Ciguatera poisoning is a critical public-health issue among Pacific island nations. Accurately predicting ciguatera outbreaks has become a priority, particularly in Rarotonga in the southern Cook Islands, which has reported the highest incidence of ciguatera poisoning globally. Since 2006, however, cases of ciguatera poisoning have declined, and in 2011 ciguatera cases were the lowest in nearly 20 years. Here we examined the relationships between cases of ciguatera poisoning, from 1994 to 2011, and: (i) coral cover, used as a proxy of reef state, (ii) the densities of herbivorous fishes, and (iii) reef disturbances. We found that coral cover was not a good predictor of cases of ciguatera poisoning, but high densities of the herbivorous fish Ctenochaetus striatus and reef disturbances were both strong predictors of ciguatera poisoning. Yet these two predictors were correlated, because the densities of C. striatus increased only after major cyclones had disturbed the reefs. Since 2006, the number of cyclones has decreased considerably in Rarotonga, because of the climatic shift toward the negative phase of the Pacific Decadal Oscillation. We suggest that fewer cyclones have led to decreases in both the densities of C. striatus and of the number of reported cases of ciguatera poisoning in Rarotonga.