Download Health Advisory: Botulism in the Region

Health Advisory
Botulism in the Region
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Date:
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Health Care Providers
Karen Milman, MD, MPH, Sonoma County Health Officer
May 18, 2017
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Situation:
The California Department of Public Health is investigating an outbreak of foodborne botulism associated with
consumption of a nacho cheese sauce served at the Valley Oak Food and Fuel gas station in Walnut Grove.
Sale of the food was stopped on the afternoon of Friday, 5 May 2017. From mid-April through May 16, 2017,
ten cases have been identified; all cases were hospitalized and there have been no deaths. It is possible that
additional cases with compatible illness and exposure exist but have not yet been accurately diagnosed.
In this current outbreak and others, recognition of botulism has been delayed, particularly in patients who
present with initially mild neurologic symptoms. We are asking clinicians who may see patients with
symptoms consistent with botulism to be alert for this potential diagnosis and follow the below actions:
ACTIONS REQUESTED OF CLINICIANS:
1. Report all patients with suspect botulism immediately to Sonoma County Department of Health
Services (DHS) Disease Control (707 565-4566). DHS Disease Control then coordinates with the
California Department of Public Health (CDPH).
2. Consider botulism as a differential diagnosis for patients exhibiting blurred vision, diplopia (double
vision), ptosis (drooping eyelids), dysphagia (trouble swallowing), dysarthria (difficulty speaking),
impaired gag reflex, and /or facial weakness.
3. Collect pre-treatment specimens and coordinate with DHS Disease Control for laboratory testing.
4. Treat patient(s) immediately with Heptavalent Botulism Antitoxin (HBAT) based on compatible
clinical presentation. Antitoxin can be obtained via DHS Disease Control. Laboratory confirmation is
not required prior to treatment.
5. Inquire about exposure to prepared food, particularly nacho cheese sauce, from the Valley Oak
Food and Fuel gas station in Walnut Grove, for patients exhibiting botulism symptoms.
Background:
Botulism is a serious paralytic illness caused by a nerve toxin produced by Clostridium botulinum. Symptoms
generally begin 18 to 36 hours after eating a contaminated food or drink, but they can occur as early as 6
hours or as late as 10 days after exposure. Clinically, the early signs of botulism are bilateral cranial nerve
palsies which may include blurred vision, diplopia, ptosis, dysphagia, dysarthria, or facial weakness. Patients
may initially remain alert and responsive with no sensory deficits. Muscle weakness then descends bilaterally
and may lead to respiratory failure and death, thus early medical attention is imperative.
If diagnosed early, botulism can be treated with an antitoxin made from horse serum which blocks the action
of toxin circulating in the blood; available only through public health departments. This can prevent patients
from worsening but cannot reverse the paralysis.
Lab testing, only available through a public health lab, may demonstrate toxin in stool, gastric aspirate or
vomitus, wound or serum of patient, or in a suspected food item. Other neurological disorders that may
resemble botulism in non-infants include myasthenia gravis and Guillain-Barré syndrome.
In California, adult botulism is more commonly associated with injection drug use or contaminated wounds.
However, foodborne botulism continues to be identified in California. While home-canned vegetables have
often been implicated in past outbreaks of foodborne botulism, the lack of exposure to home-canned foods
should not rule out the consideration for botulism in the differential diagnosis of a patient with compatible
symptoms.
Foodborne botulism can represent a major public health threat, because other people may be at risk of
poisoning from eating the same contaminated food. Early identification, reporting, investigation, and
response can prevent further disease.
Additional Information:
Centers for Disease Control and Prevention: https://www.cdc.gov/botulism/index.html
California Department of Public Health: https://archive.cdph.ca.gov/HealthInfo/discond/Pages/Botulism.aspx