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Underreporting or Failed Notification? Global Botulism Reporting, 2000-2022
1Tristan P. Learoyd, MPharm, PGCE, GradDipLaw, MA, MBA, MSc, PhD, MRPharmS, FHEA, is Director of Global Health Programs, Emergent BioSolutions UK Ltd, London, United Kingdom.
Health Security
|May 20, 2024
Summary
Botulism, a rare but fatal illness from Clostridium toxins, has significant global underreporting. This study estimates that 88.71% of botulism cases worldwide went unreported in 2016, highlighting a need for better surveillance.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health Surveillance
Background:
- Botulism is a rare, severe illness caused by Clostridium botulinum toxins.
- Current global reporting mechanisms for botulism are inadequate, leading to unreliable frequency estimates.
- Accurate case frequency data is crucial for understanding disease burden and implementing effective control measures.
Purpose of the Study:
- To establish an international benchmark for botulism case frequency.
- To estimate global rates of botulism underreporting.
- To identify factors influencing underreporting and inform public health strategies.
Main Methods:
- Conducted a comprehensive, multilingual search of global and national databases, including gray literature and government sources.
- Pooled and standardized case series data against United Nations population estimates.
- Analyzed data using Kolmogorov-Smirnov tests and compared national incidence rates with the United States as a benchmark.
Main Results:
- Identified 6,932 botulism cases from 59 nations, with a global case fatality rate of 1.37%.
- National incidence rates varied widely (0.00–8.04 cases per million), with an international mean of 0.62 cases per million.
- Estimated 88.71% of global botulism cases were unreported in 2016, with incidence rates showing normal distributions primarily in North America and Europe.
Conclusions:
- Significant underreporting of botulism cases globally necessitates improved surveillance and awareness.
- Enhanced global reporting mechanisms and research into underreporting factors are vital for accurate disease assessment.
- Improved understanding of botulism frequency can lead to reduced incidence and better patient outcomes.
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