Researchers look at 60 years of botulism data in Ukraine

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Eliminating foodborne botulism in Ukraine will only be possible with an end to home canning and state control of commercial canned products, according to a study.

Researchers assessed foodborne botulism in Ukraine from 1955 to 2018 using national epidemiological surveillance data. In this 63 year period, 8,614 cases were recorded and 659 deaths. They looked at biological, social, and economic factors that could influence prevalence of the rare illness caused by toxins produced by Clostridium botulinum bacteria.

Homemade canned meat and fish are the leading causes of botulism poisoning in Ukraine. Cases related to commercial food were rare but have increased in recent years, possibly because of the lack of government control over the production and sale of canned fish, said scientists.

Factors influencing botulism rate
Botulism in Ukraine is related to traditional socioeconomic factors and cultural food habits. Because of declining living standards and uncertainty that products will be physically or economically available, homemade preservation increases, posing a risk to the population.

The study in the journal Foodborne Pathogens and Disease was divided into periods: 1955 to 1990, when Ukraine belonged to the Soviet Union and 1991 to 2018, years of Ukraine’s independence. The latter period was split into 1991 to the early 2000s, the first decade of independence and deep social and economic crisis, and 2017 to 2018 to show the country’s current development.

In total, 5,158 botulism cases were recorded during 1955 to 1999, while from 2000 to 2018, the figure was 3,456. After Ukraine established independence, 5,665 cases were registered from 1991 to 2018. A smaller number at 2,949 occurred during 1955 to 1990 when Ukraine was in the Soviet Union. Deaths varied from none to 35 annually.

The highest fatality rates were during the Soviet period and the early years of Ukraine’s independence. Researchers hypothesized this was because the economic decline was greatest at this time and contributed to an increase in consumption of home canned foods.

Distribution of types of botulism toxins was mainly type B, followed by type E, type A, suspected as C, others and unidentified. Human botulism caused by suspected type C toxin is rare but seems to be responsible for 13 of 5,229 cases.

Rising fish risk
Researchers said a decrease in type B and increase in type E toxin are because of reduced consumption of canned meat and more intake of fish products.

Canned meat products caused the most botulism cases followed by canned fish such as dried and dehydrated fish; canned mushrooms and canned vegetables. The proportion of meat products and canned mushrooms linked to illness decreased over time while that of fish products increased.

An increased living standard of the Ukrainian population during the 1960s to 1980s led to the widespread preparation and consumption of home-cooked canned products without proper sterilization techniques. This situation contributed to the rising incidence of botulism in the decades before the Soviet Union collapse, said researchers.

In the 1990s, botulism increased further and peaked in 1999 with 345 cases. This was driven by an economic crisis following the collapse of the Soviet Union. Poverty and food shortages led to more widespread use of home canning as a means of survival. It has been on the decline since the early 2000s as the country’s situation improves and more fresh food is available.

However, in 2017-2018, the percentage of food sold that caused botulism went up sharply. This upward trend is a negative consequence of the sanitary and epidemiological service being terminated in 2017, through which state monitoring and control over the production and sale of food products were lost.

Botulism in Poland and Egypt
A different study identified 35 foodborne botulism patients from 2010 to 2018 at one site in eastern Poland.

A total of 24 cases at the Department of Infectious Diseases, Medical University of Lublin were laboratory confirmed. Most were males and all were residents from rural areas.

Toxin type B was implicated in more than half of cases. Hospitalization ranged from eight to 31 days but nobody died. The most common food source was homemade traditional pork products preserved in jars. Nine cases were associated with consumption of commercially canned food products.

Finally, in September and October 2019, 94 patients were admitted into Alexandria Poison Center in Egypt after eating Feseekh, which is a type of salted fish.

Hospitalized patients were categorized according to symptoms consistent with botulism and two people died. Sixty cases with suspected botulism were managed by supportive treatment only.

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