Global & Disaster Medicine

Archive for the ‘Botulism’ Category

Texas: Mexican honey-filled pacifiers linked to 4 infant botulism cases

ABC 13

“…… four children from around the state came down with infant botulism from August to October, and they all were reported to have been given honey pacifiers purchased in Mexico…….”

 

Infant botulism cases prompt alert about honey pacifiers

News Release

Nov. 16, 2018

Children under 12 months old should not consume honey

The Texas Department of State Health Services is warning parents and other adults not to give babies pacifiers containing honey after four babies were treated for botulism in Texas. Each infant had been given a honey-containing pacifier purchased in Mexico.

The four illnesses occurred from mid-August to the end of October and caused all four babies to be hospitalized for life-saving treatment. The unrelated infants are residents of West Texas, North Texas and South Texas.

Botulism is a serious illness caused by a toxin that attacks the body’s nerves and can cause difficulty breathing, paralysis and even death. Honey may contain bacteria that produce the toxin in the intestine of babies that eat it. By the time children get to be 12 months old, they’ve developed enough other types of bacteria in their digestive tract to prevent the botulism bacteria from growing and producing toxin.

DSHS today also issued a health alert asking health care providers to look out for cases of infant botulism and to remind parents not to let babies eat honey. The Centers for Disease Control and Prevention and the American Academy of Pediatrics have long advised that children under 12 months old should not consume honey.Honey-filled pacifiers are not common in the United States but may be available in some specialty stores and through online retailers. Most aren’t designed for the honey to be consumed, but some have a small hole so a child could eat the honey, or the pacifier could accidentally rupture or leak. Parents should also avoid pacifiers containing any other food substance, because they could also pose a risk of botulism.

Texas has had seven to eight cases of infant botulism per year in recent years. Ten confirmed or suspected cases have been reported in 2018. Additional information on botulism is available on the DSHS website.

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Since the beginning of 2018 in Ukraine botulism has sickened 80 people, of whom 7 have died.

Koz

“…..Experts urged Ukrainians not to consume dried, salted and canned fish, canned food or meat products….”

 


9 people developed botulism type A after eating homemade savory jelly at a private party in Sønderborg, Denmark.

Food Safety News

 


An outbreak of foodborne botulism in Denmark, with six confirmed cases, has been linked to a homemade dish served at a private party in June.

Food Safety News

 


Denmark: An outbreak of foodborne botulism with six confirmed cases.

Food Navigator

 


San Diego, CA: Three recent wound botulism cases are linked to black tar heroin use

San Diego Union-Tribune

“……They were hospitalized after experiencing a range of symptoms including double vision, drooping eyelids, difficulty swallowing, slurred speech and generalized weakness.

All three have required intensive care treatment with an anti-toxin that counteracts the effects of a neurotoxin produced by clostridium botulinum….”

 


14 people, including four children, were hospitalized after a mass botulism food poisoning outbreak in southern Kyrgyzstan.

Xinhua

  •  3 are in a serious condition.
  • All patients have received the anti-botulinum serum.

Jars of canned vegetables


Researchers analyzing cow feces samples collected at a South Carolina farm discovered a strain of Enterococcus carrying a newtoxin similar to the one that causes botulism.

CELL

“……“BoNT-like gene clusters have not previously been identified in any bacterial species outside of Clostridium and no toxins of E. faecium have been reported before now,” the authors said. “It is disconcerting to find a member of potent neurotoxins in this widely distributed gut microbe, which is a leading cause of hospital-acquired infections.”…..”

 

 


CDC recommendations to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas during the period of September 2017 – March 2018.

CDC

Advice for Providers Treating Patients in or Recently Returned from Hurricane-Affected Areas, Including Puerto Rico and US Virgin Islands

Distributed via the CDC Health Alert Network
October 24, 2017, 1330 ET (1:30 PM ET)
CDCHAN-00408

Summary
The Centers for Disease Control and Prevention (CDC) is working with federal, state, territorial, and local agencies and global health partners in response to recent hurricanes. CDC is aware of media reports and anecdotal accounts of various infectious diseases in hurricane-affected areas, including Puerto Rico and the US Virgin Islands (USVI). Because of compromised drinking water and decreased access to safe water, food, and shelter, the conditions for outbreaks of infectious diseases exist.

The purpose of this HAN advisory is to remind clinicians assessing patients currently in or recently returned from hurricane-affected areas to be vigilant in looking for certain infectious diseases, including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. Additionally, this Advisory provides guidance to state and territorial health departments on enhanced disease reporting.

 

Background
Hurricanes Irma and Maria made landfall in Puerto Rico and USVI in September 2017, causing widespread flooding and devastation. Natural hazards associated with the storms continue to affect many areas. Infectious disease outbreaks of diarrheal and respiratory illnesses can occur when access to safe water and sewage systems are disrupted and personal hygiene is difficult to maintain. Additionally, vector borne diseases can occur due to increased mosquito breeding in standing water; both Puerto Rico and USVI are at risk for outbreaks of dengue, Zika, and chikungunya.

Health care providers and public health practitioners should be aware that post-hurricane environmental conditions may pose an increased risk for the spread of infectious diseases among patients in or recently returned from hurricane-affected areas; including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. The period of heightened risk may last through March 2018, based on current predictions of full restoration of power and safe water systems in Puerto Rico and USVI.

In addition, providers in health care facilities that have experienced water damage or contaminated water systems should be aware of the potential for increased risk of infections in those facilities due to invasive fungi, nontuberculous Mycobacterium species, Legionella species, and other Gram-negative bacteria associated with water (e.g., Pseudomonas), especially among critically ill or immunocompromised patients.

Cholera has not occurred in Puerto Rico or USVI in many decades and is not expected to occur post-hurricane.

 

Recommendations

These recommendations apply to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas (e.g., within the past 4 weeks), during the period of September 2017 – March 2018.

  • Health care providers and public health practitioners in hurricane-affected areas should look for community and healthcare-associated infectious diseases.
  • Health care providers in the continental US are encouraged to ask patients about recent travel (e.g., within the past 4 weeks) to hurricane-affected areas.
  • All healthcare providers should consider less common infectious disease etiologies in patients presenting with evidence of acute respiratory illness, gastroenteritis, renal or hepatic failure, wound infection, or other febrile illness. Some particularly important infectious diseases to consider include leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza.
  • In the context of limited laboratory resources in hurricane-affected areas, health care providers should contact their territorial or state health department if they need assistance with ordering specific diagnostic tests.
  • For certain conditions, such as leptospirosis, empiric therapy should be considered pending results of diagnostic tests— treatment for leptospirosis is most effective when initiated early in the disease process. Providers can contact their territorial or state health department or CDC for consultation.
  • Local health care providers are strongly encouraged to report patients for whom there is a high level of suspicion for leptospirosis, dengue, hepatitis A, typhoid, and vibriosis to their local health authorities, while awaiting laboratory confirmation.
  • Confirmed cases of leptospirosis, dengue, hepatitis A, typhoid fever, and vibriosis should be immediately reported to the territorial or state health department to facilitate public health investigation and, as appropriate, mitigate the risk of local transmission. While some of these conditions are not listed as reportable conditions in all states, they are conditions of public health importance and should be reported.

 

For More Information


California: An outbreak of botulism linked to the consumption of ready-to-eat nacho cheese

 

California Department of Public Health

MEMORANDUM DATE: September 6, 2017
TO: Directors of Environmental Health
FROM: California Department of Public Health (CDPH), Food and Drug Branch (FDB)
SUBJECT: Nacho cheese warming units at retail locations

 

The CDPH Food and Drug Branch (FDB) and Sacramento County Environmental Management Department (SCEMD) recently investigated an outbreak of botulism linked to the consumption of ready to eat nacho cheese purchased at Valley Oak Food and Fuel in Walnut Grove, California. The nacho cheese was applied to chips by customers from a counter-top, self-service warming and dispensing unit supplied by the cheese manufacturer. These types of warming and dispensing units are typically designed to maintain the cheese at approximately 140 deg. F.

As of May 31, 2017, a total of 10 case-patients were laboratory-confirmed with C. botulinum toxin type A. All patients were hospitalized; nine were in an intensive care unit, seven required ventilator support, and one died. Leftover nacho cheese sauce collected from the gas station yielded C. botulinum toxin type A bacteria and toxin. Due to the extensive distribution of the same lot code of nacho cheese throughout the United States without additional botulism cases, internal testing conducted by the Wisconsin manufacturer of the nacho cheese, and only a single bag of cheese linked to human illness, FDB and SCEMD suspect the nacho cheese was likely contaminated at the retail location. A few items in particular were noted during the investigation that was concerning:

 The 5 pound bag of nacho cheese collected at the retail location on May 5, 2017 was being used past the “Best By” date.

 Records were not being maintained by the gas station employees indicating when the bag of nacho cheese was originally added to the warming unit.

 The plastic tool designed to open the bags of cheese (provided with the nacho cheese warming and dispensing unit) was not being used by employees.

FDB is aware that these types of nacho cheese warming and dispensing units are in use at many retail locations throughout California. These units generally provide safe, ready-to-eat foods without significant input from employees at each location. FDB would like to provide the following guidance regarding the use of nacho cheese warming and dispensing units in retail locations.

1. Management and employees should follow the instructions for each type of machine and product they use. Instructions for use may be included on the packaging of the

 

bagged nacho cheese or included on the interior panels of the warming and dispensing unit. These directions may include pre-heating and the length of time a product can remain at elevated holding temperatures. In some cases the product may only be held above 135 deg. F. for 4-6 days.

2. Management should ensure that records are maintained indicating when bagged cheese was last changed. This may be accomplished by writing the date the product was added to the warmer on the bag itself.

3. Management should ensure that the warming and dispensing units are not turned off at night or plugged into a timer. These types of machines need to remain “on” at all times. This will ensure that appropriate temperatures are maintained in this ready-to-eat food.

4. Management and employees should ensure that any supplied tools for opening the bags of cheese are used per the product directions. These devices need to be washed, rinsed, and sanitized between uses. In some cases these opening tools are only supplied with warming and dispensing unit.

5. Management and employees should verify on a regular basis that the internal temperature of the hot held cheese product is being held at the proper temperature. The internal temperature can be measured by placing the cheese product in a cup with a thermometer to verify the product is maintaining the minimum hot holding temperature of 135 deg. F as required under the California Retail Food Code Section113996 or hot holding temperature as recommended by the manufacturer.

CDPH hopes this information can be shared widely to ensure retail food facilities have current information and are taking appropriate measures to keep our food supply safe. Thank you for your consideration and ongoing collaboration with our Department

 


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