1. Outbreak of Botulism Associated with Fermented Beaver – Alaska, 2001
Louisa Castrodale, DVM, MPH
Section of Epidemiology
Alaska Division of Public Health

2. Outbreak Southwestern Alaska village 14 Alaska Natives
Beaver paw and tail
Lunchtime on January 17
Following morning, symptoms compatible with botulism

3. Botulism Ingestion of toxin produced by Clostridium botulinum
Blocks Ach release at neuromuscular junctions
Symmetrical descending paralysis
Incubation hrs (range 6-240)
Case fatality rate 5-10%

4. Symptoms GI, neurologic, respiratory Diagnostic Pentad
Nausea or vomiting
Dysphagia
Diplopia
Dilated, fixed pupils
Dry throat

5. Botulism in Alaska First outbreak in 1940s
Highest rate in United States
Case-patients all Alaska Natives
Consuming traditional foods
Recent decline coincident with prevention efforts by AIP-CDC

6. Methods Interviews of exposed persons Symptoms and onset Food history
Details of food preparation
Specimens collected
Serum, stool, gastric aspirate
Beaver

7. Persons Exposed Person Pentad Level Antitoxin
# (n/5) of care (A/B & E)
tertiary* Y
tertiary* Y
tertiary Y
< 1 observed N each for >48 hrs
*placed on ventilator

8. Beaver Paws Tested for Botulinum
Toxin at CDC, Atlanta, GA

9. Results Toxin type E Serum from Persons 1 and 2 Stool from Person 3
Beaver paws
Cultures pending

10. Fermentation Process Beavers hunted Nov ‘00 - Jan ‘01
Cut up and placed in heavy paper sack; left to ferment in entryway
C. botulinum spores ubiquitous; toxin production facilitated by
Anerobic conditions
Warm environment

11. Summary Outbreak associated with consumption of fermented beaver
Three cases of botulism confirmed

12. Recommendations
Still a need to evaluate educational messages and prevention strategies that emphasize safe fermentation and consumption practices

13. Acknowledgments Coauthor: Michael Beller Andrea Horn, RS, BBAHC
Susan Maslanka, CDC/Bot Lab
Arctic Investigations Program
AK State Public Health Laboratory