Information updated on 05 July 2016

On 29 April, the Spanish Agency for Consumer Affairs, Food Safety and Nutrition received information from the Catalonia Health Authorities, via the Coordinated System for the Rapid Exchange of Information (SCIRI), of the existence of a possible Botulinum toxin poisoning associated with the consumption of codfish salad with haricot beans.

Two people have been affected out of a group of nine who ate together in a work environment on Monday 27 June. The meal consisted of a home-made salad with tomatoes, onion, cod flakes, fresh red pepper and canned haricot beans, followed by desserts.

The individuals affected had the following clinical symptoms: general malaise, vomiting, double vision, difficulty talking and photophobia. Both individuals were admitted to hospital.

The remaining diners, who to date have not presented any symptoms, have been located and warned that in the event of any symptoms they should go to hospital as a matter of urgency.

After the event was reported, the Catalonia Health Authorities gave notification via the national food alert network (SCIRI). This Agency forwarded this information to all the competent Authorities of the Autonomous Communities, asking the competent Authorities for Catalonia and La Rioja to carry out the relevant investigations into the possible causes, the distribution of the batches affected, the measures adopted and the final destination of the products located. They also notified the Alert Coordination Centre and Emergency Health Services.

Both the Competent Authorities of La Rioja, and the Competent Authorities of Catalonia have provided prompt information about the investigations, distribution and actions regarding the above products.

Today, following tests on the allegedly involved food by the National Food Centre, belonging to this Agency, the presence of Botulinum toxin has been confirmed in the food:

Cooked haricot beans 400 g glass jar Make: BONPREU. L- 146-16 (10:14 O6A Bottled by Hnos. Cuevas, SA for Bon Preu SAU Best before date: 31/12/2021

The competent Authorities of the Autonomous Community of La Rioja have confirmed that the suspicious products from the same manufacturing batch as the product which gave positive results are as follows:

• 400 g glass jars of cooked haricot beans, batch 146-16 make IFA Eliges, Bon Preu. Condis catalán and Condis castellano.
• 400 g glass jars of cooked haricot beans, Batch L-151-16, make el Cultivador.
• 400 g glass jars of cooked haricot beans, Batch L-158-16, make el Cultivador.
• 400 g glass jars of cooked haricot beans, batch L 168-16 make IFA Eliges.
• 400 g glass jars of cooked haricot beans, batch L-176-16 make CONDIS castellano, CONDIS catalán and Bon Preu

It should be noted that this Agency, as the central coordinating body of the national Food Alert Network, has communicated all the information received to date through this system.

Lastly, it is noted that the competent Authorities of the Autonomous Communities concerned and of the General State Administration, have maintained all the necessary mechanisms in place, in order to guarantee the safety of the products at the disposal of the consumer. To date, there is no evidence of any other affected persons.

Anyone with a jar of this product in their home is advised to refrain from eating it.

INFORMATION ABOUT BOTULISM

1.- What is botulism?

Botulism is a serious illness which in certain cases may be fatal. However, it is relatively rare. It is an intoxication usually caused by ingestion of food contaminated by very powerful neurotoxins.

Spores produced by the bacteria Clostridium botulinum are heat-resistant and exist widely in the environment, and in the absence of oxygen they germinate, grow and then excrete toxins. There are seven distinct forms of botulinum toxin, types A–G. Four of these (types A, B, E and rarely F) may cause human botulism. Toxin A has a greater affinity with the nerve tissue. Types C, D and E cause illness in other mammals, birds and fish. The botulinum bacteria need low-acid or alkaline conditions to grow: with pH values of more than 4.5.

2.-What is the main path of intoxication?

The most frequent path of intoxication is foodborne. The toxin is obtained from the consumption of improperly prepared or stored food. Other forms of contracting the disease include the infection of open wounds, inhalation or as a collateral effect from the use of the toxin in the treatment of neuromuscular diseases or in cosmetics.

3.- In which foods does it appear most frequently?

The foods most exposed to botulism include raw meat or fish preserved using poor salting or smoking processes, or low-acid vegetables or vegetables which may lose their natural acidity due to the action of other microorganisms. It may also appear in canned products.

The botulinum toxin has been found in a variety of foods, including low-acid preserved vegetables, such as green beans, spinach, mushrooms, and beets; fish, including canned tuna, fermented, salted and smoked fish; and meat products, such as ham and sausages. The food implicated differs between countries and reflects local eating habits and food preservation procedures. Occasionally, commercially prepared foods are involved.

4.- How does the botulinum toxin act?

The botulinum toxin acts by blocking the release of acetylcholine at neuromuscular junction level, preventing nerve impulse transmission, and causing flaccid muscular paralysis and respiratory failure. In foodborne intoxication, the preformed toxin in ingested and absorbed by endocytosis through the gastrointestinal tract.

After absorption, the toxin is transported through the lymphatic system or the bloodstream to its place of action: the cholinergic nerve endings. As it does not cross the blood-brain barrier, it only acts on the peripheral nervous system, especially at neuromuscular junction level, and on the autonomic nervous system.

5.- What are the symptoms?

Early symptoms include marked fatigue, weakness and vertigo, usually followed by blurred vision, dry mouth and difficulty in swallowing and speaking. Vomiting, diarrhoea, constipation and abdominal swelling may also occur. The disease can progress to weakness in the neck and arms, after which the respiratory muscles and muscles of the lower body are affected.

The symptoms are not caused by the bacterium itself, but by the toxin produced by the bacterium. Symptoms usually appear within 12 to 36 hours (within a minimum and maximum range of 4 hours to 8 days) after exposure.

Incidence of botulism is low, but the mortality rate is high if prompt diagnosis and appropriate, immediate treatment (early administration of antitoxin and intensive respiratory care) are not given. The disease can be fatal in 5 to 10% of cases.

6.- How is foodborne botulism produced?

C. botulinum is an anaerobic bacterium, meaning it can only grow in the absence of oxygen. Foodborne botulism occurs when C. botulinum grows and produces toxins in food prior to consumption. The growth of the bacteria and the formation of toxin occur in products with low oxygen content and certain combinations of storage temperature and preservative parameters. This happens most often in lightly preserved foods and in inadequately processed, home-canned or home-bottled foods.

C. botulinum will not grow in acidic conditions (pH less than 4.6), and therefore the toxin will not be formed in acidic foods (however, a low pH will not degrade any pre-formed toxin). Combinations of low storage temperature and salt contents and/or pH are also used to prevent the growth of the bacteria or the formation of the toxin.

Though spores of C. botulinum are heat-resistant, the toxin produced by bacteria growing out of the spores under anaerobic conditions is destroyed by boiling (for example, at internal temperature greater than 85 °C for 5 minutes or longer). Therefore, ready-to-eat foods in low oxygen-packaging are more frequently involved in cases of foodborne botulism.

Food samples associated with suspicious cases must be obtained immediately, stored in properly sealed containers, and sent to laboratories in order to identify the cause and to prevent further cases.

7.- How is it diagnosed in humans?

Diagnosis is usually based on clinical history and clinical examination followed by laboratory confirmation including demonstrating the presence of botulinum toxin in serum, stool or food, or a culture of C. botulinum from stool, wound or food.

8.- How is it treated?

Treatment is directed towards respiratory care (to prevent respiratory arrest), administering the botulism trivalent antitoxin (equine) ABE to neutralise the effect of the circulating toxin and applying supporting therapy. The patient may require intubation and the administration of intravenous fluids will be necessary if they continue to experience difficulties swallowing.

Early administration is effective in reducing mortality rates. The disease may lead to complications causing prolonged weakness and nervous system dysfunction which may last for up to a year.

9.- How is it prevented?

Prevention of foodborne botulism is based on good practice in food preparation particularly preservation and hygiene. Foodborne botulism may be prevented by the inactivation of the bacterium spores in the sterilized products. Commercial heat pasteurization (including vacuum packed pasteurized products and hot smoked products) may not be sufficient to kill all spores and therefore the safety of these products must be based on preventing bacterial growth and toxin production. Refrigeration temperatures combined with salt content and/or acidic conditions will prevent the growth of the bacteria and formation of toxin.

Individuals making canned food at home must observe strict hygiene procedures to reduce the contamination of foods, especially with a low-acid content, including carrot juice, asparagus, green beans, red peppers, aubergines, mushrooms, beetroot, sweet corn, etc. Although it is considered wherever practical, it is preferable to discourage home-canning due to the problems arising if the correct technology is not applied.

On the whole, consumers are advised to exercise caution with canned or preserved foods, and not to eat food from bulging or dented cans, or incorrectly sealed cans used at home or which contain air, or cold meats of dubious origin.