Report details fatal botulism poisoning at Nome potluck
State health authorities have released an overview of a New Year’s Day potluck in Nome that left one person dead and several others with botulism poisoning, in a case linked to Alaska Native foods.
A Thursday epidemiology bulletin from the state Department of Health and Social Services offers additional details on the poisoning involving botulism bacteria, which can develop in a variety of foods. Ingesting toxin produced by the bacteria can cause symptoms ranging from abdominal pain to death, although quick treatment can lead to a 95 percent survival rate.
Louisa Castrodale, with DHSS’ Epidemiology Section, said the person who died was a man. She said Thursday’s bulletin was an attempt to chronicle the response following the New Year’s Day potluck.
“This describes the interviews of people who had been at that meal and collection of food samples, to find out which might have been the source of the botulism, and making sure anyone who ate the foods was contacted by medical care,” she said.
According to the bulletin, DHSS received word on Jan. 2 of three people who had attended the potluck arriving at the Norton Sound Regional Hospital’s emergency department suffering from “nausea, vomiting, dizziness, and double vision.”
Of the 14 people who ate food at the potluck, nine later suffered symptoms compatible with botulism. Four patients had only minor symptoms and were treated on an outpatient basis, while a fifth wasn’t suffering from botulism-related sickness.
“The remaining four received [heptavalent botulinum antitoxin] and were transferred to the Alaska Native Medical Center,” state officials wrote. “One of these patients was intubated, sustained multiple cardiac arrests, and subsequently died 13 days after symptom onset.”
Samples of 17 dishes served at the potluck were examined by investigators. Foods that were “statistically significant predictors of illness” included fermented whale flipper, as well as Eskimo ice cream with reindeer fat. Botulism toxin was found in the whale flipper, after Castrodale said it was tested at a California lab.
“Unfortunately, the [Nov. 30] earthquake impacted our public health lab, and so the samples all had to be sent out of state for testing,” Castrodale said.
According to DHSS, from 1950 to 2017 all cases of foodborne botulism in Alaska for which a food source was identified “occurred following consumption of traditionally prepared Alaska Native foods.” CDC has produced a video on avoiding botulism in traditional recipes, which is also available in Yup'ik.
Leslie Shallcross, an associate professor of extension with the University of Alaska Fairbanks’ Cooperative Extension Service, said Friday that traditional methods of preparing fermented Native foods — which involved burying items underground in tundra — had inherent protections against botulism.
“There was something of an anaerobic environment created, enough to have something go, but there were two things going on that would keep fermentation from going,” Shallcross said. “It wasn’t a truly anaerobic environment because there was air that could get into it, and you had colder temperatures and botulism doesn’t grow well in colder temperatures.”
Since then, however, two major elements have changed in the preparation of fermented foods. One of them is climate change, which can make burying food to ferment it unsafe.
“You don’t have the permafrost,” Shallcross said. “Colder temperatures are required below 37 degrees to prevent botulism, so we don’t have that.”
The other is the use of modern containers, which don’t allow air to reach food and interrupt the fermentation process.
“They’re putting things in plastic bags or plastic buckets or glass, and they are creating an anerobic environment,” Shallcross said.
CES concurs with federal recommendations to boil traditional fermented foods which may contain botulism. According to a special Centers for Disease Control and Prevention website, fermented Native foods — including whale, seal and walrus flippers, fish heads and eggs as well as beaver tail — should receive a 10-minute boil before they are eaten.
“Even if people ferment safely, [the CDC] recommends cooking them, which wouldn’t be traditional, but there you are,” Shallcross said.
Botulism can also develop in seal oil and dried fish, according to the CDC.
The most popular class Shallcross and other CES advisors teach involves how to can fish and meat, she said, because “there’s been a lot of interest and concern” about botulism in the wake of cases like the Nome incident.
“I have taught a few classes in which there were individuals who had gotten botulism,” Shallcross said. “Those individuals suffered headaches and other symptoms well after the episode and related how very sick and horrible they felt. You can recover from botulism but you may have persistent neurological problems.”
The DHSS bulletin’s recommendations to physicians following the Nome incident include considering urgent administration of botulism antitoxin to anyone showing botulism-like symptoms who has a history of eating traditional Native foods, as well as immediately contacting the Epidemiology Section.
DHSS also hosts a series of resources for avoiding botulism on its website.
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