Foodborne botulism from home- canned bamboo shoots Thailand, 1998 Wongwatcharapaiboon P Sriprasert P...
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![Page 1: Foodborne botulism from home- canned bamboo shoots Thailand, 1998 Wongwatcharapaiboon P Sriprasert P Leksririvili S Thaikruea L Nanthavas S Thanawong A.](https://reader035.fdocuments.us/reader035/viewer/2022062217/56649c9d5503460f9495be64/html5/thumbnails/1.jpg)
Foodborne botulism from home-canned bamboo shoots
Thailand, 1998
• Wongwatcharapaiboon P • Sriprasert P • Leksririvili S
• Thaikruea L• Nanthavas S • Thanawong A
Thai FETP
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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
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Objective• Confirm and describe the outbreak
• Verify diagnosis
• Identify the source
• Develop control and prevention strategies
Thai FETP
To
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Methodology• Reviewed medical records
• Interviewed patients in the hospital
• Performed
– Active case finding
– Case-control study
– Laboratory investigation
– Environmental survey
Thai FETP
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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 paralysisThai FETP
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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
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Clinical manifestations (N=13)
23%
31%
31%
38%
54%
54%
62%
85%
0% 20% 40% 60% 80% 100%
Ptosis
Paralysis
Dysarthria
Diarrhea
Dysphonia
Vomiting
Dry mouth
Dysphagia
Thai FETP
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Epidemic curve Villages A and B, April, 8-17, 1998 (n= 12)
01234567
8 9 10 11 12 13 14 15 16 17
No.cases
April 1998
Date of onsetThai FETP
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01234567
8 9 10 11 12 13 14 15 16 17
Epidemic curve Villages A and B, April, 8-17, 1998 (n= 12)
No.cases Ate
breakfast together, April 10
April 1998
Date of onset
Thai FETP
Family XFamily Y
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Food history of cases (N=13)
Food Number ofcases
Attack rate%
Home-cannedbamboo shoot
13 100
Distilled alcoholicbeverage
6 46
Undistilled alcoholicbeverage
8 62
Mushroom 3 23
Thai FETP
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Case-control study
• Control definition
– Person who participated in cremation
of 2 dead cases
Thai FETP
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Case-control study
• 66 controls,
• All were female
• 28 lived in village A
Thai FETP
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Case-control study
Home-cannedbamboo shoots
case control
ate 13 4
not ate 0 62
OR = undetermined
Thai FETP
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Case control study Suspected Foods OR 95% CI
Home-cannedbamboo shoots
undetermined
-
Distilled alcoholicbeverage
8.57 2.2 - 33.9
Undistilled alcoholicbeverage
2.62 0.8 - 8.9
Mushroom 0.94 0.2 - 3.8
Thai FETP
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Case-control study
HeatedHome-cannedbamboo shoots
case control
ate 1 3
not ate 12 1
OR = 0.03 (95 % CI = 0.00 -0.95)
Thai FETP
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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
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Laboratory result
• Soil samples from houses
surrounding that of the home- canned
bamboo shoots manufacturer
– negative for C. botulinum
Thai FETP
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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
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Interventions
• Prohibited sale of remaining 650 cans
• Extended loans
• Educated people to heat bamboo shoots
• Enforced high temperature processing
• Strengthened surveillance
Thai FETP
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Discussion• Confirmed botulism outbreak
• Common source –Home-canned bamboo shoots
• Improper process– Low acid
– 100 oC
• Aware of other home-canned foodsThai FETP
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Limitation
• Selection of controls
– only women
• Sample not collected under strictly
anaerobic condition
Thai FETP
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Recommendation
• Quality control of home-canned food
• Clinical and laboratory surveillance
– Case and Toxin detection
• Antitoxin should be available
Thai FETP
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Thank youfor your kind
attention
Thai FETP
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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
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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