Improving Public Health Response to Botulism Cases and Outbreaks

Brief Summary
This roundtable will review botulism response including a) clinical consultation and antitoxin delivery, b) public health investigation strategies for suspected foodborne botulism, and c) laboratory testing.  It will also introduce plans for the Medical Countermeasures Electronic Response System (MERIS) and provide a forum for discussion.  Every case of botulism is a public health emergency because of the severity of illness and potential for outbreaks.  Health departments and CDC are available 24/7 for clinical consultation, antitoxin release, and investigations.  Antitoxin delivery often requires assistance from state health departments.  Investigations involve two main aspects: vehicle identification and laboratory testing. Strategies for identifying suspected foods for testing will be discussed, as will routing of clinical and food specimens for testing.   As part of preparedness efforts for mass events of several types including botulism, the Strategic National Stockpile at CDC is developing MERIS, an automated electronic system for release of medical countermeasures (e.g., botulinum antitoxin). For decades, CDC has performed antitoxin releases after time-consuming consultations with clinicians via telephone.  With implementation of MERIS, CDC will continue to provide 24/7 live consultant availability, but physicians will initiate consultation through completion of an online case report form.  The draft plan is the following: For routine cases, antitoxin release will be automated. Live consultation will be required only for complex or ambiguous cases but will always be available at clinician request. Health departments’ role as first contact for clinicians, principal investigators of suspected cases, and partners in arranging laboratory testing and delivery of antitoxin will be maintained.  Because the initial CDC interface with health departments and clinicians will be electronic, however, state health department awareness of MERIS will be important to botulism response.  MERIS is designed to allow quick and efficient response in the event of a large number of botulinum antitoxin requests and to improve coordination between the various CDC divisions involved in antitoxin release.  Although the impetus for development of MERIS is preparedness for possible large events, MERIS will be used for all botulinum antitoxin releases, whether single cases or outbreaks.