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Botulism in France

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

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