AbstractIntroductionFoodborne botulism is a rare, potentially fatal illness resulting from the ingestion of foods contaminated with preformed botulinum neurotoxin types A, B, E, or F, produced by Clostridium botulinum. The descriptive epidemiology of foodborne botulism outbreaks in China during 2004−2020 was performed to inform public health response strategies.
MethodsData from 22 of 31 provincial-level administrative divisions (PLADs) of the National Foodborne Disease Outbreaks Surveillance System during 2004−2020 and Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Chinese Science and Technique Journals (CQVIP) from January 2004 to December 2020 to identify indexed publications in the Chinese literature using the following search terms “botulism,” or “botulinum toxin,” or “Clostridium botulinum.” The number and proportion of outbreaks, illnesses, and deaths by PLAD, food types, and contributing factors were calculated.
ResultsDuring 2004−2020, a total of 80 foodborne botulism outbreaks occurred in China, involving 386 illnesses and 55 deaths; most outbreaks were reported between June and August, with a sharp peak in January; 22 out of 31 PLADs reported foodborne botulism outbreaks, Xinjiang reported the largest number of outbreaks (20), followed by Qinghai (13); the most commonly implicated food was home-prepared traditional processed stinky tofu and dried beef, accounting for 51.25% events. Improper processing and improper storage in contributing factors accounted for 77.50% outbreaks. Initial misdiagnosis occurred in 27.50% of cases.
ConclusionsOutbreaks of foodborne botulism had a high case-fatality rate. Targeted food safety and popularization education to farmers and herdsmen in Xinjiang and Qinghai related to botulism prevention should be carried out, and timely outbreak investigation and hospital surge capacity should be improved.
Belgian scholars in consumers of sausages first described botulism in 1896 (1). It was confirmed that the growth and germination of toxins occurred only under particular conditions in an anaerobic low salt, low-acid environment. People who ingest food contaminated with botulinum neurotoxin (BoNT) produced by botulinum toxin can have a potentially fatal outcome (2). Outbreaks have been reported worldwide. In Canada, the first Clostridium botulinum type E outbreak in 1944 in Nanaimo, British Columbia was reported in 1947 (3); In China, Wu et al. first reported botulism in Xinjiang in 1958 due to edible semi-finished noodle sauce (4). A better understanding of the epidemiology of botulism outbreaks can help tailor local prevention and public health response strategies. Here, we reviewed surveillance data on outbreaks, illnesses, and deaths of botulism in China from 2004 to 2020.
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