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Botulism Surveillance and Emergency Response: Title and subTitle BreakA Public Health Strategy for a Global Challenge FREE

Roger L. Shapiro, MD; Charles Hatheway, PhD; John Becher, RPH; David L. Swerdlow, MD
[+] Author Affiliations

Corresponding author: Roger L. Shapiro, MD, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop A-38, Atlanta, GA 30333 (e-mail:rss9@cdc.gov).


JAMA. 1997;278(5):433-435. doi:10.1001/jama.1997.03550050095041
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Botulism is a neuroparalytic disease caused by a neurotoxin produced from an anaerobic spore-forming bacterium known as Clostridium botulinum.1 The lethal potency of this toxin has mandated intensive surveillance and control measures in the United States. Recent outbreaks of botulism have raised questions regarding the international supply and therapeutic use of botulism antitoxin, and reports that national governments2 and terrorist groups3 have stockpiled botulism toxin have increased levels of concern regarding global preparedness for an intentional episode of botulism poisoning. It is estimated that as little as 1 g of aerosolized botulism toxin has the potential to kill at least 1.5 million people, and modern techniques of aerosolization via tactical ballistic missiles or aeronautical spraying may be capable of disseminating up to 60% of this dosage to a target population.4

A description of the clinical features of aerosolized botulism toxin poisoning appears elsewhere in this issue.

REFERENCES

Smith LDS, Sugiyama H. Botulism: The Organism, Its Toxins, the Disease .2nd ed. Springfield, Ill: Charles C Thomas Publisher; 1988;.
Ekeus R. Report of the Secretary General on the Status of the Implementation of the Special Commission's Plan for the Ongoing Monitoring and Verification of Iraq's Compliance With Relevant Parts of Sector C of Security Council Resolutions 687 . New York, NY: United Nations Special Commission (UNSCOM); 1991;.
Cole LA.  The specter of biological weapons . Sci Am . 1996;; (December) :60-65.
McNally RE, Morrison MB, Berndt J E, et al. Effectiveness of Medical Defense Interventions Against Predicted Battlefield Levels of Botulinum Toxin A . Joppa, Md: Science Applications International Corp; 1994;.
Franz, DR, Jahrling PB, Friedlander AM, et al.  Clinical recognition and management of patients exposed to biological warfare agents . JAMA . 1997;;278:3990411.
Danzig R.  Biological warfare: a nation at risk—a time to act . Strategic Forum . (January) 1996;.
Siegel LS.  Destruction of botulinum toxins in food and water . In: Hauschild AHW, Dodds KL, eds. Clostridium botulinum. Ecology and Control in Foods . New York, NY: Marcel Dekker Inc; 1993;:323.
Wannemacher RW Jr, Dinterman RE, Thompson WL, et al. Treatment for Removal of Biotoxins From Drinking Water. Fort Detrick, Frederick, Md: US Army Biomedical Research and Development Laboratory. Technical report 9120.
Tacket CO, Shandera WX, Mann JM, et al.  Equine antitoxin use and other factors that predict outcome in type A foodborne botulism . Am J Med . 1984;;76:794-798.
Cardella MA.  Botulism toxoids . In: Lewis KH, Cassel K Jr, eds. Botulism: Proceedings of a Symposium . Cincinnati, Ohio: US Dept of Health, Education, and Welfare, Public Health Service; 1964;. Public Health Service publication 999-FP-1.
Weber JT, Hibbs RG, Darwish A, et al.  A massive outbreak of type E botulism associated with traditional salted fish in Cairo, Egypt . J Infect Dis . 1993;;167:451-454.
Aureli P, Franciosa G, Pourshaban M.  Foodborne botulism in Italy . Lancet . 1996;;348:1594.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Smith LDS, Sugiyama H. Botulism: The Organism, Its Toxins, the Disease .2nd ed. Springfield, Ill: Charles C Thomas Publisher; 1988;.
Ekeus R. Report of the Secretary General on the Status of the Implementation of the Special Commission's Plan for the Ongoing Monitoring and Verification of Iraq's Compliance With Relevant Parts of Sector C of Security Council Resolutions 687 . New York, NY: United Nations Special Commission (UNSCOM); 1991;.
Cole LA.  The specter of biological weapons . Sci Am . 1996;; (December) :60-65.
McNally RE, Morrison MB, Berndt J E, et al. Effectiveness of Medical Defense Interventions Against Predicted Battlefield Levels of Botulinum Toxin A . Joppa, Md: Science Applications International Corp; 1994;.
Franz, DR, Jahrling PB, Friedlander AM, et al.  Clinical recognition and management of patients exposed to biological warfare agents . JAMA . 1997;;278:3990411.
Danzig R.  Biological warfare: a nation at risk—a time to act . Strategic Forum . (January) 1996;.
Siegel LS.  Destruction of botulinum toxins in food and water . In: Hauschild AHW, Dodds KL, eds. Clostridium botulinum. Ecology and Control in Foods . New York, NY: Marcel Dekker Inc; 1993;:323.
Wannemacher RW Jr, Dinterman RE, Thompson WL, et al. Treatment for Removal of Biotoxins From Drinking Water. Fort Detrick, Frederick, Md: US Army Biomedical Research and Development Laboratory. Technical report 9120.
Tacket CO, Shandera WX, Mann JM, et al.  Equine antitoxin use and other factors that predict outcome in type A foodborne botulism . Am J Med . 1984;;76:794-798.
Cardella MA.  Botulism toxoids . In: Lewis KH, Cassel K Jr, eds. Botulism: Proceedings of a Symposium . Cincinnati, Ohio: US Dept of Health, Education, and Welfare, Public Health Service; 1964;. Public Health Service publication 999-FP-1.
Weber JT, Hibbs RG, Darwish A, et al.  A massive outbreak of type E botulism associated with traditional salted fish in Cairo, Egypt . J Infect Dis . 1993;;167:451-454.
Aureli P, Franciosa G, Pourshaban M.  Foodborne botulism in Italy . Lancet . 1996;;348:1594.
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