Tristan P. Learoyd, MPharm, PGCE, GradDipLaw, MA, MBA, MSc, PhD, MRPharmS, FHEA, is Director of Global Health Programs, Emergent BioSolutions UK Ltd, London, United Kingdom.
Health Secur. 2024 Jun;22(3):203-209. doi: 10.1089/hs.2023.0081. Epub 2024 May 20.
Botulism is a rare, potentially fatal illness caused by botulinum toxins produced by bacteria. There are no coordinated worldwide reporting mechanisms for botulism cases and therefore few reliable case frequency estimates. This study aimed to establish an international benchmark for case frequency to determine estimated global rates of underreporting of botulism cases. To this end, a comprehensive, multilingual search of major global and national databases, including gray data and government sources, was performed. Data from case series were pooled, standardized against United Nations midyear population estimates, and analyzed using Kolmogorov-Smirnov tests to identify normally distributed data series. National incidence rates of normally distributed series were compared with that of the United States, which was considered the gold standard due to its extensive data reported for 2004-2018. A total of 6,932 botulism cases from 59 nations were identified in the literature, with a global case fatality rate of 1.37%. The national mean incidence rate ranged from 0.00 to 8.04 cases per million people, with an international mean incidence rate of 0.62 cases per million people. At the continent level, incidence rates tended toward normal distributions, although few countries outside of North America and Europe exhibited normal distributions. Based on comparisons with the US standard, an estimated 88.71% of botulism cases worldwide were unreported in 2016. Better awareness of botulism among healthcare professionals, coordinated global reporting mechanisms, and research on additional contributing factors to underreporting would enable better understanding of global case frequency, thereby potentially reducing the global incidence of botulism and improving outcomes.
肉毒中毒是一种罕见的、潜在致命的疾病，由细菌产生的肉毒毒素引起。目前，全球范围内还没有协调一致的肉毒中毒病例报告机制，因此可靠的病例频率估计值很少。本研究旨在建立国际病例频率基准，以确定肉毒中毒病例漏报的全球估计率。为此，对全球和国家主要数据库进行了全面的、多语言的搜索，包括灰色数据和政府来源。对病例系列数据进行了汇总，按照联合国年中人口估计值进行了标准化，并使用柯尔莫哥洛夫-斯米尔诺夫检验对数据进行了分析，以确定正态分布数据系列。对正态分布系列的国家发病率与美国进行了比较，美国被认为是黄金标准，因为其报告了 2004-2018 年广泛的数据。从文献中确定了来自 59 个国家的 6932 例肉毒中毒病例，全球病死率为 1.37%。国家平均发病率范围为每百万人 0.00-8.04 例，国际平均发病率为每百万人 0.62 例。在大陆层面，发病率趋于正态分布，但除北美和欧洲以外的少数国家除外。根据与美国标准的比较，估计 2016 年全球有 88.71%的肉毒中毒病例未报告。提高医疗保健专业人员对肉毒中毒的认识、协调全球报告机制以及对导致漏报的其他因素的研究，将有助于更好地了解全球病例频率，从而有可能降低肉毒中毒的全球发病率并改善预后。
