Suspect Cases of Botulism in Peel Region

| Ontario Nurses’ Association |

From Ontario’s Public Health Division

This information requires knowledgeable interpretation and is intended primarily for use by health care workers and facilities/organizations providing health care including pharmacies, hospitals, long-term care facilities, community-based health care service providers and pre-hospital emergency services.

This Important Health Notice (IHN) is based on information received to date and provides the following:

• Awareness of a small cluster of suspected botulism cases
• Information for clinicians

Highlights

• A small number of suspect foodborne botulism cases have been identified in Peel Region. The suspected source is a traditional seasonal Egyptian salted mullet fish dish, also known as “feseekh” or “fesikh”.
• All three cases attended the same event in Peel. The suspect fish product was purchased and produced at a shop in Toronto.
• Symptoms of food borne botulism include nausea and/or vomiting, fatigue, dizziness, headache, double vision, dry throat, respiratory failure and paralysis. Death can occur in severe cases.
• Please refer to the Botulism Guide for Healthcare Professionals to access antitoxin and arrange for diagnosis, and contact your local Public Health Unit for investigation of any suspected cases.

Current Status

There are currently two suspect botulism cases and one person under investigation in Peel Region, all adults. All individuals ate the suspect food at a gathering on April 16. Symptoms typical of C. botulinum toxicity began between April 17 and April 19.

The shared common meal included a traditionally prepared salted mullet fish dish, also known as “feseekh” or “fesikh”. Feseekh is consumed primarily during an Egyptian holiday marking the start of spring. In previous years botulism outbreaks have been associated with this product in Egypt.

Although the salted fish has not been confirmed as the definitive source of illnesses reported, public health authorities are conducting further investigations and treating it as the most likely exposure at this time.

The suspect fish product was purchased and produced at a shop in Toronto.

Investigation is ongoing regarding the distribution of this product. The extent to which the product has been distributed in Ontario is not known at this time.

Information for Clinicians

Onset of Symptoms Symptoms usually appear 12 to 36 hours after ingesting a contaminated food, but could appear as early as six hours or as long as 10 days after ingestion.

Symptoms

Symptoms of food borne botulism include nausea and/or vomiting, fatigue, dizziness, headache, double vision, dry throat, respiratory failure and paralysis. Death can occur in severe cases.

Treatment

Please refer to the Botulism Guide for Health Care Professionals. Caregivers should use routine precautions. Laboratory confirmation is not required for treatment to be administered. Treatment may be initiated based on clinical presentation in those who have consumed an implicated food product. Patients reporting with only mild compatible symptoms, but who have reported consuming the suspect food, should also receive treatment.

Botulinum antitoxin is the treatment of choice. Contact the Ministry of Health and Long-Term Care at 416 327-7392 (business hours) or 416 325-3000 / 1 800 268-6060 (after hours) to obtain antitoxin.

Please contact your health unit for follow-up investigation of food exposures and potential public health action.

Laboratory Testing

The Botulism Reference Service for Canada at 613 957-0902 (business hours) or 613 296-1139 (after hours) provides diagnostic services for botulism and can advise on specimen collection and transport for both clinical and food samples.

For product-related specimens submitted for testing please include as much product information as available: container, label, manufacturer lot number, codes, “best before” dates.

Patient related specimens can include: feces, gastric contents, blood serum. Further information can be found in the Botulism Guide for Health CareProfessionals and the Canadian FoodInspection Agency website: