LETTER FROM BUENOS AIRES Outbreak of Type A Botulism and Development of a Botulism Surveillance and Antitoxin Release System in Argentina

BOTULISM IS A POTENTIALLY FAtal, neuroparalytic illness resulting from toxins produced by the bacterium Clostridium botulinum. Human illness occurs as infant botulism, botulism from intestinal colonization and wound infections, and foodborne botulism. Symptoms appear approximately 12 to 36 hours after toxin exposure beginning with bulbar and autonomic nervous system disturbances. Descending, symmetrical skeletal muscle weakness, paralysis, and respiratory failure may also follow, which require prompt, supportive therapy including mechanical ventilation. Botulism antitoxin, the only specific therapy available to ameliorate illness, can help prevent progression of paralysis, reduce duration of illness, and decrease fatality rates. Supportive care and prompt administration of antitoxin have reduced mortality in the United States to less than 10%, and prompt identification of suspect food vehicles during outbreaks has prevented additional cases and reshaped our understanding of the epidemiology of botulism. Global antitoxin supplies are limited and antitoxin has been unavailable for immediate use in several recent outbreaks (eg, Italy and Egypt). In the United States, the Cen-