Resources & Publications

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For more information on Clostridium botulinum outbreaks reported to CDC:

  1. Go to NORS Dashboard.
  2. Set your search parameters, being sure to select “Clostridium” as the etiology.
  3. At the bottom of the page, select “Download current search data.”
  4. Sort by “Genus Species” or select the arrow next to that heading to select only “Clostridium botulinum.

Case Definition

Surveillance

Botulism Manual

Podcast

Botulism: Countering Common Clinical MisperceptionsExternal
April 1, 2013 Dr. Agam Rao discusses how to recognize and treat botulism and addresses common clinical misperceptions about the illness.
Read the transcript

 

Publications

“Botulism,” a CDC-sponsored supplement to Clinical Infectious Diseases
Cover of Clinical Infectious Diseases

Topics include:

  • Clinical characteristics
  • Systematic reviews of literature on botulism among pregnant women and children
  • Safety, effectiveness, and allergic profile of antitoxin
  • Outbreak investigations
  • Case reports describing uncommon clinical features

Citation: Sobel J, Rao A. Making the best of the evidence: towards national clinical guidelines for botulism. Clin Infect Dis. 2017 Dec 27;66(Suppl_1):1–3. DOIExternal

 

  • Clinical Characteristics and Ancillary Test Results Among Patients With Botulism—United States, 2002–2015. DOIExternal PubMedExternal
    Rao AK, Lin NH, Jackson KA, Mody RK, Griffin PM. Clin Infect Dis. 2017 Dec 27; 66(Suppl 1): p. S4–S10.
  • Clinical Features of Foodborne and Wound Botulism: A Systematic Review of the Literature, 1932–2015. DOIExternal PubMedExternal
    Chatham-Stephens K, Fleck-Derderian S, Johnson SD, Sobel J, Rao AK, Meaney-Delman D. Clin Infect Dis. 2017 Dec 27; 66 (Suppl 1): p. S11–S16.
  • Pediatric Botulism and Use of Equine Botulinum Antitoxin in Children: A Systematic Review. DOIExternal PubMedExternal
    Griese SE1, Kisselburgh HM2, Bartenfeld MT3, Thomas E1, Rao AK2, Sobel J2, Dziuban EJ4. Clin Infect Dis. 2017 Dec 27; 66(Suppl 1): p. S17–S29.
  • Botulism During Pregnancy and the Postpartum Period: A Systematic Review. DOIExternal PubMedExternal
    Badell ML, Rimawi BH, Rao AK, Jamieson DJ, Rasmussen S, Meaney-Delman D. Clin Infect Dis. 2017 Dec 27; 66(Suppl 1): p. S30–S37.
  • Botulism mortality in the United States, 1975–2009. DOIExternal PubMedExternal PMCExternal
    Jackson KA, Mahon BE, Copeland J, Fagan R. The Botulinum J. 2016; 3(1): p. 6–17.
  • Botulism. In: Bacterial Infections of Humans. SpringerExternal
    Yu PA, Maslanka SE, St Louis ME, Swerdlow DL. Editors: Evans AS, Brachman PS. New York: Springer; 2009. p. 159–176.
  • Long-term outcomes of 217 botulism cases in the Republic of Georgia. DOIExternal PubMedExternal
    Gottlieb SL, Kretsinger K, Tarkhashvili N, Chakvetadze N, Chokheli M, Chubinidze M, Hoekstra MR, Jhorjholiani E, Mirtskhulava M, Moistsrapishvili M, Sikharulidze M, Zardiashvili T, Imnadze P, Sobel J. Clin Infect Dis. 2007 Jul 15; 45(2): p. 174–80.
  • Adult botulism type F in the United States, 1981–2002. DOIExternal PubMedExternal
    Gupta A, Sumner CJ, Castor M, Maslanka S, Sobel J. Neurology. 2005 Dec 13; 65(11): p. 1694–700.
  • Botulism. DOIExternal PubMedExternal
    Sobel J. Clin Infect Dis. 2005 Oct 15; 41(8): p. 1167–73.
  • Identification of the major steps in botulinum toxin action. DOIExternal PubMedExternal
    Simpson LL. Annu Rev Pharmacol Toxicol. 2004 Feb 10; 44: p. 167–93.
  • Botulism in the United States: a clinical and epidemiologic review. DOIExternal PubMedExternal
    Shapiro RL, Hatheway C, Swerdlow DL. Ann Intern Med. 1998 Aug 1; 129(3): p. 221–8.
  • Botulism. In: Bacterial Infections of Humans. SpringerExternal
    Angulo FJ, St. Louis ME. Editors: Evans AS, Brachman PS. New York: Plenum; 1998. p. 131­­­­­­­–3.

  • The Epidemiology of Foodborne Botulism Outbreaks: A Systematic Review. DOIExternal PubMedExternal
    Fleck-Derderian S, Shankar M, Rao AK, Chatham-Stephens K, Adjei S, Sobel J, Meltzer MI, Meaney-Delman D, Pillai SK. Clin Infect Dis. 2017 Dec 27; 66 (Suppl 1): p. S73–S81.
Botulism linked to improperly home-canned, fermented, or preserved foods, including traditional Alaska Native foods
  • Large outbreak of botulism associated with a church potluck meal—Ohio, 2015. MMWR PubMedExternal PMCExternal
    McCarty CL, Angelo K, Beer KD, Cibulskas-White K, Quinn K, de Fijter S, Bokanyi R, St Germain E, Baransi K, Barlow K, Shafer G, Hanna L, Spindler K, Walz E, DiOrio M, Jackson BR, Luquez C, Mahon BE, Basler C, Curran K, Matanock A, Walsh K, Slifka KJ, Rao AK. MMWR Morb Mortal Wkly Rep. 2015 Jul 31; 64(29): p. 802–3.
  • Regional variations in home canning practices and the risk of foodborne botulism in the Republic of Georgia, 2003. DOIExternal PubMedExternal PMCExternal
    Tarkhashvili N, Chokheli M, Chubinidze M, Abazashvili N, Chakvetadze N, Imnadze P, Kretsinger K, Varma J, Sobel J. J Food Prot. 2015 Apr; 78(4): p. 746–50.
  • Botulism associated with home-fermented tofu in two Chinese immigrants—New York City, March–April 2012. MMWR PubMedExternal PMCExternal
    Chai E, Choi E, Guitierrez C, Hochman M, Johnkutty S, Kamel W, Mekles T, Zarnegar R, Ackelsberg J, Balter S, Lee EH, Li L, Ramos A, Rodriguez T, Weiss D, Yung J, Zhao B, Davis SW, Egan C, Hannett GE, Rao A, Toprani A, Sreenivasan N. MMWR Morb Mortal Wkly Rep. 2013 July 5; 62(26): p. 529–32.
  • Three outbreaks of foodborne botulism caused by unsafe home canning of vegetables—Ohio and Washington, 2008 and 2009. DOIExternal PubMedExternal
    Date K, Fagan R, Crossland S, Maceachern D, Pyper B, Bokanyi R, Houze Y, Andress E, Tauxe R. J Food Prot. 2011; 74(12): p. 2090–6.
  • Outbreak of clinically mild botulism type E illness from home-salted fish in patients presenting with predominantly gastrointestinal symptoms. DOIExternal PubMedExternal
    Sobel J, Malavet M, John S. Clin Infect Dis. 2007 Jul 15; 45(2): p. 14–6.
  • The need for global planned mobilization of essential medicine: lessons from a massive Thai botulism outbreak. PDF [3 - pages]External PubMedExternal PMCExternal
    Ungchusak K, Chunsuttiwat S, Braden CR, Aldis W, Ueno K, Olsen SJ, Wiboolpolprasert S. Bull World Health Organ. 2007 Mar; 85(3): p. 238–240.
  • Brief Report: Foodborne botulism from home-prepared fermented tofu—California. MMWR PubMedExternal
    Meyers H, Inami G, Rosenberg J, Mohle-Boetani J, Vugia D, Yuan J. MMWR Morb Mortal Wkly Rep. 2007 Feb 9; 56(5): p. 96–7.
  • Botulism type E outbreak associated with eating a beached whale, Alaska. DOIExternal PubMedExternal PMCExternal
    McLaughlin JB, Sobel J, Lynn T, Funk E, Middaugh JP. Emerg Infect Dis. 2004 Sep; 10(9): p. 1685–7.
  • Botulism among Alaska natives in the Bristol Bay area of southwest Alaska: a survey of knowledge, attitudes, and practices related to fermented foods known to cause botulism. DOIExternal PubMedExternal
    Chiou LA, Hennessy TW, Horn A, Carter G, Butler JC. Int J Circumpolar Health. 2002 Feb; 61(1): p. 50–60.
  • Foodborne botulism from eating home-pickled eggs—Illinois, 1997. MMWR PubMedExternal
    Rifkin G, Sibounheuang K, Peterson L, Kelly K, Langkop C, Kauerauf D, Groeschel E, Adam B, Austin C, Bornstein S, Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2000 Sep 1; 49(34): p. 778–80.
Botulism linked to pruno, a type of homemade alcohol
  • Notes from the field: botulism outbreak from drinking prison-made illicit alcohol in a federal correctional facility—Mississippi, June 2016. MMWR PubMed↗ExternalMcCrickard L, Marlow M, Self JL, Watkins LF, Chatham-Stephens K, Anderson J, Hand S, Taylor K, Hanson J, Patrick K, Luquez C, Dykes J, Kalb SR, Hoyt K, Barr JR, Crawford T, Chambers A, Douthit B, Cox R, Craig M, Spurzem J, Doherty J, Allswede M, Byers P, Dobbs T. MMWR Morb Mortal Wkly Rep. 2017 Jan 6; 65(52): p. 1491–2.
  • A qualitative inquiry about pruno, an illicit alcoholic beverage linked to botulism outbreaks in United States prisons. DOIExternal PubMed PMCExternal
    Walters MS, Sreenivasan N, Person B, Shew M, Wheeler D, Hall J, Bogdanow L, Leniek K, Rao A. Am J Public Health. 2015 Nov; 105(11): p. 2256–61.
  • Alcohol production, prevention strategies, and inmate knowledge about the risk for botulism from pruno consumption in a correctional facility—Arizona, 2013. DOIExternal PubMedExternal PMCExternal
    Adams LE, Yasmin S, Briggs G, Redden K, Silvas S, Anderson S, Weiss J, Tsang CA, Henke E, Francies J, Herrick K, Lira R, Livar E, Thompson G, Sunenshine R, Robinson BF, Bisgard KM, Komatsu KK. J Correct Health Care. 2015 Oct; 21(4): p. 335–42.
  • Notes from the field: botulism from drinking prison-made illicit alcohol—Arizona, 2012. MMWR PubMedExternal PMCExternal
    Briggs G, Anderson S, Komatsu K, Weiss J, Henke E, Tsang CA, Vasiq M, Rao AK, Mody RK, Luquez C, Dykes JK, Morris JF, Anderson TC, Adams LE, Yasmin S. MMWR Morb Mortal Wkly Rep. 2013 Feb 8; 62(5): p. 88.
  • Botulism from drinking prison-made illicit alcohol—Utah, 2011. MMWR PubMedExternal
    Thurston D, Risk I, Hill MB, Vitek D, Bogdanow L, Robertson J, Price A, Smith L, Rao A, Dykes J, Luquez C, Walters M. MMWR Morb Mortal Wkly Rep. 2012 Oct 5; 61(39): p. 782–4.
  • Botulism from drinking pruno. DOIExternal PubMedExternal PMCExternal
    Vugia DJ, Mase SR, Cole B, Stiles J, Rosenberg J, Velasquez L, Radner A, Inami G. Emerg Infect Dis. 2009 Jan; 15(1): p. 69–71.
Botulism linked to other foods
  • Notes from the field: botulism caused by consumption of commercially produced potato soups stored improperly—Ohio and Georgia, 2011. MMWR PubMedExternal
    Seaman MP, Sulka AC, Tobin-D’Angelo M, Blass MA, Mills RL, Carmean J, Luquez C, Maslanka S, Jackson KA, Mahon BE, Griffin PM, O’Connor KA, Taylor EV. MMWR Morb Mortal Wkly Rep. 2011 Jul 8; 60(26): p. 890.
  • International outbreak of severe botulism with prolonged toxemia caused by commercial carrot juice. DOIExternal PubMedExternal
    Sheth AN, Wiersma P, Atrubin D, Dubey V, Zink D, Skinner G, Doerr F, Juliao P, Gonzalez G, Burnett C, Drenzek C, Shuler C, Austin J, Ellis A, Maslanka S, Sobel J. Clin Infect Dis. 2008 Nov 15; 47(10): p. 1245–51.
  • Botulism associated with commercially canned chili sauce—Texas and Indiana. MMWR PubMedExternal
    Ginsberg MM, Granzow L, Teclaw RF, Gaul LK, Bagdure S, Cole A, Drumgoole R, Barzilay EJ, Biggerstaff MS, Lynch MF, Maslanka SE, Williams IT, Juliao PC, Barton Behravesh C, Olson CK. MMWR Morb Mortal Wkly Rep. 2007 Aug 3; 56(30): p. 767–9.
  • Botulism associated with commercial carrot juice—Georgia and Florida, September 2006. MMWR PubMedExternal
    Shuler C, Drenzek C, Lance S, Gonzalez G, Miller J, Tobin-D’Angelo M, Gabel J, Burnett C, Atrubin D, Sobel J, Juliao P, Maslanka S, Wiersma P, Sheth A. MMWR Morb Mortal Wkly Rep. 2006 Oct 13; 55(40): p. 1098–9.
  • An outbreak of foodborne botulism associated with food sold at a salvage store in Texas. DOIExternal PubMedExternal
    Kalluri P, Crowe C, Reller M, Gaul L, Hayslett J, Barth S, Eliasberg S, Ferreira J, Holt K, Bengston S, Hendricks K, Sobel J. Clin Infect Dis. 2003 Dec 1; 37(11): p. 1490–5.
  • A large outbreak of botulism: the hazardous baked potato. DOIExternal PubMedExternal
    Angulo FJ, Getz J, Taylor JP, Hendricks KA, Hatheway CL, Barth SS, Solomon HM, Larson AE, Johnson EA, Nickey LN, Ries AA. J Infect Dis. 1998 Jul; 178(1): p. 172–7.
  • Foodborne botulism—Oklahoma, 1994. MMWR PubMedExternal
    Knubley W, McChesney TC, Mallonee J, Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 1995 Mar 24; 44(11): p. 200–2.
  • Epidemiologic notes and reports fish botulism—Hawaii, 1990. MMWR DOIExternal PubMedExternal
    Kershaw P, Dioso M, Wong B, Ibara C, Robertson D, Tamao W, Sugi M, Pon EW, Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 1991 Jun  21; 40(24): p. 412–4.
  • Botulism from chopped garlic: delayed recognition of a major outbreak. DOIExternal PubMedExternal
    St. Louis ME, Peck SHS, Bowering D, Morgan GB, Blatherwick J, Banerjee S, Kettyls GDM, Black WA, Milling ME, Hauschild AHW, Tauxe RV, Blake PA. Ann Intern Med. 1988 Mar; 108(3): p. 363–8.
Other foodborne botulism
  • Foodborne botulism in the United States, 1999–2000. DOIExternal PubMedExternal PMCExternal
    Sobel J, Tucker N, McLaughlin J, Maslanka S. Emerg Infect Dis. 2004 Sep; 10(9): p. 1606–11.
  • Foodborne botulism in the Republic of Georgia. DOIExternal PubMedExternal PMCExternal
    Varma JK, Katsitadze G, Moiscrafishvili M, Zardiashvili T, Chikheli M, Tarkashvili N, Jhorjholiani E, Chubinidze M, Kukhalashvili T, Khmaladze I, Chakvetadze N, Imnadze P, Sobel J. Emerg Infect Dis. 2004 Sept; 10(9): p. 1601–5.
  • Signs and symptoms predictive of death in patients with foodborne botulism—Republic of Georgia, 1980–2002. DOIExternal PubMedExternal
    Varma JK, Katsitadze G, Moiscrafishvili M, Zardiashvili T, Chokheli M, Tarkhashvili N, Jhorjholiani E, Chubinidze M, Kukhalashvili T, Khmaladze I, Chakvetadze N, Imnadze P, Hoekstra M, Sobel J. Clin Infect Dis. 2004 Aug 1; 39(3): p. 357–62.

  • Botulism in Alaska: A Guide for Physicians and Health Care Providers. CDC Stacks PDF Cdc-pdf[32 pages]External
    Castrodale LJ (ed.). State of Alaska Department of Health and Social Services. 2011.
  • Endemic foodborne botulism among Alaska Native persons—Alaska, 1947–2007. DOIExternal PubMedExternal
    Fagan RP, McLaughlin JB, Castrodale LJ, Gessner BD, Jenkerson SA, Funk EA, Hennessy TW, Middaugh JP, Butler JC. Clin Infect Dis. 2011 Mar 1; 52(5): p. 585–92.
  • Botulism among Alaska Natives in the Bristol Bay area of southwest Alaska: a survey of knowledge, attitudes, and practices related to fermented foods known to cause botulism. DOIExternal PubMedExternal
    Chiou LA, Hennessy TW, Horn A, Carter G, Butler JC. Int J Circumpolar Health. 2002 Feb; 61(1): p. 50–60.
  • Botulism among Alaska Natives. The role of changing food preparation and consumption practices. PubMedExternal PMCExternal
    Shaffer N, Wainwright RB, Middaugh JP, Tauxe RV. West J Med. 1990 Oct; 153(4): p. 390–3.

  • Equine botulinum antitoxin for the treatment of infant botulism. DOIExternal PubMed↗External PMCExternal
    Vanella de Cuetos EE1, Fernandez RA, Bianco MI, Sartori OJ, Piovano ML, Lúquez C, de Jong LI. Clin Vaccine Immunol. 2011 Nov; 18(11): p. 1845–9.
  • Clostridial infections: botulism and infant botulism. In: The Red Book: 2009 Report of the Committee on Infectious Diseases. PDF Cdc-pdf[32 pages]External
    Arnon SS, Barzilay EJ. Editors: Pickering LK, Baker CJ, Kimberlin DW, Long SS. Elk Grove Village (IL): American Academy of Pediatrics; 2009. p. 259–62.
  • Intestinal botulism formerly infant botulism. In: Control of Communicable Disease Manual. 19th ed. APHAExternal
    Barzilay E, Schlundt J, Toyofuku H. Editor: Heymann DL. Washington, D.C.: American Public Health Association. 2008. p. 79–87.
  • Global occurrence of infant botulism, 1976–2006. DOIExternal PubMedExternal
    Koepke R, Sobel J, Arnon S. Pediatrics. 2008 Jul; 122(1): p. 72–82.
  • Human botulism immune globulin for the treatment of infant botulism. DOIExternal PubMedExternal
    Arnon SS, Schechter R, Maslanka SE, Jewell NP, Hatheway CL. N Engl J Med. 2006 Feb 2; 354(5): p. 462–71.
  • Foodborne botulism in a six-month-old infant caused by home-canned baby food. DOIExternal PubMed↗External
    Armada M, Love S, Barrett E, Monroe J, Peery D, Sobel J. Ann Emerg Med. 2003 Aug; 42(2): p. 226–9.
  • Infant botulism—New York City, 2001–2002. MMWR PubMedExternal
    Reddy V, Balter S, Weiss D, Layton M, Kornstein L, Friberg I, Shechter R, Arnon S, Hung MJ, Bresnitz E, Pilot K, Matiuck S, Sobel J, Phillips M. MMWR Morb Mortal Wkly Rep. 2003 Jan 17; 52(2): p. 21–4.
  • Risk of infant botulism from corn syrup.
    Olsen SJ, Swerdlow DL. Pediatr Infect Dis J. 2000 Jun; 19(6): p. 584–5. OvidExternal PubMedExternal

  • Wound Botulism in California, 1951–1998: Recent Epidemic in Heroin Injectors. DOIExternal PubMedExternal
    Benson Werner S, Passaro D, McGee J, Schechter R, Vugia DJ. Clin Infect Dis. 2000 Oct 1; 31(4): p. 1018–24.
  • Recurrent wound botulism among injection drug users in California. DOIExternal PubMedExternal
    Yuan J, Inami G, Mohle-Boetani J, Vugia DJ. Clin Infect Dis. 2011 Apr 1; 52(7): p. 862–6.
  • Wound botulism acquired in the Amazonian rain forest of Ecuador. PDF - 4 pagesCdc-pdfExternal PubMedExternal
    Reller ME, Douce RW, Maslanka SE, Torres DS, Manock SR, Sobel J. Am J Trop Med Hyg. 2006 Apr; 74(4): p. 628–31.
  • Wound botulism among black tar heroin users—Washington, 2003. MMWR DOIExternal PubMedExternal
    Spitters C, Moran J, Kruse D, Barg N, Leslie M, Hoffman J, Moore M, Macgregor-Skinner G. MMWR Morb Mortal Wkly Rep. 2003 Sep 19; 52(37): p. 885–6.
  • Wound botulism—California, 1995. MMWR PubMedExternal
    Gollober M, Beyer RA, Kwan S, Bates RO, Billimek M, Matson SE, Feldman G, Bryant R, McGee J, Werner SB, Glaser CA, Vugia DJ, Waterman SH. MMWR Morb Mortal Wkly Rep. 1995 Dec 8; 44(48): p. 889–92.

  • Efficacy of Antitoxin Therapy in Treating Patients With Foodborne Botulism: A Systematic Review and Meta-analysis of Cases, 1923–2016. DOIExternal PubMedExternal PMCExternal
    O'Horo JC, Harper EP, El Rafei A, Ali R, DeSimone DC, Sakusic A, Abu Saleh OM, Marcelin JR, Tan EM, Rao AK, Sobel J, Tosh PK. Clin Infect Dis. 2017 Dec 27; 66 (Suppl 1): p. S43–S56.
  • Safety and Improved Clinical Outcomes in Patients Treated With New Equine-Derived Heptavalent Botulinum Antitoxin. DOIExternal PubMedExternal PMCExternal
    Yu PA, Lin NH, Mahon BE, Sobel J, Yu Y, Mody RK, Gu W, Clements J, Kim HJ, Rao AK. Clin Infect Dis. 2017 Dec 27; 66 (Suppl 1): p. S57–S64.
  • Allergic Reactions to Botulinum Antitoxin: A Systematic Review. DOIExternal PubMedExternal PMCExternal
    Schussler E, Sobel J, Hsu J, Yu P, Meaney-Delman D, Grammer LC 3rd, Nowak-Wegrzyn A. Clin Infect Dis. 2017 Dec 27; 66 (Suppl 1): p. S65–S72.
  • The eyes have it. DOIExternal PubMedExternal
    Rao AK, Jackson KA, Mahon BE. N Engl J Med. 2013 Jan 24; 368(4): p. 392.
  • Initial recovery and rebound of type F intestinal colonization botulism after administration of investigational heptavalent botulinum antitoxin. DOIExternal PubMedExternal
    Fagan RP, Neil KP, Sasich R, Luquez C, Asaad H, Maslanka S, Khalil W. Clin Infect Dis. 2011 Nov; 53(9): p. 125–8.
  • Utility of botulinum toxin ELISA A, B, E, F kits for clinical laboratory investigations of human botulism. DOIExternal
    Maslanka SE, Luquez C, Raphael BH, Dykes JK, Joseph, LA. Botulinum J. 2011; 2(1): p. 72–92.
  • Investigational heptavalent botulinum antitoxin (HBAT) to replace licensed antitoxin AB and investigational botulinum antitoxin E. MMWR PubMedExternal
    Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2010 Mar 19; 59(10): p. 299.

  • Botulism. In: Beyond Anthrax: The Weaponization of Infectious Diseases. SpringerExternal
    Sobel J. Editors: Lutwick LI, Lutwick SM. Towata (NJ): Humana Press. 2009. p. 85–105.
  • Botulinum toxin as a biological weapon: medical and public health management. DOIExternal PubMedExternal
    Arnon SS, Schechter R, Inglesby TV, Henderson DA, Bartlett JG, Ascher MS, Eitzen E, Fine AD, Hauer J, Layton M, Lillibridge S, Osterholm MT, O'Toole T, Parker G, Perl TM, Russell PK, Swerdlow DL, Tonat K. JAMA. 2001 Feb 28; 285(8): p. 1059–70.
  • Botulism surveillance and emergency response: a public health strategy for a global challenge. DOIExternal PubMedExternal
    Shapiro RL, Hatheway C, Becher J, Swerdlow DL. JAMA. 1997 Aug 6; 278(5): p. 433–5.