Botulism in Bethel

A patient sick with botulism was flown out of a Southwest Alaska village earlier this week for treatment at Bethel's Yukon Kuskokwim Health Center.

Botulism, which is more common in Alaska than anywhere else in the country, is a paralytic, potentially fatal illness caused by botulinum toxin. Traditional Native foods have caused every case of the disease in Alaska, according to the state Division of Public Health Web site.

In 2008 Alaska saw seven cases of the disease, six of them in Southwest Alaska. In 2007 there were 10 cases, nine of them in the Southwest region, even though only about 6 percent of the state's population lives there.

"Our botulism almost exclusively is related to traditionally prepared foods in Alaska Native peoples," state epidemiologist Beth Funk said.

The most recent botulism patient was treated with antitoxin and kept under observation. The disease's source is currently under investigation; a YKHC spokesperson said food items including seal oil are being tested for the disease.

When a botulism case springs up in the Lower 48, the Centers for Disease Control and Prevention ship antitoxin to the state so providers can treat the patient. Alaska is unique in that the antitoxin is prepositioned in hub cities so it's immediately ready for use, Funk said.

Although small doses of botulinum toxin are used in cosmetic procedures (under the brand name Botox) and to treat muscle spasms, botulism can be fatal. The U.S. sees about 110 cases of botulism every year, although in the last 50 years the fatality rate has dropped from half to about 8 percent, according to the CDC. Symptoms include blurry vision, dry mouth, and muscle weakness. If the patient doesn't get the antitoxin, the body and respiratory system can become paralyzed. That patient can need the use of a ventilator for weeks, and in Alaska, that means the patient has to be brought to Anchorage.

Alaska has seen 19 fatal botulism cases since 1950, all of them caused by traditional foods. They have included a 39-year-old man who died after eating white fish that had been stored in a plastic bag for nine days; two New Stuyahok women in their 50s who died after eating a fermented beaver tail; a commercial fisherman from Kipnuk who died after eating meat cut from a beached whale and kept in a plastic bucket for five days; and a 53-year-old Point Hope man who died after eating pickled walrus flipper. The state's last botulism fatality occurred in 2007.

While the Native tradition of fermenting foods underground has a worrisome tendency to breed the bacteria that cause botulism, the advent of modern materials has actually made the practice more dangerous. The traditional method of placing fish heads in a grass-lined hole in the ground allowed some oxygen to circulate, which disallowed the bacteria from developing. But when the food is stored in plastic bags or containers, the lack of oxygen makes for a botulism breeding ground, according to Kelsey Hustedt, an environmental health officer at YKHC.

Contact Joshua Saul at jsaul(at)alaskadispatch.com.