Rates of botulism in Germany have changed little since the 1980′s – as depicted in the following graph: [1, 2].

Of historic interest, the world’s first botulism outbreak was reported in this country. In 1793, thirteen residents of Wildbad acquired the disease from tainted sausage – thus the term “botulism” (Latin, botulus = sausage). [1,2]

References:
1. Berger S. Infectious Diseases of Germany, 2011. 488 pp, 145 graphs, 1906 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-germany/
2. Berger S. Botulism: Global Status, 2011. 80 pp, 86 graphs, 510 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/botulism-global-status/

The following background data on botulism in France are abstracted from Gideon www.GideonOnline.com and the Gideon e-book series. [1,2]

Time and Place:
– Botulism has been a notifiable disease in France since 1986.
– The yearly number of outbreaks has changed little during the past thirty years [see graph] [3]
– 56% of outbreaks during 1993 to 1996 were ascribed to ham products; 69% during 2001 to 2002.
– Annual botulism rates vary from 0.01 to 0.04 per 10,000, and are similar to rates reported in surrounding countries [see graph]
– 51 fatal cases were reported during 1956 to 2002
- 2 cases of infant botulism (both type B) were reported during 1983 to 2006; 7 (0 fatal) during 1991 to 2009; 1 per year from 2004 to 2008; 2 in 2009

Year(s) / Outbreaks / Cases / Deaths
1875 to 1939 / NA / 24 / 3
1940 to 1944 / 500 / 1,000 / NA
1945 to 1948 / 85 / NA / NA
1950 to 1954 / 5 / 26 / 2
1956 to 1970 / 134 / 337 / 17
1971 to 1980 / 290 / 621 / 16
1981 to 1990 / 170 / 293 / 12
1991 to 2000 / 142 / 278 / 5
2003 to 2006 / 56 / 96 / NA

Clostridium botulinum types:
- 87% of botulism cases reported during 1991 to 2000 were due to type B Clostridium botulinum, 6% type A and 6% type E.
- All cases reported during 1991 to 1996 were due to type B Clostridium botulinum, with highest incidence in the central region.
- 63 of 78 outbreaks reported during 1997 to 2002 were due to type B toxin.
- 16 cases of type E botulism were reported during 1952 to 1999.

In two cases, botulism was associated with inhaled cocaine.

Notable outbreaks:
1978 – An outbreak (31 cases, 0 fatal) of type B botulism was caused by contaminated soft cheese.
2000 – An outbreak (9 cases, 0 fatal) of type B botulism was caused by contaminated home-canned asparagus.
2001 (publication year) – An outbreak (3 cases, 0 fatal) of type B botulism was reported among members of a family.
2003 – An outbreak (4 cases, 0 fatal) of type B botulism involving two departments was caused by contaminated halal sausage.
2008 – An outbreak (2 cases, 0 fatal) of type A botulism in Brittany was caused by contaminated industrially-produced chicken enchiladas.
2009 – An outbreak (3 cases) of type E botulism in France was related to vacuum packed hot-smoked Canadian whitefish purchased in Finland.
2011 – An outbreak (8 cases) in the Vaucluse and the Somme was due to contaminated green almond tapenade.
2011 (publication year) – An outbreak (5 cases) in Corsica was related to ingestion of artisanal-produced food (canned green beans and/or salted roast pork).

References:
1. Berger SA. Infectious Diseases of France, 2011. Price: 687 pp, 286 graphs, 2159 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-france/
2. Berger SA. Botulism: Global Status, 2011. 80 pages, 86 graphs, 510 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/botulism-global-status/
3. Gideon graph tool tutorial at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps )

Steve Berger
Geographic Medicine
Tel Aviv Medical Center
mberger@post.tau.ac.il

Note featured on ProMED

Notwitstanding a recent outbreak in Utah, infant botulism has accounted for an growing percentage of total cases in recent years. [1,2] In the following graph, I’ve summarized trends for botulism in the United States. Note that total case numbers have been increasing since 1995, despite a decrease in the incidence of food-borne botulism.

(See the Graph tool tutorial at www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps )

References:
1. Berger SA. Infectious Diseases of the United States, 2011. 1030 pp, 464 graphs, 8237 references. Gideon e-books, www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/
2. Berger SA. Botulism: Global Status, 2011. 80 pages, 86 graphs, 510 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/botulism-global-status/

A recent episode involving contaminated jelly belies the fact that current botulism rates in Canada are only half those reported in the United States [see graph]

The following background data on botulism in Canada are abstracted from the Gideon e-book series. [1,2] Primary references are available on request.

Historical background:
The first outbreak of botulism in Canada was recorded in 1919.
- A total of 100 outbreaks involving over 230 cases had been reported to 2005.
- Botulism is primarily encountered among the First Nations and Inuit people.
- Rates of 30 per 100,000 per year are reported among the Inuit.
- Most cases in recent years have been caused by fermented salmon roe (‘stink eggs’ or ‘gink’) in British Columbia; and fermented sea mammal meat among the Inuit.
- 14 outbreaks (63 cases, 35 fatal) were reported during 1919 to 1954.
- 61 outbreaks (122 cases, 21 fatal) were reported during 1971 to 1984 – Inuit people accounted for 92.6% of the patients, and 59% of the cases caused by raw, parboiled or “fermented” meats from marine mammals. Fermented salmon eggs or fish accounted for 23% of the outbreaks.

Canada’s first case of infant botulism was reported in 1971.
- 27 cases of infant botulism were reported during 1979 to 2006 – including 22 type A and 5 type B.
- As of 2008, infant botulism had been reported in 26 countries – with highest numbers in United States – followed by Argentina, Australia, Canada, Italy, and Japan.

Food recalls:
2006 – Lots of imported Italian olives, American carrot juice, chili sauce and pasteurized canned crab were recalled due to contamination with botulism toxin.
2007 – A recall was issued for clams and cod liver sold in mason jars.
2010 – A recall was issued for peperoni products sold in British Columbia.
2011 – A case of botulism on Vancouver Island let to the recall of watermellon jelly.

Notable outbreaks:
1974 – Outbreaks (10 cases in 4 outbreaks, 4 fatal) of type E botulism were reported among indigenous peoples. Walrus, Arctic char, seal and fermented salmon eggs were implicated.
1977 (publication year) – Outbreaks (12 cases in 2 outbreaks) of type A and B botulism were reported among Inuit peoples.
1985 – An outbreak (36 cases) in the United States and Canada was associated with chopped garlic in soybean oil served in a restaurant in Vancouver, Canada.
1991 – An outbreak of type A botulism was reported in Ottawa.
1995 – Outbreaks (16 cases in 7 outbreaks, 0 fatal) and one case of infant botulism were reported – implicated foods included muktuk, micerak (fermented fat of marine mammals), seal, walrus and marinated/smoked fish.
1996 – Outbreaks (10 cases in 5 outbreaks, 0 fatal) of foodborne botulism were reported – implicated foods included seal, fermented fish, beluga whale and micerak.
1997 – Outbreaks (18 cases in 7 outbreaks, 1 fatal) were reported – including 9 cases in Quebec acquired from seal igunaq and 4 cases in the Northwest Territories acquired from beluga whale and caribou fat.
1999 – An outbreak (3 cases) of type B botulism in Ontario was ascribed to home-canned tomatoes.
2001 – Outbreaks (4 cases in 2 outbreaks, 1 fatal) in British Columbia were ascribed to fermented salmon roe.
2006 – An outbreak (4 cases) in the United States was associated with commercially-canned carrot juice. Three additional cases in Toronto were associated with the same product.
2009 – An outbreak (3 cases) of type E botulism in France was related to vacuum packed hot-smoked Canadian whitefish purchased in Finland.

References:
1. Berger SA. Infectious Diseases of Canada, 2011. 475 pp. Gideon e-book series, http://www.gideononline.com/ebooks/country/infectious-diseases-of-canada/
2. Berger SA. Botulism: Global Status, 2011. 80 pp. Gideon e-book series, http://www.gideononline.com/ebooks/disease/botulism-global-status/

Although botulism is commonly associated with canned foods and vegetables, tomatoes are rarely implicated. A single botulism outbreak among 116 listed in the GIDEON database is ascribed to tomatoes. In fact, only three papers could be identified through a a PubMed search using the terms “tomatoes” and “botulism.” [1-3] Interestingly, two of these papers originated in Russia, the country which reported the most recent outbreak in ProMED.

One explanation for the relative rarity of botulism in tomatoes is related to the acidity of this vegetable. A lowered pH is thought to act through two mechanisms: enhanced susceptibility of C. botulinum spores to heat sterilization, and inhibition of germination of surviving spores. [4]

1. PopugailaVM, et al. Cases of botulism caused by preserved tomato juice. Gig Sanit 1972; 37:97-199
2. Shtein A, et al. Cases of botulism caused by domestically preserved tomatoes. Vopr Pitan 1969; 28: 92-93
3. Loufty MR,. et al. An outbreak of foodborne botulism in Ontario. Can J Infect Dis 2003; 14:206-209.
4. Bacterial food poisoning and botulism, in: Wilson GS, Miles A. Toply and Wilson’s Principles of Bacteriology, Virology and Immunity, 6th ed, London, Edward Arnold, 1975. pp. 2104-2105.

Also quoted in ProMED.