Emergency Preparedness

Kern Medical Bioterrorism Response Guide Section 2-A-3 – Botulism

BOTULISM (CLOSTRIDIUM BOTULINUM) OVERVIEW

Naturally Occurring Botulism Botulism is a neuroparalytic illness caused by a potent neurotoxin produced from Clostridium botulinum, an anaerobic, spore-forming bacterium. C. botulinum produces seven (7) different, but related, toxins (A through G). Only toxins A, B, E and F cause disease in humans. The toxin exerts its effect by blocking the release of acetylcholine at cholinergic synapses. The spores are ubiquitous and are found throughout the world in soil and marine sediments. In 1999, 174 cases of botulism were reported to the CDC. Of these, 26 were foodborne, 107 were infant botulism, and 41 were cases of wound botulism. Since the disease is caused by the distribution of toxin to nerves, the clinical manifestations are identical in all forms. Botulism has historically been a foodborne disease. The most frequent source is home- canned foods, prepared in an unsafe manner. Wound botulism occurs when C. botulinum spores germinate within wounds. It can occur after gross trauma or surgery. Over recent years, wound botulism has increased in persons who are injecting drug users, primarily in California. It is seen predominately in drug users who subcutaneously inject (“skin pop”) so-called “black-tar” heroin. Inhalational botulism from aerosolized botulinum toxin does not occur in nature, but has been demonstrated experimentally in primates and has occurred in a laboratory accident. Bioterrorism Epidemiology Botulinum toxin is the most poisonous substance known. A single gram of crystalline toxin, evenly dispersed and inhaled, would kill more than 1 million people, although technical factors would make such dissemination difficult. A bioterrorist attack could involve either an aerosol or food or water contamination. Botulism is not transmitted from person to person. All materials initially contaminated by the toxin must be handled with extreme care. The toxins are detoxified in the air within 12 hours. Sunlight inactivates the toxins with 1 - 3 hours. Heat destroys the toxins in 30 minutes at 80°C and in several minutes at 100°C. Incubation Period Any suspected case of botulism ( Clostridium botulinum ) MUST BE TREATED AS A PUBLIC HEALTH EMERGENCY and reported to the infection control practitioner [ insert telephone number ] and the local health department [ insert telephone number ] immediately.

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