Dabritz Haydee A, Chung Connie H, Read Jennifer S, Khouri Jessica M
Infant Botulism Treatment and Prevention Program, Infectious Diseases Laboratories Division, Center for Laboratory Sciences, California Department of Public Health, Richmond, California.
Pediatrics. 2025 Apr 1;155(4). doi: 10.1542/peds.2024-068791.
We sought to summarize the worldwide occurrence and epidemiology of infant botulism (IB) from 2007 to 2021. Data were collected through active and passive surveillance, via hospital inquiries to the Infant Botulism Treatment and Prevention Program regarding Human Botulism Immune Globulin Intravenous for patients with suspected IB, by contact with epidemiologists in countries with historically high case counts and by searching the medical literature. A case was defined as an infant with laboratory-confirmed botulism that was not due to ingestion of food containing botulinum toxin. Eighteen countries reported their first cases between 2007 and 2021. Of the 2943 cases recognized from 2007 to 2021, 1587 were type A, 6 type Ab or A&B, 1 type Af, 1254 type B, 9 type Ba, 26 type Bf, 1 type Bh, 8 type E, 15 type F, and 36 of unknown toxin type. Median age at onset was 16.8 weeks and 48.4% of patients were female. Patients in the rest of the world (ROW) were more likely to be intubated than US patients (50.3% ROW vs 21.2%), have longer hospital stays (median 27.0 days ROW vs 12.0 days), and have consumed honey (19.7% ROW vs 3.8%). In conclusion, the distribution of IB cases worldwide does not reflect the detection of Clostridium botulinum spores in soil, suggesting IB is underrecognized in certain countries. To improve recognition of IB, physicians should consider IB when an infant presents with cranial nerve palsies, hypotonia, constipation, and/or poor feeding. Pediatricians globally should continue to educate parents about honey ingestion as one risk factor for IB.
我们试图总结2007年至2021年全球范围内婴儿肉毒中毒（IB）的发生情况和流行病学特征。数据通过主动和被动监测收集，通过医院向婴儿肉毒中毒治疗与预防项目询问疑似IB患者使用静脉注射人肉毒抗毒素的情况，与病例数历史较高国家的流行病学家联系，以及检索医学文献来获取。病例定义为实验室确诊的肉毒中毒婴儿，且不是由于摄入含有肉毒杆菌毒素的食物所致。18个国家报告了2007年至2021年期间的首例病例。在2007年至2021年确认的2943例病例中，1587例为A型，6例为Ab型或A&B型，1例为Af型，1254例为B型，9例为Ba型，26例为Bf型，1例为Bh型，8例为E型，15例为F型，36例毒素类型不明。发病的中位年龄为16.8周，48.4%的患者为女性。世界其他地区（ROW）的患者比美国患者更有可能接受插管（ROW为50.3%，美国为21.2%），住院时间更长（ROW中位住院时间为27.0天，美国为12.0天），且食用过蜂蜜（ROW为19.7%，美国为3.8%）。总之，全球范围内IB病例的分布情况并不反映土壤中肉毒梭菌孢子的检测情况，这表明在某些国家IB未得到充分认识。为了提高对IB的认识，当婴儿出现颅神经麻痹、肌张力减退、便秘和/或喂养不良时，医生应考虑到IB。全球的儿科医生应继续教育家长，让他们了解食用蜂蜜是IB的一个风险因素。
