What is botulism?
Botulism is a serious illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. The illness is rare, but its effects on the body are often paralytic in nature. The three main kinds of botulism are foodborne, wound, and intestinal (adult and infant). Foodborne botulism occurs when foods that contain the botulism toxin are ingested. Wound botulism is caused by toxin produced from a wound infected with Clostridium botulinum. Infants and adults develop a type of botulism by consuming the spores of the botulinum bacteria, which then grow in the intestines and release toxin. Foodborne botulism can be especially dangerous because many people can be poisoned by eating a contaminated food, but all forms of botulism can be fatal. Although, death can occur due to respiratory failure in botulism cases, this percentage has dropped from 50% to 8% in 50 years, due to medical advances.

Botulism Facts
The rod-shaped botulism bacterium is most often found in soil. They require an oxygen rich environment, and therefore, lie dormant in soil in the form of spores until they are exposed to conditions that are ideal for their growth. There are seven types of botulism – A through G – but humans only develop illness when exposed to types A, B, E, and F. There are about 110 case of illness due to botulism reported in the United States each year. About 25% are foodborne, 72% are infant botulism, and the remaining is due to botulism infecting wounds. The cases of wound botulism have increased in recent years due to the use of black-tar heroin. Foodborne botulism cases are usually contracted by eating contaminated home canned foods. The number of these cases has remained relatively the same through the years.

Botulism Used in Bioterrorism
Bolulinum Toxin as a bioterrorism agent is major threat to the world because it is highly concentrated, lethal characteristics, ease of production, transportation, and misuse, and the severe, long term damage that it does to the human body. It is the most poisonous substance known. This lethal substance is released from the clostridium botulinum spores, which, as stated earlier lie dormant in soil. They can be transferred to food by soiled hands, ingested, and given the environment to start releasing their toxin. These spores can also become airborne and enter the body through inhalation. These modes of spreading the spores are also used when botulism is used as a bioweapon. By contaminating food supplies and the air with just a small amount of spores, terrorists have the potential of causing great loss of human lives. Just one gram of this toxin has the capacity to kill more than one million people. Although botulism toxin is deadly, it is not contagious. It cannot be spread from person to person.

In all cases of botulism, the individual needs to undergo a detailed history and physical to get an idea if the exposure was deliberate or a contamination due to natural means. A list of past foods eaten, locations visited, and whether any of the people that they encountered were having similar symptoms. one such clue to a possible case of a deliberate contamination is a group of people that were in a common geographic area, recent dietary intakes that were not similar, yet all showed signs of botulism. This scenario could indicate inhalational botulism. Other factors that could point to a deliberate contamination: an unusual increase in cases of flaccid paralysis in a given area, an unusual botulinum toxin type that is rare or has not been seen, and multiple spontaneous outbreaks with no common source. Equine antitoxin (a passive antibody) should be administered as soon as possible after a positive diagnosis, as well as be closely monitored for respiratory failure. Hospital epidemiology officials, local and state health departments, and the CDC should be contacted with all cases of botulism to ensure an investigation.

To decontaminate food and water sources that are suspected to be infested with botulism, heat them to an internal temperature of 85 degrees celsius. The bacteria cannot live or spread when exposed to high heat. Commercial food suspected of being contaminated need to be removed from consumers immediately. If exposure was was an aerosol contamination, the substance will break down and dissipate into the atmosphere at a rate of 1% a minute. After about 2 days, most of the substance has cleared the area. If exposure is anticipated, people can protect themselves by covering their mouth and nose with cloth, such as a scarf or handkerchief. All exposed clothing and surfaces should be washed with bleach solution if they are not able to avoided for the 2-3 days of atmospheric inactivation.

An investigational botulism toxoid has been developed for use among laboratory workers that come into botulinum toxin on a regular basis. Various military personnel have also started to utilize the toxoid in high risk situations. The toxoid causes temporary immunization for several months. A recombinant vaccine is also presently in development. No vaccine is yet recommended or developed for the general public for the reasons which include scarcity of the toxoid, rarity of natural disease, and elimination of the potential therapeutic benefits of medicinal botulinum toxin.

Public Health Agencies and Botulism Prevention and Control
Public education about botulism prevention is an ongoing activity. Information about safe canning is widely available for consumers through the Department of Agriculture. State health departments and CDC have persons knowledgeable about botulism are available to consult with physicians 24 hours a day. If antitoxin is needed to treat a patient, it can be quickly delivered to a physician anywhere in the country. Suspected outbreaks of botulism are quickly investigated, and if they involve a commercial product, the appropriate control measures are coordinated among public health and regulatory agencies. Physicians should report suspected cases of botulism to a state health department.

Source: CDC (Center for Disease Control and Prevention), the Center for Civilian Biodefense Strategies, and the American Medical Association (AMA)