Botulism cases reported in Nome
Public health officials confirmed that four Nome residents had been hospitalized in early January with preliminary results pointing to poising from foodborne type E botulism from an aged beluga flipper.
One person died. The remaining patients recovered and were released from the hospital.
According to Epidemiologist Dr. Louisa Castrodale with the Alaska Dept. of Health and Social Services, Division of Public Health’s Epidemiology Section, botulism is a public health emergency as it immediately requires health care providers and public health nurses to identify other people who may have eaten the same foods that led to the poisoning.
Dr. Castrodale said that in this incident a family gathering shared a New Year’s potluck when the people fell ill and went to the Emergency Room at Norton Sound Regional Hospital. She said the Epidemiology Section was alerted by the ER physician. The person who was the most ill was flown out to the Alaska Native Medical Center on January 2. Four others were also medivaced and hospitalized at ANMC later.
Deanna Stang, team leader at Nome’s Public Health Center, said that when botulism cases are reported, Public Health immediately springs into action to find other people who may have shared the food, to identify what food bore the botulism bacteria and to monitor for ten days those who may have eaten from the food.
She said that 16 people were at the potluck, but not all consumed the suspected beluga flipper.
“Julie Newsome, PHN and I conducted foodborne illness interviews on January 2 and submitted suspected food items to the Anchorage state lab,” Stang said. Dr. Castrodale said that the state lab section that usually processes food items suspected of containing the botulism bacteria was badly damaged in the Nov. 31 earthquake and the samples had to be sent out to a lab in California. Preliminary results indicate that a fermented beluga flipper showed signs of type E botulism bacteria.
The next day Chanda Hesson, an EPI nurse, and Amanda Tiffany, a CDC Epidemic Intelligence Service Officer, arrived from Anchorage to help with the investigation. PHN’s and EPI continued symptom monitoring for contacts in the investigation for 10 days, Stang said.
The purpose of the investigation was to identify and gather samples of the foods that may have been causing the illness, identifying if any of the food was shared outside the potluck, and who may have consumed the food.
Stang said that symptoms of botulism present themselves about 12 to 48 hours after consumption of the contaminated food. Dr. Castrodale explained that the toxin is causing paralysis and symptoms include abdominal pain, vomiting, diarrhea, dry mouth, large pupils, vision problems, trouble swallowing, drooping eyelids, slurred speech and difficulty breathing. She said that preexisting health conditions can impact the severity of the symptoms. Signs can occur as early as six hours to as late as ten days after consuming the contaminated foods. Stang said that other individuals at the potluck also reported signs but were released by their medical provider.
According to a Public Health monograph, all documented Alaska foodborne botulism outbreaks have been associated with the consumption of traditional Alaska Native foods that were aged or fermented. However, the division does not discourage eating traditional foods, but preparing them properly. Botulism is caused by the C. botulinum bacteria that are naturally occurring and that make poisons when the right circumstances for the bacteria exist: warmth, low salinity and low oxygen flow. Foods such as dried fish and home canned foods can also be affected by the bacteria.
Public Health officials recommend keeping foods that age under 36°F, practicing good hygiene of hand washing and safe food handling, using salt to preserve dried fish, for example, and not to use plastic, glass or sealed containers to age foods because they create a low-oxygen environment that encourages the growth of the bacteria. Although it is changing the texture and taste of aged foods, cooking them is recommended as the heat destroys the bacteria.
According to data from Public Health, between 1950 and 2016, there were 366 cases of foodborne botulism reported with 22 deaths.