An international outbreak of type E botulism due to uneviscerated fish

In October and November 1987, eight cases of type E botulism occurred in New York City and Israel. All eight patients had eaten uneviscerated, salted, air-dried whitefish known as kapchunka. Clostridium botulinum was isolated from samples of fish, and trypsinized portions of kapchunka contained type E toxin despite levels of salt that were far in excess of those considered adequate for safety. As C. botulinum has been found in the viscera of fish from the Great Lakes, possible explanations for the outbreak include multiplication of C. botulinum and production of toxin during shipping or during processing before the fish reached inhibitory salt levels. However, there was no evidence of mishandling of the fish. More likely, the viscera provided a relatively low salt "protective" environment for organism multiplication and toxin production. A major public health campaign was initiated and regulations were passed prohibiting the processing, distribution, and sale of raw, uneviscerated, salt-cured fish products within New York City.