66. Poison centre data on botulism: results from an EAPCCT survey 39th International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 21-24 May 2019, Naples, Italy

Objective: To collect epidemiological data and information on the clinical management, diagnostic capability and antidote availability in cases of botulism in poison control centers/poisoning treating facilities (PCCs) located in different countries. Methods: An electronic survey was sent to EAPCCT members in March 2018. The survey included 19 questions on (i) epidemiological data (registered by PCCs during 2015-2017) as well as questions on (ii) availability/location of specific laboratory, (iii) clinical management, (iv) type of antitoxin availability (including dosage/adverse drug reaction) and (v) its location. A reminder email was sent after 3 weeks. Results: Fourteen PCCs completed the survey (Austria, Belgium, Czech Republic, Estonia, France, Germany, Greece, Iceland, Ireland, Italy, Poland, Slovenia, South Africa and Switzerland). Ireland, Estonia, Slovenia and Poland PCCs declared no experience with botulism because cases were managed by Infectious Diseases Services. Therefore 10 questionnaires were analyzed. Cases of foodborne botulism, infant and adult intestinal botulism, and wound botulism were registered by PCCs. Specific laboratories for diagnosis are available in 7 countries (70%), all located in government services (in 2 countries operative 24 hours). The detection of botulinum/ botulinum producing clostridia is carried out by polymerase chain reaction (PCR) and in vivo tests. Turnaround time (TAT) varies from 2 to 72 hours for PCR and from 12 hours to 7 days for in vivo testing. All PCCs, except two, prescribe antidote before laboratory confirmation. Trivalent Equine Antitoxin is the unique formulation available, and the dosage varies from 1 to 4 bottles. No severe acute adverse reactions have been reported. Antitoxin is stocked in PCCs/hospitals/pharmacies and in 6 countries in strategic stockpiles. Conclusion: PCC experience on botulism varied greatly: some services manage all cases occurring in the country as reference centers, while others refer to Infectious Diseases Services. During the study period (3 years), all forms of botulism have been observed by PCCs (including rare forms such as wound and intestinal botulism). PCR diagnosing testing is not routinely available, and in vivo tests remain the gold standard, even if, accordingly, TAT is too long to be useful in the first phase of clinical management. Trivalent Equine Antitoxin is available, and administration is safe. On the contrary, the recommended dose varies significantly among countries. Antidote storage in strategic stockpiles may be useful to manage public health emergencies or unconventional events. A harmonization of management of botulism between PCCs would seem appropriate for the future.