Bureau of Emergency Preparedness and Response
Botulism - Frequently Asked Questions
What is botulism?
Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. There are three main kinds of botulism. Foodborne botulism is caused by eating foods that contain the botulism toxin. Wound botulism is caused by toxin produced from a wound infected with Clostridium botulinum. Infant botulism is caused by consuming the spores of the botulinum bacteria, which then grow in the intestines and release toxin. All forms of botulism can be fatal and are considered medical emergencies.
What kind of germ is Clostridium botulinum?
Clostridium botulinum is the name of a group of bacteria commonly found in soil. These rod-shaped organisms grow best in low oxygen conditions. The bacteria form spores that allow them to survive in a dormant state until exposed to conditions that can support their growth. There are seven types of botulism toxin designated by the letters A through G.
How common is botulism?
In the United States an average of 110 cases of botulism are reported each year. Of these, approximately 25% are foodborne, 72% are infant botulism, and the rest are wound botulism. Outbreaks of foodborne botulism involving two or more persons occur most years and usually caused by eating contaminated home-canned foods. The number of cases of foodborne and infant botulism has changed little in recent years, but wound botulism has increased because of the use of black-tar heroin, especially in California.
What are the symptoms of botulism?
The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36 hours after eating a contaminated food, but they can occur as early as 6 hours or as late as 10 days.
How is botulism diagnosed?
Physicians may consider the diagnosis if the patient's history and physical examination suggest botulism. However, these clues are usually not enough to allow a diagnosis of botulism. Other diseases such as Guillain-Barré syndrome, stroke, and myasthenia gravis can appear similar to botulism, and special tests may be needed to exclude these other conditions. These tests may include a brain scan, spinal fluid examination, nerve conduction test (electromyography, or EMG), and a tensilon test for myasthenia gravis. The most direct way to confirm the diagnosis is to demonstrate the botulinum toxin in the patient's serum or stool by injecting serum or stool into mice and looking for signs of botulism. The bacteria can also be isolated from the stool of persons with foodborne and infant botulism. These tests can be performed at the Centers for Disease Control and Prevention.
How can botulism be treated?
The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine (ventilator) for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly improves. If diagnosed early, foodborne and wound botulism can be treated with an antitoxin that blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism.
Are there complications from botulism?
Botulism can result in death due to respiratory failure. However, in the past 50 years the proportion of patients with botulism who die has fallen from about 50% to 8%. A patient with severe botulism may require a breathing machine as well as intensive medical and nursing care for several months. Patients who survive an episode of botulism poisoning may have fatigue and shortness of breath for years and long-term therapy may be needed to aid recovery.
How can botulism be prevented?
Botulism can be prevented. Foodborne botulism has often been from home-canned foods with low acid content, such as asparagus, green beans, beets and corn. However, outbreaks of botulism have occurred from more unusual sources such as chopped garlic in oil, chili peppers, tomatoes, improperly handled baked potatoes wrapped in aluminum foil, and home-canned or fermented fish. Persons who do home canning should follow strict hygienic procedures to reduce contamination of foods. Oils infused with garlic or herbs should be refrigerated. Potatoes that have been baked while wrapped in aluminum foil should be kept hot until served or refrigerated. Because botulism toxin is destroyed by high temperatures, persons who eat home-canned foods should consider boiling the food for 10 minutes before eating it to ensure safety. Instructions on safe home canning can be obtained from county extension services or from the US Department of Agriculture. Because honey can contain spores of Clostridium botulinum and this has been a source of infection for infants, children less than 12 months old should not be fed honey. Honey is safe for persons 1 year of age and older. Wound botulism can be prevented by promptly seeking medical care for infected wounds and by not using injectable street drugs.
What are public health agencies doing to prevent or control botulism?
Public education about botulism prevention is an ongoing activity. Information about safe canning is widely available for consumers. State health departments and CDC have persons knowledgeable about botulism available to consult with physicians 24 hours a day. If antitoxin is needed to treat a patient, it can be quickly delivered to a physician anywhere in the country. Suspected outbreaks of botulism are quickly investigated, and if they involve a commercial product, the appropriate control measures are coordinated among public health and regulatory agencies. Physicians should report suspected cases of botulism to county or state health departments.
For information and guidelines on canning foods at home visit the USDA Home Canning Guide at http://foodsafety.cas.psu.edu/canningguide.html
For more information call (602) 364-3289
__________________________________________________________________________
__________________________________________________________________________
Release: Arizona Receives New CDC Award to Increase Cardiovascular Disease Prevention and Education
Release Date: FOR IMMEDIATE RELEASE – July 13, 2007
Contact: Janey Pearl, ADHS Public Information Officer: (602) 364-1201
The Arizona Department of Health Services (ADHS) received its first award from the Centers for Disease Control and Prevention (CDC) for cardiovascular disease prevention and education. The five-year $325,000 grant calls on ADHS Cardiovascular Disease Prevention Program to support public education, increase cardiovascular disease surveillance, and develop employer resources regarding healthy workplace policies. Arizona is one of 34 states to receive CDC funding for cardiovascular disease prevention efforts.
Cardiovascular disease, including heart attack and stroke, is the leading cause of death in Arizona. According to Arizona Vital Statistics, heart disease is the most commonly reported reason for hospital and emergency room visits in the state with the average hospital stay lasting over four days. As Arizona’s population ages, these figures are only expected to increase.
The funding primarily calls for education highlighting the signs and symptoms of heart attack and stroke. "It is imperative that we educate people on what they should look for now so that they know what to do when a heart attack or stroke occurs," says Nicole Olmstead, Cardiovascular Disease Prevention Program Manager at ADHS. "The more quickly medical care is received during or after an acute event, the better the outcome tends to be."
The funding will also be used for cardiovascular disease surveillance. "Increasing our data analysis and surveillance will help us determine where the greatest burden of cardiovascular disease in the state resides, so we can concentrate our efforts where it is needed most," Olmstead adds.
The ADHS Cardiovascular Disease Prevention Program was established in 2001 to reduce cardiovascular disease in Arizona through education, prevention, data surveillance, and community partnerships. The program looks at the relationship between health education, health status and policy to determine the burden of cardiovascular disease in the state.
For more information on the ADHS Cardiovascular Disease Prevention Program or the grant award, call 1-888-542-1886 or visit www.azcvd.gov.
__________________________________________________________________________
__________________________________________________________________________
Release: Fourth of July Brings Arizona's First Extreme Heat Warning of 2007
And Tips on How to Stay Safe This Summer
Release Date: FOR IMMEDIATE RELEASE – July 3, 2007
Contact: Michael Murphy, ADHS Public Information: (602) 542-1094
Jeanene Fowler, Maricopa County Public Health: (602) 722-1806
Arizona's first extreme heat warning arrives this week with the Fourth of July holiday, prompting state and local health officials to remind residents about the importance of taking extra precautions this summer especially against the heat.
"Our region is rallying to ensure that people don't suffer needlessly during these hot summer months. Municipalities are developing heat relief plans, faith-based groups are organizing volunteers, and individuals are contributing water, sun block and other critical donations," said Greg Stanton, City of Phoenix Councilmember and Chair of the Maricopa Association of Governments (MAG) Continuum of Care Regional Committee on Homelessness.
The MAG Continuum of Care Regional Committee on Homelessness has developed two maps of resources available for those in need and for those who want to help. One with information about where water hydration stations and refuge locations are located throughout the county and the second showing where water collection and donation sites are located in Maricopa County. The maps are being distributed throughout the community and are linked to the CONTACS shelter hotline at (602) 263-8900 and available on the MAG website at http://www.mag.maricopa.gov/display.cms.
“Your best defense against heat-related illness is prevention," said Susan Gerard, Director of the Arizona Department of Health Services. “Staying indoors and making simple changes in your fluid intake, and limiting your activities can help to prevent heat-related illness and death."
“Yes, heat can kill, but during the summer months, we also want to remind residents to be vigilant about a host of health issues; Heat, West Nile Virus, Carbon Monoxide poisoning at our lakes and the potential for childhood drownings are all messages that we need to treat with the highest level of importance," said Dr. Bob England, director of Maricopa County Department of Public Health.
Health officials offered these tips on how to stay safe:
HEAT
People who work outdoors are at especially high risk. People that have outdoor occupations need to take more breaks and get more of their work done in the early morning hours if possible. Young children and the elderly are also at greater risk to suffer from heat-related illness.
People suffer heat-related illness when the body's temperature control system is overloaded and the body can no longer cool itself. As long as blood is flowing properly to the skin, extra heat from the body is pumped to the skin and removed by sweat evaporation. If fluids are not replaced soon enough, heat stroke can result, potentially leading to brain damage or death.
Symptoms of heat illness include heavy sweating, muscle cramps, weakness, dizziness, nausea, weak but rapid pulse and headaches. People with these symptoms should find shade, drink water slowly and make sure there is good ventilation.
Staying in an air-conditioned area, either at home or in a public place such as a mall, library or recreation center is the most effective way to fight heat. If air conditioning is not available, pull the shades over the windows and use cross-ventilation and fans to cool rooms. A cool shower or bath also is an effective way to cool off. Limit use of stoves and ovens to keep home temperatures lower.
Visit Heataz.org for more information.
WEST NILE VIRUS
WNV is transmitted to humans by the bite of an infected mosquito. Approximately 20 percent of people infected with the virus will feel flu-like symptoms occurring three to 15 days after the mosquito bite.
Symptoms may include fever, headache, body aches, nausea, vomiting, swollen lymph glands, and skin rash on the chest, stomach and back. A small percentage of people who are infected with WNV will experience severe symptoms, such as meningitis, encephalitis, paralysis, and even death. People over the age of 50 are generally at a higher risk for severe symptoms. If a person thinks he or she has WNV symptoms, he or she should consult their health care provider.
Residents are encouraged to mosquito-proof their home by taking the following precautions:
- Eliminate mosquito-breeding sites around your property. Drain standing water in potted plants, tires, and other containers.
- Install or repair window and door screens to keep mosquitoes out of the home.
- Keep fountains, animal troughs, and swimming pools properly operating and free from debris.
Visit westnilesaz.org for more information.
CARBON MONOXIDE POISONING
Carbon monoxide is a highly toxic, odorless and colorless gas produced by boat engines, generators, and stoves. It can accumulate inside engine compartments, and pool in deadly concentrations outside the boat as well – around engine and generator exhaust outlets, under and around swim platforms, and even in an open cabin when conditions are right. In ski boats, high concentrations are found around decks, where youngsters like to “teak surf" – a practice in which individuals hold onto the swim platform while the boat is underway. This puts the individual in the path of the vessel's exhaust - and propellers -- and exposes them to deadly levels of carbon monoxide.
Also, boaters should be especially careful when they anchor or ride along side one another. Deadly fumes can waft from other vessels. Carbon monoxide also can pool in the back of a boat when the boat is moving at slow speeds, creating a back draft that brings noxious fumes into the open cabin.
To avoid problems:
- Don't swim near or under the back deck or swim platform. NEVER enter an enclosed area under a swim platform where exhaust is vented.
- Don't allow teak surfing, dragging or water-skiing within 20 feet of a moving watercraft.
- Assign an adult to watch when anyone is swimming or playing in the water.
- Keep forward-facing hatches open, even in inclement weather, to allow fresh air circulation in living spaces.
- Don't confuse carbon monoxide poisoning with seasickness, intoxication or heat stress. If someone complains of irritated eyes, headache, nausea, weakness or dizziness, immediately move the person to fresh air, investigate the cause, and take corrective action. Seek medical attention if necessary.
- Install a carbon monoxide detector in each accommodation space on your boat. Check detectors before each trip to make sure they are functioning properly.
- Don't idle, especially when people are on or near the rear swim platform.
- Wear life jackets.
_________________________________________________________________________
_________________________________________________________________________
Release: Maricopa County Mental Health Contract Awarded
Release Date: FOR IMMEDIATE RELEASE – June 12, 2007
Contact: Michael Murphy, ADHS Public Information: (602) 542-1094
Eddy Broadway, ADHS Behavioral Health: (602) 364-4566
The Arizona Department of Health Services has awarded a $500 million contract for the provision of public mental health services in Maricopa County to one of the largest and most experienced behavioral health management firms in the nation.
Magellan Health Services was selected to provide services in Maricopa County beginning Sept. 1 over two other offerors – ValueOptions, which currently provides public mental health services in Maricopa County, and Cenpatico Behavioral Health.
An exhaustive review of the three proposals by an independent evaluation team consumed three months. The contract will run three years, with an estimated value of $500 million annually, with an option for two more years based on performance. See Frequently Asked Question's at www.azdhs.gov.
Eddy Broadway, Department of Health Services Deputy Director, said the agency has a special obligation to ensure there is no disruption in service to consumers during the transition to the county’s new mental health services provider. ValueOptions has provided behavioral health services in Maricopa County since 1998.
"We will be working overtime to ensure people with mental illness in Maricopa County continue to receive services without interruption," he said.
A Community Stakeholder Meeting has been scheduled at the City of Phoenix Pulliam Auditorium in the Burton Barr Central Library from 10 am to noon on Friday, June 15. The library is at 1221 N. Central Avenue.
There are approximately 70,000 adults and children receiving behavioral health services in Maricopa County.
___________________________________________________________________________
___________________________________________________________________________
Release: Arizona Health Officials Urge Continued Caution of Ground Beef
Release Date: FOR IMMEDIATE RELEASE – June 12, 2007
Contact: Janey Pearl, ADHS Public Information: (602) 364-1201
Michael Murphy, ADHS Public Information: (602) 542-1094
The Arizona Department of Health Services is notifying the public about the expansion of a USDA ground beef recall because of concerns that repackaged meat by grocery stores may contain E. coli 0157:H7, and not be labeled with the Establishment Code 1241. Additionally this recall includes earlier production dates beginning 4/6/07 and ending 4/20/07.
The Department is concerned that the United Food Group recall, which includes several companies including Moran’s Meat Company and Miller Meat Company, does not mention that these brands are re-packaged and sold as local grocery store brands.
Consumers may not be aware of the actual brand they have purchased and stored in their freezers.
The following Arizona grocery stores receive ground beef from United Food Group and may repackage it under their store brand name.
Albertson’s
Basha’s
Fry’s
‘R’ Ranch Markets
Safeway
Sam’s Club
Save-a-lot
Smart and Final
Smith’s
Trader Joe’s
To date, there are six reported human cases of E. coli 0157 in Arizona linked to this outbreak; three in Maricopa, two in Yavapai, and one in Navajo Counties. These individuals became ill between May 2 and May 12, 2007. Their ages range from 6 – 63 years of age. Four cases could be contacted by public health, three required hospitalization and have recovered. No deaths have been reported due to this outbreak.
Consumers should be aware that any ground beef needs to be cooked thoroughly so there is no pink or red. Specifically the meat must be cooked to 160 degrees Fahrenheit using a meat thermometer in the thickest part of the meat. If you are concerned about your meat, please contact your grocery store to determine if its brand of meat is part of this recall.
For questions about the ground beef recall in Arizona, please call the Arizona Department of Health Services at 602-364-3122, 602-364-3118, or 602-364-4562.
If you are ill, please see your doctor or health care provider.
For more information, please visit the following link:
http://www.fsis.usda.gov/News_&_Events/Expanded_Recall_025_Release_060907/index.asp
___________________________________________________________________________
___________________________________________________________________________
Release: Consumers Advised To Avoid Raw Oysters
Release Date: FOR IMMEDIATE RELEASE – May 11, 2007
Contact: Michael Murphy, ADHS Public Information: (602) 542-1094
Janey Pearl, ADHS Public Information: (602) 364-1094
Jeanene Fowler, Maricopa County Public Health: (602) 506-4926
State and local health officials are advising consumers to avoid eating raw oysters from Puerto Peñasco, Mexico, better known as Rocky Point, following the identification of 13 cases of hepatitis A associated with raw oyster consumption.
Eleven cases have been identified in Maricopa County, and one each in Pima and Yuma counties. All reported traveling to Rocky Point between March 8 and March 25, and eating raw oysters at several different locations, including oyster farms and street vendors. Mexican health officials are investigating to identify possible sources of the contaminated oysters.
"These cases are a reminder there is a real risk of getting sick from uncooked shellfish – regardless of where it is from," said State Epidemiologist Ken Komatsu. Illnesses associated with eating uncooked oysters are not uncommon and have been reported in numerous states, including California, Florida, Texas, Alabama, and Louisiana.
Illness resulting from hepatitis A infection may include fever, fatigue, loss of appetite, nausea or abdominal discomfort, which may be followed within a few days by jaundice. Hepatitis A can take from 15 to 50 days to develop, however it usually takes about 30 days. The illness is rarely fatal, and is usually of mild to moderate severity.
Due to a higher risk of complications, anyone with any other form of hepatitis or underlying liver disease and who ate raw oysters in Puerto Peñasco during this time may wish to consult with their health care provider. There is an effective vaccine that virtually eliminates the possibility of getting hepatitis A. The Centers for Disease Control advises people traveling to countries where hepatitis A is common should consider getting immunized against hepatitis A.
Hepatitis A can be contracted anywhere. It is usually spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with hepatitis A. To avoid contracting hepatitis A, always wash your hands after using the bathroom, changing a diaper, or before preparing or eating food.
For more information, please log on to www.cdc.gov or contact your local health department (In Maricopa County, 602-747-7500).