Botulism prevention

Public education about botulism prevention is an ongoing activity. Information about safe canning is widely available for consumers. State health departments and CDC have persons knowledgeable about botulism 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 measui es are coordinated among public health and regulatory agencies. Physicians should report suspected cases of botulism co a state health department. 

Sodium Nitrate and Sodium Nitrite. Nitrates and nitrites ate used in meat-curing processes to prevent the growth of bacteria that cause botulism. Nitrates have been shown to form low, but possibly toxic, levels of nitrosamines in certain cured meats. For this reason, the safety of these products has been questioned, and use is limited (80). 

Bacteria not only attack teeth but can also make people extremely sick. Therefore, canned food must be specially prepared to prevent the growth of bacteria. This is usually done by boiling or steaming. People who can their own food at home, however, do not have the sophisticated machines that food-canning manufacturers have. Even so, there are other methods that home canners can use to preserve their own food and keep their families safe. For example, high heat can be used to kill the bacteria Clostridium botulinum, which causes one deadly form of food poisoning called botulism. Acidic conditions will also kill C. botulinum. Because the bacteria cannot survive at a pH below 4.5, very acidic foods such as tomatoes, pears, and peaches are safe for home canning. 

The function of sodium nitrite, NaN02, as a food additive is two-fold (1) it inhibits the oxidation of blood, preventing the discoloring of red meat, and (2) it prevents the growth of botulism bacteria. There is now some controversy regarding this food additive because nitrites are suspected of combining with amines under the acidic conditions of the stomach to produce carcinogenic nitrosoamines. 

Botulism is usually not transmissable from one person to another. A supply of antitoxin against botulism is maintained by the Center for Disease Control and Prevention located in Atlanta, Georgia. Such antitoxin is effective against the severity of symptoms if administered early in the course of disease, and most patients eventually recover after weeks to months of supportive care. 

Drugs There is an antitoxin stored at the CDC. To arrange to use this antitoxin, call your state health department (or CDC at 404-639-2206 or 404-639-3753 workdays, or call weekends or evenings at 404-639-2888). This chemotherapy (antitoxin) available from CDC is a licensed trivalent equine antitoxin for serotypes A, B, and E. There is no reversal of botulism disease with this drug, but the antitoxin does usually prevent further nerve damage. The U.S. Department of Defense (DOD) has a heptavalent equine despeciated antitoxin for serotypes A - G (IND). DOD also has pentavalent toxoid (vaccine) for serotypes A - E (IND). The currently recommended schedule is for use at zero, two, and twelve weeks with a one year booster. This vaccine is supposed to induce solidly protective antitoxin levels in greater that 90 percent of those vaccinated after one year. Contact USAMRIID, (U.S. Army Medical Research Institute of Infectious Diseases), Fort Detrick, Maryland. Tel. 301-619-2833. 

Botulism can be prevented by the administration of neutralizing antibody in the bloodstream... 

Wound botulism occurs where C. botulinum spores germinate in wound infections and develop into vegetative cells. In such cases, neurotoxin is produced which leads to the onset of neurological symptoms. According to the Centers for Disease Control and Prevention, 23 cases of wound botulism (13.6% of all botulism cases) were reported in 2001 in the U.S. Wound botulism has also been diagnosed after intravenous drug injection (Rundervoort et al., 2003). 

Spores may be transferred from soil and plants to the sea via rainwater, causing the prevalence in coastal waters of the same C. botulinum types as on the land. Such a correlation was observed in Great Britain, where the type B predominates both in soil and in bottom sediments. Similarly, 71% of fish and bottom-sediment samples collected in southern France were contaminated with type B, while C. botulinum type E was found only in 9.6% of samples (Each et al., 2002). However, it is commonly believed that non-proteolytic type E is characteristic for the marine environment. A distinguishing feature of type E strains is the ability to grow in low temperatures (about 3°C), which are typical for bottom layers of seas and oceans. Moreover, the bottom sediments provide anaerobic conditions for the outgrowth of Clostridium. Therefore, the marine environment promotes C. botulinum type E distribution. This has been further supported by the rate of fish and seafood contamination fish and seafood isolated in many countries are most frequently contaminated with C. botulinum type E (Dodds, 1993 a,b). Furthermore, epidemiological studies have shown that the majority of botulism cases linked to fish and seafood consumption reported between 1950 and 1996 in the U.S. were caused by C. botulinum type E (Centers for Disease Control and Prevention 1998). C. botulinum type F,... 

Fish and seafood are generally responsible for infections caused by C. botulinum type E (Centers for Disease Control and Prevention, 1998). Many verified cases of botulism type E have been reported in Japan (166 cases and 58 deaths between 1951 and 1960). In 2003, C. botulinum type E was involved in the outbreak in western Alaska linked to consumption of a beached whale (Anonymous, 2003). Many outbreaks were also associated with a Japanese izuschi dish containing fermented raw fish, vegetables, and cooked and malted rice (okji). In Canada, Alaska, or Scandinavia, botulism is caused by consumption of fish and fermented meat dishes, very often prepared as traditional native dishes (Kotev et ah, 1987 Knubley et ah, 1995). 

Commercial products usually do not pose health threats to their consumers. However, botulism cases acquired after consumption of commercially prepared canned foods have been reported. In the U.S., 62 outbreaks occurred in the years 1899 to 1973 (Lynt et al., 1975). Only 7% of outbreaks reported between 1950 and 1996 were linked to commercially processed foods (Centers for Disease Control and Prevention, 1998). The implicated foodstuffs included chopped garlic in soy oil stored in glass bottles at room temperature (Louis et al., 1988), sliced roasted eggplant in oil, yogurt with hazelnuts, stuffed lotus rhizome, bottled caviar, and canned peanuts (Chou et al., 1988 D Argenio et al., 1995). 

IK. 13 Zinc is a much more reactive metal than cadmium, as expected from the discussion on pages 877-879. Yet both are ised to protect iron from rusting. How is this possible 18.14 Sodium hypo phosphite. NaH.PQ . has been suggested as a repbeemem of sodium nitrite. NaNCK. as a meat preservative to prevent botulism Draw the structure of each anion. 

Byrne MP, Smith LA (2000) Development of vaccines for prevention of botulism. Biochimie 82 955-66... 

Botulism is a neuroparalytic, primarily foodborne illness first described in 1897 (GDC, 1998). The disease is caused by a toxin produced by the anaerobic bacterium Clostridium botulinum. Although botulism is rare, it can kill rapidly and foodborne botulism is a public health emergency carrying significant risk for widespread disease and death, as potentially preventable deaths may occur if the source of botulism is not discovered and eliminated. There are classically four major types of botulism foodborne botulism, infantile botulism, wound botulism, and intestinal botulism. 

Centers for Disease Control and Prevention. (1998). Botulism in the United States, 1899-1996 Handbook for epidemiologists, clinicians, and laboratory workers. Atlanta, GA Centers for Disease Control and Prevention. 

Some additives clearly serve an important function. Preservatives help to prevent food from spoiling and enable processed food to be stored for much longer. They reduce the likelihood of bacterial contamination in the food we eat. Sodium nitrite is added to cured meat, for example, to prevent the growth of organisms like Clostridium botulinum, which causes severe toxicity, botulism (see pp. 249-51). Preservatives also reduce chemical degradation and so allow food to have a longer shelf life. Other additives may also have a beneficial function, for example artificial sweeteners reduce the sugar intake of people who suffer from diabetes or obesity. 

There are as yet no FDA-approved vaccines to prevent botulism. An investigational pentavalent botuliniun toxoid (PBT) product, developed at Fort Detrick, is available for persons at risk for botulism (i.e. laboratory workers, warfighters). While determined to be safe and immunogenic, PBT is not useful or recommended for post-exposure prophylaxis. Antitoxin titers do not develop until a month after the third dose in the vaccine schedule. PBT is reserved for employees at high risk for BoNT exposure but not the general population. Several factors limit the usefrdness of PBT as a vaccine for inoculating the general population. 

CDC (Centers for Disease Control and Prevention) (1995). Foodbome botulism - Oklahoma, 1994. Morb. Mortl. Wkly Rep. 44 200-2. 

A pentavalent botulinum toxoid (botulinum toxin in different antigenic types) has been used for more than 30 years in some countries to prevent the disease in laboratory workers and to protect troops against attack. Pre-exposure immunization for the general population is neither feasible nor desirable the vaccine is ineffective for postexposure prophylaxis. Treatment of botulism consists of passive immunization and supportive care. Most licensed antitoxins contain antibodies against the most common toxin types A, B, and E. About 9% of recipients of equine antitoxin developed urticaria, serum sickness, or other hypersensitivity reactions. In 2% of recipients anaphylaxis occurred within 10 minutes of antitoxin... 

Sodium hypophosphite, NaHiPOi, has been suggested as a replacement of sodium nitrite, NaNO , as a meat preservative to prevent botulism. Draw the structure of each anion. 

Chemical Abstracts Service Registry Number CAS 93384-43-1. Botulinum toxins comprise a series of seven related protein neurotoxins that prevent fusion of synaptic vesicles with the presynaptic membrane and thus prevent release of acetylcholine. Exposure in a battlefield or terrorist setting would most likely be to inhaled aerosolized toxin. The clinical presentation is that of classical botulism, with descending skeletal muscle weakness (with an intact sensorium) progressing to respiratory paralysis. A toxoid vaccine is available for prophylaxis, and a pentavalent toxoid can be used following exposure its effectiveness wanes rapidly, however, after the end of the clinically asymptomatic latent period. Because treatment is supportive and intensive (involving long-term ventilatory support), the use of botulinum toxin has the potential to overwhelm medical resources especially at forward echelons of care. 

The treated toxins are sometimes referred to as formol toxoids. Toxoid vaccines are very effective in the prevention of those diseases such as diphtheria, tetanus, botulism and clostridial infections of farm animals, in which the infecting bacteria produce disease through the toxic effects of secreted proteins which enzymically modify essential cellular components. Many of the clostridial toxins are lytic enzymes. Detoxification is also required for the pertussis toxin component of acellular pertussis vaccines. 

Centers for Disease Control and Prevention, National Center for Infectious Diseases, Division of Bacterial and Mycotic Diseases. Surveillance for Botulism. Summary of 2001 Data, http // www.cdc.gOv/ncidod/dbmd/diseaseinfo/files/BotCSTE2001.pdf. Last accessed 4/15/06... 

The brown color of old meat is the result of oxidation of blood and is objectionable to many consumers. Nitrites and nitrates are added to food to retard this oxidation and also to prevent growth of botulism bacteria. Nitrate ions, N03, are reduced to N02 ions, which are then converted to NO. This in turn reacts with the brown oxidized form of the heme in blood. This reaction keeps meat red longer. Controversy has arisen, however, concerning the possibility that nitrites combine with amines under the acidic conditions in the stomach to produce carcinogenic nitrosoamines. 

Centers for Disease Control and Prevention (CDC). (2006), Botulism Treatment Overview for Clinicians. Atlanta, GA, Centers for Disease Control and Prevention, June 14. Last viewed October 10, 2006, http / www.bt.cdc.gov/agent/Botulism/clinicians/treatment.asp... 

Food-borne botulism results from the ingestion of food contaminated with preformed toxins or toxin-producing spores from C. bo-tulinum. C. botulinum poisoning is relatively rare only 110 cases are reported per year in the United States. Botulism is almost always associated with improper preparation or storage of food. Seven distinct toxins (A to G) have been described. The toxins, which are produced by the bacteria and released on lysis, are the most potent biologic or chemical toxins known to humans. The toxin prevents the release of acetylcholine at the peripheral cholinergic nerve terminal. Toxin activity has prompted the use of minute locally injected doses to treat select spastic disorders, such as blepharospasm, hemifacial spasm, and certain dystonias. ... 

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