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Botulism

In the United States an average of 110 cases of botulism are reported each year. Botulism is a muscle-paralyzing disease caused by a toxin made by a bacterium called Clostridium botulinum. Botulinum toxins are some of the most poisonous substances known. Miniscule quantities are capable of producing disease in humans.

Cases of botulism are usually associated with consumption of preserved foods. However, botulinum toxins are currently among the most common compounds explored by terrorists for use as biological weapons.

There are currently no specific OSHA standards for botulism and emergency response activities as a result of a bioterrorist attack.

OSHA Standards

This section highlights OSHA standards, preambles to final rules (background to final rules), and directives (instructions for compliance officers) related to botulism.

Note: Twenty-five states, Puerto Rico and the Virgin Islands have OSHA-approved State Plans and have adopted their own standards and enforcement policies. For the most part, these States adopt standards that are identical to Federal OSHA. However, some States have adopted different standards applicable to this topic or may have different enforcement policies.

General Industry (29 CFR 1910)

Construction Industry (29 CFR 1926)

Preambles to Final Rules

Directives

Hazard Recognition

Botulinum toxin is the single most poisonous known substance. There are three main kinds of botulism. Foodborne botulism is caused by eating foods that contain the botulism toxin and is especially dangerous because many people can be poisoned by eating a contaminated food. Wound botulism is caused by toxin produced from a wound infected with Clostridium botulinum. Infant botulism is caused by consuming the spores of the botulinum bacteria, which then grow in the intestines and release toxins. All forms of botulism can be fatal and are considered medical emergencies. The following references aid in recognizing disease characteristics and hazards associated with botulinum toxin.

  • Botulism. Centers for Disease Control and Prevention (CDC). Provides links to fact sheets and overviews and information on infection control, laboratory testing, and surveillance and investigation.

  • Botulism. Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases. Answers frequently asked questions related to botulism.

  • Botulism. MedlinePlus. Provides links to botulism topics including clinical trials, diagnosis, symptoms, prevention, and infant botulism.

  • Botulism. World Health Organization (WHO).

  • Clostridium Botulinum [146 KB PDF, 32 pages]. World Health Organization (WHO), International Programme on Chemical Safety. Provides a thorough overview of botulism, its associated bacteria, and the toxins they produce.

  • Current Description of Botulism: Identification. University of California Los Angeles (UCLA), School of Public Health, Department of Epidemiology. Includes a description of the various forms of botulism, its mode of transmission, and data on its occurrence.

Bioterrorist Threat Evaluation

On September 11, 2001, following the terrorist incidents in New York City and Washington, DC, the Centers for Disease Control and Prevention (CDC) recommended heightened surveillance for any unusual disease occurrence or increased numbers of illnesses that might be associated with the terrorist attacks.

Botulinum toxin poses a bioweapons threat because of its extreme potency and lethality, ease of production, and the potential need for intensive care of affected persons. A number of states named by the US State Department as "state sponsors of terrorism" have developed or are developing botulinum toxin as a biological weapon. The following references provide information on evaluating the threat of botulinum toxin being used as biological weapon.

  • Medical Management of Biological Casualties Handbook, Seventh Edition [2 MB PDF, 254 pages]. US Army Medical Research Institute of Infectious Diseases (USAMRIID), (2011, September). Contains specific information on a number of potential bioterrorist agents.

  • Zajtchuk, Brigadier General Russ. "Medical Aspects of Chemical and Biological Warfare." (1997). Office of the Surgeon General, Borden Institute, Walter Reed Army Medical Center, Washington, DC. Textbook of military medicine.
    • Middlebrook, John L. and David R. Franz. "Chapter 33: Botulinum Toxins [106 KB PDF, 12 pages]." Provides a thorough discussion of botulinum toxins, including biowarfare history, and biochemical descriptions of the toxins and their pathogenesis.
    • Botulism. University of Minnesota (UM), Center for Infectious Disease Research and Policy (CIDRAP). Offers an overview of botulism, including pathogenesis, microbiology, and epidemiology, and provides current news items, images, and resources related to bioterrorism.

  • Botulinum toxin (Botulism). University of Pittsburgh Medical Center (UPMC), Center for Biosecurity Agent Fact Sheet, (2014, February 26). Answers basic questions regarding the signs and symptoms of botulism, how long it takes to develop and recover, what treatments and vaccines exist, as well as provides a background for naturally occurring botulism and as a biological weapon.

  • Recognition of Illness Associated with the Intentional Release of a Biologic Agent. Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) 50(41);893-7, (2001, October 19). Provides guidance for health-care providers and public health personnel about recognizing illnesses or patterns of illness that might be associated with an intentional release of biologic agents.

  • Arnon, Steven S., et al. "Botulinum Toxin as a Biological Weapon." Journal of the American Medical Association (JAMA), 285.8(2001, February 28). Considers the aerosol or foodborne dissemination of botulinum toxin and provides a variety of facts about botulism/botulinum toxin, including its history as a bioweapon, microbiology, pathogenesis/clinical manifestation, epidemiology, diagnosis, therapy, prophylaxis, and decontamination.

Exposure Evaluation

Person to person transmission of botulism does not occur. The symptoms are not caused by the organism itself, but by the toxin that the bacterium releases which usually appear within 12 to 36 hours but can range from four hours to eight days after exposure. Incidence of botulism is low, but the mortality rate is high if not treated immediately. The disease can be fatal in 5 to 10 percent of cases. The following references provide useful information about the management of exposures to botulinum toxin.

Evaluation and Investigation

Prompt and thorough laboratory evaluation of cases and suspected foods is essential. Cases of foodborne disease involving botulism, are identified by a distinctive clinical syndrome. For information about conducting evaluations of foodborne disease and reporting foodborne disease epidemics to local health authorities, see the following reference:

Diagnosis and Treatment

  • Bioterrorism Agent Fact Sheet: Botulism/Botulinum Toxin [165 KB PDF, 2 pages]. Saint Louis University (SLU) School of Public Health, Centers for the Study of Bioterrorism, and Emerging Infections (CBS&EI), (2002, November). Provides a basic disease description and information on diagnosis and treatment.

Control and Prevention

Public education about botulism prevention is an ongoing activity. State health departments and the Centers for Disease Control and Prevention (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 measures are coordinated among public health and regulatory agencies. Physicians should report suspected cases of botulism to a state health department.

Additional Information

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