Published Date: 2006-10-09 00:00:00
Subject: PRO/EDR> Botulism, carrot juice - Canada (ON)
Archive Number: 20061009.2899
BOTULISM, CARROT JUICE - CANADA (ON) ex USA
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Mon 9 Oct 2006
From: ProMED-mail <email@example.com>
Source: Canadian Broadcasting Corp. [edited]
Two Toronto residents are paralyzed after drinking carrot juice that had
been linked to a botulinum toxin, according to the city's public health
"There are 2 adults who are severely ill in hospital, and they had a
history of drinking the exact same juice that's been part of the carrot
juice recall," Dr Elizabeth Rea, an associate medical officer of health,
told the Toronto Star on Sun 8 Oct 2006.
The juice, produced by Bolthouse Farms in Bakersfield, California, was
ordered off North American store shelves late in September 2006, after 4
cases of botulism in the United States were linked to toxic carrot juice.
Toronto Public Health has warned the public to avoid drinking 3 brands of
carrot juice. The federal regulator, the Canadian Food Inspection Agency,
issued a product recall covering the brands on 30 Sep 2006.
Bolthouse Farms bottles the 3 brands. The recalled products, all sold in
both one litre and 450 mL containers, are Bolthouse Farms 100 per cent
Carrot Juice, Earthbound Farm Organic Carrot Juice, and President's Choice
Organics 100 per cent Pure Carrot Juice. Products with a "best by" date up
to 11 Nov 2006 have been recalled. Consumers who have any brand should
"take it out of the fridge, dump it down the sink," Rae said.
Bolthouse said the cases may have resulted from improper refrigeration.
Carrot juice is low in acids, so bacteria can grow unless it is kept in the
[The suspect carrot juice was distributed in all 50 states, Mexico, Canada,
and Hong Kong. The posting does not say whether the Canadian cases were
linked to juice that, as in the cases in the United States, had not been
The following statement was extracted from the recent MMWR Dispatch
regarding the 4 USA cases: "_Clostridium botulinum_ spores are found in the
environment and can be present naturally in carrot juice and other foods
that have not undergone the retort canning process, which involves high
temperatures and high pressure. Anaerobic conditions, low acidity (pH
greater than 4.6), low salt and sugar concentrations, and temperatures
greater than 39 F (greater than 4 C) promote germination of _C. botulinum_
spores and botulinum toxin production. Carrot juice has low acidity, with a
natural pH of approximately 6.0; therefore, in the absence of another
inhibitor, refrigeration at temperatures less than 40 F (less than 4 C) is
necessary to prevent germination of _C. botulinum_ spores and production of
botulinum toxin. Inhibiting _C. botulinum_ growth in other ways, such as
through acidification, can retard its growth in juice that is not properly
"Acidification has been used as a solution to previous foodborne botulism
outbreaks. In 1985, 36 patients in the USA and Canada were identified with
botulism after eating at a restaurant in Vancouver, British Columbia. A
case-control study implicated commercially produced, chopped garlic in
soybean oil stored at room temperature as the source of the outbreak (1).
In 1989, a 2nd outbreak of botulism associated with chopped garlic in oil
occurred when 3 patients in New York were identified with botulism after
consuming a meal containing un-refrigerated, commercially produced, chopped
garlic in virgin olive oil (2). After these outbreaks, FDA rules were
altered to require that garlic-in-oil products contain an acidifying agent
such as phosphoric or citric acid.
"1. St Louis ME, Peck SH, Bowering D, et al. Botulism from chopped garlic:
delayed recognition of a major outbreak. Ann Intern Med 1998; 108: 363-8.
"2. Morse DL, Pickard LK, Guzewich JJ, et al. Garlic-in-oil associated
botulism: episode leads to product modification. Am J Public Health 1990;
80: 1372-3." - Mod.LL]