Epidemiology of Foodborne Botulism Outbreaks in Romania, 2007-2024

Foodborne botulism, caused by ingestion of pre-formed botulinum neurotoxin, is the most common form of botulism. While large outbreaks linked to commercial foods are rare, smaller outbreaks associated with home-processed products are more frequent, reflecting local dietary habits and traditional preservation practices. The aim of this paper is to provide a public health overview of reported foodborne botulism outbreaks in Romania over an 18-year period to raise awareness among clinicians and public health officials. Between 2007 and 2024, a total of 337 foodborne botulism cases were reported in Romania, of which 43% (147) were related to 55 outbreaks (median number of cases per outbreak: 2; IQR: 2-3). Most outbreaks were reported in Bihor County (11 outbreaks with 29 cases) and its neighboring county, Satu Mare (seven outbreaks, accounting for a total number of 20 cases). Outbreak-related cases were observed in younger persons with a median age of 31 years (compared to 45 years for sporadic cases) and were statistically significantly associated with consumption of pork products (p < 0.001). Fifteen deaths occurred (case fatality ratio: 4%), including three outbreak-related cases (case fatality ratio: 2%). These findings highlight the ongoing public health challenge of foodborne botulism in Romania and the need for robust surveillance, targeted educational initiatives in high-incidence counties to deliver information about safe food preparation and preservation practices, and the continuous availability of botulinum antitoxin supplies.