Unsolved Mysteries: Three Botulism cases linked to korma sauce in 2011 outbreak

In the world of food safety risks botulism ranks high – while the probability of illness is low, the consequences are pretty dire. Paralysis (often leading to a ventilator) and potentially months of recovery.

Or death.

In November 2011, three kids from the same Scottish family became ill with botulism after eating from a jar of commercially-produced korma sauce. Health Protection Scotland released their report on the outbreak with no concrete answers as to what led to the illnesses: in-home contamination was unlikely, no other illnesses were linked to the product and the processing facility/supply chain controls checked out.

Executive summary of the report is below:

An outbreak of food-borne botulism in Scotland, November 2011

Health Protection Scotland

On Tuesday 8 November 2011, a 5 year old boy was admitted to Forth Valley Royal Hospital (FVRH), NHS Forth Valley (FV) with a history of transient double vision commencing on Monday 7 November, followed by a sore mouth and lower limb weakness. 

On Wednesday 9 November, after a deterioration in his condition he was ventilated and transferred to the Royal  Hospital for Sick Children (RHSC) Yorkhill.  At the time of his transfer the most likely diagnosis was thought to be Guillain-Barré syndrome.

Also on Wednesday 9 November, the boy’s 7 year old sister was admitted to FVRH with similar symptoms and the same date of onset.  Botulism was now considered a possible though unlikely diagnosis.  Later that evening the 7 year old sister was also transferred to RHSC, and ventilated.  By late evening the suspicion of the diagnosis of botulism was sufficiently strong to warrant the obtaining of trivalent botulinum antitoxin which was administered to both children, after which their condition stabilized.

At around 11pm, RHSC informed the Health Protection Agency (HPA) as well as NHS Greater Glasgow  and Clyde (GG&C) Consultant in Public Health Medicine (CPHM) who undertook an interview with the parents of the affected children.  HPA informed Health  Protection Scotland (HPS) who again informed NHS GG&C and NHS FV HPTs.

On the morning of Thursday 10  November, NHS FV HPT convened a Problem Assessment Group (PAG).   On the afternoon of Thursday 10 November, NHS FV HPT and Stirling Council (SC) Environmental Health Officers (EHOs) undertook an in-depth interview with the father of the children and collected food related specimens.

On Friday 11 November the HPA alerted the competent public health authorities throughout the European Union (EU) via the Early Warning and Response System (EWRS).

On Sunday 13 November, following  epidemiological,  environmental, microbiological and toxicological investigations, a jar of commercially produced korma sauce was identified as the vehicle of intoxication and the UK Food Standards Agency (FSA) took immediate action to withdraw the potentially affected batch from the  supply chain and retail market and informed the European Commission (EC) via the Rapid Alert System for Food and Feed (RASFF).  The FSA also alerted  the public to the potential risks from consumption of sauce from jars of korma sauce from the same batch.

HPS alerted clinicians in Scotland to the incident, reminding them of the early signs and symptoms of botulism.

Five days later, on Monday 14 November 2011, a third (female) sibling aged 3.5 years became unwell and  deteriorated over the course of the following day, choking whilst trying to swallow liquids.  This child was admitted to RHSC on Wednesday 16 November with a diagnosis of suspected botulism. 

SC EHOs’ detailed inspection and history-taking identified no evidence that the jar of korma sauce had been contaminated in the family’s home.  Despite the FSA’s intensive investigations at the production facility and the product’s supply chain, no faults were identified  to explain the contamination.  No evidence suggested that any jar, other than the one purchased by the affected family, had been contaminated.

The incident was closed at an Incident Management Team (IMT) meeting on Tuesday 6 December 2011.  All three children have recovered.

Click here for the report.