Botulism, carrot juice - USA (GA): alert

International Society for Infectious Diseases
<http://www.isid.org>

Source: CDC Health Advisory [edited]
< http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00250>

A commercial beverage has been confirmed as the cause of a cluster of
3 botulism cases in Georgia. The 3 patients had onset of symptoms on
Friday, 8 Sep 2006, after consuming a common meal that included
commercially produced carrot juice on Thu, 7 Sep 2006. Of 2 bottles
of juice consumed, all 3 patients drank from bottle 1; whether all 3
patients drank from bottle 2 is unknown.

Botulinum toxin type A was identified in the serum and stool of all 3
patients by mouse bioassay. Subsequently, botulinum toxin type A was
identified from carrot juice remaining in bottle 1 by mouse
bioassay. Bottle 2 had been rinsed with water, and the test for
toxin was negative.

***The label on the implicated bottle reads "Bolthouse Farms,
Bakersfield, California, 100 percent carrot juice." The 'use by' date
is 18 Sep 2006.***

The investigation is ongoing. It is unknown whether the contaminated
juice was subjected to time or temperature abuse that might have
facilitated the growth of _Clostridium botulinum_ spores, which can
survive pasteurization. CDC has not been notified of any cases of
suspected botulism since this cluster was reported on 8 Sep 2006. We
encourage state and local officials to inquire specifically about
consumption of carrot juice in the food history of suspect botulism cases.

CDC has dispatched a notice of this outbreak to public health
officials in all 50 states through the Foodborne Disease Listserve,
reminding them about the contact numbers for CDC's Botulism Clinical
Consultation and Antitoxin Release Service. The Georgia Department
of Health issued an Epi-X alert, alerts to Georgia clinicians and
local health officials, and a press release about this outbreak and
the implicated food. We anticipate that the FDA will be issuing a
press release about this outbreak and advising consumers to properly
refrigerate juices and follow other food safety guidelines for
illness prevention.

Any suspected botulism case reported by a clinician to a state health
department should be reported immediately by the state to CDC via the
24/7 CDC Botulism Clinical Consultation and Antitoxin Release
Service, by calling the CDC Emergency Operations Center at (770)
488-7100 and asking for the botulism officer on call.

In the past 30 years, 2 notable USA food-borne outbreaks related to
distributed food have occurred. One was in the New York area,
involving commercially produced vichyssoise soup June/July 1971 (type
A) (CDC: Botulism associated with commercial vichyssoise (Morbid
Mortal Week Rep 1971;20: 242) and another involving home-canned green
peppers in Michigan in March/April 1977 (Terranova W, Breman JG,
Locey RP, Speck S: Botulism type B:Epidemiologic aspects of an
extensive outbreak. Am J Epidemiol 1978;108: 150-56)