International Outbreak of Type E Botulism Associated With
Ungutted, Salted Whitefish
On November 2, 1987, a 39-year-old Russian immigrant and his
9-year-old son were admitted to a suburban New York hospital with
symptoms indicative of botulism. The father's stool specimen
contained
type E botulinum toxin. On October 23, the father had purchased a
whole, ungutted, salted, air-dried whitefish known as either
ribyetz
or kapchunka from a delicatessen in Queens, New York City. He and
his
son had eaten the fish on October 30 and 31. On November 3, 1987,
CDC
received a report from the Ministry of Health, Jerusalem, Israel,
of
five additional cases suspected to be botulism; one case was fatal.
The patients had eaten ribyetz purchased in a grocery in Brighton
Beach, Brooklyn, New York City, on October 17 and taken to Israel.
The
fish as well as a serum sample from one surviving patient
subsequently
yielded type E botulinum toxin.
The implicated fish was distributed in the New York City area
by
Gold Star Smoked Fish Inc., a firm in Brooklyn. On November 3, the
New
York City Department of Health issued an embargo on the sale and
distribution of ribyetz or kapchunka and removed the implicated
product from the shelves of stores selling Gold Star products. The
public was alerted through news releases, and acute care hospitals
in
New York City and surrounding areas were notified. No additional
cases
have been identified in New York. However, one additional
laboratory-confirmed case of botulism has been reported in Israel.
On
November 13, the patient, a 17-year-old female, had eaten whitefish
that had been purchased on October 18 at the same delicatessen in
Queens associated with the original patients.
Reported by: S Kotev, MD, Hadassah Univ Hospital, Jerusalem; A
Leventhal, MD, MPH, A Bashary, RN, H Zahavi, RN, Jerusalem Dist
Health
Office; A Cohen, National Botulism Reference Lab; P Slater, MD,
MPH,
Ministry of Health, Israel. A Ruston, MD, E Baron, PhD, B Farber,
MD,
J Greenspan, MD, M Tenenbaum, MD, R vanAmerongon, MD, North Shores
Univ Hospital, Manhasset; V Tulumello, J Lynch, Nassau County
Health
Dept; S Schultz, MD, C Reisberg, S Shahidi, PhD, S Joseph, MD, New
York City Dept of Health; L Crowell, DVM, J Ferrara, New York State
Dept of Agriculture and Markets; J Guzewich, M Shayegani, PhD, G
Hannett, DL Morse, MD, MS, State Epidemiologist, New York State
Dept
of Health. US Food and Drug Administration. Div of Field Svcs,
Epidemiology Program Office; Enteric Diseases Br, Div of Bacterial
Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial note: Ribyetz, or kapchunka, is an ethnic food consumed
in
this country primarily by Russian immigrants. It has been
implicated
as a vehicle for botulism twice in recent years. In 1981, a
California
man became ill (1), and, in 1985, two Russian immigrants died in
New
York City after eating the fish (2,3). Type E botulism is typically
associated with foods of marine origin (4). The mechanism of
contamination of the ribyetz has not been established. However,
Clostridium botulinum spores can be found in the intestinal
contents
of fish, and the fact that the fish were uneviscerated may have
been
important (5).
The whitefish implicated in this outbreak was produced by one
firm
and distributed only in New York City. In addition to halting the
distribution of the fish, officials in New York City and New York
State are developing regulations that would in effect prohibit the
production and sale of such uneviscerated whitefish. Although
refrigeration is recommended, some consumers may be storing the
fish
unrefrigerated before eating it uncooked. Persons who purchased
ribyetz in New York City in October should dispose of any remaining
fish in such a way as to make it inaccessible to others.
Public health personnel should be aware of the potential
problem,
especially for people in ethnic groups known to eat this product.
Guidance in treating botulism and testing serum and stool samples
for
botulinal toxin can be obtained through state or city health
departments. Requests for testing specimens of ribyetz can be made
through the district offices of the Food and Drug Administration
(FDA)
or the FDA Division of Emergency and Epidemiological Operations,
Rockville, Maryland 20857; telephone number (301) 443-1240.
References
California Department of Health Services. Alert: botulism
associated with commercially produced, dried, salted whitefish.
California Morbidity, November 6, 1981;(suppl 43).
Centers for Disease Control. Botulism associated with
commercially
distributed kapchunka-- New York City. MMWR 1985;34:546-7.
Badhey H, Cleri DJ, D'Amato RF, et al. Two fatal cases of type
E
adult food-borne botulism with early symptoms and terminal
neurologic signs. J Clin Microbiol 1986;23:616-8.
Centers for Disease Control. Botulism in the United States,
1899-1977: handbook for epidemiologists, clinicians, and
laboratory workers. Atlanta: US Department of Health,
Education,
and Welfare, Public Health Service, 1979.
Bott TL, Deffner JS, McCoy E, Foster EM. Clostridium botulinum
type E in fish from the Great Lakes. J Bacteriol
1966;91:919-24.
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