Foodborne botulism: an international outbreak.

We report an outbreak of fishborne botulism caused by type E Clostridium botulinum. The eight cases, six in Israel and two in New York City, resulted from the consumption of ribbetz or kapchunka, a freshwater whitefish soaked in brine and air-dried, that was processed commercially in New York. Half the cases were males; the age range was 9 to 77 years. Five of the victims were hospitalized; the oldest died, and two others required ventilatory assistance. Laboratory confirmation of botulism was obtained in three cases. Prolonged lack of refrigeration during transatlantic flight and packaging contributing to an anaerobic environment were felt to be contributing environmental factors in the Israeli cases. Rapid communication and full cooperation between Israeli and US health authorities limited the extent of the outbreak. Despite adequate understanding of how foodborne botulism may be avoided, outbreaks still occur, particularly among people consuming certain high-risk or ethnic foods.

Illness and excretion of organophosphate metabolites four months after household pest extermination.

Diethyl phosphate (DEP), an organophosphate metabolite, was found in the urine of symptomatic residents who resided in a household that had been sprayed with diazinon 4.5 mo earlier. Pre- and post-decontamination data with regard to symptoms, DEP, cholinesterase, and surface and air levels underscore the utility of alkyl phosphate metabolites for monitoring exposure. The data also emphasize the efficacy of clean-up measures when baseline data are not available to determine if "within-normal" cholinesterase levels are, in fact, depressed.