Botulism cases linked to obesity procedure in Turkey, no cases reported in Malta yet

As of March 23, 2023, there have been 30 cases of botulism reported in a number of countries in Europe. Between February 3 and February 25, 2023, these patients underwent a medical procedure involving the injection of botulinum neurotoxin to treat obesity in Turkey.

Furthermore, there were 53 cases of botulism between February 28 and March 8, 2023, among individuals who underwent the same procedure in two private hospitals in Istanbul (50 cases) and Izmir (three cases). Among the 65 cases with known information, the procedure was performed in a single clinic in Istanbul, Turkey. No fatalities have been reported so far.

The Superintendent for Public Health is informed that there have been no reported cases in Malta as of yet. However, individuals who travelled to Turkey for intragastric injection of botulinum neurotoxin between February 3 and March 1, 2023, are encouraged to seek medical advice from their healthcare provider, particularly if they experience symptoms such as weakness, difficulty breathing, and/or swallowing.

Botulism is a serious neuroparalytic illness caused by BoNTs mainly produced by the bacterium, Clostridium botulinum. The disease naturally occurs in four different forms: a) food-borne botulism, b) intestinal botulism, c) infant botulism, and d) wound botulism. There are two other forms of botulism which do not occur naturally: a) inhalation botulism and b) iatrogenic botulism, which is the most recent human-made form of botulism. Intoxication may occur as an adverse event following the administration of BoNTs for therapeutic or cosmetic reasons. While it is considered rare, individuals receiving BoNT injections for cosmetic purposes (e.g. for facial wrinkle lines) or therapeutic treatments (e.g. for management of muscle spasticity), may develop iatrogenic botulism if they are injected with an excessive dose of the BoNTs.

The European Centre for Disease Prevention and Control (ECDC) strongly encourages EU/EEA citizens to avoid intragastric treatments with BoNT for obesity in Turkey, as this is currently associated with a significant risk of developing botulism.