Volume 22-21
1 November 1996

[Table of Contents]

BOTULISM REFERENCE SERVICE FOR CANADA

The Botulism Reference Service (BRS) for Canada, established at the Health Protection Branch in Ottawa in 1974, has the following objectives:

• to assist physicians and Provincial Departments of Health when botulism is suspected;
• to examine suspect foods and clinical specimens submitted for analysis;
• to rapidly alert responsible agencies when commercial foods are involved;
• to maintain reference cultures of Clostridium botulinum; and
• to liaise with centres that have similar interests and responsibilities in Canada and abroad.

Botulism is a neuroparalytic disease with mortality rates in Canada of about 14%. Most foodborne outbreaks in Canada are due to home-prepared foods, especially fermented Inuit foods, and improperly stored meat of marine origin; however, some involve commercially prepared foods. Symptoms of foodborne botulism include ptosis, visual disturbance, vomiting and diarrhea, dry mouth and sore throat, followed by descending symmetrical flaccid paralysis in an alert afebrile person. Similar symptoms are associated with wound botulism, but vomiting does not occur. The earliest and most frequently observed symptom of infant botulism is constipation followed by lethargy, poor feeding, ptosis, difficulty swallowing, hypotonia, and generalized weakness ("floppy" baby). In cases of foodborne or wound botulism, specific antitoxin is administered as soon as possible. For all types of botulism, accessibility to respiratory support is essential.

When botulism is suspected, a member of the BRS should be called immediately, day or night. The possible diagnosis of botulism should be validated by checking the case history, and plans for transporting suspect food and clinical specimens to Ottawa for laboratory analysis can be finalized. The food samples may be leftovers or unopened containers. When commercial foods are involved, it is important to retrieve the label, the manufacturer's lot number, codes embossed on the can or package, etc. Suitable clinical specimens for analyses include fecal samples (approximately 10 g) or enema fluid, gastric contents (adjusted to approximately a pH of 6.0 with 1N NaOH, if possible) and serum (from 20 mL of blood collected BEFORE administration of antitoxin). When infant botulism is suspected, the essential material for analysis is the infant's feces. If necessary, soiled parts of diapers may be submitted.

For safe shipment, the specimens must be in a watertight primary receptacle, in a watertight secondary container, with sufficient absorbent material between the two containers to absorb the entire contents of the primary receptacle. The preferred method of preserving the material during shipment is by cooling rather than freezing, i.e., by including commercial cooling packs in the parcel. In urgent cases, the parcels are picked up immediately upon arrival.

The persons or agencies listed below may be called for laboratory services or medical consultation. Antisera may be obtained directly from Connaught Laboratories.

Laboratory Services

J. Austin, PhD, Chairman [office (613) 957-0902]; E. Todd, PhD, Vice Chairman [office (613) 957-0887]; B. Blanchfield, Analyst [office (613) 957-0885], Health Protection Branch, Health Canada, Ottawa, Ontario, KIA 0L2, Postal Locator 2204A2.

Epidemiologic Consultation

Dr. J. Hockin, Chief, [office (613) 957-1764] Field Epidemiology Training Program, Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario, K1A 0L2, Postal Locator 0602B.

Supplier of Antisera

Connaught Laboratories Ltd., 1755 Steeles, Avenue West, Willowdale, Ontario, M2R 3T4, (416) 667-2701.

Source:

J Austin, PhD, Botulism Reference Service for Canada, K Dodds, Bureau of Microbial Hazards, Food Directorate, Health Protection Branch, Health Canada, Ottawa, Ontario.

[Previous] [Table of Contents] [Next]