Assessment of Human Health Impacts from Invasive Pufferfish (Attacks, Poisonings and Fatalities) across the Eastern Mediterranean

Simple Summary Invasive alien species are a global threat to biodiversity, ecosystem services (e.g., tourism and fisheries) and human health. Pufferfishes are notorious for their toxicity and may also display aggressive behavior, thus posing a threat to human health. In this work, we collected records of attacks, poisonings and fatalities, due to Lagocephalus sceleratus and Torquigener hypselogeneion, in the Eastern Mediterranean Sea, for the years 2004-2023. These records were retrieved from social media, and the grey and scientific literature, as well as from personal observations. Overall, 198 events impacting human health were documented: 28 records of physical attacks, at least 143 non-lethal poisoning episodes, and 27 human fatalities resulting from consumption. The number of recorded incidents greatly increased after 2019, especially with regards to poisonings, yet whether related to greater media attention, or to increased abundance is unclear. This is a baseline work for future monitoring and raising awareness. Thus, we urge the continuation of national campaigns to caution residents and tourists of these species' high toxicities and potential aggressiveness.Abstract The silver-cheeked toadfish Lagocephalus sceleratus (Gmelin 1789), and to a lesser degree the orange spotted toadfish Torquigener hypselogeneion (Bleeker, 1852), pose threats to human health from physical attacks and poisonings in the Eastern Mediterranean Sea. This study reviewed human health-related impacts resulting from these pufferfish, compiling and assessing records from online sources, the peer-reviewed literature, medical records, personal interviews, and observations across the Eastern Mediterranean in the years 2004 to 2023. A total of 198 events impacting human health were documented: 28 records of physical attacks, at least 144 non-lethal poisoning episodes, and 27 human fatalities resulting from consumption. The majority of the reported incidences occurred in Syria, T & uuml;rkiye, and Lebanon. Most physical attacks occurred in summer, while most poisoning events occurred during winter. The number of recorded incidents greatly increased after 2019, especially with regard to poisonings, yet whether this is related to greater media attention, or to increased fish abundance is unclear. This is the first comprehensive study to collate findings on attacks, poisonings and fatalities caused by these pufferfish in the Mediterranean Sea, and may help in improving national health policies. We urge the continuation of national campaigns to caution residents and tourists of these species' high toxicities and potential aggressiveness.