Author Affiliations: Foodborne and Diarrheal Diseases Branch (Villar, Shapiro, Maslanka, and Swerdlow), Scientific Resources Program (Becher), National Center for Infectious Diseases (Villar, Shapiro, Maslanka, Swerdlow, and Becher), Epidemic Intelligence Service, Epidemiology Program Office (Villar and Shapiro), Centers for Disease Control and Prevention, Atlanta, Ga (Villar, Shapiro, Maslanka, Swerdlow, and Becher); Ministerio de Salud-Region V (Busto) and Ministerio de Salud y Accion Social (Riva-Posse and Julia), Medicina Sanitaria (Julia), Direccion de Epidemiologia (Riva-Posse), Pan American Health Organization (Verdejo), Departamento de Bacteriologia, Instituto Nacional de Enfermedades Infecciosas, ANLIS Carlos G. Malbran (Farace and Rosetti), Hospital F. J. Muñiz (San Juan), Buenos Aires, Argentina.
Edited by Annette Flanagin, RN, MA,
Associate Senior Editor.
Context 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.
Objectives To determine the source of the outbreak, improve
botulism surveillance, and establish an antitoxin supply and release
system in Argentina.
Design, Setting, and Participants Cohort study in January 1998 of
21 drivers of a specific bus route in urban Buenos Aires.
Main Outcome Measure Occurrence of botulism and implication of a
particular food as the vehicle causing this outbreak.
Results 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°C to 80°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.
Conclusions 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.
Villar RG, Shapiro RL, Busto S, et al. Outbreak of Type A Botulism and Development of a Botulism Surveillance and Antitoxin Release System in Argentina. JAMA. 1999;281(14):1334–1340. doi:10.1001/jama.281.14.1334
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