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Botulism Outbreak Information

Botulism is a rare form of foodborne illness.  It is very dangerous.  Botulism can be lethal if not immediately treated.

What is Botulism?

Clostridium botulinum is a bacterium. Unlike many foodborne bacteria, it does not need oxygen to grow. Foodborne Botulism is transmitted by the bacteria known as Clostridium botulinum. These bacteria release botulinum toxin.  Just a few nanograms of this toxin can cause botulism.

Botulinum toxin is one of the most powerful known toxins: about one microgram is lethal to humans when inhaled

How Does Someone Become Sick with Botulism?

Botulism spores are commonly found in soils and water sources. It Is when they are exposed to low levels of oxygen that they release their deadly toxin. Once someone is infected with Botulism, they are not contagious. The infection is not spread from direct contact from person to person.

Botulism usually can be spread in three different ways. These include:

  • Through wounds (typically found among those who inject illicit drugs)
  • By eating contaminated food or drinks
  • Infants may develop the bacteria in their intestines before they reach 6 months of age

Infants typically become infected with Botulism through ingesting honey or by inhaling Botulism spores from the natural environment.

The most common cause for foodborne Botulism infections are contaminated homemade canned foods. However, it is possible for Botulism to be caused by canned cheese sauce, chili peppers, tomatoes, carrot juice, and even chopped garlic in oil. Studies have found that foods with low acidity are at an increased risk of Botulism contamination. The Centers for Disease Control and Prevention recommend following proper canning methods, refrigerating garlic or herbs in oil, and keeping baked potatoes either hot or refrigerated as ways to help prevent the spread of Botulism. They also recommend boiling canned foods for 10 minutes prior to serving, regardless if they are homemade or store bought.

How Rare Is It?

In 2008, only 153 cases of Botulism were reported to the Centers for Disease Control and Prevention. Out these, only 18 were considered to be foodborne in nature.

What Are the Symptoms of Botulism Infection?

Symptoms of a Botulism infection have a fairly quick onset. Someone who has been exposed to the bacteria will usually begin to show symptoms within 18 to 36 hours. The timeline in some individuals can extend to 6 hours and as late as 10 days after exposure.

The symptoms of Botulism poisoning include:

  • double vision
  • blurred vision
  • droopy eyelids
  • slurred speech
  • difficulty swallowing
  • dry mouth
  • muscle weakness
  • decreased mental state

Infections in infants have additional symptoms of:

  • lethargy
  • loss of appetite
  • constipation
  • weak cry
  • poor muscle tone.

The most concerning aspect of the infection is that, if the illness is left untreated, it can develop into causing paralysis in the arms, legs, and respiratory muscles. This is why immediate medical treatment of Botulism infections is highly recommended.

Recovery from a Botulism infection can take weeks to months. Those with severe upper body paralysis, the use of a mechanical ventilator is necessary – sometimes for up to a few months. In some cases, after a full recovery, someone who had Botulism may have shortness of breath and fatigue for up to a few years after the illness.

It is important to note that Botulism is only deadly in 3-5% of cases, which has drastically been reduced from the 50 percent mortality rate of a mere 50 years ago. Despite these statistics, Botulism infections are still considered highly deadly and high risk, as the infection can cause paralysis.

Who is Most at Risk of Becoming Infected with Botulism?

While anyone can become sick with Botulism, some people are at a higher risk for a Botulism infection. For example, users of intravenous street drugs are at an increased risk of developing wound Botulism. Also, children under the age of 1 year who are fed honey are at a high risk for Botulism infection.

How Are Botulism Infections Diagnosed?

Healthcare providers are able to diagnose Botulism infections through several methods, including:

  • brain scans
  • spinal fluid testing
  • Botulinum toxin testing
  • nerve conduction testing

The reasons and necessity for such a wide range of tests is because Botulism infections present in a similar way to other diseases, including Guillain-Barré syndrome, myasthenia gravis, and strokes.

How Are Botulism Infections Treated?

Botulism infections are treated with an antitoxin that is housed and distributed by the Centers for Disease Control and Prevention and through state health departments. The antitoxin can shorten and reduce the severe symptoms and prevent the progression of the illness. Those with Botulism infections typically require hospitalization to manage their severe symptoms.

What Has the CDC Done Lately with Botulism?

The Centers for Disease Control and Prevention track illnesses. One of the major illnesses they track are Botulism infections. Just recently, the CDC released its data on these bacterial illnesses. In the year 2015, Clostridium botulinum was responsible for 199 confirmed cases of Botulism infection, as well as an additional 14 probable cases. There were 39 cases of foodborne Botulism reported in 2015, making up about 20% of all cases. Six out of the 14 probable cases were also caused by foodborne Botulism.

The study found that, despite the reduction in illnesses over the last 50 years due to progressive food safety methods, the infection could be making a comeback. Botulism infections appear to be on the rise, and outbreaks, like the latest one in California in 2017 linked to nacho cheese, have shown that the 2015 numbers may not be a fluke.

Why the Increase?

One of the main probable reasons for the increase in Botulism infections in 2015 came from a single outbreak in the state of Ohio. A potluck dinner at a church in Lancaster, Ohio led to 25 confirmed cases and 4 probable cases of the illness. Of those sickened, 27 ill patients had to go to the hospital because of these illnesses. Of these, 25 received antitoxin and 11 required incubation. The CDC sent 50 doses of the antitoxin to Ohio.

With so many people ill, the CDC declared this incident the largest botulism outbreak in almost 40 years. The outbreak culprit – homemade potato salad brought to the potluck. Health agency investigators found that the potatoes used in the salad were home-canned using improper canning methods. While a pressure canner would kill Clostridium botulinum spores, these potatoes were canned in a boiling water canner and were not reheated prior to making the potatoes salad.

Is Home Canning the Only Concern?

No. We are seeing a rise in recalls by companies and the Food and Drug Administration linked to Botulism contamination.

In 2017 alone, there have been several food recalls linked to Botulism contamination. Past food recalls linked to Botulism contamination include:

  • coffee
  • deer antler herbal tea
  • lemongrass satay/ shrimp satay sauces
  • canned meats
  • baked beans
  • frozen fish
  • baby food
  • Honey may also contain the organism, and for this reason, honey should not be fed to children under 12 months of age

The CDC recommends boiling and heating foods from jars or cans for at least 10 minutes after opening to reduce the risk of Botulism infection.

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