HONEY AND OTHER ENVIRONMENTAL RISK-FACTORS FOR INFANT BOTULISM

Infant botulism results from the in vivo production of toxin by Clostridium botulinum after it colonizes the infant''s gut. Epidemiologic and laboratory investigations of this recently recognized disease were undertaken to identify risk factors and routes by which C. botulinum spores might reach susceptible infants. C. botulinum organisms, but no preformed toxin, were identified in 6 different honey specimens fed to 3 California [USA] patients with infant botulism and from 10% (9/90) of honey specimens studied. By food exposure history, honey was significantly associated with type B infant botulism (P = 0.005). In California, 29.2% (12/41) of hospitalized patients were fed honey prior to onset of constipation; worldwide, honey exposure occurred in 34.7% (28/75) of hospitalized cases. Of all food items tested, only honey contained C. botulinum organisms. One household vacuum cleaner dust specimen and 5 soil specimens (3 from case homes, 2 from control homes) contained C. botulinum. The known ubiquitous distribution of C. botulinum implies that exposure to its spores is universal and that host factors contribute importantly to the pathogenesis of infant botulism. Honey is now an identified and avoidable source of C. botulinum spores, and it should not be fed to infants.