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Most infant botulism patients require supportive care in a hospital setting. The only drug currently available to treat infant botulism is Botulism Immune Globulin Intravenous-Human (BIG-IV or BabyBIG). BabyBIG was developed by the Infant Botulism Treatment and Prevention Program at the California Department of Public Health.

The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a ventilator for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly improves. If diagnosed early, foodborne and wound botulism can be treated by inducing passive immunity with a horse-derived antitoxin, which blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism.

Furthermore each case of food-borne botulism is a potential public health emergency in that it is necessary to identify the source of the outbreak and ensure that all persons who have been exposed to the toxin have been identified, and that no contaminated food remains.

There are two primary Botulinum Antitoxins available for treatment of wound and foodborne botulism. Trivalent (A,B,E) Botulinum Antitoxin is derived from equine sources utilizing whole antibodies (Fab & Fc portions). This antitoxin is available from the local health department via the CDC. The second antitoxin is heptavalent (A,B,C,D,E,F,G) Botulinum Antitoxin which is derived from "despeciated" equine IgG antibodies which have had the Fc portion cleaved off leaving the F(ab')2 portions. This is a less immunogenic antitoxin that is effective against all known strains of botulism where not contraindicated. This is available from the US Army. On 1 June 2006 the US Department of Health and Human Services awarded a $363 million contract with Cangene Corporation for 200,000 doses of Heptavalent Botulinum Antitoxin over five years for delivery into the Strategic National Stockpile beginning in 2007.

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Botulinum toxin rapidly denatures with prolonged exposure to sunlight and chlorine, or boiling. For items that can't be boiled, wash in chlorine bleach and rinse thoroughly. Allow to dry in the sun for as long as possible, weeks or at least days. For cooking canned food or other items that can be boiled, boil at 240 degrees Fahrenheit (116 C) for at least 5 minutes to break down the toxin and kill the bacteria and its spores (which can survive drying and come back to life after rehydrating). Home canning and jarring of food takes simple precautions which are detailed below.

Despite the bacterium's fearsome reputation, _C. botulinum_ is still a microbe, and can be killed using a little basic microbiology. Preserving recipes utilize at least one of these 5 microbiological facts, good recipes often use several.

1. _C. botulinum_ bacterium dies at 212 F/ 100 C.
2. _C. botulinum_ spores die at 240 F/ 116 C.
3. Botulism toxin denatures at 185 F/ 85 C.
**(All temperatures must be maintained for least 15 minutes, and the heat must be consistent throughout the food, fluid, and jar.)**
4. _C. botulinum_ spores cannot hatch in strong acid solutions of pH 4.6 or below. (Some sources claim pH 4.7.)
5. _C. botulinum_ cannot grow, develop, or multiply in food with a water content of less than 35%. (Food dehydrators have another set of toxic pests to worry about, see IV.6 about aflatoxin.)

Common sense is a first step in the prevention of botulism.

For instance:

1.) _C. botulinum_ bacteria and spores usually live in soil. Thus clean foods of soil, dust, grit, etc, using fresh, cold water. Change wash water often. Don't can "drops", fruit that has dropped to the ground. Pay special attention to cleaning root crops (including garlic!), shucking skins or peeling that produce if need be.

2.) One variety of _C. botulinum_ (E) lives in flat water. So, you want to make your brines, etc, with fresh cold water. Start with fresh, cold water if you are boiling to sterilize, or perform other operations.

3.) Botulism spores remain dormant under high acid conditions. Fruit is quite high in acid but also contains a lot of sugar, so the fruit still tastes sweet. Vinegar is added to vegetables to pickle them. You can can foods like this in a boiling waterbath. However, the concentration of acid (ionic strength) is also very important, so you want to use vinegars of a known strength (5% or 5 grain); add the recommended amount of vinegar, citric acid, or ascorbic acid described in your recipe; can just-ripe fruits. For safety's sake, you shouldn't cut down the amount of vinegar in a recipe, take a cue from fruit and add a little bit of sugar to cut down the extreme acid taste. Vegetable pickles should be immersed in the vinegar or brine. *BTW, finding out that honey is a source of botulism spores (infant botulism), means that I'm not thrilled about the idea of substituting honey for sugar, as the Rodale Institute appears to be.*

4.) Botulism spores, bacterium, and the toxin are killed by high heat. However, all the contents of the jar has to get to the target temperature, no matter the volume, and the temperature should be sustained for about 15 minutes. Follow recipes exactly, including jar sizes and treatment of the jars. Process at least for the times indicated, but remember that you have to increase processing time or pressures depending on your altitude. (Water boils at lower temperatures the higher your altitude.) Note that larger size jars usually require longer processing time, because the heat has to penetrate through the jar.

Acid and heat are each used in canning things that are borderline acid, such as tomatoes, tomato vegetable mixes (like salsa and spaghetti sauce), vegetable relishes, and other vegetable mixes. The idea here is that you can't increase one thing to avoid other procedures. (You can't increase acid to avoid pressure canning).

5.) Botulism cannot grow or develop without water. In making jams or jellies, enough sugar and pectin is added to form a gel, depressing the amount of free water available for bacteria to grow. This is one of the reasons why special care has to be taken if the jam or jelly is extremely runny.

Foods preserved in oil (raw garlic, chilis, dried tomatoes) create a special case. Oil contains no water, as it is centrifuged out during processing. If an item is dependably dry, under 35% water content, adding it to the oil should not cause problems, as long as your items are well immersed (1 inch of oil covering). Dry herbs, seeds and spices, dried chiles, even sundried tomatoes should not cause problems. (N.B: Research from the Australian Extension Service--sundried tomatoes are more acid than hydrated ones: pH 4.0 for dried, 4.6 for hydrated--LEB). However, the dehydrated food must be properly dried, conditioned, and not case hardened (case hardened things are hard and crunchy on the outside, soft and gooey on the inside). The jury is out on wet herbs.

If you try to preserve a lot of "wet" items in oil (garlic cloves, chopped onions, ginger root, fresh chiles), you might have a heap of trouble. Oil doesn't contain much dissolved oxygen, so it is a good anaerobic medium. Raw garlic, onions, ginger are all rootcrops, and each contain over 35% water. Chilies often are added to oil in a non-dried state. Generally, you want to "pickle", or at least allow your wet, raw item to take up some 5% vinegar for about 15-20 minutes before putting into the oil. Chunky items (i.e. garlic cloves) should be smashed, crushed, or chopped to get the vinegar into the item.

Simple, but through, sauteing of your chosen flavoring in your oil can also get rid of spores, since they evaporate free water, and the oil can be heated to above 240 F. Yet another idea is to refrigerate your flavored oils, as bacterial growth is very slow below 40 F/4 C.

In addition, the garlic-in-oil botulism problem began when garlic pastes in olive oil were introduced in grocery stores. Many of the botulism poisonings occurred when these pastes were used in cold pasta, salads, and salad dressings. If you are going to be using your flavored oil for sauteing, stir fry, or deep fat frying you will easily heat your oil to above any of the target temperatures described above.

Since the toxin is denatured at 185 F/85 C, if you are concerned about a canned good the usual procedure is as described in the above section (to hard boil the contents for 15 minutes). NOTE: This will denature the botulism toxin. Other toxins, such as those caused by _Staphococcus_, will not denature until temps of 240 F/116 C are reached and sustained for 30 minutes. As a matter of fact, a hard boil in that case will break open the bacteria, and more toxin would be released into the food.

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