Published Date: 2006-10-12 00:00:00
Subject: PRO/EDR> Botulism, carrot juice - North America (USA, Canada)
Archive Number: 20061012.2925

BOTULISM CARROT JUICE - NORTH AMERICA (USA, CANADA)
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[1]
Date: Wed 11 Oct 2006
From: Marianne Hopp <mjhopp12@yahoo.com>
Source: WHO Outbreak Reports [edited]
<http://www.who.int/csr/don/2006_10_11a/en/index.html>
As of 11 Oct 2006, 4 cases of botulism associated with commercial carrot
juice have been reported in the states of Georgia and Florida in the USA,
and 2 cases have been reported in Toronto, Canada. All cases had consumed
the same brand of carrot juice and no fatalities have been reported to
date. The CDC and the Canadian Food Inspection Agency have issued advisory
information.
The International Food Safety Authorities Network (INFOSAN) has notified
Mexico and Hong Kong SAR where the carrot juice has also been exported.
--
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[2]
Date: Wed 11 Oct 2006
From: Vinita Dubey <vdubey@toronto.ca>

The two cases of botulism in Toronto are both paralyzed, ventilated and in
the ICU [intensive care unit]. The first case first developed mild symptoms
of diarrhea and vomiting on 24 August 2006, progressing to weakness and
blurry vision by 25 August, and paralysis and ventilation by 28 August that
is still ongoing. The second case developed diarrhea and general fatigue on
12 September, progressing to blurred vision, difficulty moving tongue,
dysarthria, dysphagia, shortness of breath, and ptosis in the next 24 to 48
hours. By 16 September, this case developed paralysis and was ventilated.
Both cases developed botulism before the carrot juice recall was issued in
Canada. The Canadian Food Inspection Agency (CFIA) issued its recall on 30
September.
Following the 30 September recall by the CFIA, the possibility of botulism
from carrot juice was investigated by Toronto Public Health staff in these
two cases. Both cases live in the same household and consumed from the same
bottle of one of the 3 recalled carrot juices. A sample of the leftover
juice was obtained from the refrigerator of the cases. It was sent to the
botulism reference laboratory in Ottawa on 5 October along with clinical
samples from both patients. The juice was found refrigerated in the cases'
house. There was no evidence of lack of refrigeration by the cases. The
carrot juice tested positive for botulism toxin A on 7 October, and one of
the cases had clinical samples that were positive for toxin on 8 October, 6
weeks since onset of symptoms. This case received anti-toxin after
consultation from the CDC [Centers for Disease Control and Prevention].
Since the recall, issued on 30 September by the Canadian Food Inspection
Agency (CFIA), there have been no additional cases reported to date.
Toronto Public Health has been sending public health inspectors into food
premises to ensure the three recalled juices are not available for sale or
consumption. As of 11 October, of 1288 establishments inspected, 11 stores
still had the juice available for sale. The establishments ranged from
large chain grocery stores to smaller food produce establishments. Some
received their stock from a cash and carry vendor and were not aware of the
recall. Others did not get the recall information from their head office
store. The CFIA is enhancing its communication channels to distributors and
doing effectiveness checks. Product has been prohibited from coming across
the border. An additional 1250 establishments will be inspected by Toronto
Public Health over the next few days to ensure the recalled brands are not
available for consumption. The provincial Ministry of Health also had
inspectors fan out across the province from other health units. Additional
testing of recalled bottles of carrot juice are planned to be submitted.
--
Barbara Yaffe, MD, MHSc, FRCPC
Director, Communicable Disease Control & Associate Medical Officer of Health
Vinita Dubey MD MPH CCFP FRCPC
Associate Medical Officer of Health
Division of Communicable Diseases
Toronto Public Health
277 Victoria St. 3rd floor
Toronto ON M5B 1W2
email: <vdubey@toronto.ca>
[Many thanks both to Marianne Hopp, for the official WHO report and to
Barbara Yaffe and Vinita Dubey for their detailed report from Toronto. -
Mod.SH]

See Also

Botulism, carrot juice - Canada (ON) ex USA 20061009.2899
Botulism, carrot juice - USA (multistate) (02) 20061007.2880
Botulism, carrot juice - USA (multistate): FL 20060930.2808
Botulism, carrot juice - USA (GA): alert 20060916.2638
Botulism, gravy, chili sauce - Canada (02): background 20060927.2760
Botulism, gravy, chili sauce - Canada: recall 20060926.2748
Botulinum toxin, laboratory exposure - USA (MA) (02) 20060410.1067
Botulinum toxin, laboratory exposure - USA (MA) 20060408.1058
2005
---
Botulism, fermented salmon - USA (AK) 20050829.2555
2004
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Botulism, prison brew - USA (CA) 20040806.2155
2003
---
Botulism, whale blubber, 2002 - USA (Alaska) 20030117.0142
2002
---
Botulism, humans - USA (Alaska) 20020721.4823
Botulism, canned clams - USA (Northeast): recall 20020112.3233
Botulism, Canned Asparagus - USA: Recall 20020209.3521
2001
---
Botulism - USA (Maryland) 20011102.2714
Botulism, chili - USA (Texas): recall 20010904.2116
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