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Foodborne botulism from home-canned bamboo shoots Thailand, 1998

Foodborne botulism from home-canned bamboo shoots Thailand, 1998. Wongwatcharapaiboon P Sriprasert P Leksririvili S . Thaikruea L Nanthavas S Thanawong A. Thai FETP. Acknowledgements. Nan Provincial Health Office and Hospital National Institute of Health

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Foodborne botulism from home-canned bamboo shoots Thailand, 1998

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  1. Foodborne botulism from home-canned bamboo shootsThailand, 1998 • Wongwatcharapaiboon P • Sriprasert P • Leksririvili S • Thaikruea L • Nanthavas S • Thanawong A Thai FETP

  2. Acknowledgements • Nan Provincial Health Office and Hospital • National Institute of Health • Armed Force Research Institute of Medical Science • US Army Medical Research Institute for infectious Disease Thai FETP

  3. Objective To • Confirm and describe the outbreak • Verify diagnosis • Identify the source • Develop control and prevention strategies Thai FETP

  4. Methodology • Reviewed medical records • Interviewed patients in the hospital • Performed • Active case finding • Case-control study • Laboratory investigation • Environmental survey Thai FETP

  5. Case definition • Resident of village A or B • At least 3 symptoms between April 8 -17, 1998 • Ptosis - Dysphagia • Dysarthria - Dysphonia • Dry mouth - Sore throat • Diarrhea - Vomiting • Symmetrical flaccid paralysis Thai FETP

  6. Descriptive results • 13 cases with 2 deaths (CFR 15%) • 12 (92%) lived in village A • 9 (69%) were hospitalized • 9 (69%) were female • Median age 44 years (range: 38-68) Thai FETP

  7. Clinical manifestations (N=13) Thai FETP

  8. Epidemic curve Villages A and B, April, 8-17, 1998 (n= 12) No.cases Date of onset April 1998 Thai FETP

  9. Epidemic curve Villages A and B, April, 8-17, 1998 (n= 12) No.cases Ate breakfast together, April 10 Family X Family Y Date of onset April 1998 Thai FETP

  10. Food history of cases (N=13) Thai FETP

  11. Case-control study • Control definition • Person who participated in cremation of 2 dead cases Thai FETP

  12. Case-control study • 66 controls, • All were female • 28 lived in village A Thai FETP

  13. Case-control study OR = undetermined Thai FETP

  14. Case control study Thai FETP

  15. Case-control study OR = 0.03 (95 % CI = 0.00 -0.95) Thai FETP

  16. Laboratory result • EMG of 2 cases - consistent with botulism • Stool culture -negative C. botulinum • Home-canned bamboo shoots • negative culture • positive botulinum toxin type A by ELISA and mouse antitoxin bioassay Thai FETP

  17. Laboratory result • Soil samples from houses surrounding that of the home- canned bamboo shoots manufacturer • negative for C. botulinum Thai FETP

  18. Botulism • Caused by toxin of anaerobic bacteria • Outbreak usually due to home- canned low acid foods ( pH < 4.5) • Toxin is heat labile (100 oC, 10 min) • Spores are destroyed in 120 oC, 30 min Thai FETP

  19. Interventions • Prohibited sale of remaining 650 cans • Extended loans • Educated people to heat bamboo shoots • Enforced high temperature processing • Strengthened surveillance Thai FETP

  20. Discussion • Confirmed botulism outbreak • Common source • Home-canned bamboo shoots • Improper process • Low acid • 100 oC • Aware of other home-canned foods Thai FETP

  21. Limitation • Selection of controls • only women • Sample not collected under strictly anaerobic condition Thai FETP

  22. Recommendation • Quality control of home-canned food • Clinical and laboratory surveillance • Case and Toxin detection • Antitoxin should be available Thai FETP

  23. Thank youfor your kind attention Thai FETP

  24. Why did it not occur in the past? • Culture of Thai people ate fresh foods • Home canning was promoted in only past 2 years • Screening abnormal can • Air detection by percussion • Abnormal smell or taste • Depend on chance • To find spores in soils • To wash bamboo shoots incompletely

  25. Result of EMG • Normal nerve conduction velocities • Low amplitude response to single stimulus • Decremental trend in amplitude to repetitive low-frequency stimulation (2-5 Hz) • Incremental (facilitation) trend to rapid repetitive stimulation (20-50 Hz) Thai FETP

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