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Botulism A Bioterrorism Agent A Bioterrorism Agent Presented by: Donna Anderson, RN Staff Epidemiologist North Central District Health Department April.

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Presentation on theme: "Botulism A Bioterrorism Agent A Bioterrorism Agent Presented by: Donna Anderson, RN Staff Epidemiologist North Central District Health Department April."— Presentation transcript:

1 Botulism A Bioterrorism Agent A Bioterrorism Agent Presented by: Donna Anderson, RN Staff Epidemiologist North Central District Health Department April 6, 2006

2 What is Botulism The Illness The Illness The Germ Clostridium botulinum The Germ Clostridium botulinum Therapeutic use of botulinum toxin Therapeutic use of botulinum toxin How common is botulism How common is botulism Illness in US Illness in US –Incidence<200 annual cases all forms

3 Categories of Botulism Foodborne botulism Foodborne botulism Intestinal botulism (infant and child/adult) Intestinal botulism (infant and child/adult) Wound botulism Wound botulism Inhalation botulism Inhalation botulism

4 Usually Seen Following…. Home-canned goods (foodborne) Home-canned goods (foodborne) –Particularly low-acid foods such as asparagus, beets, and corn Honey (ingestion) Honey (ingestion) –Can contain C. botulinum spores –Not recommended for infants <12 month old Crush injuries, injection drug use (wound) Crush injuries, injection drug use (wound)

5 Botulism Prevention Proper Canning Proper Canning Proper heating of home canned foods Proper heating of home canned foods No honey for < 1 year olds No honey for < 1 year olds Seek medical care for wounds Seek medical care for wounds Avoid injectable street drugs Avoid injectable street drugs Botulism vaccine Botulism vaccine

6 Botulism: As a Weapon Weaponized by several nations including the U.S., Japan, and Soviet Union, beginning in the 1930s Weaponized by several nations including the U.S., Japan, and Soviet Union, beginning in the 1930s Iraq (1980s) produced 19,000 L of concentrated botulism toxin Iraq (1980s) produced 19,000 L of concentrated botulism toxin Japan (1990s) Aum Shinrikyo cult Japan (1990s) Aum Shinrikyo cult

7 What Makes Botulism Toxin a Good Weapon? Extreme potency and lethality Extreme potency and lethality Ease of production Ease of production Difficult to distinguish intentional exposures Difficult to distinguish intentional exposures Expensive, long-term care needed for recovery Expensive, long-term care needed for recovery

8 What causes illness Incubation period varies with type of poisoning Incubation period varies with type of poisoning Toxin enters bloodstream from mucosal surface or wound Toxin enters bloodstream from mucosal surface or wound Binds to peripheral nerve endings Binds to peripheral nerve endings Preventing muscles from contracting Preventing muscles from contracting

9 And then……. Symmetrical, descending paralysis occurs beginning with cranial nerves and progressing downward Symmetrical, descending paralysis occurs beginning with cranial nerves and progressing downward Can result from airway obstruction or paralysis of respiratory muscles Can result from airway obstruction or paralysis of respiratory muscles Secondary complications related to prolonged ventilatory support and intensive care Secondary complications related to prolonged ventilatory support and intensive care

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11 How is it Diagnoses? Toxin neutralization mouse bioassay Toxin neutralization mouse bioassay –Serum, stool, gastric aspirate, suspect foods Isolation of C. botulinum or toxin Isolation of C. botulinum or toxin –Feces, wound, tissue

12 Botulism Treatment Closely monitor known/suspected exposed Closely monitor known/suspected exposed Treat with antitoxin at first sign of disease Treat with antitoxin at first sign of disease Elimination Elimination –Induced vomiting High enemas High enemas Supportive care Supportive care –Mechanical ventilation –Body positioning Parenteral nutrition Parenteral nutrition

13 Botulism Antitoxin Equine antitoxin Equine antitoxin –Effective in the treatment of foodborne, intestinal, and wound botulism –Effectiveness for inhalation botulism has not been proven –Does not reverse current paralysis, but may limit progression and prevent nerve damage if administered early

14 What do I do now? Immediately Call North Central District Health if during office hours (208) or State Communications Public Health Paging System (24/7) Public Health will be paged

15 Botulism Infection Control Botulism cannot be transmitted person- to-person Botulism cannot be transmitted person- to-person Standard precautions should be taken when caring for botulism patients Standard precautions should be taken when caring for botulism patients

16 Decontamination Aerosolized toxin viability Aerosolized toxin viability –Inactivate by 2 days in optimal conditions Re-aerosolization a theoretical concern Re-aerosolization a theoretical concern Mask over the face may be protective Mask over the face may be protective Exposed clothing and surfaces Exposed clothing and surfaces –Wash with 1:10 hypochlorite solution

17 Botulism Talk Takeaways Disease caused by C. botulinum toxin Disease caused by C. botulinum toxin Most toxic substance ever identified Most toxic substance ever identified Known to be weaponized Known to be weaponized Classic Signs and Symptoms Classic Signs and Symptoms –Symmetric, descending flaccid paralysis –No fever –Alert

18 Botulism Talk Takeaways Clinical diagnosis Clinical diagnosis Report to State/Local Health Department ASAP Report to State/Local Health Department ASAP Start antitoxin ASAP Start antitoxin ASAP Supportive care Supportive care Recovery may take weeks Recovery may take weeks


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