Posted: October 28, 2024

A new study has found that a 17-county area in the Mid-Atlantic region of the United States has a significantly higher incidence of infant botulism (IB) than the rest of the country, and the study also links this higher incidence to specific soil types. The research, published in Applied and Environmental Microbiology, highlights a concerning health disparity and points to potential environmental factors contributing to the disease.

New research has identified a geographic hotspot for infant botulism (IB) in a 17-county region spanning Delaware, Maryland, New Jersey, New York, and Pennsylvania. The study, conducted from 2000 to 2019, highlights a strong correlation between IB incidence and specific soil types in the area. These findings have significant implications for understanding and preventing this rare but serious disease.

Dabritz, H.A., Friberg, I.K., Payne, J.R., Moreno-Gorrin, C., Lunquest, K., Thomas, D., Newman, A.P., Negrón, E.A. and Drohan, P.J., 2024. Elevated incidence of infant botulism in a 17-county area of the Mid-Atlantic region in the United States, 2000–2019, including association with soil types. Applied and environmental microbiology, 90(11), pp.e01063-24.

Key Findings

  • Elevated Incidence: The 17-county area exhibits an IB incidence rate nearly seven times higher than other counties in the five states studied. The incidence was 17.5 cases per 100,000 live births, compared to 2.6 cases per 100,000 in the remaining 161 health jurisdictions.
  • Geographic Hotspot: The area spans approximately 80 km by 250 km, including the lower Delaware and Raritan River Valleys. Counties with the highest 20-year incidence rates included Cecil County, MD (38.2), Hunterdon County, NJ (44.5), and Bucks (45.7) and Montgomery (48.1) counties in PA.
  • Soil Association: A strong link was found between IB cases and specific soil types, including Alfisols (clay soils with base saturation ≥35%), the soil suborder Orthents, and the soil great groups Fragiudalf and Udorthent.
  • Soil Particle Size: Cases were significantly associated with soils containing coarse particle sizes, a characteristic favorable to the growth of Clostridium botulinum, the bacterium responsible for botulism.
  • Toxin Type: The predominant toxin type in the affected area was botulinum toxin type B (99%), consistent with the types typically found in Eastern U.S. soils.

Implications

The findings suggest that soil composition plays a critical role in the higher incidence of IB in the Mid-Atlantic region. The area's soils are rich in organic material and exhibit pH levels conducive to the growth of C. botulinum. Increased awareness among healthcare providers in these regions is essential for early diagnosis and treatment of IB.

About Infant Botulism

Infant botulism occurs when Clostridium botulinum spores are ingested, germinate in the intestines, and produce a toxin. Symptoms include constipation, poor feeding, weak cry, loss of head control, and descending bilateral paralysis. If untreated, the condition can cause severe complications. Treatment involves supportive care and administration of Human Botulism Immune Globulin Intravenous (BIG-IV or BabyBIG).

The study reviewed 830 IB cases in the northeastern U.S. and the District of Columbia, with 415 cases originating from the 17-county hotspot. Interestingly, feeding regimens in the area showed no significant differences from national trends, except that affected infants were less likely to have been fed honey, powdered formula, or solid food.

Call to Action

The researchers recommend further investigation into the soil properties of the affected region to assess the prevalence of C. botulinum. A proposed case-control study could use soil samples from the residences of IB cases and healthy infants to confirm the association between soil types and C. botulinum presence. These efforts could pave the way for more effective prevention strategies.

Contact

For more information, please contact:

Haydee A. Dabritz, PhD
Infant Botulism Treatment and Prevention Program
California Department of Public Health
Email: haydee.dabritz@cdph.ca.gov, ibtpp@infantbotulism.org