December 8, 2022

Rapid Response on Ohio’s Church Potluck Botulism Outbreak

The botulism outbreak at the Cross Pointe Free Will Baptist Church in Lancaster, Ohio in April 2015 was the nation’s largest in 40 years. The CDC’s Morbidity and Mortality Weekly Report (MMWR) released a study on the outbreak that gives credit to early diagnoses that limited the number of deaths.

Potato Salad FPBOne person died in this botulism outbreak; and 29 people were sickened. The last time an outbreak of 10 or more people resulted in a death in the U.S. was in 1978. An outbreak in New Mexico  at that time sickened 34 people and killed one person.

It can be difficult to diagnose botulism, since the early symptoms, including difficulty swallowing, facial weakness, and drooping eyelids, can mimic a stroke. On April 21, 2015, the Fairfield Medical Center contacted with Ohio Department of Health because one person presented to the hospital with botulism. A single case is a public health emergency, because it can signal an outbreak, according to the report.

Within the next two hours, four more patients arrived at the emergency room. All five people had eaten at the potluck two days before. The CDC’s Strategic National Stockpile sent 50 doses of botulinum antitoxin to Ohio, in a rapid response to the diagnoses.

Among the 77 people at the potluck, 25 met the confirmed-case definition, and four met the probable-case definition. The median patient age was 64 years. Seventeen of the patients were female.

Twenty-five patients received the antitoxin. Eleven required intubation and mechanical ventilation to help them breathe. Among 19 cases that were lab-confirmed, specimens were positive for botulinum neurotoxin type A or Clostridium botulinum type A. Sixteen people were able to go home after a week.

When patients were interviewed, it became clear that potato salad was the food with the highest association with probable or confirmed cases. Of the 12 food specimens collected from the church dumpster, six were positive for botulinum neurotoxin type A: five were potato salad and one was contaminated macaroni and cheese that was probably contaminated after it was thrown away.

The person who prepared the potato salad used home-canned potatoes, and used a boiling water canner, which does not kill botulism spores. Only a pressure canned kills the spores.

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