Please use this identifier to cite or link to this item: http://sgc.anlis.gob.ar/handle/123456789/499
Title: Outbreak of type A botulism and development of a botulism surveillance and antitoxin release system in Argentina
Authors: Villar, R. G. 
Shapiro, R.L. 
Busto, Silvina 
Riva Posse, Clara 
Verdejo, G. 
Farace, María Isabel 
Rosetti, F. 
San Juan, Jorge 
Julia, C. M. 
Becher, J. 
Maslanka, S. E. 
Swerdlow, D. L. 
Keywords: Botulismo;Antitoxina Botulínica;Salud Pública
Issue Date: 14-Apr-1999
Journal: Journal of the American Medical Association 
Abstract: 
Context: Botulism is an important public health problem in Argentina, but obtaining antitoxin rapidly has been difficult because global supplies are limited. In January 1998, a botulism outbreak occurred in Buenos Aires.

Objectives: To determine the source of the outbreak, improve botulism surveillance, and establish an antitoxin supply and release system in Argentina.

Design, Setting, and Participants: Cohort study in January 1998 of 21 drivers of a specific bus route in urban Buenos Aires.

Main Outcome Measure: Occurrence of botulism and implication of a particular food as the vehicle causing this outbreak.

Results: Nine (43%) of 21 bus drivers developed botulism, presenting with gastroenteritis, symptoms of acute cranial nerve dysfunction including ptosis, dysphagia, blurred vision, and motor weakness. One driver experienced respiratory failure. Type A toxin was detected from 3 of 9 patients' serum samples. All drivers received botulism antitoxin; there were no fatalities. Consumption of matambre (Argentine meat roll) was significantly associated with illness. Among 11 persons who ate matambre, 9 developed illness, compared with none of those who did not eat it (P<.001). The matambre had been cooked in water at 78°C to 80°C for 4 hours, sealed in heat-shrinked plastic wrap, and stored in refrigerators that did not cool adequately. Subsequently, a botulism surveillance and antitoxin release system was established.

Conclusions Insufficient cooking time and temperatures, storage in heat-shrinked plastic wrap, and inadequate refrigeration likely contributed to Clostridium botulinum spore survival, germination, and toxin production. A rapid-response botulism surveillance and antitoxin release system in Argentina should provide more timely distribution of antitoxin to patients and may serve as a model for other nations.
Description: 
Fil: Villar, Rodrigo G. Centers for Disease Control and Prevention. Epidemiology Program Office. Epidemic Intelligence Service. National Center for Infectious Diseases. Scientific Resources Program. Foodborne and Diarrheal Diseases Branch, Atlanta, Georgia; Estados Unidos.

Fil: Shapiro, Roger L. Centers for Disease Control and Prevention. Epidemiology Program Office. Epidemic Intelligence Service. National Center for Infectious Diseases. Scientific Resources Program. Foodborne and Diarrheal Diseases Branch, Atlanta, Georgia; Estados Unidos.

Fil: Busto, Silvina. Ministerio de Salud y Acción Social - Región V; Argentina.

Fil: Riva-Posse, Clara. Ministerio de Salud y Acción Social - Región V. Dirección de Epidemiología; Argentina.

Fil: Verdejo, Guadalupe. Pan American Health Organization.

Fil: Farace, María Isabel. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Bacteriología; Argentina.

Fil: Rosetti, Francisco. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Bacteriología; Argentina.

Fil: San Juan, Jorge A. Hospital de Infecciosas Francisco Javier Muñiz; Argentina.

Fil: Julia, Carlos María. Ministerio de Salud y Acción Social - Región V. Medicina Sanitaria; Argentina.

Fil: Becher, John. Centers for Disease Control and Prevention. Epidemiology Program Office. Epidemic Intelligence Service. National Center for Infectious Diseases. Scientific Resources Program. Foodborne and Diarrheal Diseases Branch, Atlanta, Georgia; Estados Unidos.

Fil: Maslanka, Susan E. Centers for Disease Control and Prevention. Epidemiology Program Office. Epidemic Intelligence Service. National Center for Infectious Diseases. Scientific Resources Program. Foodborne and Diarrheal Diseases Branch, Atlanta, Georgia; Estados Unidos.

Fil: Swerdlow, David L. Centers for Disease Control and Prevention. Epidemiology Program Office. Epidemic Intelligence Service. National Center for Infectious Diseases. Scientific Resources Program. Foodborne and Diarrheal Diseases Branch, Atlanta, Georgia; Estados Unidos.
URI: http://sgc.anlis.gob.ar/handle/123456789/499
DOI: 10.1001/jama.281.14.1334
Rights: Closedd Access
Appears in Collections:Preproducción
Publicaciones INEI

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