410 IAC 1-2.5-84 Botulism; specific control measures

Sec. 84. The specific control measures for botulism - foodborne, infant, wound, or other (infectious agent: Clostridium botulinum), are as follows: (1) An investigation by the local health officer shall meet the following conditions: (A) Be performed immediately (within three (3) hours after clinical suspicion). (B) Include the following prior to symptom onset: (i) Five (5) day food and drink history. (ii) Fourteen (14) day wound history. (C) Recover all suspected food for appropriate testing and disposal. (D) If suspicion is high that the source is a commercial food product or a product served in a restaurant, the local health officer shall perform active surveillance to identify additional cases. The purpose of the investigation shall be case ascertainment, assurance of availability of the appropriate antitoxin through the department, and identification of the infection source. (2) Isolation is not required. (3) Implicated food that is not collected for laboratory analysis shall be double-bagged and discarded. The department shall direct bulk disposal. Contaminated environmental surfaces shall be sterilized by boiling or by chlorine disinfection to inactivate any remaining toxin. Feces from infant cases may be disposed of in a sanitary sewer. Terminal cleaning shall be followed. (4) Quarantine is not applicable. (5) Prophylaxis with antitoxin is not recommended for asymptomatic people who have ingested a food known to contain botulinum toxin. Physicians treating a patient who has been exposed to toxin or is suspected of having any type of botulism should contact the department immediately. People exposed to toxin who are asymptomatic should have close medical observation in nonsolitary settings. (6) The investigational botulinum toxoid pentavalent vaccine (types A, B, C, D, and E) has been discontinued for immunization among laboratory workers at high risk of exposure and is no longer available. (7) Requests for botulinum antitoxin for treatment of suspected wound or foodborne botulism shall be made through the department. Botulism immune globulin for treatment of infants with botulism may be requested through the department. Antitoxin for noninfant forms of botulism: Antitoxin should be procured immediately through the department. If contact cannot be made with the department, the CDC Emergency Operations Center should be contacted for botulism case consultation and antitoxin. Equine-derived investigational heptavalent botulinum antitoxin (HBAT) is the only botulinum antitoxin available for treatment. Antitoxin for infant botulism: Botulism immune globulin (BabyBIG) caused by C. botulinum type A or type B is made and distributed by the California Department of Public Health. HBAT is available and is not recommended routinely for infant botulism, but has been used to treat patients with type F infant botulism on a case-by-case basis. (8) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.