Written by Hannah Harp
Spoon Feed
Babies outside of the U.S. who are treated for infantile botulism (IB) have longer hospital stays, longer time to treatment with antitoxin, and are more likely to be intubated.
Infantile botulism, international edition
Worldwide, there are about 200 cases of IB reported annually. Incidence varies widely, with many countries never having had a reported case. The U.S. makes up the vast majority of worldwide reported cases of IB, though there is a far higher incidence noted in Argentina (7.0/100,000 live births) than in other countries. This global surveillance study assessed the incidence and clinical characteristics of IB from 2007-2021 using data from surveillance systems, clinical consultation, and literature. Across 2,943 confirmed cases, type A (n=1587) and type B (n=1254) were predominant. Median age at onset was 16.8 weeks. Compared to U.S. cases, international patients had longer mean hospital stays (27 vs 12 days), longer time to treatment with antitoxin (6.0 days vs 2.0 days in US), higher intubation rates (50.3% vs 21.2%), and more frequent honey exposure (19.7% vs 3.8%). It’s unclear to me how much IB surveillance systems vary from country to country, or if that infrastructure even exists in many countries. In the U.S. we have the benefit of a centralized source of antitoxin, which makes tracking confirmed IB cases very straightforward. The addition of a comparison of surveillance systems would add some much-needed context to this study.
How does this change my practice?
With such a low incidence, I hope I never see a case of IB in clinic. Even still, I’ve learned that education around not giving newborns tea, honey, or water is more necessary than I thought it would be, so I will keep it on my radar!
Source
Global Occurrence of Infant Botulism: 2007-2021. Pediatrics. 2025 Apr 1;155(4):e2024068791. doi: 10.1542/peds.2024-068791. PMID: 40132623
