Health Advisory
OUTBREAK OF BOTULINUM TOXIN TYPE A ASSOCIATED WITH BOTTLED CARROT JUICE

The Division of Public Health is forwarding this Health Advisory from the Centers for Disease Control and Prevention. To contact DPH about this Health Advisory, call 1-888-295-5156. This number is answered during normal business hours, and during non-business hours for emergencies.

This is an official
CDC Health Advisory

Distributed via Health Alert Network
September 16, 2006, 12:31 EDT (12:31 PM EDT)
CDCHAN-00250-06-09-16-ADV-N

Outbreak of Botulinum toxin Type A associated with
bottled carrot juice

A commercial beverage has been confirmed as the cause of a cluster of three botulism cases in Georgia. The three patients had onset of symptoms on Friday, September 8th, after consuming a common meal that included commercially produced carrot juice on Thursday, September 7th. Two bottles of juice were consumed.  All three patients drank from bottle #1; whether all three patients drank from bottle #2 is unknown. Botulinum toxin type A was identified in the serum and stool of all three patients by mouse bioassay. Subsequently, botulinum toxin type A was identified from carrot juice remaining in bottle #1 by mouse bioassay. Bottle #2 had been rinsed with water, and the test for toxin was negative. The label on the implicated bottle reads “Bolthouse Farms, Bakersfield, California, 100% carrot juice.” The use by date is 09-18-06.

The investigation is ongoing. It is unknown whether the contaminated juice was subjected to time or temperature abuse that might have facilitated the growth of Clostridium botulinum spores, which can survive pasteurization. CDC has not been notified of any cases of suspected botulism since this cluster was reported on September 8. We encourage state and local officials to inquire specifically about consumption of carrot juice in the food history of suspect botulism cases.

CDC has dispatched a notice of this outbreak to public health officials in all 50 states through the Foodborne Disease Listserve, reminding them about the contact numbers for CDC’s Botulism Clinical Consultation and Antitoxin Release Service. The Georgia Department of Health issued an Epi-X alert, alerts to Georgia clinicians and local health officials, and a press release about this outbreak and the implicated food. We anticipate that the Food and Drug Administration (FDA) will be issuing a press release about this outbreak and advising consumers to properly refrigerate juices and follow other food safety guidelines for illness prevention.

Any suspected botulism case reported by a clinician to a state health department should be reported immediately by the state to CDC via the 24/7 CDC Botulism Clinical Consultation and Antitoxin Release Service, by calling the CDC Emergency Operations Center at (770) 488-7100 and asking for the botulism officer on call.

For more information on botulism visit this CDC website:

• http://www.cdc.gov/ncidod/dbmd/diseaseinfo/botulism_g.htm

NOTE:  The CDC HAN web site has been relocated. The link to the new site location is: http://www2a.cdc.gov/HAN/  If you maintain or contribute to a web site that links to the CDC HAN web site you should update the link. Also, to ensure the widest dissemination of this change it would be appreciated if you would distribute this notification as appropriate. Thank you!