Update: International Outbreak of Restaurant-Associated
Botulism -- Vancouver, British Columbia, Canada
A restaurant in Vancouver, British Columbia, Canada has been
the
source of two discrete clusters of botulism cases during the latter
half of summer 1985. The eating establishment, the White Spot
Restaurant at 1616 Georgia Street, is located near Stanley Park, a
popular attraction. Eight cases have been recognized in the first
cluster, which followed a meal at this restaurant between July 26
and
August 2. An additional 26 cases have been recognized in the
second
cluster, which followed meals eaten between August 29 and September
5. Cases have been reported in Canada, the United States, and the
Netherlands.
A notable feature of this outbreak has been the slow
development
and progression of symptoms, up to 10 days following exposure.
Because cases were widely dispersed and initially involved atypical
manifestations of acute botulism, many practitioners and
specialists
were misled in their primary diagnosis. Consequently, many of
these
patients were hospitalized with a range of other neurologic and
psychiatric diagnoses.
Type B botulinal toxin was detected in the serum of three
patients. Seven patients have required ventilator support. There
have been no fatalities. A case-control study demonstrated two
sandwiches on the menu to be highly associated with illness, and
further analysis implicated a preparation of chopped garlic in
soybean
oil as the specific vehicle of intoxication. It is suspected that
the
product was unrefrigerated for several months before being opened.
Control measures included voluntary withdrawal of the implicated
menu
items and the chopped garlic product from all White Spot
Restaurants.
Reported by FJ Blatherwick, MD, SH Peck, MB, City of Vancouver
Health
Dept, Vancouver, British Columbia, GB Morgan, ME Milling, Field
Operations Directorate, Health Protection Br, Health and Welfare,
Canada; GD Kettyls, MD, Provincial Laboratories, Vancouver, TJ
Johnstone, MB, Provincial Epidemiologist, DW Bowering, MD, Field
Epidemiologist, Laboratory Centre for Disease Control, Provincial
Ministry of Health, Victoria, British Columbia; U.S. Food and Drug
Administration; Enteric Diseases Br, Div of Bacterial Diseases,
Center
for Infectious Diseases, CDC.
Editorial Note
Editorial Note: The U.S. Food and Drug Administration has decided
that the garlic product is safe if it is kept refrigerated as the
label directs, so it is still being sold in the United States. No
persons who consumed this product in the United States have been
reported with botulism. However, further patients with unusual
neurologic illness and travel histories to Vancouver within the
time
periods in question may yet be diagnosed retrospectively as cases
of
botulism associated with this outbreak. Clinicians should contact
their provincial or state epidemiologist if this possibility is
entertained. Cases outside Canada or the United States should be
reported to Chief, Communicable Disease Division, Bureau of
Epidemiology, Laboratory Centre for Disease Control, Ottawa,
Canada.
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