title: National outbreak of type a foodborne botulism associated with a widely distributed commercially canned hot dog chili sauce.
abstract: BACKGROUND
  On 7 and 11 July 2007, health officials in Texas and Indiana, respectively, reported 4 possible cases of type A foodborne botulism to the US Centers for Disease Control and Prevention. Foodborne botulism is a rare and sometimes fatal illness caused by consuming foods containing botulinum neurotoxin.
  
  
  METHODS
  Investigators reviewed patients' medical charts and food histories. Clinical specimens and food samples were tested for botulinum toxin and neurotoxin-producing Clostridium species. Investigators conducted inspections of the cannery that produced the implicated product.
  
  
  RESULTS
  Eight confirmed outbreak associated cases were identified from Indiana (n = 2), Texas (n = 3), and Ohio (n = 3). Botulinum toxin type A was identified in leftover chili sauce consumed by the Indiana patients and 1 of the Ohio patients. Cannery inspectors found violations of federal canned-food regulations that could have led to survival of Clostridium botulinum spores during sterilization. The company recalled 39 million cans of chili. Following the outbreak, the US Food and Drug Administration inspected other canneries with similar canning systems and issued warnings to the industry about the danger of C. botulinum and the importance of compliance with canned food manufacturing regulations.
  
  
  CONCLUSIONS
  Commercially produced hot dog chili sauce caused these cases of type A botulism. This is the first US foodborne botulism outbreak involving a commercial cannery in >30 years. Sharing of epidemiologic and laboratory findings allowed for the rapid identification of implicated food items and swift removal of potentially deadly products from the market by US food regulatory authorities.
authors.affiliation: Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA. pcjuliao@gmail.com
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Juliao
authors.forename: Susan
authors.initials: S
authors.lastname: Maslanka
authors.forename: Janet
authors.initials: J
authors.lastname: Dykes
authors.forename: Linda
authors.initials: L
authors.lastname: Gaul
authors.forename: Satish
authors.initials: S
authors.lastname: Bagdure
authors.forename: Lynae
authors.initials: L
authors.lastname: Granzow-Kibiger
authors.forename: Ellen
authors.initials: E
authors.lastname: Salehi
authors.forename: Donald
authors.initials: D
authors.lastname: Zink
authors.forename: Robert P
authors.initials: RP
authors.lastname: Neligan
authors.forename: Casey
authors.initials: C
authors.lastname: Barton-Behravesh
authors.forename: Carolina
authors.initials: C
authors.lastname: Lúquez
authors.forename: Matthew
authors.initials: M
authors.lastname: Biggerstaff
authors.forename: Michael
authors.initials: M
authors.lastname: Lynch
authors.forename: Christine
authors.initials: C
authors.lastname: Olson
authors.forename: Ian
authors.initials: I
authors.lastname: Williams
authors.forename: Ezra J
authors.initials: EJ
authors.lastname: Barzilay
mesh_terms: D000293:Adolescent; D000328:Adult; D001905:Botulinum Toxins / Q000302:isolation & purification*; D001906:Botulism / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D003014:Clostridium botulinum / Q000302:isolation & purification*; D004196:Disease Outbreaks; D005260:Female; D005506:Food Contamination; D005516:Food Microbiology; D005519:Food Preservation / Q000379:methods / Q000592:standards; D057141:Food, Preserved / Q000382:microbiology*; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D013781:Texas / Q000453:epidemiology
chemical_list: D001905:Botulinum Toxins