Botulism

Botulism Menu Workers' Rights

Potential Bioterrorism Threats

Botulinum toxin may pose a bioweapons threat because of its extreme potency, lethality, and ease of production. A small amount of botulinum toxin seeded in the food or water supply can make many people very sick. However, the process of weaponizing the toxin into an aerosolized form requires complex procedures, and the current likelihood of a bioterrorist attack using aerosolized botulinum is extremely low.

The Centers for Disease Control and Prevention (CDC) recommends heightened surveillance for any unusual disease occurrence or increased numbers of illnesses that might be associated with a terrorist attack, and has developed a strategic plan with recommendations for preparedness and response in the event such an attack were to occur. For more information about botulinum toxin as a bioterror weapon, visit:

  • Botulism: Bioterrorism. Centers for Disease Control and Prevention (CDC) provides links describing the threat, preparedness, and detection and response.
Emergency Responders

In a covert attack involving aerosolized botulinum toxin, the first evidence that a potential bioterrorist attack had occurred would be diagnosis of exposed individuals, which would happen 24 hours to several days after the actual release of the toxin. However, in an overt or public bioterrorist attack involving real or suspected aerosol dissemination, emergency responders would be required to respond very rapidly. The following references provide additional information regarding PPE, decontamination, and other precautions for emergency responders to consider during such an incident.

Healthcare Workers

National infection control guidelines recommend specific precautions to be taken when treating patients with known or suspected exposure to botulinum toxin. Patient isolation and similar precautions may also be necessary. The following references provide detailed information regarding treatment of such an event.

  • Bioterrorism Prevention Plan: Botulism. CDC, (April 1999). Provides descriptions of the C. botulinum and symptoms of disease, infection control practices, and botulism patient management strategies.

  • Best Practices for Hospital-Based First Receivers of Victims. OSHA, (January 2005). Provides hospitals with practical information to assist them in developing and implementing emergency management plans that address the protection of hospital-based emergency department personnel during the receipt of contaminated victims from mass casualty incidents occurring at locations other than the hospital. Among other topics, it covers victim decontamination, PPE, employee training, and includes several informational appendices.

  • Medical Management of Biological Casualties Handbook, Ninth Edition. U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), (September 2020). Contains specific information on several potential bioterrorist agents. Specific information about exposure recognition, diagnosis, medical management, and prophylaxis of botulinum toxin can be found on pp. 107-112.

Laboratory Workers

Researchers, pathologists, and technicians in the laboratory should follow relevant biosafety procedures. There has been at least one instance of inhalation botulism in researchers exposed to the toxin in a laboratory. Also, workers can be exposed to chemical hazards related to the cleaning and disinfecting of surfaces contaminated with botulism toxins. Procedures to protect these workers include use of personal protective equipment (PPE), engineering controls, and any additional work practices that have been established for handling Clostridium botulinum and botulinum toxin in laboratories. The following references provide additional information:

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