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Botulism In The Alaska Bush

Botulism In The Alaska Bush. “A Public Health Emergency” CDC (2009) By Deborah Forcht MPH Student Walden University August 2, 2009. Learning Objectives. What is Botulism? Alaska Public Health Department reporting list Types of Botulism Wound Infantile Foodborne Incubation period

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Botulism In The Alaska Bush

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  1. Botulism In The Alaska Bush “A Public Health Emergency” CDC (2009) By Deborah Forcht MPH Student Walden University August 2, 2009

  2. Learning Objectives • What is Botulism? • Alaska Public Health Department reporting list • Types of Botulism • Wound • Infantile • Foodborne • Incubation period • Occurrence • Signs and symptoms • Treatment • Alaska health care providers awareness • 2002 Outbreak • Delivery of botulism antitoxin

  3. Clostridium Botulinum Toxin • A neurotoxin that originates in soil • Prevalent along the coastline of Alaska • Found in marine mammals • Anaerobic spores • Survive w/o oxygen • Low PH (4.6) • High moisture • 39 degrees Fahrenheit (Moeller 2005 p138)

  4. State of Alaska EpidemiologyTracking of Reportable Conditions of Public Health Concern • Outbreak surveillance and response • Notation of trends • Monitoring of new infectious diseases • Measles • Botulism • Rabies • Paralytic shellfish poisoning • Food borne and waterborne diseases • Tuberculosis To report Public Health Emergencies call (907) 269-8000
or after hours (800) 478-0084 (State of Alaska Public Health Epidemiology 2009)

  5. Food Types of Botulism • Wound • Infantile • Foodborne (Angulo 2005) Photo: Courtesy of HHS Public Health State of Alaska

  6. Wound Botulism • Botulism infection in open wounds • Signs & symptoms are the same as with food botulism • Risky behavior • Intravenous drug use • Dirty needles • Black tar Heroin use • Poor wound care (Sobel 2005)

  7. Infantile Botulism • Ingestion of honey • Children under 1 year of age (WHO 2009) • Signs & symptoms • Constipation • Anorexia • Malaise • Change in their cry • Loss of muscle tone most noticeable in the ability to move their head and neck (Heymann 2004 p.70)

  8. Occurrence • Fermented foods • Muktuk-fermented whale • Beaver tail • Typically found at • Potlatches • Group Gatherings with Foods • Single or multiple victims, dependent upon the number of persons who ingest the food source (State of Alaska Public Health 2009) Photo: Courtesy of HHS Public Health State of Alaska

  9. Incubation Period • Incubation Period • 12-24 hours • Onset of symptoms may occur up to 2 weeks after ingestions of food source • 2 week food history required for investigation of botulism (Jong & Sanford 2008).

  10. Signs & Symptoms • General malaise • Decreased muscle strength • Dizziness • Lightheadedness • Blurred vision • Nausea • Vomiting • Diarrhea or constipation • Abdominal bloating • Respiratory depression (WHO 2009)

  11. Treatment of Botulism Oxygen therapy and support for patients demonstrating respiratory distress from decrease in muscle strength Intravenous delivery of antitoxin: equine botulinum “Dilute 10-ml vial, 1:10 in 0.9% saline solution: deliver IV slowly” (Veenema, T. 2006 p.116) Available through the State of Alaska Public Health Department Public Health Emergencies call (907) 269-8000 or after hours (800) 478-0084 (State of Alaska Public Health 2009)

  12. C. Botulinum Type E • Prevalent along the coastline of Alaska • Found in marine mammals • Can be killed if boiled for more than 10 minutes (MMWR 2003)

  13. Cluster Outbreak • July 13-15, 2002 • Muktuk (fermented whale) is eaten during a potlatch in a western Alaskan fishing village • Estimated death of whale several weeks prior • 14 persons aged 13-83 years are suspected of botulism poisoning • 57% of these are confirmed with botulism poisoning • 5 hospitalized • 4 receive antitoxin • 2 require ventilator assistance in the ICU (MMWR 2003)

  14. Delivery of Botulism antitoxin • Botulinum antitoxin is available in the United States through the public health system • Report all suspected cases • Rapid treatment of Botulism is essential • To report: Public Health Emergencies in Alaska call (907) 269-8000
or after hours (800) 478-0084 (State of Alaska Public Health 2009)

  15. Review • What is Botulism? • Alaska Public Health Department reporting list • Types of Botulism • Wound • Infantile • Foodborne • Incubation period • Occurrence • Signs and symptoms • Treatment • Alaska health care providers awareness • 2002 outbreak • Delivery of botulism antitoxin

  16. REFRENCES: • Angulo, F. (2005) Botulism. Clinical Infectious Diseases 41(8)1167-1173 • CDC (2009) Center for Disease Control and Prevention: “Botulism” Division of Foodborne, Bacterial and Mycotic Disease. Retrieved from the internet on July 6, 2009 at: http://www.cdc.gov/nczved/dfbmd/disease_listing/botulism_gi.html • Cox, N., Hinkle, R. (2002) Infant Botulism. American Family Physician. 65(7) 1388-1392. • Heymann, D. (2004) Control of Communicable Diseases 4th ed. Washington D.C. American Public Health Association. • MMWR (2003) Morbidity & Mortality Weekly: Outbreak of Botulism Type E Associated with Eating a Beached Whale--- Western Alaska, July 2002. MMWR 52(02)24-26. Retrieved from the internet on July 10,2009 at:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5202a2.htm • Moeller, D. (2005) Environmental health 3rd. Ed. Cambridge, MA. Harvard University Press

  17. References Continued: • State of Alaska Public Health Epidemiology (2009). Conditions Reportable to Public Health in Alaska. Retrieved from the internet on July 19, 2009 at: http://www.epi.hss.state.ak.us/pubs/conditions/default.stm • Veenema, T. (2006) 3rd ed. Ready RN: Handbook for Disaster Nursing and Emergency Preparedness. St. Louis, MO. Mosby. • WHO (2009) World Health Organization: Botulism retrieved from the internet on July 9,2009 at: http://www.who.int/mediacentre/factsheets/fs270/en/

  18. Sources for Further Reading • Angulo, F. (2005) Clinical Infectious Diseases. • Cox, N., Hinkle, R. (2002) Infant Botulism. American Family Physician. 65(7) 1388-1392 • Drexler, M. (2002). Secret Agents: The Menace of Emerging Infections. • Jong, E., Sandord, C. (2003) 3rd ed. Travel and Tropical Medicine Manual. • Melnick, D., Rouse, B. (2001). Portrait of Health in the United States: Major Statistical Trends and Guide to Resources 2001. • Rhoades, M. Everett, R. (2000). American Indian Health: Innovations in Health Care, Promotion, and Policy. • State of Alaska Epidemiology. Botulism in Alaska: http://www.epi.hss.state.ak.us/pubs/botulism/bot_01.ht • Tayfun, A., Sencan,A.,Aksun,M. (2007). A Food Borne Botulism May Cause Unnecessary Operation: A Case Report. • Veenema, T. (2006). Ready RN: Handbook for disaster Nursing and Emergency Preparedness.

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