22-25 October 2002
G. Katsitadze, M
Moistsrafishvili, N. Chakvetadze, P. Imnadze, E. Jhorjholiani, T. Zardiashvili,
M. Chokheli and N. Tarkhashvili
Background: Botulism is a rare
diseases in the U.S, but is reported worldwide. The Republic of Georgia an
independent, ethnically diverse nation in Western Asia, has previously reported
the highest rate of foodborne botulism in the world, but the epidemiology has
never been formally described.
Methods: Georgia`s National Center
for Diseases Control (NCDC) conducts national surveillance for botulism. Prior
to 1996, NCDC collected summary reports from regional epidemiology offices and
only investigated large outbreaks. In 1996, NCDC began collecting detailed
histories on all botulism cases ascertained by regional epidemiology offices.
We analyzed data from summary reports and vital statistics for the period from
1980-2000, and combined this data with case histories and hospital records for
the period from 1996-2000.
Results: From 1980-2000, NCDC
ascertained 806 cases of botulism. From 1980-1995, a total of 563 botulism
cases (mean 35.2 cases/year) and 36 deaths (mean 2.3 cases/year) were reported.
From 1996-2000, the average number of cases and deaths increased; 243 cases
(mean 48.6 cases/year) and 18 deaths (mean 3.6 deaths/year) were reported. This
corresponds to annual incidence of 1.1 per 100, 000 persons. There was marked
regional variability with the vast majority of cases ascertained in the eastern
and western regions of the country. Of the 243 persons with botulism from
1996-2000, 109 (45%) were female, and 224 (92%) were over 15 years of age. Most
cases (107,44%) occurred in the winter, and the least occurred in the spring
(36, 14.8%). 210 cases (86%) occurred as part of outbreaks (>1 ill case).
The largest of these outbreaks involved 23 persons in 1999. All reported cases
of botulism were foodborne. Home conserved vegetables were implicated in 197
(81%) cases and smoked fish in 45 (18.5%). The most commonly implicated
vegetables were tomatoes 44 (18.10%). Laboratory testing was performed for 121
(50%) cases; of these, 111 (92%) were positive for botulism. All
laboratory-confirmed cases associated with smoked fish were type E, and all
cases associated with vegetables were type B. Anti-toxin was administered to
238 (97.94%) patients, of the five that did not receive anti-toxin, four
survived.
Conclusion: Foodborne botulism is a
major public health problem in Georgia. NCDC has begun a multiyear project to
improve physician and public education, public health surveillance, laboratory
diagnostic capacity, and anti-toxin distribution. Reducing the burden of
botulism will involve learning which food conservation practices increase risk
of botulism and will require developing a cheap, effective, culturally
appropriate, home-based intervention.