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


Related Links

CDC - Botulism Page