National Botulism Surveillance Summary, 2017

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In 2017, 182 laboratory-confirmed botulism cases were reported to CDC—141 (77%) infant, 19 (10%) foodborne, 19 (10%) wound, and three (1%) “other” classified as: two (1%) iatrogenic, and one (1%) suspected adult intestinal colonization (Table 1).

Infant botulism cases were reported from 26 states and the District of Columbia, with California reporting the most (n=48, 34%). Toxin types were A (n=52, 37%), B (n=88, 62%), and Ba (n=1, 1%). The median age of infants was four months (range: 0–12 months); 72 (51%) were girls. No deaths were reported.

Foodborne botulism cases were reported from California (n=15) and Alaska (n=4). Among the 15 toxin type A foodborne botulism cases in California, 10 were from an outbreak linked to nacho cheese at a convenience store, two were from an outbreak linked to an herbal deer antler tea, one was from a suspected soup with bulging lid but was not available testing, and two were not linked to a known food source. (1) Among the four toxin type E foodborne botulism cases in Alaska, three were from an outbreak linked to seal blubber with seal oil, and one was linked to dried herring in seal oil (Table 2a). The median age of patients was 42 years (range: 14–85 years); 11 were men. Three deaths were reported.

Two probable foodborne botulism cases^* were reported from Alaska. They occurred in one household among women 29 and 54 years old who ate fermented white fish. (Table 2b). No deaths were reported.

Nineteen wound botulism cases were reported from four states—16 from California, and one each from Arizona, New Mexico, and Washington. Seventeen were among persons who inject drugs, one was linked to injuries from an all-terrain vehicle crash, and one was from an arm fracture contaminated with soil. Most were toxin type A (n=18); the presence of toxin was confirmed in one patient’s blood but there was not enough blood to determine the toxin type. The median age of patients was 48 years (range: 14–71 years); 15 were men. No deaths were reported.

Eleven probable wound botulism cases^† were reported from six states. Ten were among persons who inject drugs and one case was in a child who had a wound. The median age of patients was 39 years (range: 10–63 years). Five patients were male; no deaths were reported.

California reported two iatrogenic cases—one was toxin type A, and one was toxin type B. No deaths were reported. California also reported one patient with toxin type A and suspected adult intestinal colonization who died.

^* Clinically compatible illness, not laboratory-confirmed, with an epidemiologic link to a food or drink suspected to be contaminated with botulinum toxin.

^† Clinically compatible case with no suspected exposure to contaminated food and with a history in the 2 weeks before illness began of either a fresh wound or injection drug use.