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Botulism patients face paralysis risk as Vietnam runs out of antitoxin

Three men poisoned with botulinum after eating pork bologna and fermented food in Ho Chi Minh City could be paralyzed completely, doctors have said.

Le Quoc Hung, chief of the Department of Tropical Diseases at Cho Ray Hospital in the city, said on Monday that two patients at the hospital and one at the city’s Gia Dinh Hospital are all on ventilators.

If there is no botulism antitoxin heptavalent (BAT), a licensed, commercially available botulism antitoxin that effectively neutralizes all known botulinum nerve toxin serotypes, the poison will attack the bodies and cause complete paralysis, said Hung.

The doctor explained that those poisoned with botulinum would be completely safe if taking BAT within 72 hours.

Between May 13 and 20, the six people in Thu Duc were poisoned with botulinum. Five of them were sick after eating pork bologna sold by street vendors, and one ate fermented food.

Of the six cases, three children aged 10-14 are now in stable condition after they were given BAT at HCMC’s Children’s Hospital 2. But the fates of the three remaining patients, who are all male adults, are now hung in the balance as Vietnam has no BAT left.

A doctor pulls botulism antitoxin heptavalent (BAT) from the last vial of the medicine in Vietnam at HCMCs Childrens Hospital 2, May 2023. Photo by the hospital
A doctor pulls botulism antitoxin heptavalent (BAT) from the last vial of the medicine in Vietnam at HCMCs Childrens Hospital 2, May 2023. Photo by the hospital

For patients who suffer respiratory failure and must rely on ventilators for 1-2 days after getting poisoned, BAT could help them recover within one week. However, after that, they still need physical therapy to return to normal activities.

Thu Duc’s Health Department said the bologna in the five poisoning cases was produced by an illegal facility in the city. Though it has no license, the facility has been operating for two months.

“If the antidote is available, we could make sure that the patient’s health returns to normal soon, and ease pressure on the doctors,” said Hung.

In the past, patients poisoned with BAT had a high mortality rate due to a lack of ventilators. While doctors can now keep them alive, antitoxin is still required to save them.

Hung added that patients should not be kept on ventilators for a long period because the process could result in secondary infection and malnutrition.

According to the U.S. Center for Disease Control and Prevention, botulinum poisoning rarely occurs around the world and therefore the supply of BAT is limited. In Vietnam, BAT is not listed among medicines covered by the health insurance fund.

The Ministry of Health is working closely with the World Health Organization (WHO) to get BAT as soon as possible.

According to the WHO, the growth of the bacteria and the formation of toxin occur in products with low oxygen content and certain combinations of storage temperature and preservative parameters. This occurs most often in lightly preserved foods and in inadequately processed, home-canned or home-bottled foods.

Botulinum toxins are neurotoxic and therefore affect the nervous system. Early symptoms include marked fatigue, weakness and vertigo, usually followed by blurred vision, dry mouth and difficulty in swallowing and speaking. Vomiting, diarrhea, constipation and abdominal swelling may also occur.

The disease can progress to weakness in the neck and arms, after which the respiratory muscles and muscles of the lower body are affected. There is no fever and no loss of consciousness.

Symptoms usually appear within 12-36 hours. Incidence of botulism is low, but the mortality rate is high if prompt diagnosis and appropriate, immediate treatment are not given.

The disease can be fatal in 5-10% of cases.

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