1166. Botulism poisoning fatalities linked to home-canned food products - Tajikistan, 2021

Abstract

Abstract Background Botulism is a rare but fatal illness often caused by consumption of foods containing Clostridium botulinum neurotoxins. We investigated an outbreak among people having attended a family dinner in Kushkiya village, Tajikistan in December 2021. Methods We interviewed dinner participants using a structured questionnaire to collect clinical, demographic, and prior 48-hour food histories. We abstracted data from medical records. A case was defined as a person who attended the event with symptoms clinically compatible with botulism. Results Thirteen people attended the dinner event. Of these, 10 (77%) were classified as a case. Case-patients ages ranged from 2 to 40 years old; five were children < 12 years old. All case-patients had muscle weakness, dizziness, dry mouth, nausea, and vomiting. Two had abdominal pain, five had symmetric paresis, two had shortness of breath, and two had double vision. Median time from dinner event to development of symptoms was 22 hours (range 17-30 hours). Four patients (40%) were hospitalized in serious condition, including two children in comas. Four patients died (40%). Deaths occurred on average 48 hours after the dinner (range 41-55 hours). All ten cases had eaten homemade canned salad. Two other dinner participants ate the canned salad, but did not get sick. The canned salad was made of tomatoes, onions, garlic, and oil. It had been prepared in September 2021. Due to limited capacity for botulism testing in Tajikistan diagnostics were not performed. The infectious disease hospital did not have botulism antitoxin in stock upon patient admission. Deceased patients had not received antitoxin. On the third day after exposure, botulism antitoxin (A, B, C and E) was given to 9 dinner participants; all of whom survived. Conclusion The high case fatality rate highlights the need to increase clinician awareness of botulism, educate and improve their ability to provide emergency and respiratory care, and ensure stocks of anti-botulinum serum in health facilities. Additionally, improved national diagnostic capabilities to detect botulism and identify toxin types can help identify sources. Lastly, public health messaging may help increase safe food preparation practices. Disclosures All Authors: No reported disclosures.