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Outbreak of foodborne botulism in Alexandria, Egypt: modulating indications for administration of heptavalent botulinum antitoxin


In October 2019, ninety-four patients were admitted into Alexandria Poison Center (APC) with a history of ingestion of Feseekh (salted fish). In an attempt to allocate the resources, not all patients were given HBAT (botulism antitoxin heptavalent (A, B, C, D, E, F, G) equine immediately. The current study aimed to portray the clinical characteristics of the cases, explore the possible relation between these characteristics and necessity of HBAT administration, explore the reliability of mouse lethal test, and establish a clinical guide for management including preservation of resources. The current prospective study included 94 patients who were admitted to Alexandria Poison Center (APC) in the period from the 29th of September to the 27th of October 2019. The patients’ data were recorded using a checklist that includes: personal data, past medical history, clinical assessment, investigations, treatment, and the outcome. The checklist was carried out to assess and follow up each patient. Hospitalized patients were categorized according to symptoms consistent with botulism. The equine HBAT, made by Emergent BioSolutions Canada Inc. (formerly Cangene Corporation), was used in the treatment. HBAT was given to thirty-four patients (36.2%) only out of the total admission. However, eighty-two (87.2%) of patients were completely cured, whereas ten patients (10.6%) were discharged with mild neurological sequels and death occurred only in two cases (2.2%). Sixty cases (63.8%) with suspected foodborne botulism could be managed by supportive treatment only with no need for HBAT, while patients with evident neurological signs received HBAT immediately.

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Sara A. Ghitani participated in the design of the study, drafted the manuscript, and participated in reviewing its final version; Maha A. Ghanem participated in data collection and in drafting the manuscript and reviewing the final version; Eman A. Sultan participated in the design of the study and performed the statistical analysis; Maram Atef participated in data collection and storage and reviewing the final version; and Maii F. Henaidy participated in writing the results section.

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Correspondence to Maram Atef.

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Approval was obtained from the Research Ethics Committee of Faculty of Medicine, Alexandria University (IRB NO:00012098, FWA NO: 00018699, serial protocol NO:0304565).

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The Ethics Committee is constituted and operates according to ICH GCP Guidelines and applicable local and institutional regulations and guidelines that govern ethics committees’ operation.

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Not applicable as the research didn’t include any individual person’s data in any form.

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The authors declare no competing interests.

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Responsible Editor: Lotfi Aleya

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Ghitani, S.A., Ghanem, M.A., Sultan, E.A. et al. Outbreak of foodborne botulism in Alexandria, Egypt: modulating indications for administration of heptavalent botulinum antitoxin. Environ Sci Pollut Res 28, 61547–61553 (2021).

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  • Botulism
  • Heptavalent botulinum antitoxin
  • Outbreak