All you need to know about the outbreak of botulism in Ukraine

Author : Olena Holubeva

Source : 112 Ukraine

Ukrainian hospitals are not provided with serum antibody response to botulism, without it the probability of a fatal outcome increases several times
10:00, 20 August 2018

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According to the Ministry of Health, for 3 months, 62 cases of botulism were registered in Ukraine, 9 of them resulted in the death. And if in previous years, the cause of the disease was most often the home-made products, recently the cases of the disease after consuming products purchased in the supermarkets have become more frequent. The peculiarity of the current outbreak is that Ukrainian hospitals are not provided with serum antibody response, and without it the probability of a fatal outcome increases several times.

According to the Ministry of Health for the past 3 months, 62 cases of botulism have already been registered in Ukraine, 9 of them were lethal. These figures are just catastrophic, said Deputy Minister of Health Oksana Sivak.

"Last year, there were more overall cases, but this year the fish season began on June 10. And more than half of the number of cases occurred last year," says Olga Golubovska, head of the Department of Infectious Diseases, chief infectious disease specialist at the Ministry of Health. According to the Ministry of Health, in the past year, 105 cases of botulism have been reported, 12 deaths were registered.

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According to Sivak, cases of deaths from botulism that occurred this year in Kyiv, Poltava, Sumy, and Cherkasy regions were associated with the use of dried fish of industrial production. In other cases, people died after consuming dried fish of domestic production, as well as homemade stew (Cherkasy region) and salted-smoked fish (Odesa region).

According to the State Procurement Service, a man who died of botulism in Kyiv, as well as three other cases, reported that fish goods were produced by Merkulov PIF, the supplier of "Chudo-Yudo" (Kirovograd region), which they purchased in a store network. People from the Vinnytsia, Kyiv, and Kherson region associate consuming of this product with their disease.

Alarming is the fact that recently the cause of botulism is the products of industrial production, Oksana Sivak, deputy minister of the Ministry of Health, said: “This shows that the system of checks does not work.” “The peculiarity of these recent outbreaks is that they are associated with products bought in supermarkets, which is just unacceptable! Earlier, botulism was associated only with domestic products, not industrial production, as now,” Olga Golubovska agrees. She clarified that the cases of botulism registered in previous years were associated with the use of home-made pates, sausages, canned mushrooms.

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The spread of diseases may be due to the fact that many entrepreneurs have felt uncontrollable due to the limitation of opportunities to conduct inspections, the State Procurement Service.

"According to the Law of Ukraine "On the Fundamentals of State Control in the Sphere of Economic Activity," the business entity should be warned about an inspection for 10 days. In addition, the number of scheduled inspections have significantly decreased after the Cabinet of Ministers adopted resolution No. 1405 of 30 November 2011," State Procurement Service representatives complained: "If earlier some of the objects were inspected annually, now it happens once every 3-5 years. A moratorium on inspections does not allow for the timely conduct the necessary examinations and anti-epidemic measures at the facilities."

According to Olga Golubovska, most often botulinum toxin in fish is a consequence of non-compliance with cooking technology. Botulism pathogen Clostridium can be anywhere (on the surface of furniture, on the skin of the hands, in the intestines or in the mouth of healthy people), but if there is oxygen, it exists in the form of spores and does not excrete toxin. And only when clostridium falls into anaerobic conditions (without oxygen), the spore germinates, acquires vegetative form and it starts to release toxin. If oxygen did not serve as a deterrent to this phenomenon, clostridium could simply destroy humanity on the planet.

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If the fish deposits and it is not gutted immediately, anaerobic conditions are created in its body, the botulinum toxin is absorbed into the body. And then it remains in it, even if the fish are then gutted, explains Golubovska. "Toxin, which is a protein by its nature, is destroyed by exposure to high temperatures, but it should be boiled for 10-15 minutes, if the temperature does not reach 100 degrees during drying or smoking, the toxin is not destroyed there," she explains.

Also, according to her, contrary to popular belief, the salt has no effect on butolotoxin: "No matter how much salt you put on fish, even if the concentration is over 50%, it acts only on the causative agent itself."

Another reason for the spread of botulism is a decline in the level of people's well-being. "When the living standard of the population falls, people use domestic conservation, especially in the villages," said Olga Golubovska. According to her, for a similar reason, large-scale outbreaks of botulism were recorded in the 90s.

No serum in the hospitals

One feature of the current outbreak of botulism is that it occurs against the background of the lack of serum in Ukrainian hospitals.

"In Ukraine, there is neither botulism nor diphtheria antitoxin, there are problems with tetanus antitoxin too. These are immunobiological preparations that we were previously buying from Russia and do not buy them now. It is almost impossible to buy them in Europe, because in Europe they are produced in very little amounts, they are expensive, we need to look for other producers, perhaps China and India," says Olga Golubovska.

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"We have great problems with serum, because, as you know, we can use only registered medications. Today there is no single registered drug. The registration of Russian serum was finished in 2014. All our negotiations with the producers were unsuccessful, because they are financially disadvantageous. The serum has limited shelf life, it needs special storage conditions, so this is one of the reasons that manufacturers and pharmacies do not want to buy it," Oksana Sivak, Deputy Minister of Health, explained.

The employee of the Ministry of Health did not inform on the availability of the serum in the regional hospital. "Now I cannot tell you the percentage of serum availability, because in some regions it was bought from local budgets and I do not have such information," she said.

The main freelance infectious disease doctor of the Zaporizhya Regional State Administration Iryna Ivanova stated about the serum issue. The majority of regional mass media report about its absence.

At the same time, there is no alternative to treating botulism with serum. "The most effective treatment is, of course, serum. We realize this problem and we are working on it," Oksana Sivak says. She said that the Ministry of Health has an agreement with the Red Cross and with UNDP to supply serum against botulism in the form of humanitarian assistance.

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"We ask for as many doses as possible, considering that we already have 62 cases, we need several hundred doses," Sivak said, refusing to predict when the humanitarian aid might arrive in Ukraine.

According to Golubovska, a pressure chamber is used for treatment of botulism. "It really has a very good effect on improving the patients’ health, but it does not replace serum," she noted.

Now in most Ukrainian hospitals, doctors offer relatives of patients with botulism to buy serum for their own money. "Serum from the black market mainly comes from Russia, in most cases it is smuggling, in fact, illegal import. Actually, there is a serum for 55 USD, and a Polish one costs 630 USD," Olga Golubovska states. She notes that polyvalent serum is more expensive (it is acting immediately on several types of pathogens that cause botulism): "Last year, a young man paid 6 thousand USD for treatment with the use of serum."

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"In fact, this is the wrong situation for the country, because the immunobiological drug should be kept properly. Doctors take the responsibility by introducing serum of unknown origin. A patient can be killed after taking the serum. Such cases are rare, but serum is an immunobiological drug, it sometimes gives very severe allergic reactions, including fatal outcome," Golubovska states.

She also points out that people who have very serious clinical syndromes of the disease get to the hospital: "As soon as the diagnosis is established, the person should receive serum at the same moment. And if relatives spend long hours in looking for this serum, naturally, the risk of really great. If the serum is not injected at all, the risk of fatal outcome increases several times."

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