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Alarming increase of botulism cases in European Region

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A total of 71 cases of botulism resulting from medical procedures involving botulinum neurotoxin type A (BoNT/A) injections have been reported in four European countries.

Of this number, 53 cases were in Turkey, 16 in Germany, one in Austria, and one in Switzerland. All cases are adults, and the majority are middle-aged women.

This is according to the Medicines and Healthcare Products Regulatory Agency (MHRA), which in turn alerted the Joint Council for Cosmetic Practitioners (JCCP)

Two private hospitals in two locations in Turkey were identified, with 66 cases linked to one hospital and three cases to the other.

Investigations carried out by the Turkish authorities reported that licensed BoNT products were administered for a different purpose other than for which the products were approved (off-label use). The relevant departments of both hospitals had their activities suspended on 1 March 2023 and the products used for the treatment were seized and taken for examination and evaluation.

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Botulism outbreaks are rare, but outbreaks require rapid recognition to identify the source of the disease, distinguish between types of outbreaks (natural, accidental, or potentially deliberate), prevent additional cases, and effectively administer treatment to affected patients. Successful treatment depends significantly on early diagnosis.

In the reported cases, the clinical presentation ranged from mild to severe. Clinical signs of BoNT intoxication were observed, including fatigue, headache, blurred and/or double vision, dizziness, ptosis, dysphagia, dyspnea, neck weakness, generalized muscle weakness, and swollen tongue.

Several cases were hospitalised, some cases were treated with botulinum antitoxin, and at least five cases were admitted to intensive care units. There are no reported deaths.

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