Jackson Kelly A, Mahon Barbara E, Copeland John, Fagan Ryan P
Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D63, Atlanta, GA 30333, USA.
Biostatistics and Information Management Office, Centers for Disease Control and Prevention, 2500 Century Boulevard, MS E33, Atlanta, GA 30345, USA.
Botulinum J. 2015;3(1):6-17. doi: 10.1504/TBJ.2015.078132. Epub 2016 Aug 4.
Botulism had mortality rates >60% before the 1950s. We reviewed confirmed botulism cases in the USA during 1975-2009 including infant, foodborne, wound, and other/unknown acquisition categories, and calculated mortality ratios. We created a multivariate logistic regression model for non-infant cases (foodborne, wound, and other/unknown). Overall mortality was 3.0% with 109 botulism-related deaths among 3,618 botulism cases [18 (<1%) deaths among 2,352 infant botulism cases, 61 (7.1%) deaths among 854 foodborne botulism cases, 18 (5.0%) deaths among 359 wound botulism cases, and 12 (22.6%) deaths among 53 other/unknown botulism cases]. Mortality among all cases increased with age; it was lowest among infants (0.8%) and highest among persons ≥80 years old (34.4%). Toxin type F had higher mortality (13.8%) than types A, B, or E (range, 1.4% to 4.1%). Efforts to reduce botulism mortality should target non-infant transmission categories and older adults.
在20世纪50年代之前，肉毒中毒的死亡率超过60%。我们回顾了1975年至2009年美国确诊的肉毒中毒病例，包括婴儿、食源性、伤口感染以及其他/不明感染途径的病例，并计算了死亡率。我们为非婴儿病例（食源性、伤口感染以及其他/不明感染途径）建立了多变量逻辑回归模型。总体死亡率为3.0%，在3618例肉毒中毒病例中有109例与肉毒中毒相关的死亡[2352例婴儿肉毒中毒病例中有18例（<1%）死亡，854例食源性肉毒中毒病例中有61例（7.1%）死亡，359例伤口感染肉毒中毒病例中有18例（5.0%）死亡，53例其他/不明感染途径肉毒中毒病例中有12例（22.6%）死亡]。所有病例中的死亡率随年龄增长而增加；婴儿中死亡率最低（0.8%），80岁及以上人群中死亡率最高（34.4%）。F型毒素的死亡率（13.8%）高于A、B或E型毒素（范围为1.4%至4.1%）。降低肉毒中毒死亡率的努力应针对非婴儿感染途径和老年人。
