THE JOURNAL OF INFECTIOUS DISEASES. VOL. 136. NO.1. JULY 1977
© 1977 by the University of Chicago. All rights reserved.
From the Center for Disease Control Food-Borne Botulism in the United States, 1970-1975
of food processing in outbreaks reported from 1970 through 1975 and contrasts these data with those reported previously. We also, for the first time, present accumulated data on age- and sex-specific incidence and case-fatality ratios, and on seasonal trends.
Methods
Records of all outbreaks of food-borne botulism reported to the CDC's Botulism Surveillance Activity from 1970 through 1975 were reviewed. The CDC is notified of botulism outbreaks by many sources, including physicians, hospital personnel, state and local health departments, the Food and Drug Administration (FDA), and the USDA. Lederle Laboratories (New York, N.Y.) participates in this activity by notifying the CDC whenever it receives a request for botulinal antitoxin. In addition, CDC epidemiologists and microbiologists often assist in investigations of outbreaks.
Results
From 1970 through 1975,68 outbreaks of reported food-borne botulism occurred in the United States, with a mean of 11.3 outbreaks per year. This number can be compared with a mean of 9.4 outbreaks per year recorded from 1899 through 1969 and represents a reversal of the trend over the last four decades of decreasing mean numbers of outbreaks per decade (figure 1). The 68 outbreaks affected 152 persons, with a mean of 2.2 per outbreak. This mean was slightly lower than that of 2.6 reported in 1899-1969. However, the mean for the last two years, 1974 and 1975, was a substantially lower 1.4. Paralleling this decline in the average number of cases per outbreak was a recent trend toward an increasing percentage of outbreaks involving only one person. From 1950 through 1969 and again from 1970 through 1973, some 54% of the outbreaks involved one case, but in 1974 the percentage had risen to 62% and in
We thank Dr. V. R. Dowell, Jr., Dr. Charles L. Hatheway, Dr. George L. Lombard, and Ms. Loretta M. McCroskey, Enterobacteriology Branch, Bacteriology Division, Bureau of Laboratories, Center for Disease Control (CDC), who provide laboratory support in most outbreaks of botulism. We also thank numerous officials in state and local health departments, the Food and Drug Administration, and the U.S. Department of Agriculture, and many Epidemic Intelligence Service officers who investigate outbreaks of botulism and report the findings to the CDC Botulism Surveillance Activity. Please address requests for reprints to Dr. Marcus A. Horwitz, Enteric Diseases Branch, Bacterial Diseases Division, Bureau of Epidemiology, Center for Disease Control, Atlanta, Georgia 30333.
153
Downloaded from http://jid.oxfordjournals.org/ at University of Manitoba on September 8, 2015
Food-borne botulism is under intensive surveillance in the United States because of its potential to cause serious disease and to affect large numbers of persons if caused by a widely distributed product. In addition, data from outbreaks of botulism help to identify errors in home and commercial canning techniques and provide stimulus for control measures. For example, data from recent outbreaks caused by home-canned tomatoes helped lead to the establishment of new recommendations for canning this food. Also, in response to the increase in outbreaks of botulism reported to the Center for Disease Control (CDC) in 1974 [1], most of which were caused by homecanned foods, the U.S. Department of Agriculture (USDA) increased its efforts to educate the approximately 25 million home canners in the United States in proper canning techniques. The first recorded outbreak of botulism in this country occurred in 1899. Since then, data on food-borne outbreaks have been summarized twice: in 1950 Meyers and Eddie reviewed data collected from 1899 through 1949 [2], and in 1971 Gangarosa et al. reviewed data collected from 1899 through 1969 [3] and focused in particular on those data collected since 1950, the year when the CDC began its surveillance of the disease. Beginning where the second review stopped, this paper describes the incidence, case-fatality ratios, geographical distribution, type of food, and place
154
Horwitz et al.
40
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( ) NUMBER PEOPLE AGE GROUP
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Figure 1. Mean annual outbreaks and cases of food-borne botulism in the United States, 1899-1975.
(18)
10 (16)
0 L..-..--r-,...---r--r----r-..,.....---,.-..,.....--,
40
1975 to 71%. The type of toxin produced by Clostridium botulinum was determined in 58 (85
© 1977 by the University of Chicago. All rights reserved.
From the Center for Disease Control Food-Borne Botulism in the United States, 1970-1975
of food processing in outbreaks reported from 1970 through 1975 and contrasts these data with those reported previously. We also, for the first time, present accumulated data on age- and sex-specific incidence and case-fatality ratios, and on seasonal trends.
Methods
Records of all outbreaks of food-borne botulism reported to the CDC's Botulism Surveillance Activity from 1970 through 1975 were reviewed. The CDC is notified of botulism outbreaks by many sources, including physicians, hospital personnel, state and local health departments, the Food and Drug Administration (FDA), and the USDA. Lederle Laboratories (New York, N.Y.) participates in this activity by notifying the CDC whenever it receives a request for botulinal antitoxin. In addition, CDC epidemiologists and microbiologists often assist in investigations of outbreaks.
Results
From 1970 through 1975,68 outbreaks of reported food-borne botulism occurred in the United States, with a mean of 11.3 outbreaks per year. This number can be compared with a mean of 9.4 outbreaks per year recorded from 1899 through 1969 and represents a reversal of the trend over the last four decades of decreasing mean numbers of outbreaks per decade (figure 1). The 68 outbreaks affected 152 persons, with a mean of 2.2 per outbreak. This mean was slightly lower than that of 2.6 reported in 1899-1969. However, the mean for the last two years, 1974 and 1975, was a substantially lower 1.4. Paralleling this decline in the average number of cases per outbreak was a recent trend toward an increasing percentage of outbreaks involving only one person. From 1950 through 1969 and again from 1970 through 1973, some 54% of the outbreaks involved one case, but in 1974 the percentage had risen to 62% and in
We thank Dr. V. R. Dowell, Jr., Dr. Charles L. Hatheway, Dr. George L. Lombard, and Ms. Loretta M. McCroskey, Enterobacteriology Branch, Bacteriology Division, Bureau of Laboratories, Center for Disease Control (CDC), who provide laboratory support in most outbreaks of botulism. We also thank numerous officials in state and local health departments, the Food and Drug Administration, and the U.S. Department of Agriculture, and many Epidemic Intelligence Service officers who investigate outbreaks of botulism and report the findings to the CDC Botulism Surveillance Activity. Please address requests for reprints to Dr. Marcus A. Horwitz, Enteric Diseases Branch, Bacterial Diseases Division, Bureau of Epidemiology, Center for Disease Control, Atlanta, Georgia 30333.
153
Downloaded from http://jid.oxfordjournals.org/ at University of Manitoba on September 8, 2015
Food-borne botulism is under intensive surveillance in the United States because of its potential to cause serious disease and to affect large numbers of persons if caused by a widely distributed product. In addition, data from outbreaks of botulism help to identify errors in home and commercial canning techniques and provide stimulus for control measures. For example, data from recent outbreaks caused by home-canned tomatoes helped lead to the establishment of new recommendations for canning this food. Also, in response to the increase in outbreaks of botulism reported to the Center for Disease Control (CDC) in 1974 [1], most of which were caused by homecanned foods, the U.S. Department of Agriculture (USDA) increased its efforts to educate the approximately 25 million home canners in the United States in proper canning techniques. The first recorded outbreak of botulism in this country occurred in 1899. Since then, data on food-borne outbreaks have been summarized twice: in 1950 Meyers and Eddie reviewed data collected from 1899 through 1949 [2], and in 1971 Gangarosa et al. reviewed data collected from 1899 through 1969 [3] and focused in particular on those data collected since 1950, the year when the CDC began its surveillance of the disease. Beginning where the second review stopped, this paper describes the incidence, case-fatality ratios, geographical distribution, type of food, and place
154
Horwitz et al.
40
,....-.-
35 r--~
30 25 CJ)
1&.1 CJ)
«
-
-
~
20
-
0
10 5
0 20 CJ)
~
I5
«
60
1&.1
a: 10 m ::::>
50
0
40
«
t-
o
fIl ILl fIl
5
( ) NUMBER PEOPLE AGE GROUP
IN EACH
(2 )
1970-1975
0
s
a:: 30
ILl
o~==1---+--.J--J---J.--+-+-1
Q.
fIl :I:
1899-1909 '10-19 '20-29 '30-39'40-49 '50-59'60-69'70-75
(5)
20
....
«
ILl 0
Figure 1. Mean annual outbreaks and cases of food-borne botulism in the United States, 1899-1975.
(18)
10 (16)
0 L..-..--r-,...---r--r----r-..,.....---,.-..,.....--,
40
1975 to 71%. The type of toxin produced by Clostridium botulinum was determined in 58 (85
