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. MedlinePlus. Provides links to botulism topics including clinical trials, diagnosis, symptoms, prevention, and infant botulism.
  • Botulism. World Health Organization (WHO).
  • Clostridium Botulinum. 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 U.S. 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.

  • Botulinum toxin (Botulism). University of Pittsburgh Medical Center (UPMC), Center for Biosecurity Agent Fact Sheet, (February 26, 2014). 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.
  • Medical Management of Biological Casualties Handbook, Seventh Edition. U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), (September 2011). 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". 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.
  • 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, (October 19, 2001). 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(February 28, 2001). 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.