Ho Chi Minh City has recently recorded a series of cases of botulinum poisoning, however, Botulism Antitoxin Heptavalent (BAT), a specific antidote for botulinum poisoning, has run out. This is causing difficulties for treating doctors and endangering the lives of patients.

Patients receive supportive treatment only.

Last week, hospitals in Ho Chi Minh City received 6 cases of botulinum poisoning from food. Of these, 5 cases were caused by eating pork rolls with bread bought from street vendors and the oldest case was suspected to be caused by eating a type of fish sauce that had been fermented for a long time.

Botulinum toxin is a highly toxic substance and requires BAT. However, among the 6 patients with botulinum poisoning, only 3 patients admitted to Children's Hospital 2 (Ho Chi Minh City) were lucky enough to receive BAT on May 16, while 3 adult patients recently discovered required supportive treatment because Vietnam has run out of BAT.

Dr. Le Quoc Hung, Head of the Department of Tropical Diseases at Cho Ray Hospital, said that in cases of botulinum poisoning, if the specific antidote BAT is used early, within 48 to 72 hours, the patient can escape from paralysis and will not need a ventilator. Or if the ventilator is started 1-2 days, that is, very soon after the poisoning, within an average period of about 5 to 7 days, the patient can recover and can be removed from the ventilator, do physical therapy, and have stable health again.

“Currently, the lack of BAT antidote specifically for botulinum poisoning is a very unfortunate problem for patients and also a difficult problem for treating doctors. In cases where there is no BAT antidote, patients are treated with supportive care, mainly nutrition and mechanical ventilation, because botulinum toxin damages the nervous system, leading to muscle paralysis and the inability to breathe on their own. Although patients are supported with mechanical ventilation, the results are not as expected as when using BAT antidote,” said Dr. Le Quoc Hung.

According to Dr. Le Quoc Hung, through the practice of treating patients with botulinum poisoning since 2020 when there is no antidote, the average time a patient is on a ventilator must last from 3 to 6 months. During the time a patient is on a ventilator, many complications can occur. Such as secondary respiratory infections, malnutrition due to prolonged mechanical ventilation, complete paralysis leading to vascular stenosis...

Dr. Truong Thi Ngoc Phu, Deputy Head of the General Planning Department of Children's Hospital 2, said that when botulinum toxin penetrates more, it will cause blurred vision, dry mouth, signs of muscle paralysis such as drooping eyelids, difficulty swallowing, difficulty speaking, and more seriously, paralysis of respiratory muscles leading to severe respiratory failure that can be fatal if the patient does not receive timely intervention. The antidote BAT should be used as soon as possible after diagnosis to help improve mortality rates. However, this is a very rare drug, not always available, and expensive.

According to doctors, BAT is a rare drug not only in Vietnam but also globally, costing more than 8,000 USD/bottle. Not only is it expensive, the drug is also very rare, currently only one company in Canada produces it in the world. Before 2020, Vietnam did not have an antidote for botulinum. It was only when the Minh Chay pate poisoning incident occurred, leaving many people in critical condition, that the World Health Organization (WHO) supported the drug for Vietnam.

By 2021, Cho Ray Hospital imported 6 bottles of BAT from Canada (out of a total of 30 bottles licensed for import by the Ministry of Health). However, the last 2 bottles of medicine from Cho Ray Hospital were transferred from Quang Nam to save the lives of 3 siblings who were poisoned by eating pork roll from a street vendor, at Children's Hospital 2 on May 16.

The possibility of botulism toxin infection is always lurking.

According to Dr. Le Quoc Hung, botulinum poisoning cases are not rare in the world. For example, according to data in the US, each year the country still records between 150 and 300 cases of botulinum poisoning. In Vietnam, in the past, there was little ability to diagnose this disease.

However, in recent years, especially in 2020, when Cho Ray Hospital first diagnosed a cluster of botulinum cases, it sounded the alarm bell for doctors nationwide to know and pay attention to this disease.

“In my opinion, botulinum poisoning is not more common than before, but the ability to diagnose is now better. In addition, more modern supporting clinical tests make diagnosis easier,” Dr. Le Quoc Hung shared.

Dr. Le Quoc Hung said that the cause of botulinum poisoning is botulinum bacteria. This bacteria lives anaerobically, meaning that it can only function in an environment without air and with very low oxygen concentrations. This botulinum bacteria is found everywhere and is most abundant in sandy soil.

“All types of food that we process, package, can, or seal in a sealed bag without oxygen can have this type of bacteria grow… Thus, the possibility of poisoning by this type of bacteria is always lurking. Therefore, in the stages of processing and preserving food, we need to ensure that it is clean and should not be sealed without good techniques to avoid being infected with this type of bacteria. In addition, we should not eat or use expired or spoiled food…”, Dr. Le Quoc Hung emphasized.

In addition, Dr. Truong Ngoc Phu recommends that parents pay special attention to ensuring hygiene in the preparation of fresh food, and not to use honey for children under 1 year old. For canned food, it is necessary to choose products with clear origin, safe packaging, and expiration date.

When you detect food with strange color or smell, you need to notify the seller, supplier or the authorities to intervene. Absolutely do not consume suspicious and poor quality food to ensure the health and life of yourself and your family.

Treatment for patients with food poisoning such as botulinum toxin and snakebite poison is also difficult due to the lack of rare antidotes. According to Dr. Nguyen Tri Thuc, Director of Cho Ray Hospital, rare drugs are drugs that very few patients need because they are only used for special antidotes.

Rare drugs are often very expensive, and if purchased and not used for a long time, it may be a crime of waste when the drug expires. Therefore, the health sector needs a clear mechanism for purchasing and storing rare drugs. Establishing a national rare drug storage center is necessary.