Botulinum toxin
Symptoms:
Symptoms are similar to those for foodborne or inhaled botulism.
Recovery/Mortality Rate:
The fatality rate for wound botulism is less than 3 percent.
Inhalational botulism
Exposure:
- This form does not occur naturally and only three cases (from a laboratory accident) have ever been reported.
- It would be caused if people inhaled refined botulinum toxin disseminated through the air.
Symptoms:
- Symptoms of inhaled botulinum toxin are similar to those of foodborne botulism.
- Symptoms may begin several hours to several days after an airborne attack (e.g., studies with monkeys show that symptoms begin 12 to 80 hours after exposure).
Recovery/Mortality Rate:
Because there are so few recorded cases, it is unclear what the fatality rate of inhalation botulism would be in an attack.
Diagnosis
Botulism is a rare disease. Whether it is naturally occurring or the result of terrorism, a single case of the illness may be difficult for physicians to diagnose. However, if several or many cases appear together, it is likely that the diagnosis would be made quickly.
- There is no single test to detect botulinum poisoning.
- A blood test can detect traces of botulinum.
- A stool sample test may be useful in detecting foodborne or infant botulism.
- Suspected foods should also be tested for presence of the botulinum toxin.
- Special tests (e.g., brain scan) may be needed to exclude similar conditions from botulism.
Treatment
Prompt medical attention is the key to successful treatment for a botulism illness.
- Treatment should begin as soon as botulism is suspected.
- Botulism antitoxin derived from horse serum is prescribed.
- This antitoxin reduces the spread of paralysis but will not reverse paralysis that has already set in, so early treatment is critical.
- With treatment, most paralysis will eventually go away.
- In severe cases, patients may need long-term care, including a ventilator to help assist breathing.
Vaccine
A vaccine to protect against botulism is not available to the general public.
- An experimental vaccine produced in the 1960s is given to lab workers and military troops sent to high-risk areas.
- This experimental vaccine is not considered useful for the general population because many months pass before a vaccinated person builds full immunity and because repeated vaccination is required to maintain this immunity.
- People who receive the experimental vaccine may not benefit from the medical uses of botulinum toxin, including cosmetic surgery and treatment of vocal chord spasms.
Prevention
Proper food handling and cooking is the best way to prevent naturally occurring botulism poisoning.
- Do not eat food that has been left out for long periods of time.
- Practice proper home canning of food to reduce the risk of botulism.
- Boiling food for 10 minutes can destroy botulinum toxin if there is concern that food has been contaminated.
Assessing the Risk
- Clostridium botulinum is a common, naturally occurring bacteria, but the toxin is not easily available because one has to have the laboratory knowledge to produce the toxin from the bacteria.
- Botulinum toxin is only moderately stable because the aerosol form can deteriorate in sunlight.
- Terrorists would have to be highly skilled to stabilize the botulinum toxin for airborne release. A foodborne release would be somewhat easier.
- An airborne attack could produce highly lethal results; a foodborne attack could also be lethal.
More information on disasters and emergencies is available at the U.S. Department of Health and Human Service's website: http://www.hhs.gov/emergency
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