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Outbreak of Type A Botulism and Development of a Botulism Surveillance and Antitoxin Release System in Argentina
Rodrigo G. Villar, MD;
Roger L. Shapiro, MD;
Silvina Busto, MD, MPH;
Clara Riva-Posse, MD, MPH;
Guadalupe Verdejo, MD, MPH;
Maria Isabel Farace, DVM;
Francisco Rosetti, MS;
Jorge A. San Juan, MD;
Carlos Maria Julia, MD, MPH;
John Becher, RPh;
Susan E. Maslanka, PhD;
David L. Swerdlow, MD
JAMA. 1999;281:1334-1340.
ABSTRACT
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Context Botulism is an important public health problem in Argentina, but obtaining antitoxin rapidly has been difficult because global supplies are limited. In January 1998, a botulism outbreak occurred in Buenos Aires.
Objectives To determine the source of the outbreak, improve botulism surveillance, and establish an antitoxin supply and release system in Argentina.
Design, Setting, and Participants Cohort study in January 1998 of 21 drivers of a specific bus route in urban Buenos Aires.
Main Outcome Measure Occurrence of botulism and implication of a particular food as the vehicle causing this outbreak.
Results Nine (43%) of 21 bus drivers developed botulism, presenting with gastroenteritis, symptoms of acute cranial nerve dysfunction including ptosis, dysphagia, blurred vision, and motor weakness. One driver experienced respiratory failure. Type A toxin was detected from 3 of 9 patients' serum samples. All drivers received botulism antitoxin; there were no fatalities. Consumption of matambre (Argentine meat roll) was significantly associated with illness. Among 11 persons who ate matambre, 9 developed illness, compared with none of those who did not eat it (P<.001). The matambre had been cooked in water at 78°C to 80°C for 4 hours, sealed in heat-shrinked plastic wrap, and stored in refrigerators that did not cool adequately. Subsequently, a botulism surveillance and antitoxin release system was established.
Conclusions Insufficient cooking time and temperatures, storage in heat-shrinked plastic wrap, and inadequate refrigeration likely contributed to Clostridium botulinum spore survival, germination, and toxin production. A rapid-response botulism surveillance and antitoxin release system in Argentina should provide more timely distribution of antitoxin to patients and may serve as a model for other nations.
Author Affiliations: Foodborne and Diarrheal Diseases Branch (Villar, Shapiro, Maslanka, and Swerdlow), Scientific Resources Program (Becher), National Center for Infectious Diseases (Villar, Shapiro, Maslanka, Swerdlow, and Becher), Epidemic Intelligence Service, Epidemiology Program Office (Villar and Shapiro), Centers for Disease Control and Prevention, Atlanta, Ga (Villar, Shapiro, Maslanka, Swerdlow, and Becher); Ministerio de Salud-Region V (Busto) and Ministerio de Salud y Accion Social (Riva-Posse and Julia), Medicina Sanitaria (Julia), Direccion de Epidemiologia (Riva-Posse), Pan American Health Organization (Verdejo), Departamento de Bacteriologia, Instituto Nacional de Enfermedades Infecciosas, ANLIS Carlos G. Malbran (Farace and Rosetti), Hospital F. J. Muñiz (San Juan), Buenos Aires, Argentina.
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