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Botulism outbreak, batch of Twin Hills seal oil to blame

State of Alaska DHSS

"This is as concerning as it gets," says one state official, citing number of reported illnesses and the high toxicity of the seal oil.

DILLINGHAM:  A botulism outbreak in Bristol Bay communities is being closely monitored by state and local health officials. The Department of Epidemiology said Wednesday that at least 25 individuals have so far been linked to a batch of contaminated seal oil produced in the village of Twin Hills.

Of the 25, several have been hospitalized, some are being monitored, and health officials are still trying to contact others.

The botulism infections were reported Friday, after two individuals were flown from the village of Quinhagak to Bethel. The two were later medevaced to Anchorage, and remain on respiratory support Wednesday, reportedly unable to breathe on their own.

Three others from Quinhagak were treated for symptoms of botulism, and others in Twin Hills and Dillingham have reported symptoms or are being monitored. One child has also shown symptoms of the disease, which can be fatal, according to Dr. Michael Cooper, the Infectious Disease Program Manager at the State Department of Epidemiology.

"This is a very concerning outbreak," said Dr. Cooper. "This is one of the largest clusters of botulism we've ever seen."

An investigation linked the illnesses to a batch of seal oil produced in Twin Hills, and Dr. Cooper said sampling at a state lab showed the oil was particularly toxic.

"When it was tested, it came back at the highest level the lab instrument can measure for botulinum toxin," he said Wednesday. The testing was completed Tuesday, and on Wednesday morning the state dispatched a second public health nurse from Anchorage to continue the investigation out of Dillingham. 

"In an odd twist to this case, after we showed preliminary test results to the family who produced the oil, they sort of refused to stop eating or serving it," said Dr. Cooper.

On Wednesday, the state did not have further details about where that batch of seal oil may have been sold or traded in the region.

Botulism is a paralytic illness caused by the Clostridium botulinum bacteria. In Alaska, botulism occurs almost always in fermented or preserved foods like improperly canned fish and stink heads. According to state data, seal oil appears to be the main culprit behind botulism cases in Alaska, responsible for 54 outbreaks from 1950 to 2010.

"Botulism can be lethal," said Dr. Catherine Hyndman, a family physician at the Kanakanak Hospital in Dillingham, where staff were helping track and treat infected individuals. "But one of the big problems, as many know, is that botulism toxin does not necessarily smell or taste out of the ordinary. The food can look and seem to be perfectly normal, but yet be contaminated."

Credit State of Alaska DHSS
From "Botulism in Alaska. A guide for physicians and health care providers." 2011.

Early symptoms may include nausea and gastrointestinal distress such as vomiting, diarrhea, and abdominal pain. According to Dr. Hyndman, early signs of muscle paralysis are indicative of botulism.

"This is a poison that paralyzes the muscles," she said. "The smallest muscle is the muscle that moves the eye to the sides, to the right or the left, and often times that is the first muscle that is paralyzed." Blurred or double vision, unreactive pupils, or drooping eyelids can be a sign of botulism poisoning.

Symptoms may appear as early as one day after consuming contaminated food, but could also not appear for up to ten days.

Health care officials are urging those who may have eaten some of the contaminated seal oil to seek medical advice, and perhaps plan to be near a medical care facility for observation.

Credit State of Alaska DHSS
From "Botulism in Alaska. A guide for physicians and health care providers." 2011.