Editing Botulism (section)

== Epidemiology ==
Globally, botulism is fairly rare,<ref name=WHO2018/> with approximately 1,000 identified cases yearly.<ref>{{cite web|url=http://www.health.gov.on.ca/en/public/publications/disease/botulism.aspx|title=Botulism - Diseases and Conditions - Publications - Public Information - MOHLTC|publisher=Government of Ontario, Ministry of Health and Long-Term Care|website=www.health.gov.on.ca|language=en|access-date=29 October 2017|archive-date=17 October 2017|archive-url=https://web.archive.org/web/20171017005607/http://www.health.gov.on.ca/en/public/publications/disease/botulism.aspx|url-status=live}}</ref>

=== United States ===
In the United States an average of 145 cases are reported each year. Of these, roughly 65% are infant botulism, 20% are wound botulism, and 15% are foodborne.<ref name=CDCsurv /> Infant botulism is predominantly sporadic and not associated with epidemics, but great geographic variability exists. From 1974 to 1996, for example, 47% of all infant botulism cases reported in the U.S. occurred in California.<ref name=CDCsurv />

Between 1990 and 2000, the [[Centers for Disease Control and Prevention]] reported 263 individual foodborne cases from 160 botulism events in the United States with a case-fatality rate of 4%. Thirty-nine percent (103 cases and 58 events) occurred in Alaska, all of which were attributable to traditional Alaskan aboriginal foods. In the lower 49 states, home-canned food was implicated in 70 events (~69%) with canned asparagus being the most frequent cause. Two restaurant-associated outbreaks affected 25 people. The median number of cases per year was 23 (range 17–43), the median number of events per year was 14 (range 9–24). The highest incidence rates occurred in Alaska, Idaho, Washington, and Oregon. All other states had an incidence rate of 1 case per ten million people or less.<ref>{{cite journal | vauthors = Sobel J, Tucker N, Sulka A, McLaughlin J, Maslanka S | title = Foodborne botulism in the United States, 1990-2000 | journal = Emerging Infectious Diseases | volume = 10 | issue = 9 | pages = 1606–11 | date = September 2004 | pmid = 15498163 | pmc = 3320287 | doi = 10.3201/eid1009.030745 | publisher = Centers for Disease Control }}</ref>

The number of cases of food borne and infant botulism has changed little in recent years, but wound botulism has increased because of the use of [[black tar heroin]], especially in [[California]].<ref>{{cite journal | vauthors = Passaro DJ, Werner SB, McGee J, Mac Kenzie WR, Vugia DJ | title = Wound botulism associated with black tar heroin among injecting drug users | journal = JAMA | volume = 279 | issue = 11 | pages = 859–63 | date = March 1998 | pmid = 9516001 | doi = 10.1001/jama.279.11.859 | doi-access =  }}</ref>

All data regarding botulism antitoxin releases and laboratory confirmation of cases in the US are recorded annually by the Centers for Disease Control and Prevention and published on their website.<ref name="CDCsurv">{{cite web |url=https://www.cdc.gov/nationalsurveillance/botulism_surveillance.html |title=National Case Surveillance: National Botulism Surveillance &#124; CDC National Surveillance |publisher=Centers for Disease Control and Prevention |date=25 June 2013 |access-date=12 February 2014 |url-status=live |archive-url=https://web.archive.org/web/20140130152612/http://www.cdc.gov/nationalsurveillance/botulism_surveillance.html |archive-date=30 January 2014 }}</ref>
* On 2 July 1971, the [[U.S. Food and Drug Administration]] (FDA) released a public warning after learning that a New York man had died and his wife had become seriously ill due to botulism after eating a can of [[Bon Vivant Soup Company|Bon Vivant]] [[vichyssoise]] soup.
* Between 31 March and 6 April 1977, 59 individuals developed type B botulism. All who fell ill had eaten at the same Mexican restaurant in [[Pontiac, Michigan]], and had consumed a hot sauce made with improperly home-canned jalapeño peppers, either by adding it to their food, or by eating [[nachos]] that had been prepared with the hot sauce. The full clinical spectrum (mild symptomatology with neurologic findings through life-threatening ventilatory paralysis) of type B botulism was documented.<ref>{{cite journal | vauthors = Terranova W, Breman JG, Locey RP, Speck S | title = Botulism type B: epidemiologic aspects of an extensive outbreak | journal = American Journal of Epidemiology | volume = 108 | issue = 2 | pages = 150–6 | date = August 1978 | pmid = 707476 | doi = 10.1093/oxfordjournals.aje.a112599 }}</ref>
* In April 1994, the largest outbreak of botulism in the United States since 1978 occurred in [[El Paso, Texas]]. Thirty people were affected; 4 required mechanical ventilation. All ate food from a Greek restaurant. The attack rate among people who ate a potato-based dip was 86% (19/22) compared with 6% (11/176) among people who did not eat the dip. The attack rate among people who ate an eggplant-based dip was 67% (6/9) compared with 13% (24/189) among people who did not. Botulism toxin type A was detected in patients and in both dips. Toxin formation resulted from holding aluminum foil-wrapped baked potatoes at room temperature, apparently for several days, before they were used in the dips. Food handlers should be informed of the potential hazards caused by holding foil-wrapped potatoes at ambient temperatures after cooking.<ref>{{cite journal | vauthors = Angulo FJ, Getz J, Taylor JP, Hendricks KA, Hatheway CL, Barth SS, Solomon HM, Larson AE, Johnson EA, Nickey LN, Ries AA | title = A large outbreak of botulism: the hazardous baked potato | journal = The Journal of Infectious Diseases | volume = 178 | issue = 1 | pages = 172–7 | date = July 1998 | pmid = 9652437 | doi = 10.1086/515615 | doi-access = free }}</ref>
* In 2002, fourteen [[Alaska]]ns ate ''[[muktuk]]'' (whale blubber) from a beached whale, resulting in eight of them developing botulism, with two of the affected 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 | author1 = Centers for Disease Control and Prevention (CDC) | access-date = 8 September 2017 | archive-date = 25 June 2017 | archive-url = https://web.archive.org/web/20170625130732/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5202a2.htm | url-status = live }}</ref>
* Beginning in late June 2007, 8 people contracted botulism poisoning by eating canned food products produced by [[Castleberry's Food Company]] in its [[Augusta, Georgia]] plant. It was later identified that the Castleberry's plant had serious production problems on a specific line of retorts that had under-processed the cans of food. These issues included broken cooking alarms, leaking water valves and inaccurate temperature devices, all the result of poor management of the company. All of the victims were hospitalized and placed on mechanical ventilation. The Castleberry's Food Company outbreak was the first instance of botulism in commercial canned foods in the United States in over 30 years.<ref>{{cite journal |title=Botulism associated with commercially canned chili sauce--Texas and Indiana, July 2007 |journal=MMWR. Morbidity and Mortality Weekly Report |volume=56 |issue=30 |pages=767–9 |date=3 August 2007 |pmid=17673898 |author=Centers for Disease Control and Prevention (CDC) |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5630a4.htm }}</ref>
* One person died, 21 cases were confirmed, and 10 more were suspected in [[Lancaster, Ohio]] when a botulism outbreak occurred after a church potluck in April 2015. The suspected source was a salad made from home-canned potatoes.<ref>{{cite news|title=1 dead in botulism outbreak linked to Ohio church potluck|url=http://fox8.com/2015/04/28/contaminated-potato-salad-to-blame-for-deadly-botulism-at-ohio-church-potluck-dinner/|publisher=CNNWIRE|access-date=19 July 2015|agency=CNN|date=28 April 2015|url-status=live|archive-url=https://web.archive.org/web/20150722103827/http://fox8.com/2015/04/28/contaminated-potato-salad-to-blame-for-deadly-botulism-at-ohio-church-potluck-dinner/|archive-date=22 July 2015}}</ref>
* A botulism outbreak occurred in Northern California in May 2017 after 10 people consumed nacho cheese dip served at a gas station in Sacramento County. One man died as a result of the outbreak.<ref>{{cite news|title=Man dies in Sacramento county botulism outbreak from nacho cheese|url=http://www.kcra.com/article/man-dies-in-sacramento-county-botulism-outbreak-from-nacho-cheese/9909013|publisher=KCRA|access-date=22 May 2017|date=22 May 2017|url-status=live|archive-url=https://web.archive.org/web/20170523000126/http://www.kcra.com/article/man-dies-in-sacramento-county-botulism-outbreak-from-nacho-cheese/9909013|archive-date=23 May 2017}}</ref>

=== United Kingdom ===
The largest recorded outbreak of foodborne botulism in the United Kingdom occurred in June 1989. A total of 27 patients were affected; one patient died. Twenty-five of the patients had eaten one brand of hazelnut yogurt in the week before the onset of symptoms. Control measures included the cessation of all yogurt production by the implicated producer, the withdrawal of the firm's yogurts from sale, the recall of cans of the hazelnut conserve, and advice to the general public to avoid the consumption of all hazelnut yogurts.<ref>{{cite journal | vauthors = O'Mahony M, Mitchell E, Gilbert RJ, Hutchinson DN, Begg NT, Rodhouse JC, Morris JE | title = An outbreak of foodborne botulism associated with contaminated hazelnut yoghurt | journal = Epidemiology and Infection | volume = 104 | issue = 3 | pages = 389–95 | date = June 1990 | pmid = 2347382 | pmc = 2271776 | doi = 10.1017/s0950268800047403 }}</ref>

=== China ===
From 1958 to 1983 there were 986 outbreaks of botulism in China involving 4,377 people with 548 deaths.<ref>{{cite journal |last1=Ying |first1=S. |last2=Shuyan |first2=C. |title=Botulism in China |journal=Clinical Infectious Diseases |date=November 1986 |volume=8 |issue=6 |pages=984–990 |doi=10.1093/clinids/8.6.984 }}</ref>

====Qapqal disease====
After the [[Chinese Communist Revolution]] in 1949, a mysterious plague (named '''Qapqal disease''') was noticed to be affecting several [[Sibe people|Sibe villages]] in [[Qapqal Xibe Autonomous County]]. It was endemic with distinctive epidemic patterns, yet the underlying cause remained unknown for a long period of time.<ref name="nat_med_j_chin">{{cite journal| vauthors = Wu CR, Lian EH, Chen WJ, Liu YZ |title=Botulism: A report for Qapqal disease|journal=National Medical Journal of China|date=1958|volume=44|issue=10|pages=932–942}}</ref> It caused a number of deaths and forced some people to leave the place.<ref name="BMEnvS">{{cite journal | vauthors = Fu SW, Wang CH | title = An overview of type E botulism in China | journal = Biomedical and Environmental Sciences | volume = 21 | issue = 4 | pages = 353–6 | date = August 2008 | pmid = 18837301 | doi = 10.1016/S0895-3988(08)60054-9 | bibcode = 2008BioES..21..353F }}</ref>

In 1958, a team of experts were sent to the area by the Ministry of Health to investigate the cases. The epidemic survey conducted proved that the disease was primarily type A botulism,<ref name="PD">{{cite news|url=http://english.people.com.cn/102759/7567650.html|title=The Xibe ethnic minority|date=12 November 2011|access-date=29 January 2018|newspaper=People's Daily|editor=Huang Beibei|archive-date=24 October 2012|archive-url=https://web.archive.org/web/20121024013056/http://english.people.com.cn/102759/7567650.html|url-status=live}}</ref> with several cases of type B.<ref name="nat_med_j_chin"/> The team also discovered that the source of the botulinum was local fermented grain and beans, as well as a raw meat food called ''mi song hu hu''.<ref name="BMEnvS"/> They promoted the improvement of fermentation techniques among local residents, and thus eliminated the disease.

=== Canada ===
From 1985 to 2005 there were outbreaks causing 91 confirmed cases of foodborne botulism in [[Canada]], 85% of which were in [[Inuit]] communities, especially [[Nunavik]], as well as  [[First Nations in Canada|First Nations]] of the coast of [[British Columbia]], following consumption of traditionally prepared marine mammal and fish products.<ref>{{cite journal | vauthors = Leclair D, Fung J, Isaac-Renton JL, Proulx JF, May-Hadford J, Ellis A, Ashton E, Bekal S, Farber JM, Blanchfield B, Austin JW | title = Foodborne botulism in Canada, 1985-2005 | journal = Emerging Infectious Diseases | volume = 19 | issue = 6 | pages = 961–8 | date = June 2013 | pmid = 23735780 | pmc = 3713816 | doi = 10.3201/eid1906.120873 }}</ref>

=== Ukraine ===
In 2017, there were 70 cases of botulism with 8 deaths in Ukraine. The previous year there were 115 cases with 12 deaths. Most cases were the result of dried fish, a common local [[bar food|drinking snack]].<ref>{{Cite news|url=https://en.lb.ua/news/2017/06/14/3936_eight_ukrainians_died_botulism.html|title=Eight Ukrainians died of botulism in 2017|work=LB.ua|access-date=29 October 2017|archive-date=29 October 2017|archive-url=https://web.archive.org/web/20171029172901/https://en.lb.ua/news/2017/06/14/3936_eight_ukrainians_died_botulism.html|url-status=live}}</ref>

===Vietnam===
In 2020, several cases of botulism were reported in [[Vietnam]]. All of them were related to a product containing contaminated vegetarian [[pâté]]. Some patients were put on life support.<ref>{{cite web|url=https://vnexpress.net/doc-to-trong-pate-minh-chay-duoc-phat-hien-cach-nao-4156196.html|title=Độc tố trong pate Minh Chay được phát hiện cách nào?|access-date=4 September 2020|archive-date=4 September 2020|archive-url=https://web.archive.org/web/20200904001043/https://vnexpress.net/doc-to-trong-pate-minh-chay-duoc-phat-hien-cach-nao-4156196.html|url-status=live}}</ref><ref>{{cite web|url=https://ampe.vnexpress.net/news/news/lethal-bacteria-in-vegan-pate-puts-seven-people-on-life-support-4154479.html|title=Lethal bacteria in vegan pate puts seven people on life support|access-date=4 September 2020|archive-date=22 July 2021|archive-url=https://web.archive.org/web/20210722080831/https://ampe.vnexpress.net/news/news/lethal-bacteria-in-vegan-pate-puts-seven-people-on-life-support-4154479.html|url-status=live}}</ref>