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 12-36 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) 1 4tertiary* Y 2 3tertiary* Y 3 3tertiary Y 4-14 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