1721. An Outbreak of Botulism Associated with Nacho Cheese Sauce from a Gas Station in California
Session: Oral Abstract Session: Public Health: Epidemiology and Outbreaks
Saturday, October 6, 2018: 9:00 AM
Room: S 157
Background: Foodborne botulism is rare with 0-6 cases reported annually in California. During April 24 - 28, 2017, four hospitalized patients with suspect foodborne botulism were reported to the California Department of Public Health (CDPH) from two adjacent California counties. In collaboration with local public and environmental health, CDPH conducted an investigation to determine the magnitude of the outbreak, identify potential sources, and implement control measures.

Methods: A case was defined as clinical botulism in a visitor to or resident of Sacramento County with illness onset during April 20 - May 5, 2017. Case-patients or their proxies were interviewed. Patient specimens and suspect food items were tested for presence of botulinum toxin and toxin-producing Clostridium botulinum; C. botulinum isolates underwent whole genome sequencing (WGS) at the CDPH laboratory.

Results: In April - May 2017, a total of ten patients were hospitalized with laboratory-confirmed botulism. Median age was 34 years (range 16-57); seven were male, and eight Latino. All patients required intensive care, seven required ventilator support, and one died. Nine patients confirmed visiting Gas Station A in the week before illness onset; eight reported consuming nacho cheese sauce served from a dispenser there. Inspection of Gas Station A on May 5 indicated that the cheese in the dispenser had a best by date of April 11; the dispenser was removed that day, before all patients were identified. The remaining pouch of nacho cheese sauce was laboratory confirmed to have botulinum toxin type A and toxin-producing C. botulinum. C. botulinum isolates from three patients clustered with the cheese isolate by WGS.

Conclusion: Contaminated nacho cheese sauce served at a local gas station was the source of the largest outbreak of foodborne botulism reported to date in California. No other botulism cases associated with this commercial cheese sauce were identified elsewhere in the U.S.; though the mechanism of contamination is unclear, the cheese was likely contaminated locally. Intensive public health investigation and intervention, before all cases were identified and C. botulinum toxin was detected in the product, likely prevented additional cases and possible deaths

Hilary Rosen, MPH1, Akiko Kimura, MD1, Rituparna Mukhopadhyay, PhD2, June Nash, RN, Sr PHN3, Jason Boetzer, REHS4, Alyssa Poe, BS Microbiology2, Selam Tecle, MPH5, Katherine McAuley, RN MS PHN3, Olivia Kasirye, MD MS3, Alvaro Garza, MD MPH6, John Crandall, BS2, Mahtab Shahkarami, MS2, Vishnu Chaturvedi, PhD7, David Kiang, PhD8, Jeff Vidanes, BS9, Kelly McCoy, REHS4, Tammy Derby, REHS4, Mark Barcellos, REHS4, Seema Jain, MD5 and D Vugia, MD5, (1)California Department of Public Health, Los Angeles, CA, (2)Microbial Diseases Laboratory, California Department of Public Health, Richmond, CA, (3)Department of Health Services, County of Sacramento, Sacramento, CA, (4)Environmental Management Department, Sacramento County, Mather, CA, (5)California Department of Public Health, Richmond, CA, (6)San Joaquin County Health Department, Modesto, CA, (7)California Institute for Medical Research, San Jose, CA, (8)California Department of Public Health, Food and Drug Laboratory Branch (FDLB), Richmond, CA, (9)Food and Drug Branch, California Department of Public Health, Sacramento, CA


H. Rosen, None

A. Kimura, None

R. Mukhopadhyay, None

J. Nash, None

J. Boetzer, None

A. Poe, None

S. Tecle, None

K. McAuley, None

O. Kasirye, None

A. Garza, None

J. Crandall, None

M. Shahkarami, None

V. Chaturvedi, None

D. Kiang, None

J. Vidanes, None

K. McCoy, None

T. Derby, None

M. Barcellos, None

S. Jain, None

D. Vugia, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.