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: immediately notifiable to local health jurisdiction
  • Health care facilities: immediately notifiable to local health jurisdiction
  • Laboratories: Clostridium botulinum immediately notifiable to local health jurisdiction. Specimen submission is required - Serum and/or stool; any other specimens available (i.e., foods submitted for suspected foodborne case; debrided tissue submitted for suspected wound botulism) (2 business days)
  • Local health jurisdictions: suspected and confirmed cases are immediately notifiable to the Washington State Department of Health (DOH) Communicable Disease Epidemiology (1-877-539-4344)