West Virginia Department of Health and Human Resources Botulism: Information for Public Health Officials

Pre-formed bacterial toxin

Unique Epidemiological Characteristics

• Natural reservoir for the bacteria is soil
• A newly reported case should be urgently investigated considering:
  • Foodborne (intentional or unintentional)
  • Wound
  • Aerosol (intentional)
• Incubation: 12-72 hours; sometimes longer
• No person-to-person transmission
• Mortality: very high (without therapy) due to respiratory muscle paralysis – dire emergency
• Environmental:
  • Aerosolized toxin decays at about 1-4% per minute – not environmentally stable
  • Foods can continue to be a source as long as they are in circulation
• Prophylaxis – not available
• Treatment – antitoxin + artificial respiration – effective if initiated early

Lab confirmation

• Virginia State Health Department
• Implications: Use a clinical case definition early in the investigation: diplopia, dysarthria, dysphonia, dysphagia

Employee Health Considerations

• Exposed employees should be placed under surveillance for development of symptoms
• Standard precautions for work with affected individuals

Lifesaving interventions – in order:

1. Recognition / reporting / casefinding + early and appropriate therapy
2. Collect and analyze risk information to identify source AND
   • remove source (e.g., food) from the environment AND
   • identify the exposed population to be placed under surveillance.

Training considerations

• Physicians: recognition / treatment / reporting
• ICPs: reporting, active surveillance procedures
• Labs: procedure for referral of specimens
• Local health departments, regional epidemiologists: investigation
• IDEP / DSDC / BPH: employee health / investigation / priorities for control
• Environmental Health: sampling of foods and other environmental specimens