title: Foodborne botulism: an international outbreak.
abstract: We report an outbreak of fishborne botulism caused by type E Clostridium botulinum. The eight cases, six in Israel and two in New York City, resulted from the consumption of ribbetz or kapchunka, a freshwater whitefish soaked in brine and air-dried, that was processed commercially in New York. Half the cases were males; the age range was 9 to 77 years. Five of the victims were hospitalized; the oldest died, and two others required ventilatory assistance. Laboratory confirmation of botulism was obtained in three cases. Prolonged lack of refrigeration during transatlantic flight and packaging contributing to an anaerobic environment were felt to be contributing environmental factors in the Israeli cases. Rapid communication and full cooperation between Israeli and US health authorities limited the extent of the outbreak. Despite adequate understanding of how foodborne botulism may be avoided, outbreaks still occur, particularly among people consuming certain high-risk or ethnic foods.
authors: Department of Epidemiology, Ministry of Health, Jerusalem, Israel.
authors: P E
authors: PE
authors: Slater
authors: D G
authors: DG
authors: Addiss
authors: A
authors: A
authors: Cohen
authors: A
authors: A
authors: Leventhal
authors: G
authors: G
authors: Chassis
authors: H
authors: H
authors: Zehavi
authors: A
authors: A
authors: Bashari
authors: C
authors: C
authors: Costin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001904:Botulinum Antitoxin / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000302:isolation & purification; D001906:Botulism / Q000453:epidemiology* / Q000628:therapy; D002648:Child; D004196:Disease Outbreaks; D005260:Female; D005399:Fishes; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009519:New York City
chemical_list: D001904:Botulinum Antitoxin; D001905:Botulinum Toxins