Scientific advice on type F botulism

Literature review Technical report
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European Centre for Disease Prevention and Control. Scientific advice on type F botulism. Stockholm: ECDC; 2013.

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This report seeks to identify available evidence on botulism type F epidemiology, morbidity and availability of treatment in the EU/EEA.

In 2011, a familiar cluster of type F botulism caused by Clostridium baratii was identified in Spain. In response to an official request from the Spanish authorities, ECDC performed a literature review and consulted with the European Medicines Agency (EMA) to advise on the availability and effectiveness of different treatment in the European Union.

The available evidence points towards the lack of effectiveness of the currently available treatment with bivalent AB antitoxin or trivalent ABE antitoxins for type F botulism. In addition, there is very limited clinical evidence of cross neutralisation between antitoxin E and neurotoxin F. In 2010, a new heptavalent antitoxin (HBAT) became the only available treatment for non-infant botulism in the United States. According to the information available at the time of this report there is no heptavalent botulinum antitoxin currently approved as a medicinal product in the EU. However it cannot be excluded that Member States may have a heptavalent botulism antitoxin available for emergency situations. Despite type F botulism being a rare form of intoxication, the ineffectiveness of currently available treatment choices warrants a discussion on preparedness in the EU/EEA.

Executive summary

This report seeks to identify available evidence on botulism type F epidemiology, morbidity and availability of treatment in the EU/EEA.

In 2011, a familiar cluster of type F botulism caused by Clostridium baratii was identified in Spain. In response to an official request from the Spanish authorities, ECDC performed a literature review and consulted with the European Medicines Agency (EMA) to advise on the availability and effectiveness of different treatment in the European Union.

The available evidence points towards the lack of effectiveness of the currently available treatment with bivalent AB antitoxin or trivalent ABE antitoxins for type F botulism. In addition, there is very limited clinical evidence of cross neutralisation between antitoxin E and neurotoxin F. In 2010, a new heptavalent antitoxin (HBAT) became the only available treatment for non-infant botulism in the United States. According to the information available at the time of this report there is no heptavalent botulinum antitoxin currently approved as a medicinal product in the EU. However it cannot be excluded that Member States may have a heptavalent botulism antitoxin available for emergency situations. Despite type F botulism being a rare form of intoxication, the ineffectiveness of currently available treatment choices warrants a discussion on preparedness in the EU/EEA.

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