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Botulism Clusters in Orange and Sacramento Counties 16May2017



Health Advisory

May 16, 2017


From:  Edward L. Moreno, MD, MPH                                                                       Kristy Michie, MS
             Health Officer   831-755-4585                                                                       Epidemiologist    831-755-4503


Botulism Clusters in Orange and Sacramento Counties


Monterey County Health Officials urge medical providers to consider botulism when evaluating patients with unexplained neurological symptoms.

Current Situation

The Orange County Public Healthcare Agency and the Sacramento County Health and Human Services Department report recent clusters of foodborne botulism.  At least two cases of foodborne botulism in the Orange County area have been linked with consumption of deer antler tea produced in the Los Angeles area.  Sacramento County Health Officials report nine cases of botulism associated with food prepared at a gas station in Oak Valley.  At this time, the Monterey County Health Department recommends that health care providers:

  1. Consider botulism as a differential diagnosis in individuals presenting with otherwise unexplained neurological symptoms including blurred vision, diplopia (double vision), ptosis (drooping eyelids), dysphagia (trouble swallowing), dysarthria (difficulty speaking), impaired gag reflex, and/or facial weakness.
  2. Promptly report cases of suspected botulism to the Monterey County Health Department’s Communicable Disease Unit (phone: 831-755-4521; fax: 831‑754-6682; after hours: 831‑869‑6465).
  3. Collect pre-treatment specimens and coordinate laboratory testing with the Monterey County Health Department:
    1. Draw 30 mL whole blood from a free-flowing site.Hemolyzed or low volume sera cannot be tested.
    2. Label with patient’s name, “pre-antitoxin” serum, date and time collected.Refrigerate.
    3. Centrifuge and transfer about 15 mL of serum to a separate tube. Refrigerate.
    4. If recommended by the Health Department, also collected:
      1. 25 gm feces unpreserved or 25 mL of a sterile water enema. Refrigerate.
      2. 25 mL gastric aspirate, if taken within 72 hours of symptom onset. Refrigerate.
    5. Keep specimens refrigerated.Do not expose to heat. Do not freeze.
  4. Treat patient(s) immediately with Heptavalent Botulism Antitoxin (HBAT) based on compatible clinical presentation. HBAT can be requested through the Health Department. Laboratory confirmation is not required prior to treatment.

For additional information about botulism, please contact the Communicable Disease Unit at 831‑755‑4521 (or 831-869-6465 after normal business hours).

Health Alert:  Warrants immediate action or attention.   Health Advisory:  Provides information for a specific incident or situation; may not require immediate action. Health Update:  Provides updated information regarding an incident or situation; unlikely to require immediate action