Editing Botulism (section)

== Prevention ==
Although the vegetative form of the bacteria is destroyed by boiling,<ref name="whodestroy">{{cite web |url=https://www.who.int/mediacentre/factsheets/fs270/en/ |title=Botulism |publisher=WHO |access-date=12 February 2014 |url-status=live |archive-url=https://web.archive.org/web/20140216031452/http://www.who.int/mediacentre/factsheets/fs270/en/ |archive-date=16 February 2014 }}</ref><ref>{{cite web |url=http://www.fsai.ie/faqs/botulism.html |title=Foodborne Botulism FAQ |publisher=Food Safety Authority of Ireland |date=15 November 2011 |access-date=20 May 2014 |url-status=dead |archive-url=https://web.archive.org/web/20140521032214/http://www.fsai.ie/faqs/botulism.html |archive-date=21 May 2014 }}</ref> the spore itself is not killed by the temperatures reached with normal sea-level-pressure boiling, leaving it free to grow and again produce the toxin when conditions are right.<ref>{{cite news |url=https://www.thestar.com/news/gta/2008/02/21/couple_suing_over_tainted_juice.html |title=Couple suing over tainted juice |newspaper=Toronto Star |first1=Isabel |last1=Teotonio |date=21 February 2008 |url-status=live |archive-url=https://web.archive.org/web/20160304062530/http://www.thestar.com/news/gta/2008/02/21/couple_suing_over_tainted_juice.html |archive-date=4 March 2016 }}</ref><ref>{{cite web |url=https://www.fda.gov/food/guidanceregulation/guidancedocumentsregulatoryinformation/ucm072481.htm |date=June 2007 |title=Guidance for Industry: Refrigerated Carrot Juice and Other Refrigerated Low-Acid Juices |publisher=FDA |url-status=live |archive-url=https://web.archive.org/web/20150924165600/https://www.fda.gov/food/guidanceregulation/guidancedocumentsregulatoryinformation/ucm072481.htm |archive-date=24 September 2015 }}</ref><ref>{{cite web|url=https://www.byoulaserclinic.com/what-is-the-difference-and-similarity-between-botox-and-dysport/|date=August 2021|title=Similarities Between Botox and Dysport|url-status=live|archive-url=https://web.archive.org/web/20210820180909/https://www.byoulaserclinic.com/what-is-the-difference-and-similarity-between-botox-and-dysport/|archive-date=20 August 2021|access-date=20 August 2021}}</ref>

A recommended prevention measure for infant botulism is to avoid giving honey to infants less than 12 months of age, as botulinum spores are often present. In older children and adults the normal intestinal bacteria suppress development of ''C. botulinum''.<ref name="honey-risk">{{cite journal | vauthors = Arnon SS, Midura TF, Damus K, Thompson B, Wood RM, Chin J | title = Honey and other environmental risk factors for infant botulism | journal = The Journal of Pediatrics | volume = 94 | issue = 2 | pages = 331–6 | date = February 1979 | pmid = 368301 | doi = 10.1016/S0022-3476(79)80863-X }}</ref>

While commercially canned goods are required{{Citation needed|reason=Critical health related fact, probably right, but citation to an authoritative source should be added|date=August 2022}} to undergo a "botulinum cook" in a pressure cooker at {{convert|121|°C|°F}} for 3 minutes,<ref>{{cite web |title=Importance Of F0 Value In Sterilization {{!}} TERRA Food-Tech |url=https://www.terrafoodtech.com/en/importance-of-f0-value-in-sterilization/ |website=www.terrafoodtech.com |date=24 May 2022}}</ref> and thus rarely cause botulism, there have been notable exceptions. Two were the 1978 Alaskan salmon outbreak and the 2007 [[Castleberry's Food Company]] outbreak. Foodborne botulism is the rarest form, accounting for only around 15% of cases (US)<ref name="cdc.gov" /> and has more frequently resulted from [[Home canning|home-canned]] foods with low acid content, such as [[carrot juice]], [[asparagus (vegetable)|asparagus]], green [[bean]]s, [[beet]]s, and [[maize|corn]]. However, outbreaks of botulism have resulted from more unusual sources. In July 2002, fourteen [[Alaska]]ns ate ''muktuk'' ([[whale meat]]) from a [[beached whale]], and eight of them developed symptoms of botulism, two of them requiring [[mechanical ventilation]].<ref>{{cite journal | title = Outbreak of botulism type E associated with eating a beached whale--Western Alaska, July 2002 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 52 | issue = 2 | pages = 24–6 | date = January 2003 | pmid = 12608715 | url = https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5202a2.htm | archive-url = https://web.archive.org/web/20170625130732/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5202a2.htm | url-status = live | archive-date = 25 June 2017 | author1 = Centers for Disease Control Prevention (CDC) }}</ref>

Other, much rarer sources of infection (about every decade in the US<ref name="cdc.gov" />) include [[garlic]] or herbs<ref name="Infusions">{{cite web|url=http://www.ext.colostate.edu/safefood/newsltr/v2n4s08.html |title=Oil Infusions and the Risk of Botulism |publisher=Colorado State University Cooperative Extension |website=Safefood News |date=1998 |volume=2 |issue=4 |url-status=dead |archive-url=https://web.archive.org/web/20130404000129/http://www.ext.colostate.edu/safefood/newsltr/v2n4s08.html |archive-date=4 April 2013}}</ref> stored covered in [[Cooking oil|oil]] without [[Souring|acidification]],<ref>{{cite journal | title = Update: international outbreak of restaurant-associated botulism--Vancouver, British Columbia, Canada | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 34 | issue = 41 | page = 643 | date = October 1985 | pmid = 3930945 | url = https://www.cdc.gov/mmwr/preview/mmwrhtml/00000627.htm | archive-url = https://web.archive.org/web/20170625230758/https://www.cdc.gov/mmwr/preview/mmwrhtml/00000627.htm | url-status = live | archive-date = 25 June 2017 | author1 = Centers for Disease Control (CDC) }}</ref> [[capsicum|chili peppers]],<ref name="cdc.gov">{{cite web |url=https://www.cdc.gov/ncidod/aip/research/bot.html |title=Arctic Investigations Program – DPEI |publisher=Centers for Disease Control and Prevention (CDC) |date=1 April 2011 |access-date=12 February 2014 |url-status=dead |archive-url=https://web.archive.org/web/20101016104945/http://www.cdc.gov/ncidod/aip/research/bot.html |archive-date=16 October 2010 }}</ref> improperly handled baked potatoes wrapped in [[aluminum]] foil,<ref name="cdc.gov" /> tomatoes,<ref name="cdc.gov" /> and home-canned or [[fermented fish]].

When canning or preserving food at home, attention should be paid to hygiene, pressure, temperature, refrigeration and storage. When making home preserves, only acidic fruit such as apples, pears, stone fruits and berries should be used. Tropical fruit and tomatoes are low in acidity and must have some acidity added before they are canned.<ref>{{cite web |url=http://www.public.health.wa.gov.au/2/594/2/botulism_fact_sheet.pm |title=Botulism fact sheet |publisher=Department of Public Health, Western Australia |access-date=12 February 2014 |url-status=dead |archive-url=https://web.archive.org/web/20131230234538/http://www.public.health.wa.gov.au/2/594/2/botulism_fact_sheet.pm |archive-date=30 December 2013 }}</ref>

Low-acid foods have pH values higher than 4.6. They include red meats, seafood, poultry, milk, and all fresh vegetables except for most tomatoes. Most mixtures of low-acid and acid foods also have pH values above 4.6 unless their recipes include enough lemon juice, citric acid, or vinegar to make them acidic. Acid foods have a pH of 4.6 or lower. They include fruits, pickles, sauerkraut, jams, jellies, marmalades, and fruit butters.<ref name="usda-canning-guide1"/>

Although tomatoes usually are considered an acid food, some are now known to have pH values slightly above 4.6. Figs also have pH values slightly above 4.6. Therefore, if they are to be canned as acid foods, these products must be acidified to a pH of 4.6 or lower with lemon juice or citric acid. Properly acidified tomatoes and figs are acid foods and can be safely processed in a boiling-water canner.<ref name="usda-canning-guide1">{{cite web |url=https://nchfp.uga.edu/publications/usda/GUIDE01_HomeCan_rev0715.pdf |title=Complete Guide to Home Canning; Guide 1: Principles of Home Canning |publisher=United States Department of Agriculture |access-date=15 August 2018 |url-status=live |archive-url=https://web.archive.org/web/20180127101352/https://nchfp.uga.edu/publications/usda/GUIDE01_HomeCan_rev0715.pdf |archive-date=27 January 2018 }}</ref>

Oils infused with fresh garlic or herbs should be acidified and refrigerated. Potatoes which have been baked while wrapped in aluminum foil should be kept hot until served or refrigerated. Because the botulism toxin is destroyed by high temperatures, home-canned foods are best boiled for 10 minutes before eating.<ref>{{cite web|last=U.S. Food and Drug Administration|title=Bad Bug Book: Foodborne Pathogenic Microorganisms and Natural Toxins Handbook Clostridium botulinum|website=[[Food and Drug Administration]]|url=https://www.fda.gov/food/foodsafety/foodborneillness/foodborneillnessfoodbornepathogensnaturaltoxins/badbugbook/ucm070000.htm|access-date=12 January 2013|url-status=dead|archive-url=https://web.archive.org/web/20121129060830/https://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/ucm070000.htm|archive-date=29 November 2012}}</ref> Metal cans containing food in which bacteria are growing may bulge outwards due to gas production from bacterial growth or the food inside may be foamy or have a bad odor; cans with any of these signs should be discarded.<ref name="IFAS">{{cite web|last1=Schneider|first1=Keith R.|last2=Silverberg|first2=Rachael|last3=Chang|first3=Alexandra|last4=Goodrich Schneider|first4=Renée M. |title=Preventing Foodborne Illness: Clostridium botulinum|url=http://edis.ifas.ufl.edu/fs104|website=edis.ifas.ufl.edu|publisher=University of Florida IFAS Extension|access-date=7 February 2017|language=en|date=9 January 2015|url-status=live|archive-url=https://web.archive.org/web/20170208133143/http://edis.ifas.ufl.edu/fs104|archive-date=8 February 2017}}</ref><ref name="HGIC">{{cite web|title=Botulism Factsheet (HGIC 3680)|url=https://hgic.clemson.edu/factsheet/botulism/|publisher=Clemson Cooperative Extension - College of Agriculture, Forestry and Life Sciences - Home & Garden Information Center (HGIC)|access-date=9 February 2022|language=en|date=13 May 2020|url-status=live|archive-url=https://web.archive.org/web/20210123173114/https://hgic.clemson.edu/factsheet/botulism/|archive-date=23 January 2021}}</ref>

Any container of food which has been heat-treated and then assumed to be airtight which shows signs of not being so, e.g., metal cans with pinprick holes from rust or mechanical damage, should be discarded. Contamination of a canned food solely with ''C. botulinum'' may not cause any visual defects to the container, such as bulging. Only assurance of sufficient thermal processing during production, and absence of a route for subsequent contamination, should be used as indicators of food safety.

The addition of [[Nitrite#Nitrite in food preservation and biochemistry|nitrites]] and [[nitrates]] to processed meats such as ham, bacon, and sausages reduces growth and toxin production of ''C. botulinum''.<ref>{{cite journal | vauthors = Christiansen LN, Johnston RW, Kautter DA, Howard JW, Aunan WJ | title = Effect of nitrite and nitrate on toxin production by Clostridium botulinum and on nitrosamine formation in perishable canned comminuted cured meat | journal = Applied Microbiology | volume = 25 | issue = 3 | pages = 357–62 | date = March 1973 | pmid = 4572891 | pmc = 380811 | doi = 10.1128/AEM.25.3.357-362.1973 }}</ref><ref>{{Cite journal |last1=Lee |first1=Soomin |last2=Lee |first2=Heeyoung |last3=Kim |first3=Sejeong |last4=Lee |first4=Jeeyeon |last5=Ha |first5=Jimyeong |last6=Choi |first6=Yukyung |last7=Oh |first7=Hyemin |last8=Choi |first8=Kyoung-Hee |last9=Yoon |first9=Yohan |date=August 2018 |title=Microbiological safety of processed meat products formulated with low nitrite concentration — A review |journal=Asian-Australasian Journal of Animal Sciences |volume=31 |issue=8 |pages=1073–1077 |doi=10.5713/ajas.17.0675 |pmc=6043430 |pmid=29531192}}</ref> Other food additives (such as [[Lactic acid|lactate]] and [[sorbate]]) provide similar protection against bacteria, but do not provide a desirable pink color.<ref>{{cite journal | vauthors = Seward RA, Deibel RH, Lindsay RC | title = Effects of potassium sorbate and other antibotulinal agents on germination and outgrowth of Clostridium botulinum type E spores in microcultures | journal = Applied and Environmental Microbiology | volume = 44 | issue = 5 | pages = 1212–1221 | date = November 1982 | pmid = 6758699 | pmc = 242170 | doi = 10.1128/AEM.44.5.1212-1221.1982 | bibcode = 1982ApEnM..44.1212S}}</ref><ref>{{cite journal | vauthors = Sofos JN, Busta FF, Bhothipaksa K, Allen CE, Robach MC, Paquette MW |title=Effects of various concentrations of sodium nitrite and potassium sorbate on Clostridium botulinum toxin production in commercially prepared bacon |journal=Journal of Food Science |date=September 1980 |volume=45 |issue=5 |pages=1285–1292 |doi=10.1111/j.1365-2621.1980.tb06539.x}}</ref><ref>{{cite journal |last1=Linton |first1=Mark |last2=Connolly |first2=Malachy |last3=Houston |first3=Laurette |last4=Patterson |first4=Margaret F. |title=The control of Clostridium botulinum during extended storage of pressure-treated, cooked chicken |journal=Food Control |date=March 2014 |volume=37 |pages=104–108 |doi=10.1016/j.foodcont.2013.09.042}}</ref><ref>{{cite journal |last1=Alnoman |first1=Maryam |last2=Udompijitkul |first2=Pathima |last3=Paredes-Sabja |first3=Daniel |last4=Sarker |first4=Mahfuzur R. |title=The inhibitory effects of sorbate and benzoate against Clostridium perfringens type A isolates |journal=Food Microbiology |date=June 2015 |volume=48 |pages=89–98 |doi=10.1016/j.fm.2014.12.007}}</ref>

=== Vaccine ===
A [[vaccine]] for botulism exists, but it is rarely used.<ref name=WHO2018>{{cite web|title=Fact sheets - Botulism|url=https://www.who.int/news-room/fact-sheets/detail/botulism|work=World Health Organization|access-date=23 March 2019|date=10 January 2018|archive-date=23 March 2019|archive-url=https://web.archive.org/web/20190323162924/https://www.who.int/news-room/fact-sheets/detail/botulism|url-status=live}}</ref> The US CDC discontinued use of the vaccine in 2011 when the available product showed declining potency and an increase in moderate local reactions to booster shots.<ref>{{cite web |title=Notice of CDC's Discontinuation of Investigational Pentavalent (ABCDE) Botulinum Toxoid Vaccine |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6042a3.htm |work=CDC|access-date=5 May 2025|date=28 October 2011}}</ref> As of 2017 work to develop a better vaccine was being carried out, but the US FDA had not approved any vaccine against botulism.<ref>{{cite journal |last1=Webb |first1=Robert P |last2=Smith |first2=Leonard A |title=What next for botulism vaccine development? |journal=Expert Review of Vaccines |date=May 2013 |volume=12 |issue=5 |pages=481–492 |doi=10.1586/erv.13.37 |pmid=23659297 }}</ref><ref>{{cite journal | vauthors = Sundeen G, Barbieri JT | title = Vaccines against Botulism | journal = Toxins | volume = 9 | issue = 9 | page = 268 | date = September 2017 | pmid = 28869493 | pmc = 5618201 | doi = 10.3390/toxins9090268 | doi-access = free }}</ref>