Background
Botulism is a serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. C. botulinum is an anaerobic, gram-positive, spore-forming rod that commonly found in the soil.
Botulism is not a common illness but it does occur naturally. Naturally-occurring botulism frequently occur when a person eats food containing botulism toxin (food-borne botulism). Botulinum toxins are diverse proteins and are currently represented by at least seven serotypes (A, B, C, D, E, F, and G). Although most illness were resulted from serotype A, B and E, serotype F or G-caused illness were also reported in history. 
Foodborne route is the primary cause of botulism. Therefore, the most effective way to prevent foodborne botulism is practice food hygiene, maintaining environmental cleanliness, separating raw and cooked foods, consuming only thoroughly cooked foods, keeping food at the appropriate temperatures, and using safe water could reduce the risk of botulism.

Epidemiology
Botulism was categorized as anotifiable disease in Taiwan since 2007. Totally 46 cases were all indigenousand confirmed during 2007-2016. Within this decade, the biggest annual numberof botulism cases was 11, which was both observed in 2008 and 2011. Thereafter,the number declined and no patient was detected in 2012 and 2014. However, sixcases (age ranged from 13 to 74; the sex ratio was 1:1) were confirmed asbotulism in Taiwan of 2016. Therefore, prevention and control of botulism arestill necessary to reduce risk of paralytic illness.

Botulism Surveillance in Taiwan

1. Taiwan National Infectious Disease Statistics System–Botulism
2. Self-reporting through the toll-free 1922 hotline or the local health bureau. 

1. To prevent botulism, boil canned, fermented, or salted foods for at least 10 minutes prior to consumption and avoid feeding infants younger than 12 months honey, corn syrup, and undercooked foods.
2. Probable cases are required to be notified to the local health bureau within 24 hours. Epidemiology inspections will be carried out and suspected foods will be recalled when suspected cases are reported. Food samples and clinical specimen will both be tested at the laboratory for confirmation. Physician could request antitoxin for patients after clinical evaluation.  

FAQs

1. What is Botulism?
   • Botulism is a serious illness that causes paralysis or muscle weakness, including weakness in muscles needed for breathing. It is caused by a poisonous nerve toxin released by bacteria named Clostridium botulinum
2. How do people get Botulism?
   • Botulism is not contagious (not spread from person to person). Generally, Botulism could be divided into “foodborne botulism”, “infant botulism”, “wound Botulism”, and “other botulism.” Foodborne botulism results from ingestion of preformed toxin present in contaminated foods. Because C. botulinum can only grow in the absence of oxygen, foodborne botulism occurs in products with low oxygen content (e.g. in airtight packaging) as well as with right combination of storage and preservative parameters. The bacterium will grow and produce toxin in these products which are then eaten without sufficient heating or post-production cooking to inactivate the botulinum toxin. Besides, infant botulism is caused by the ingestion of the C. botulinum spores that germinate and grow in the intestine of infants and release botulinum toxin. Infant botulism is rarely observed in persons over one year old as the better developed natural microbiological flora in their intestines reduce the germination of the spores. Wound botulism is an illness resulting from botulinum toxin has infected a wound. Other botulism include getting the toxin by inhalation of toxins in aerosols or injection of botulinum toxin for surgical operation or self-murder.
3. What are the symptoms of botulism?
   • Clinical symptoms include blurred vision, drooping eyelids, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism could lead to lethargy, lacks of appetite, constipation, and poor muscle tone etc.. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the respiratory muscles, arms, legs, and trunk.
4. How can I keep from getting Botulism?
   • Store food at the appropriate temperature. For example, refrigerate food at all times if the package says "Refrigerate" or "Perishable" or if it was refrigerated at the store. Discard foods after the expiration date or if a food can is swollen, rusty, or damaged.
   • Boil canned foods for at least 10 minutes prior to consumption. Do not feed infants younger than 12 months honey, corn syrup, and undercooked foods.

1. WHO|Botulism
2. USA CDC|Botulism