Botulism

Cause: Bacterial toxin from Clostridium botulinum, mainly Types A, B, and E.

Illness and treatment: Forms are foodborne botulism (ingested toxin), wound botulism (toxin production in an infected wound), infant botulism (toxin produced in the intestine of a child under a year of age), adult colonization botulism (toxin produced in the intestine of an adult), and inhalational botulism (inhaling toxin, which does not happen naturally). Paralysis starts with facial muscles and often progresses to involve the breathing muscles. Infants may have a weak cry, difficulty feeding leading to weight loss, and weakness. Treatment is supportive care plus either human-derived botulism hyper-immune globulin (BIG-IV) for infants or botulism antitoxin for older children and adults. Antibiotics are given for wound botulism.

Sources: C. botulinum spores are common in soil. No consistent exposure is known for infants. Inadequately processed home-canned foods are implicated in food botulism. Wound botulism is associated with subcutaneous black-tar heroin injection (“skin popping”).

Additional risks: Infant botulism cases usually occur in babies under 3 months old (almost always under 6 months), both breast fed and formula fed.

Prevention: Follow safe home canning procedures. Boil risky home-canned foods (i.e., low acidic, non-pickled foods) before consumption.

Recent Washington trends: Each year there are 0 to 4 reports of foodborne botulism, 0 to 9 reports of infant botulism and 0 to 7 reports of wound botulism. Almost all are type A.

Purpose of Reporting and Surveillance

To assist in the diagnosis of potential cases and facilitate prompt administration of either antitoxin or botulism immune globulin when indicated.
For foodborne botulism, to identify contaminated food(s) and to prevent further exposures.
For foodborne botulism, to identify and assure the proper evaluation and care of other persons who may be at immediate risk of illness because they have already eaten the implicated food.
For wound botulism, to alert others at risk regarding the importance of promptly identifying illness and obtaining medical care.

Legal Reporting Requirements

Health care providers and Health care facilities: immediately notifiable to local health jurisdiction
Laboratories: immediately notifiable to local health jurisdiction; submission required – presumptive positive isolate or if no isolate available specimen associated with presumptive positive result, within 2 business days. On request of a public health agency, send diagnostic specimen(s): serum (food or wound botulism) or stool (food or infant botulism); also include as requested by DOH or LHJ any other specimens available (i.e., implicated foods, debrided tissue or wound swab).
Local health jurisdictions: suspected and confirmed cases immediately notifiable to the Washington State Department of Health (DOH) Office of Communicable Disease Epidemiology (CDE) (877-539-4344 or 206-418-5500).