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- Title
Outbreak of type A botulism and development of a botulism surveillance and antitoxin release system in Argentina.
- Authors
Villar, Rodrigo G.; Shapiro, Roger L.; Busto, Silvina; Riva-Posse, Clara; Verdejo, Guadalupe; Farace, Maria Isabel; Rosetti, Francisco; San Juan, Jorge A.; Julia, Carlos Maria; Becher, John; Maslanka, Susan E.; Swerdlow, David L.; Villar, R G; Shapiro, R L; Busto, S; Riva-Posse, C; Verdejo, G; Farace, M I; Rosetti, F; San Juan, J A
- Abstract
<bold>Context: </bold>Botulism is an important public health problem in Argentina, but obtaining antitoxin rapidly has been difficult because global supplies are limited. In January 1998, a botulism outbreak occurred in Buenos Aires.<bold>Objectives: </bold>To determine the source of the outbreak, improve botulism surveillance, and establish an antitoxin supply and release system in Argentina.<bold>Design, Setting, and Participants: </bold>Cohort study in January 1998 of 21 drivers of a specific bus route in urban Buenos Aires.<bold>Main Outcome Measure: </bold>Occurrence of botulism and implication of a particular food as the vehicle causing this outbreak.<bold>Results: </bold>Nine (43%) of 21 bus drivers developed botulism, presenting with gastroenteritis, symptoms of acute cranial nerve dysfunction including ptosis, dysphagia, blurred vision, and motor weakness. One driver experienced respiratory failure. Type A toxin was detected from 3 of 9 patients' serum samples. All drivers received botulism antitoxin; there were no fatalities. Consumption of matambre (Argentine meat roll) was significantly associated with illness. Among 11 persons who ate matambre, 9 developed illness, compared with none of those who did not eat it (P<.001). The matambre had been cooked in water at 78 degrees C to 80 degrees C for 4 hours, sealed in heat-shrinked plastic wrap, and stored in refrigerators that did not cool adequately. Subsequently, a botulism surveillance and antitoxin release system was established.<bold>Conclusions: </bold>Insufficient cooking time and temperatures, storage in heat-shrinked plastic wrap, and inadequate refrigeration likely contributed to Clostridium botulinum spore survival, germination, and toxin production. A rapid-response botulism surveillance and antitoxin release system in Argentina should provide more timely distribution of antitoxin to patients and may serve as a model for other nations.
- Subjects
ARGENTINA; BUENOS Aires (Argentina); BOTULISM; FOOD poisoning; DISEASE outbreaks; ANTITOXINS
- Publication
JAMA: Journal of the American Medical Association, 1999, Vol 281, Issue 14, p1334
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.281.14.1334