An outbreak of botulism tied to contaminated baby formula has sickened at least 23 infants since August, frightening parents and underscoring the vulnerability of the United States’ food supply.
The formula blamed for the outbreak, from the company ByHeart, has been recalled. But botulism is a continuing, if rare, threat. Here’s what you need to know.
What is botulism?
Botulism is a life-threatening illness for people of all ages, caused when the bacterium Clostridium botulinum releases toxins. These toxins attack nerves and can paralyze muscles, including those involved in breathing.
Some symptoms resemble those of other food-borne illnesses: nausea, vomiting, stomach pain and diarrhea, though some people experience constipation instead. Other symptoms are characteristic of neurotoxicity: blurred or double vision, drooping eyelids, slurred speech, difficulty swallowing and muscle weakness.
The weakness typically starts in the head and moves down the body, said Dr. Iain Jeffery, the associate director of emergency medicine at St. John’s Episcopal Hospital in Far Rockaway, N.Y., who co-wrote a medical resource about botulism.
An infant often experiences subtler symptoms, including changes in feeding behavior like weaker suckling, Dr. Jeffery said. The head may flop as the neck muscles weaken, and the limbs may as well. Any “unexplained weakness in a child that’s otherwise healthy should raise a red flag,” he said.
Dr. Maureen Ahmann, a pediatrician at Cleveland Clinic Children’s in Ohio, said an infant’s crying might sound weaker or simply different than normal, or the face may become less expressive.
What causes botulism?
It’s important to distinguish between infant botulism and the type of botulism that adults and older children get, because the causes are different.
Clostridium botulinum forms spores, tough protective structures seen in some types of bacteria. In infants, botulinum spores can produce toxins within the digestive tract, leading to illness as much as a month after exposure. These spores are extremely hardy; they can even survive being boiled.
Honey is a source of botulism in infants, a reason doctors advise parents not to feed honey to children under 1. But other foods — like the recalled baby formula — can also contain spores, as can small amounts of dirt that infants consume.
In adults and older children, exposure to botulinum spores generally isn’t dangerous. They can’t compete with the many good bacteria in the digestive tract, so they don’t have a chance to produce toxins, according to Don Schaffner, a food microbiology professor at Rutgers University. In these age groups, botulism occurs when people eat food in which the bacteria have already produced toxins, and symptoms occur much faster after exposure.
That toxin production occurs in environments without oxygen, including in improperly canned foods.
Dr. Schaffner said past outbreaks had been linked to a variety of tiny environments that blocked out oxygen: baked potatoes wrapped in aluminum foil, olive oil infused with garlic, and the bottom of a pile of sautéed onions on a diner’s stove.
It is also possible to get botulism from an infected wound or through botched Botox treatments, which use botulinum toxin. The illness is not contagious from person to person.
How is it treated?
Botulism requires prompt medical attention, often in a hospital. Don’t wait to contact a doctor. “We would rather get 100 phone calls than have one not come in,” Dr. Ahmann said.
If doctors suspect botulism, they will start treatment before getting test results back, because the illness can progress so quickly, Dr. Ahmann added.
In adults, the first line of treatment is an intravenous antitoxin that binds to the toxin in the bloodstream, preventing it from binding to nerves. The equivalent for infants is a product called BabyBIG, derived from antibodies in the plasma of people with immunity to botulism.
These treatments can limit how severe the symptoms get, but can’t remove toxins that have already hit the nerves. The body will eventually clear those, but patients may need mechanical ventilation to keep them alive in the meantime.
Patients may face a long hospitalization, but “generally, as long as they get to the hospital in time to support their breathing, they should have a complete recovery,” Dr. Jeffery said. “The mortality from botulism is very low if somebody can get respiratory support in a timely way.”
Without prompt treatment, though, the toxins can paralyze the diaphragm or the lungs. The mortality rate is 5 percent to 10 percent, according to the World Health Organization.
“All food poisoning is serious business, but botulism is especially serious business,” Dr. Schaffner said.
How can I protect myself and my children?
Many cases of botulism come from improper canning of homemade foods, said Melanie Firestone, an assistant professor at the University of Minnesota School of Public Health. Many universities offer guides to safe canning, as does the Agriculture Department.
Bulging or swelling packaging can be a sign that botulinum toxin is growing, but toxins can be present with no visual sign, and you cannot smell or taste them.
Ten minutes of boiling should kill botulinum toxin, Dr. Firestone said. However, boiling is not sufficient to kill the spores that can sicken infants.
Dr. Ahmann recommended washing infants’ bottles and pacifiers daily with soapy water and thoroughly washing hands before filling or otherwise handling bottles.
And the longstanding guidance holds: Children under 1 shouldn’t eat honey.
Maggie Astor covers the intersection of health and politics for The Times.
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