: Incidence of anisakidosis in Japan In Japan where raw fish are frequently eaten with no anti-parasite processing the infection of the nematode Anisakiasis became a required reportable diagnosis in 2012. Nevertheless, only

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Incidence of anisakidosis in Japan
In Japan where raw fish are frequently eaten with no anti-parasite processing the infection of the nematode Anisakiasis became a required reportable diagnosis in 2012. Nevertheless, only 89 cases were reported in 2013. According to a study on the subject they claimed that health insurance records suggested over 7000 cases (https://academic.oup.com/cid/article/60/9/e43/405137/Is-the-Quality-of-Sushi-Ruined-by-Freezing-Raw).

This seems to be a huge divergence in numbers.

I guess there are two things I don't understand. If it is required to report it, how could they have only 89 reported cases but 7000+ "insurance" cases? The other thing I don't understand is that another study I read found Anisakiasis infection in 20% of the mackerels that they examined. If the nematode is so prevalent, shouldn't people in Japan be getting sick on a much larger scale? I mean there are millions of people in Japan eating raw mackerel. If 20% of that mackerel has Anisakiasis larva, then shouldn't we be seeing hundreds of thousands of cases of human infection, not just 7000 or 89?

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