Botulinum Toxin Poisoning Author: Allison Brashear, MD; Larry E. Davis, MD, FAAN, FACP
Module updated - 2009-12-29
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Prevention
  • Support education about botulinum toxin poisoning in the community.
  • Prepare for the possibility of botulinum toxin poisoning as part of a bioterrorist attack.
  • Inform parents of new babies about measures to prevent and recognize infant botulinum toxin poisoning.
  • Recognize that botulinum toxin poisoning can occur in patients with traumatic wound infections or in those who inject heroin and other recreational drugs.
  • Note that immunization against botulinum toxin is not recommended for the general population.

Support education about botulinum toxin poisoning in the community. C

  • Learn about the clinical presentation of botulinum toxin poisoning and sources with the potential to cause widespread outbreaks due to intentional or accidental exposure.
  • Tell patients that 90% of foodborne botulism comes from home-canned or home-prepared foods that were improperly prepared and to be wary of poorly cooked or canned food such as home-canned tomatoes, cheese, oils, and salted or fermented fish or meat.
  • Direct patients who are concerned about botulinum toxin exposure to public health officials and the CDC for further information.
  • Educate Native Americans in Alaska about the dangers of home-processed foods consisting of aquatic mammal tissues or uneviscerated fish.
  • Ensure that ongoing education about botulism is available for first point-of-contact hospital personnel such as EMTs and ER nurses.
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Prepare for the possibility of botulinum toxin poisoning as part of a bioterrorist attack. C

  • Ensure that local emergency departments have a rapid response system in place for assessing outbreaks of botulinum toxin poisoning resulting from a bioterrorist attack.
  • Know the contact information for reporting an outbreak and be able to activate a rapid notification of their key personnel in the event of an outbreak to limit the size and prevent further exposure.
  • Understand that physical containment by removing the materials containing the botulinum toxin and limiting the number of people who may eat or inhale the toxin are key to preventing the spread of the disease in the population.
  • Encourage local and state medical agencies to supply educational materials to physicians and other health personnel providing first-line care to potential victims of botulinum toxin poisoning.
  • Incorporate education about clinical recognition of botulinum toxin poisoning in CME for physicians who may treat victims of a bioterrorist attack.
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Inform parents of new babies about measures to prevent and recognize infant botulinum toxin poisoning. C

  • To prevent infantile botulism in children under 1 year of age:
    • Do not feed honey or corn syrup
    • Wash or remove skins of fruits and vegetables before feeding
    • Minimize or prevent ingestion of soil that may contain spores
  • Inform parents to take the child to the pediatrician if progressive constipation, poor suck and cry, and weakness appear.
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Recognize that botulinum toxin poisoning can occur in patients with traumatic wound infections or in those who inject heroin and other recreational drugs. C

  • Prevent botulinum poisoning by using:
    • Scrupulous wound care in patients with traumatic wounds
    • Clean needles and attention to skin lesions to prevent botulinum toxin poisoning in intravenous drug abusers
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Note that immunization against botulinum toxin is not recommended for the general population. C

  • Reserve immunization with a serotype-specific botulinum toxin for at-risk military personnel and workers exposed directly to botulinum toxin in research and the pharmaceutical industry.
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FAQs
Allison Brashear, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Larry E. Davis, MD, FAAN, FACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.

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