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BOTULISM
Public Health Preparedness Program
What is Botulism?
Botulism is a rare but serious muscle paralyzing disease caused by a nerve toxin that is produced
by the bacterium Clostridium botulinum. This type of bacteria is found naturally in the soil.
There are three main kinds of botulism:
 Foodborne botulism is caused by eating foods that contain the botulinum toxin.
 Wound botulism is caused when wounds are infected by the toxin produced from
Clostridium botulinum. This can occur when a wound is contaminated during an outdoor
injury by contact with contaminated soil. The bacteria can only infect damaged skin.
 Infant botulism occurs in a small number of susceptible infants each year who harbor
Clostridium botulinum bacteria in their intestinal tract.
All forms of botulism can be fatal and are considered medical emergencies. Foodborne botulism
is a public health emergency because the contaminated food source may be unknown and still
available, and many additional people can be poisoned by eating the contaminated food.
Why are we Concerned About Botulism as a Bioweapon?
Botulism toxin could be used as a biological weapon because it can be spread through a food
source and has the potential to be aerosolized.
Transmission: How does Someone Become Infected with Botulism?
Botulism is not contagious, meaning it is NOT spread from one person to another person.
Foodborne botulism is caused by eating foods that contain the botulinum toxin. You can also get
botulism when the bacteria enter your skin through a wound. Most wound botulism cases are
associated with black-tar heroin injection, especially in California.
A bioweapon carrying Clostridium botulinum is possible because it is easy to produce, though
technical factors make dissemination difficult.
What are the Signs and Symptoms of Botulism?
Symptoms include double vision, blurred vision, drooping eyelids, slurred speech, difficulty
swallowing, dry mouth, and muscle weakness that moves down the body, usually affecting the
shoulders first, then the upper arms, lower arms, thighs, calves, etc. Finally, paralysis of
breathing muscles can cause a person to stop breathing and die, unless assistance with
breathing by mechanical ventilation is provided.
Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and
poor muscle tone, all symptoms of the muscle paralysis caused by the bacterial toxin.
The first symptoms of foodborne botulism may also include nausea and vomiting.
How Soon do Infected People get Sick?
With foodborne botulism, symptoms can begin within 6 hours to 10 days, but most commonly
between 12 and 36 hours after eating food that contains the toxin. For wound botulism and
infant botulism, it is difficult to estimate the incubation period because exposure times cannot be
ascertained. The time of onset for inhalational botulism cannot be stated with certainty because
so few cases have been observed.
How is Botulism Treated?
Botulism can be treated with an antitoxin which blocks the action of toxin circulating in the
blood. The antitoxin is most effective in reducing the severity of symptoms if administered early
in the course of the disease.
Antitoxin for infants is available from the California Department of Public Health, and antitoxin
for older children and adults is available through the Centers for Disease Control and Prevention.
The respiratory failure and paralysis that occur with severe botulism may require a patient to be
on a breathing machine (ventilator) for weeks or months, plus intensive medical and nursing
care. If given before paralysis is complete, antitoxin can prevent worsening and shorten
recovery time. The paralysis slowly improves and eventual recovery can take many months of
supportive care.
Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using
enemas. Wounds should be treated, usually surgically, to remove the source of the toxinproducing bacteria followed by administration of appropriate antibiotics. Good supportive care in
a hospital is the mainstay of therapy for all forms of botulism.
Can a Person Exposed to Botulism Avoid Becoming Sick?
There is no vaccine or medication to prevent botulism. The preventive measures that will be
taken in the event of a botulism outbreak will involve determining the source of exposure and
isolation from that source.
Would Enough Antitoxin be Available in the Event of a Bioterrorism Attack?
National and state public health officials have large supplies of drugs needed in the event of a
bioterrorism attack. These supplies can be sent anywhere in the United States within 12 hours.
What is the Washoe County Health District Doing to Prepare for a Botulism Outbreak?
In the event of a weaponized botulism attack or outbreak, the Washoe County Health District will
work closely with the Nevada Division of Public and Behavioral Health and the Centers for
Disease Control and Prevention (CDC) to provide community partners and the public with
recommendations regarding infection control activities. This information will be available
through the media and the Washoe County Health District website.
Sources: www.cdc.gov
JAMA, February 28, 2001 – Vol. 285, No. 8