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Update: International Outbreak of Restaurant-Associated Botulism -- Vancouver, British Columbia, Canada

A restaurant in Vancouver, British Columbia, Canada has been the source of two discrete clusters of botulism cases during the latter half of summer 1985. The eating establishment, the White Spot Restaurant at 1616 Georgia Street, is located near Stanley Park, a popular attraction. Eight cases have been recognized in the first cluster, which followed a meal at this restaurant between July 26 and August 2. An additional 26 cases have been recognized in the second cluster, which followed meals eaten between August 29 and September 5. Cases have been reported in Canada, the United States, and the Netherlands.

A notable feature of this outbreak has been the slow development and progression of symptoms, up to 10 days following exposure. Because cases were widely dispersed and initially involved atypical manifestations of acute botulism, many practitioners and specialists were misled in their primary diagnosis. Consequently, many of these patients were hospitalized with a range of other neurologic and psychiatric diagnoses.

Type B botulinal toxin was detected in the serum of three patients. Seven patients have required ventilator support. There have been no fatalities. A case-control study demonstrated two sandwiches on the menu to be highly associated with illness, and further analysis implicated a preparation of chopped garlic in soybean oil as the specific vehicle of intoxication. It is suspected that the product was unrefrigerated for several months before being opened. Control measures included voluntary withdrawal of the implicated menu items and the chopped garlic product from all White Spot Restaurants. Reported by FJ Blatherwick, MD, SH Peck, MB, City of Vancouver Health Dept, Vancouver, British Columbia, GB Morgan, ME Milling, Field Operations Directorate, Health Protection Br, Health and Welfare, Canada; GD Kettyls, MD, Provincial Laboratories, Vancouver, TJ Johnstone, MB, Provincial Epidemiologist, DW Bowering, MD, Field Epidemiologist, Laboratory Centre for Disease Control, Provincial Ministry of Health, Victoria, British Columbia; U.S. Food and Drug Administration; Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: The U.S. Food and Drug Administration has decided that the garlic product is safe if it is kept refrigerated as the label directs, so it is still being sold in the United States. No persons who consumed this product in the United States have been reported with botulism. However, further patients with unusual neurologic illness and travel histories to Vancouver within the time periods in question may yet be diagnosed retrospectively as cases of botulism associated with this outbreak. Clinicians should contact their provincial or state epidemiologist if this possibility is entertained. Cases outside Canada or the United States should be reported to Chief, Communicable Disease Division, Bureau of Epidemiology, Laboratory Centre for Disease Control, Ottawa, Canada.

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