1. Epidemiological paper based on Jeanette K.Stehr-Green, CDC, Atlanta (USA) work and the Villar and colleagues publishing (1999) Outbreak of Type A Botulism and Development of a Botulism Surveillance and Antitoxin Release System in Argentina. JAMA, 281: 1334-1340. BOTULISM Research of an outbreak of Botulism type A in Argentina. Case study

2. What is Botulism? Neuro paralytic disease, frequently fatal. It results from the ingestion of the botulinum toxin developed by the bacterium Clostridium botulinum and other bacteria. This microrganism is strictly anaerobic and its spores are widely distributed among animal intestines, soil and river and sea banks. The botulinum toxin is a powerful poison and is also termolabil.

3. It is told that the outbreak affected bus drivers which had eaten “matambre” (rolled beef with vegetables and boiled egg). On January, 10 bus drivers got sick with diarrheic symptoms, blurred vision, dysphagia, double vision, motor weakness, one of them showed shortness of breath... (cont.) Background

4. cont.... A cohort study was performed for 22 company drivers, 11 of them, had eaten matambre. Type A toxin was found on 3 of the analysed patients. All patients received the anti toxin provided by the CDC.

5. By the time the anti toxin is required the Centers for Disease Control and Prevention (CDC), Atlanta, Ga. USA, participate in the outbreak investigation. The research is done by an epidemiological team which included epidemiologists, microbiologists, food, sanitation and environmental experts. Critical points are identified for contamination, survival and microbial growth and next steps are discussed....the CDC intervention

6. Epidemiological exercise Based on this material, Jeanette K. Stehr-Green from the CDC along with a support team prepared a thorough, detailed and extended case study where they describe the procedures and policies on the outbreak research and on the prevention and control measures set up.

7. Based on the fact told on this papers and modifying and simplifying the data for didactical reasons, we have re formulated the problem and have prepared a case study adapted to SAPUVETNET goals. The main goals of this job ( SAPUVETNET case study) : Understand the sanitary importance of botulism outbreaks. Take immediate control and prevention measures in order to avoid the spreading of the outbreak. cont…

8. (cont.) Identify all food involved, all deficiencies that allow the outbreak and the critical points to take into consideration in order to prevent future incidents. Apply the research methodology for outbreak investigation. Emphasize the importance of sanitary and feeding education at all levels. Case study developed by a member of SAPUVETNET II – University of Salvador, Pilar-Buenos Aires (Argentina) Contact: Dora Dobosch E-mail: ddobosch@pccp.com.ar