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International Outbreak of Type E Botulism Associated With Ungutted, Salted Whitefish

On November 2, 1987, a 39-year-old Russian immigrant and his 9-year-old son were admitted to a suburban New York hospital with symptoms indicative of botulism. The father's stool specimen contained type E botulinum toxin. On October 23, the father had purchased a whole, ungutted, salted, air-dried whitefish known as either ribyetz or kapchunka from a delicatessen in Queens, New York City. He and his son had eaten the fish on October 30 and 31. On November 3, 1987, CDC received a report from the Ministry of Health, Jerusalem, Israel, of five additional cases suspected to be botulism; one case was fatal. The patients had eaten ribyetz purchased in a grocery in Brighton Beach, Brooklyn, New York City, on October 17 and taken to Israel. The fish as well as a serum sample from one surviving patient subsequently yielded type E botulinum toxin.

The implicated fish was distributed in the New York City area by Gold Star Smoked Fish Inc., a firm in Brooklyn. On November 3, the New York City Department of Health issued an embargo on the sale and distribution of ribyetz or kapchunka and removed the implicated product from the shelves of stores selling Gold Star products. The public was alerted through news releases, and acute care hospitals in New York City and surrounding areas were notified. No additional cases have been identified in New York. However, one additional laboratory-confirmed case of botulism has been reported in Israel. On November 13, the patient, a 17-year-old female, had eaten whitefish that had been purchased on October 18 at the same delicatessen in Queens associated with the original patients. Reported by: S Kotev, MD, Hadassah Univ Hospital, Jerusalem; A Leventhal, MD, MPH, A Bashary, RN, H Zahavi, RN, Jerusalem Dist Health Office; A Cohen, National Botulism Reference Lab; P Slater, MD, MPH, Ministry of Health, Israel. A Ruston, MD, E Baron, PhD, B Farber, MD, J Greenspan, MD, M Tenenbaum, MD, R vanAmerongon, MD, North Shores Univ Hospital, Manhasset; V Tulumello, J Lynch, Nassau County Health Dept; S Schultz, MD, C Reisberg, S Shahidi, PhD, S Joseph, MD, New York City Dept of Health; L Crowell, DVM, J Ferrara, New York State Dept of Agriculture and Markets; J Guzewich, M Shayegani, PhD, G Hannett, DL Morse, MD, MS, State Epidemiologist, New York State Dept of Health. US Food and Drug Administration. Div of Field Svcs, Epidemiology Program Office; Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial note: Ribyetz, or kapchunka, is an ethnic food consumed in this country primarily by Russian immigrants. It has been implicated as a vehicle for botulism twice in recent years. In 1981, a California man became ill (1), and, in 1985, two Russian immigrants died in New York City after eating the fish (2,3). Type E botulism is typically associated with foods of marine origin (4). The mechanism of contamination of the ribyetz has not been established. However, Clostridium botulinum spores can be found in the intestinal contents of fish, and the fact that the fish were uneviscerated may have been important (5).

The whitefish implicated in this outbreak was produced by one firm and distributed only in New York City. In addition to halting the distribution of the fish, officials in New York City and New York State are developing regulations that would in effect prohibit the production and sale of such uneviscerated whitefish. Although refrigeration is recommended, some consumers may be storing the fish unrefrigerated before eating it uncooked. Persons who purchased ribyetz in New York City in October should dispose of any remaining fish in such a way as to make it inaccessible to others.

Public health personnel should be aware of the potential problem, especially for people in ethnic groups known to eat this product. Guidance in treating botulism and testing serum and stool samples for botulinal toxin can be obtained through state or city health departments. Requests for testing specimens of ribyetz can be made through the district offices of the Food and Drug Administration (FDA) or the FDA Division of Emergency and Epidemiological Operations, Rockville, Maryland 20857; telephone number (301) 443-1240. References

  1. California Department of Health Services. Alert: botulism associated with commercially produced, dried, salted whitefish. California Morbidity, November 6, 1981;(suppl 43).

  2. Centers for Disease Control. Botulism associated with commercially distributed kapchunka-- New York City. MMWR 1985;34:546-7.

  3. Badhey H, Cleri DJ, D'Amato RF, et al. Two fatal cases of type E adult food-borne botulism with early symptoms and terminal neurologic signs. J Clin Microbiol 1986;23:616-8.

  4. Centers for Disease Control. Botulism in the United States, 1899-1977: handbook for epidemiologists, clinicians, and laboratory workers. Atlanta: US Department of Health, Education, and Welfare, Public Health Service, 1979.

  5. Bott TL, Deffner JS, McCoy E, Foster EM. Clostridium botulinum type E in fish from the Great Lakes. J Bacteriol 1966;91:919-24.

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