Botulism: 452 cases and 14 deaths in Italy between 2001 and 2020

ISS: "The country has one of the highest incidences in the EU, with a population more exposed due to its strong canning tradition."

Italy is among the European countries with the highest number of botulism poisoning cases. Why? The Italian National Institute of Health explains.

In the period 2001-2020, 1,039 suspected clinical cases were reported to the national botulism surveillance system of the Istituto Superiore di Sanità, and 452 were laboratory confirmed . Of these, 412 (91%) were cases of foodborne botulism, 36 (8%) referred to cases of infant botulism and 4 (1%) to cases of wound botulism. The number of deaths was 14 and the average case fatality rate of the disease was 3.1%; this case fatality rate decreased from 3.8% in the period 2001-2011 to 2.6% in 2012-2020.

The national surveillance system "receives an average of 52 reports per year and laboratory confirms an average of 22," the report continues. "The trend in laboratory confirmations, however, does not always follow the trend in notifications. In fact, the peaks in reports recorded in 2004 and 2013 were not followed by a corresponding increase in the number of laboratory-confirmed cases."

Why so many cases in Italy

The national average incidence for the period 2001-2020 was 0.39 cases per million inhabitants. The incidence of botulism cases "reported annually in Italy is consistently one of the highest in Europe, indicating that the national population is more exposed to the risk of botulism than other European populations." This phenomenon "finds a logical explanation in the strong canning tradition still present in our country. In fact," the ISS specifies, "in the early years of the last century, with the spread of food preservation techniques at the domestic level, the number of botulism cases increased significantly, prompting the institutions of the time to promote studies in thermo-bacteriology and food technology, which still today represent the cornerstones of the canning industry."

"For the period considered, the regions with the highest incidence rates were Basilicata and Molise, with rates of 1.36 and 1.17 cases per million inhabitants, respectively. Comparing the average regional incidence rates for the periods 2001-2011 and 2012-2020, an increase is observed in 14 regions and a decrease in 5," the report highlights. "Only the incidence recorded in Abruzzo remained stable in the two periods examined." Most botulism cases occurred in the male population, and the age group with the highest number of laboratory-confirmed botulism cases was 25-64 years.

"Considering that the age stratification of the Italian population did not undergo significant changes between 2001 and 2020, the increase in the number of cases in the 25-64 age group between 2012 and 2020, compared to 2001-2011, appears significant," the report concludes.

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