Public health Epidemiology Artificial intelligence
Introduction: Botulism is a rare, potentially fatal illness resulting from intoxication with a botulinum neurotoxin. Outbreaks are reported worldwide in humans, animals, and the environment. With toxin identification reliant on traditional surveillance methods conducted in laboratories. Open-source epidemic intelligence (OSINT) provides an alternative disease surveillance method in which outbreaks are reported from open sources such as news media, websites, or social media.
Methods: Using the AI-driven OSINT early warning system EPIWATCH, we extracted a dataset published between 31 December 2016 and 1 January 2025 and filtered by our search terms to identify botulism outbreaks. Data collected included country, event date, location, symptoms, outbreak type (human/animal), case numbers, hospitalisations, antitoxin treatment, deaths, source and origin of outbreaks, botulism type, toxin strain, and time from exposure to symptom onset. Analyses were conducted using STATA/BE 17.0 and hotspot mapping in ArcGIS Pro v.3.1.
Results: We identified 296 botulism outbreaks, affecting 28,634 individuals, with 27,334 deaths. Human outbreaks (87.5%, n = 259) resulted in 1,097 cases and 47 deaths, while animal outbreaks (12.5%, n = 37) accounted for 27,537 cases and 27,287 deaths. The highest number of human outbreaks occurred in Ukraine (56.0%, n = 145), the Russian Federation (10.8%, n = 28), and the United States of America (7.0%, n = 18). Common symptoms included dysphagia (11.0%), nausea (9.0%), and generalised weakness (8.8%). The primary transmission routes were foodborne (79.5%), unknown (13.5%), and iatrogenic (3.1%). The most frequently implicated sources were dried fish (33.2%), unknown (15.4%), and canned fish (5.4%). Toxin strain was rarely reported (97.7%), with strain B (1.2%), strain E (0.8%), and strain A (0.4%) identified. Symptom onset most often occurred within one day (8.1%) or the same day (5.0%) after exposure.
Conclusions: There is no global surveillance system for botulism. OSINT-based surveillance provides a unique way to understand the global epidemiology of outbreaks, especially for diseases for which global surveillance systems do not exist, and to guide outbreak response.
Details
Title
Global epidemiology of botulism outbreaks from open-source intelligence, 2016-2025
Creators
Damian Honeyman - University of New South Wales (Australia, Sydney)
David James Heslop A/Prof - University of New South Wales (Australia, Sydney)
Raina MacIntyre Professor - University of New South Wales (Australia, Sydney)