Carrot juice cited in 2 botulism cases in Canada

Oct 10, 2006 (CIDRAP News) – Two botulism cases in Toronto have been linked to carrot juice from a California company, raising the number of people sickened by the juice to six, according to Canadian news reports.

The Toronto Star reported yesterday that two Toronto residents were paralyzed after drinking carrot juice from Bolthouse Farms, Bakersfield, Calif. The US Food and Drug Administration (FDA) reported in September that three people in Georgia and one in Florida had fallen ill with botulism after drinking the company's carrot juice.

Dr. Elizabeth Rea, an associate medical officer of health in Toronto, told the Star, "There are two adults who are severely ill in hospital and they had a history of drinking the exact same juice that's been part of the carrot juice recall."

She said laboratory tests on Oct 7 confirmed that Bolthouse Farms carrot juice bought in Toronto sometime in September and drunk by the two patients contained botulinum toxin, according to the story.

Rea declined to say if the two people drank carrot juice from the same container, but other sources said the two patients are a couple, the newspaper reported.

The FDA reported the three Georgia cases Sep 17, saying they were associated with pasteurized carrot juice that might not have been properly refrigerated. On Sep 29 the agency reported the Florida case and warned consumers not to drink Bolthouse Farms carrot juice with "best if used by" dates of Nov 11 or earlier.

A statement on the Bolthouse Farms Web site says the company has recalled all its 100% carrot juice products from the market in the United States, Canada, Mexico, and Hong Kong because of the FDA's concern that consumers may be exposed to botulism if the juice is not refrigerated.

Rea said Toronto health inspectors visited more than 500 stores over the weekend and found 10 that still had "suspect products" on the shelves, according to a report today in Toronto's Globe and Mail. She said store managers apparently hadn't heard about the health risk.

Rea said all four US patients were on ventilators but wouldn't say whether the two Toronto patients required ventilators, according to the Star.

In reporting on the investigation of the four US cases last week, the Centers for Disease Control and Prevention (CDC) said the Florida patient was "completely paralyzed" and on a ventilator. The information was in the Oct 6 issue of Morbidity and Mortality Weekly Report.

Botulinum toxin is produced by Clostridium botulinum. Spores of the bacteria can occur naturally in carrot juice and other foods that have not undergone retort canning, which involves high temperature and pressure, the CDC said. Temperatures above 39ºF, along with certain other conditions, can promote the growth of C botulinum and production of the toxin.

The CDC report said the Florida patient had drunk unrefrigerated carrot juice while staying in a hotel. But interviews with the Georgia patients did not confirm any "mishandling" of the juice.

The recalled carrot juice products carry the labels "Bolthouse Farms 100% Carrot Juice," "Earthbound Farm Organic Carrot Juice," and "President's Choice Organics 100% Pure Carrot Juice," according to the CDC.

See also:

Oct 3 CIDRAP News story "Four botulism case linked to carrot juice"

Oct 6 MMWR report: "Botulism associated with commercial carrot juice—Georgia and Florida, September 2006" [Full text]

CIDRAP overview of botulism

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