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A recent outbreak of illness affecting tourists who eat local shellfish officially became an epidemic Tuesday, according to the Lee County Health Department.

Doctors diagnosed three more people this week with neurological shellfish poisoning, bringing the total to 11 cases in July.

The red tide-related toxin infects bi-valves, such as clams, oysters, scallops and conch. Cooking the shellfish does not destroy the toxin.

There is no threat from eating shellfish purchased in grocery stores and restaurants because it comes from other areas of the country, said J. Robert South, biological administrator for the Lee County Health Department.

“There is no danger to the public if they do not collect and eat shellfish off of Lee County shores,” South said. “This is a self-inflicted injury. If you eat the shellfish you are going to get sick if the toxin is present.”

Doctors hospitalized six of the victims, four of whom needed intensive care, with symptoms including dizziness, difficulty walking, nausea, vomiting, diarrhea and prickling or tingling of the skin, South said. The victims recovered after the toxin cleared their system.

All of the victims were from out of town and got sick after collecting the shellfish in waist-deep water in the Gulf of Mexico just off the beach, South said. The practice of collecting shellfish without a permit in Lee County is illegal.

Ten of the 11 cases came from Sanibel and one originated in Fort Myers Beach. The outbreaks became an epidemic because four different groups were affected by the illness, South said.

The epidemic is another blow to Lee County’s tourism industry brought on by red tide and pollution from Lake Okeechobee discharges, said Ava Hinojosa, interim executive director of the Sanibel and Captiva Islands Chamber of Commerce.

“It compounds the troubles that we have with the severe red tide bloom,” Hinojosa said. “Red tide comes and goes but the damages stay behind. It takes awhile for that to dissipate totally.”

The chamber is working with the city of Sanibel and other agencies to educate tourists and prevent another incident, Hinojosa said.

Sanibel city manager Judith Zimomra said the multi-agency plan includes going door-to-door with police and code enforcement, reverse 911 calls to every phone, posting signs at beach access points, e-mailing community leaders and handing out information to every driver that passes through the toll booth to enter the island.

“When you get to the point where there are 11 cases and 10 were on Sanibel ... you take that seriously,” Zimomra. “I think it’s bad for tourism that it’s occurring and will be even worse for tourism if we have a fatality.”

The Lee County Visitor and Convention Bureau is helping by distributing information to area hotels, said Tamara Pigott, deputy director of the bureau.

Last week the bureau sent all hotels a notice telling managers to educate guests. The agency sent out another notice to hoteliers Tuesday morning.

Sharon Tombs, general manager for the Holiday Inn Sanibel Island Beach Resort, said her staff put notices in all rooms with cooking facilities. The hotel also hands out information to tourists when they check in, Tombs said.

Local leaders can warn tourists, Zimomra said, but eradicating the problem will only come from cleaning the area’s water, which starts with slowing polluted releases from Lake Okeechobee.

“I’m no scientist but I know we didn’t have anyone in the hospital eating our shellfish prior to the dirty water releases,” Zimomra said. “This entire Gulf Coast has to realize that the water quality issue is continuing to hit us in the pocketbook, which is tourism.”