Incubation period as a clinical predictor of botulism: analysis of previous izushi-borne outbreaks in Hokkaido, Japan, from 1951 to 1965

Epidemiol Infect. 2007 Jan;135(1):126-30. doi: 10.1017/S0950268806006169. Epub 2006 May 10.

Abstract

This study investigated 21 foodborne type-E botulism outbreaks, without antitoxin administration, from 1951 to 1965 in Hokkaido, Japan, to characterize the descriptive epidemiology and evaluate the relationship between case fatality and incubation period. The median (25-75% quartile) attack rate and case fatality, which were evaluated by outbreak, were 58.3% (38.0-73.2) and 25.7% (0.1-50.0) respectively. Individual records of 64 diagnoses, including 31 deaths, were also examined using logistic regression analysis, revealing that a shorter incubation period is likely to result in a significantly higher risk of death (P=0.01). The observed case fatality was more than 50% for those who developed symptoms within the first 18 h after exposure, possibly reflecting underlying dose-dependent mechanisms. In the event of intentional contamination of food with botulinum toxin, rapidly determining the incubation periods may be critical for guiding public health response efforts.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Animals
  • Botulinum Toxins / analysis
  • Botulinum Toxins / toxicity*
  • Botulism* / diagnosis
  • Botulism* / epidemiology
  • Botulism* / mortality
  • Botulism* / physiopathology
  • Clostridium botulinum / pathogenicity*
  • Disease Outbreaks*
  • Female
  • Fishes / microbiology*
  • Foodborne Diseases* / diagnosis
  • Foodborne Diseases* / epidemiology
  • Foodborne Diseases* / mortality
  • Foodborne Diseases* / physiopathology
  • Humans
  • Japan
  • Likelihood Functions
  • Logistic Models
  • Male
  • Mortality
  • Oryza / microbiology*
  • Predictive Value of Tests
  • Time Factors

Substances

  • Botulinum Toxins
  • botulinum toxin type E