Botulism/Primary Prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Michael Maddaleni, B.S., Hafiz M. Ahmed, M.D.[2]
Overview
Primary prevention of botulism includes safe food preservation and storage, appropriate wound care, avoidance of honey in infants younger than 1 year, and safe administration of botulinum toxin products. Prevention measures differ according to the route of exposure, and most cases of infant botulism cannot be prevented.
Primary Prevention
A. Foodborne botulism
Safe food preservation
- Follow current USDA-based home-canning instructions and use equipment appropriate for the food being preserved.
- Use pressure canning for low-acid foods, including vegetables, meat, poultry, fish, and seafood. A boiling-water canner is not an adequate substitute for these foods.
- Do not eat food when its canning, preservation, or fermentation safety is uncertain.
- Discard food in leaking, swollen, bulging, cracked, or otherwise damaged containers. Other warning signs include spurting liquid or foam on opening and food that is moldy, discolored, or smells abnormal.
- Never taste suspect food to assess its safety; botulinum toxin cannot be reliably detected by appearance, smell, or taste.
Boiling before consumption
- Before eating, boil home-canned tomatoes, foods containing home-canned tomatoes, and all low-acid home-canned foods in a saucepan.
- At elevations below 1,000 feet, boil for 10 minutes. Increase the boiling time by 1 minute for each additional 1,000 feet of elevation.
B. Food storage
- Refrigerate canned and pickled foods after opening.
- Keep homemade garlic- or herb-infused oils refrigerated and discard unused oil after 4 days.
- Keep foil-wrapped baked potatoes at 140°F (60°C) or hotter until serving. Alternatively, refrigerate at 40°F (approximately 4°C) or colder with the foil loosened to allow air circulation.
C. Fermented fish and Alaska Native foods
- Follow traditional preparation methods that permit air circulation; avoid fermenting Alaska Native foods in plastic or glass containers.
- Keep fermenting foods cold, ideally below 37°F (approximately 3°C), and use salt when drying fish.
- Boil home-fermented Alaska Native foods before consumption for 10 minutes below 1,000 feet, adding 1 minute for each additional 1,000 feet of elevation.
- Discard foods when safe preparation cannot be established.
D. Wound botulism
- Keep wounds clean and seek prompt medical attention for suspected wound infection. Wound botulism can occur even when a wound does not appear infected.
- Avoid injecting illicit drugs. Subcutaneous or intramuscular injection and black tar heroin use are particularly associated with wound botulism.
- Heating heroin does not eliminate the bacteria responsible for botulism.
- For people who continue injecting drugs, clean equipment and safer injection practices can reduce other infections, but their effectiveness in preventing botulism is unknown.
E. Infant botulism
- Do not give honey or honey-containing products, including honey-filled pacifiers, to infants younger than 1 year.
- Most infant botulism cannot be prevented because exposure to spores in soil and dust may occur despite household cleaning.
F. Iatrogenic botulism
- Obtain botulinum toxin injections from appropriately licensed healthcare professionals trained in their administration.
- Confirm that the product is FDA-approved and obtained from an authorized source.
- Do not self-inject botulinum toxin products.
- If the provider's qualifications or product source cannot be verified, do not proceed with the injection.[1]
References
- ↑ Centers for Disease Control and Prevention. Botulism Prevention. February 26, 2026. Accessed October 16, 2026. https://www.cdc.gov/botulism/prevention/index.html
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