A large travel-associated outbreak of iatrogenic botulism in four European countries following intragastric botulinum neurotoxin injections for weight reduction, Türkiye, February to March 2023 - INRAE - Institut national de recherche pour l’agriculture, l’alimentation et l’environnement Access content directly
Journal Articles Eurosurveillance Year : 2023

A large travel-associated outbreak of iatrogenic botulism in four European countries following intragastric botulinum neurotoxin injections for weight reduction, Türkiye, February to March 2023

Martin Bernhard Dorner
Hendrik Wilking
  • Function : Author
Martin Skiba
  • Function : Author
Laura Wilk
Maximilian Steinberg
  • Function : Author
Sylvia Worbs
  • Function : Author
Sabahat Çeken
  • Function : Author
Sedat Kaygusuz
  • Function : Author
Agata Mikolajewska
  • Function : Author
Christian Kornschober
  • Function : Author
Timo Bütler
  • Function : Author
Nathalie Jourdan-Da-Silva
Maria an Der Heiden
Lars Schaade
Klaus Stark
  • Function : Author
Brigitte Gertrud Dorner
Christina Frank

Abstract

In March 2023, 34 associated cases of iatrogenic botulism were detected in Germany (30 cases), Switzerland (two cases), Austria (one case), and France (one case). An alert was rapidly disseminated via European Union networks and communication platforms (Food- and Waterborne Diseases and Zoonoses Network, EpiPulse, Early Warning and Response System) and the International Health Regulation mechanism; the outbreak was investigated in a European collaboration. We traced sources of the botulism outbreak to treatment of weight loss in Türkiye, involving intragastric injections of botulinum neurotoxin. Cases were traced using a list of patients who had received this treatment. Laboratory investigations of the first 12 German cases confirmed nine cases. The application of innovative and highly sensitive endopeptidase assays was necessary to detect minute traces of botulinum neurotoxin in patient sera. The botulism notification requirement for physicians was essential to detect this outbreak in Germany. The surveillance case definition of botulism should be revisited and inclusion of cases of iatrogenic botulism should be considered as these cases might lack standard laboratory confirmation yet warrant public health action. Any potential risks associated with the use of botulinum neurotoxins in medical procedures need to be carefully balanced with the expected benefits of the procedure.

Dates and versions

hal-04401743 , version 1 (17-01-2024)

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Martin Bernhard Dorner, Hendrik Wilking, Martin Skiba, Laura Wilk, Maximilian Steinberg, et al.. A large travel-associated outbreak of iatrogenic botulism in four European countries following intragastric botulinum neurotoxin injections for weight reduction, Türkiye, February to March 2023. Eurosurveillance, 2023, 28 (23), ⟨10.2807/1560-7917.ES.2023.28.23.2300203⟩. ⟨hal-04401743⟩
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