National Botulism Surveillance

Since 1973, CDC, in partnership with state and local health officials and the Council of State and Territorial Epidemiologists (CSTE), has maintained the National Botulism Surveillance System for intensive surveillance for cases of botulism in the United States. The National Botulism Surveillance System collects reports of all confirmed botulism cases in the United States and is continuously monitored for early detection of outbreaks.

All 50 states and the District of Columbia report the following types of data for cases: Demographic (age, sex, race and ethnicity), clinical (transmission category, case-patient outcome), laboratory (laboratory testing method, toxin type), and epidemiologic (source of toxin). To be confirmed, cases must meet the CSTE case definition of botulism.

Transmission Categories

For surveillance purposes, CDC categorizes human botulism cases into four transmission categories: foodborne, wound, infant, and “other.”

• Foodborne botulism is caused by the consumption of foods containing pre-formed botulinum toxin.
• Wound botulism is caused by toxin produced in a wound infected with Clostridium botulinum.
• Infant botulism by definition occurs in persons less than one year of age and is caused by consumption of spores of C. botulinum, which then grow and release toxins in the intestines.
• “Other” botulism: Consistent with the Council of State and Territorial Epidemiologists (CSTE) position statements, the “other” category includes botulism in which the route of transmission is unknown. Cases are classified as “other” if the patient with confirmed botulism is not an infant, has no history of ingesting a suspect food, and has no wounds. The “other” category also includes iatrogenic botulism, which is caused by an accidental overdose of botulinum toxin (that is, a therapeutic or cosmetic injection), and adult intestinal colonization (adult intestinal toxemia) botulism, a rare kind of botulism that occurs among adults by the same route as infant botulism.

All data regarding antitoxin releases and laboratory confirmation of cases are recorded annually by CDC and published on this website. Because CDC, the Alaska Division of Public Health, and the California Department of Public Health (CDPH), are the only sources of botulism antitoxin administered in the United States, nearly all recognized cases of botulism are reported.

Surveillance Overview

National Botulism Surveillance Overview [PDF – 3 pages]