Published online July 1, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. e73-e82 (doi:10.1542/10.1542/peds.2007-1827)

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Koepke, R. Articles by Arnon, S. S. Search for Related Content PubMed PubMed Citation Articles by Koepke, R. Articles by Arnon, S. S. Related Collections Infectious Disease & Immunity Social Bookmarking                         What's this?

ARTICLE

Global Occurrence of Infant Botulism, 1976–2006

Ruth Koepke, MPH^a, Jeremy Sobel, MD, MPH^b and Stephen S. Arnon, MD^a

^a Infant Botulism Treatment and Prevention Program, California Department of Public Health, Richmond, California
^b National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

OBJECTIVE. To summarize the worldwide occurrence of reported infant (intestinal toxemia) botulism cases since first recognition of the disease in 1976.

PATIENTS AND METHODS. We collected information on infant botulism cases by active and passive surveillance, by provision of therapeutic Human Botulism Immune Globulin to suspected cases, and by searching the medical literature. We defined a case as laboratory-confirmed botulism that occurred in an infant 12 months of age that was not caused by the ingestion of botulinum toxin in food.

RESULTS. Twenty-six countries representing 5 continents reported the occurrence of at least 1 case of infant botulism among their residents. The United States, Argentina, Australia, Canada, Italy, and Japan, in this order, reported the largest number of cases. A history of honey exposure was significantly more common among case subjects hospitalized outside of the United States than among those who were recently hospitalized in California.

CONCLUSIONS. Most countries have not yet reported cases of infant botulism. This limited reporting of the disease to date contrasts with the known global occurrence of Clostridium botulinum spores in soils and dust and suggests that infant botulism may be underrecognized, underreported, or both. When bulbar palsies, hypotonia, and weakness are present, physicians should consider the possibility of infant botulism even if the patient has not been fed honey. Publication of additional case reports and surveillance summaries will enhance understanding of the occurrence and extent of this underrecognized disease.

---

Key Words: Clostridium botulinum • infant botulism • botulinum toxin • epidemiology • Human Botulism Immune Globulin • BabyBIG

Abbreviations: BIG-IV—Botulism Immune Globulin Human (Intravenous) • CDC—Centers for Disease Control and Prevention • CDHS—California Department of Health Services • CDPH—California Department of Public Health • IBTPP—Infant Botulism Treatment and Prevention Program • UCBSPH—University of California-Berkeley School of Public Health

---

Accepted Feb 25, 2008.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				N. Dover, J. R. Barash, and S. S. Arnon Novel Clostridium botulinum Toxin Gene Arrangement with Subtype A5 and Partial Subtype B3 Botulinum Neurotoxin Genes J. Clin. Microbiol., July 1, 2009; 47(7): 2349 - 2350. [Full Text] [PDF]

				Y. Ibrahim, T. A. Merritt, J. R. Barash, and S. S. Arnon Index of Suspicion in the Nursery NeoReviews, January 1, 2009; 10(1): e36 - e38. [Full Text] [PDF]