National Enteric Disease Surveillance : botulism surveillance overview
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National Enteric Disease Surveillance : botulism surveillance overview

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      Surveillance System Overview: National Botulism Surveillance System.

      Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum and sometimes by strains of Clostridium butyricum and Clostridium baratii. Botulism can be treated with an antitoxin that blocks the action of toxin circulating in the blood.Antitoxin for children one year of age and older and for adults is available through the Centers for Disease Control and Prevention (CDC), the Alaska Division of Public Health (ADPH), and the California Department of Public Health (CDPH); antitoxin for infants is available from CDPH.

      Antitoxin can be released through state public health officials for suspected botulism cases and is most effective when administered early in a patient’s illness. State public health officials can reach the CDC clinical emergency botulism service for consultation and antitoxin 24/7 at 770-488-7100. Physicians should contact their state health department as soon as they suspect that a patient may have botulism.

      For surveillance purposes, CDC categorizes human botulism cases into four transmission categories: foodborne, wound, infant, and other. Foodborne botulism is caused by the consumption of foods containing pre-formed botulinum toxin. Wound botulism is caused by toxin produced in a wound infected with Clostridium botulinum. Infant botulism by definition occurs in persons less than one year of age and is caused by consumption of spores of C. botulinum, which then grow and release toxins in the intestines. Cases are classified as “other” if the patient is not an infant, has no history of ingesting a suspect food, and has no wounds. Consistent with the Council of State and Territorial Epidemiologists (CSTE) position statements, the “other” category includes botulism in which the route of transmission is unknown. The “other” category also includes iatrogenic botulism, which is caused by an accidental overdose of botulinum toxin (i.e., therapeutic injection), and adult intestinal colonization botulism, which is very rare but occurs through a mechanism similar to infant botulism.

      Since 1973, CDC, in partnership with CSTE, has maintained the National Botulism Surveillance System for intensive surveillance for cases of botulism in the United States. The National Botulism Surveillance System collects reports of all laboratory-confirmed botulism cases in the United States and is continuously monitored for early detection of outbreaks. Demographic (e.g., age, sex, race and ethnicity), clinical (e.g., transmission category, case-patient outcome), laboratory (e.g., laboratory testing method, toxin type), and epidemiologic (e.g., vehicle) data are reported by all 50 states and the District of Columbia. To be confirmed, cases must meet the CSTE case definition ( of botulism. Because CDC, ADPH, and CDPH are the only sources of botulism antitoxin for cases in the United States, all or almost all recognized cases of botulism are recorded. However, some cases may not be recognized either because of misdiagnosis (2) or because mildly affected persons may not seek medical care (3).

      Reference citation: Centers for Disease Control and Prevention (CDC). National Botulism Surveillance System Overview. Atlanta, Georgia: US Department of Health and Human Services, CDC, 2012.

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