By: James Peacock

Northern California has been rocked recently by a deadly botulism outbreak, the second botulism outbreak to hit the state this year. One person has died, and nine more remain hospitalized, after eating nacho cheese sauce from a gas station in Walnut Grove, California. All who have been sickened in this outbreak have required hospitalization, and those who are still in the hospital are in varied conditions. One person has been paralyzed by the illness. The 10 people sickened in this outbreak have been from 4 different counties. The California Department of Public Health (CDPH) has released a statement regarding the outbreak but has not provided details about patient conditions and the specific counties affected in an effort to protect patient privacy.


The CDPH has been investigating this outbreak. The process of investigating an outbreak usually occurs after there is a spike in illnesses. Health officials have studied for years the average rate that specific pathogens cause illness, and are able to track when these background infections suddenly change. When a random spike in illnesses is detected, health officials can then investigate the outbreak, usually by taking samples and by conducting interviews. There is sometimes a correlation between interview answers, which can help investigators locate a source. Although interviews can help locate potential sources, the best way for health officials to learn more about an outbreak is through the testing of samples. When medical providers retrieve samples from ill people or from the environment, the samples undergo testing to learn more about them. In this case, the nacho cheese sauce taken from the Walnut Grove gas station was tested by the CDPH, who found that the sauce was positive for botulinum toxin, the agent that causes botulism. Further, the testing revealed that the botulinum found in the nacho cheese sauce is the same type that has been identified in patients affected by the outbreak. An independent lab has also confirmed these findings. The CDPH investigation led to the removal of the nacho cheese sauce from the gas station on May 5. The gas station, located about a 34 minute drive south of Sacramento, appears to be the only station affected by the contaminated nacho cheese sauce. The CDPH has said that they do not think there is any further danger presented to the public.

The nacho cheese sauce that caused the outbreak was distributed to the gas station by Gehl Foods. The company was notified by the FDA that their product had been seized, leading to the company testing the rest of the batch. Gehl Foods has confirmed that the retesting of their samples taken from the lot of nacho cheese sauce in question. The botulism testing came back negative, and again an independent lab confirmed the results. Due to continuing negative sample, Gehl Foods is not issuing a recall for any products. Gehl Foods, in a statement, said that they are working with authorities to determine the cause of the outbreak, and reiterated that there would be no recall because of the negative test results and the authorities stating that there was no further risk to the public.

What is Botulism?

Botulism is a very rare form of foodborne illness. In fact, foodborne botulism is only one of 5 distinct ways to develop an infection. These 5 kinds of botulism include wound, infant, adult intestinal, iatrogenic, and foodborne botulism. Even with 5 different types, botulism is fairly rare. In 2008, for instance, only 153 cases of botulism were reported to the CDC. Out of those cases, only 18 were considered to be foodborne in nature. Foodborne Botulism is transmitted by the bacteria known as Clostridium botulinum. These bacteria secrete botulinum toxin, of which only a few nanograms is required to cause illness. Most often, the cause for a foodborne botulism case is contaminated homemade canned foods. However, it is possible for Botulism to be caused by canned cheese sauce, chili peppers, tomatoes, carrot juice, and chopped garlic in oil. Foods that are not very acidic are at an increased risk of being contaminated with botulinum bacteria so it is a good idea to keep these foods refrigerated. The CDC recommends following proper canning methods, keeping garlic or herbs in oil refrigerated, and keeping baked potatoes either hot or refrigerated as ways to help prevent the spread of Botulism. Boiling canned foods for 10 minutes prior to serving, regardless of if they are homemade or store bought.

The symptoms of Botulism poisoning will typically surface within an 18 to 36 hour window after infection, but there is the chance that symptoms show as early as 6 hours or as late as 10 days after infection. The symptoms of Botulism poisoning include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. In infants, the following symptoms may appear: lethargy, loss of appetite, constipation, weak cry, and poor muscle tone. If the illness is left untreated, it can develop into causing paralysis in the arms, legs, and respiratory muscles. Diagnosis of a Botulism infection can take many forms, including the usage of a brain scan, spinal fluid examination, tests for botulinum toxins, or a nerve conduction test. The reason for such a wide range of tests is because botulism presents in a similar way to other diseases, including Guillain-Barre, myasthenia gravis, and stroke. Botulism is treated with an antitoxin that is distributed by the CDC and through state health departments. The antitoxins can shorten the symptoms, as well as prevent the progression of the illness. Botulism is only deadly between 3 and 5 percent of the time, which is drastically reduced from the 50 percent mortality rate that was present just 50 years ago. Botulism poisoning still represents a significant risk though, as it can cause paralysis. Recovery from botulism poisoning can take weeks to months. Even after a recovery is made, someone who had botulism may have shortness of breath and fatigue for up to a few years after the illness. While all persons are at some risk for a botulism infection, users of IV drugs are at an increased risk of developing wound botulism. If you or a loved one begins to show the symptoms of botulism poisoning, contact a medical professional immediately.