Botulism Outbreak in Alaska - Term Paper Example

* Botulism outbreak in Alaska The paper discusses Botulism outbreak in Alaska due to consumption of fermented food and analysis various causative agents along with the preventive measures that were suggested post the outbreak. The paper also sums up the findings of an investigatory team and closely examines the new anti-botulism program that was implemented in Alaska after the outbreak of the disease. * Introduction On January 18, 2001, a local physician in a southwest Alaska village informed The Alaska Division of Public Health of a possible botulism outbreak. Botulism is a paralytic illness which is caused by a nerve toxin. Rare yet serious, food-borne botulism is caused by consumption of food items which contain the botulism toxin. The disease can be fatal and epidemical as a large number of people can be infected due to consumption of contaminated food. The disease often generates from canned food which have low acid content like asparagus, green beans, beets and corn. Botulism often begins with cranial nerve paralysis, including diplopia, dilated and fixed pupils, dysarthria, dysphagia, and dry throat. Botulism intoxication can result in death, which most often is caused by respiratory failure. The latent period is typically 12-36 hours but can range from 6 hours to 10 days. Stringent hygienic procedures while cooking and canning are recommended for keeping the disease at bay. This report explains how conventional practices of fermenting food before consumption are a major cause of food-borne botulism in Alaska, as found in this particular case. Discussion In this case of food-borne botulism was termed as a clinically compatible illness in a village resident after laboratory confirmation of botulism or a history of eating the same food as previous botulism cases. It was found that 14 persons in the village had eaten fermented beaver tail and paw on January 17. Almost 20 hours after consuming these items, three of the 14 people developed symptoms suggestive of botulism, including dry mouth, blurry vision, and general weakness. Two patients developed respiratory failure and required intubations and mechanical ventilation. One of the two intubated patients suffered a cardiac arrest and had to undergo a cardiopulmonary resuscitation, which was successful. Six hours after the onset of symptoms, the three patients were administered with A/B and E botulism antitoxin. Two patients recovered without any further complication. The third one required tracheotomy tube placement and mechanical ventilation for one month. This patient had also been hospitalized with botulism in 1997. Of the other 11 infected persons, four reported minor symptoms compatible with botulism, including dry mouth and nausea, and were admitted to a hospital for overnight observation. One of them was hospitalized for 10 days with persistent ileus. The remaining seven were kept under observation for 48 hours. The clinical specimens from the 14 infected persons were tested for botulinum toxin at CDC. Type E toxin was detected in serum specimens from two of the ICU patients and in stool from the third. Despite minor symptoms, the other 11 persons had no toxin found in specimens and were not considered laboratory-confirmed cases. The same toxin was also found in the three beaver paws tested from the implicated meal. Beaver is hunted in southwest Alaska, and certain parts are often fermented and are eaten later. In this outbreak, the tail and paws had been wrapped in a paper rice sack and had been stored for up to three months in a patient's house before consumption. Some of the beaver tail and paw had been added to the sack as recently as 1 week before it was eaten. The severity of the case was low. The number of people infected was less and proper treatment was immediately administered to them. Out of the the 14 infected persons only three had to be hospitalized, rest eleven were discharged after being kept under observation for 48 hours. There were no causalities in the outbreak and it was brought under control in a short span of time. The investigations revealed that unhygienic and traditional methods of storing and fermenting food before consumption were a prime cause of botulism in Alaska. In traditional fermentation procedure, the food is kept in a grass-lined hole in the ground or a wooden barrel sunken into the ground or is placed in a shady area above ground for several weeks to months. However post the 1970s, people started using plastic or glass containers for fermentation and the process was done above the ground or indoors. The anaerobic condition of sealed containers and warmer temperatures make fermentation more rapid and production of botulism toxin more likely. These nontraditional methods have been associated with increased botulism rates in Alaska during a period of 1970-1989. Although plastic containers were not used during this outbreak, the beaver tail and paw were fermented in a closed rice sack and stored in a warm area. Alaska's food-borne botulism rates are found to be higher than in any other state and are also among the highest in the world. The investigative team found that during 1950-2000, Alaska recorded 226 cases of food- borne botulism from 114 outbreaks. All the patients were Alaska Natives, and all cases with known causes were associated with eating fermented foods. Approximately 27% of U.S. food-borne botulism cases occur in Alaska. Early diagnosis and antitoxin treatment have contributed to the decline of the case fatality rate from approximately 31% during 1950-1959 to no deaths in Alaska since 1994. However, Alaska continues to have high food-borne botulism rates because fermented foods are part of Alaska Native culture. In a 1999 survey, 107 (77%) of 140 Alaska Natives reported having eaten fermented foods at least once in their lifetime. Summary and Recommendations CDC (Centre for Disease Control and Prevention) has also laid out certain legislations and control procedures for food borne diseases which aim at effective prevention of such fatal diseases through immediate reporting and well coordinated treatment procedure. In various reports CDC has repeatedly recommended proper and continuous surveillance of areas which are prone to such diseases by medical experts. Without an adequate surveillance system it is not possible to gauge the impact and extent of existing diseases and neither is it possible to recognize any new disorder arising from the same. Officials also rely on the surveillance data for effectively deputing their staff and financial resources for preventing and controlling the food-borne diseases in the affected areas. The surveillance is also crucial to judge the effectiveness of current preventive measures and control programs. Also, an a control initiative, Bristol Bay Area Health Corporation, a health-care delivery organization operated by Alaska Natives in southwest Alaska, collaborated with CDC's Arctic Investigations Program in 1998 to design a community-based botulism prevention strategy, including an education video entitled, "A Helping Hand: Keeping Your Family Safe From Botulism." It features Alaska Native elders and botulism survivors discussing the risks of eating improperly fermented foods and recommends returning to traditional methods. The video also suggests boiling fermented foods for 10 minutes to destroy botulism toxin. Both English and an Alaska Native language version of the video were produced and distributed to all village clinics and schools in the Bristol Bay region. However to gauge the success rate of such control initiatives, an effective surveillance or monitoring system is a must. A surveillance system is the only way to determine what alterations need to be made to various programs in order to get the maximum output. Legislations also make it mandatory for medical practitioners to report every case of food borne botulism to CDC immediately. Immediate reporting help in expedite accessing of the situation and help in controlling the disease before it spreads further. Deputation of staff and accessing the probable cost of the disease is also calculated on the basis of early reporting of the disease and surveillance data. The strategies for controlling food borne botulism in Alaska fall largely into two approaches: 1. Reducing contamination of food with C. botulinum spores and preventing toxin production in food. 2. Early identification of botulism cases. Reducing contamination and preventing toxin formation are difficult to achieve The Centers for Disease Control and Prevention (CDC) estimates 76 million people suffer food borne illnesses each year in the United States, accounting for 325,000 hospitalizations and more than 5,000 deaths. Food borne disease is extremely costly. Health experts estimate that the yearly cost of all food borne diseases in this country is 5 to 6 billion dollars in direct medical expenses and lost productivity. Infections with the bacteria Salmonella alone account for $1 billion yearly in direct and indirect medical costs. Following are the suggested preventive measures for food borne diseases like botulism: Follow strict hygienic steps when home canning. Refrigerate oils containing garlic or herbs. Keep baked potatoes wrapped in aluminum foil either hot until served or refrigerated. Consider boiling home-canned food before eating it to kill any bacteria which might lurk in the food. Appendix: Reference link: http://66.102.7.104/searchq=cache:r5qbEwL0Yq4J:www.niaid.nih.gov/factsheets/foodbornedis.htm+foodborne+diseases+%2B+cost+%2B+botulism&hl=en&gl=in&ct=clnk&cd=1 http://www.ers.usda.gov/ http://www.ifama.org/conferences/2001Conference/ForumPresentations/castillo_alejandro.PDF http://www.epi.alaska.gov/pubs/botulism/bot_05.html http://www.cdc.gov/ncidod/eid/vol10no9/03-0745.html Read More