Prevention of Sargassum toxicity relies on avoidance of exposure. Prevention of exposure is challenging for travellers as tour operators and hotels may not be transparent about the likelihood or severity of Sargassum invasion. Additionally, tidal variations translate into rapidly shifting Sargassum rafts, leading to beaches that are affected in an unpredictable manner. Peak Sargassum season in the Caribbean is January to April. If Sargassum is present, travellers should avoid touching the weed or inhaling its gasses (Box 1). Nations are investing heavily in capacity to monitor H2S levels, train health care workers and remove the weed within 48 h of its deposition to reduce health effects.3 Cross-disciplinary efforts are underway to better understand the incursion of Sargassum into the Caribbean. The distribution of recent Sargassum accumulation stretches from Florida, along the Gulf of Mexico and across to the lesser Antilles, with close to 1700 sq. km of ocean coverage in the Caribbean by late 2018.5 Collaboration between oceanographers, ecologists, marine biologists and national, regional and international public health agencies are ongoing to better elucidate the causes, health effects and mitigation strategies for this enormous threat to public, economic and marine ecological health. Key messages regarding Sargassum toxicity for the international traveller. Sargassum in Belize, March 2018. (A) A large swath of the weed carpeting a beach; (B) piles of Sargassum weed shoveled onto a beach by local hotel workers

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