You can’t even trust th’pruno any more

Via the ProMed list:

Riverside County briefly uses up antitoxin supply
————————————————-
Treating 5 inmates for botulism contracted from a prison-made alcoholic
concoction briefly wiped out the Southwest’s supply of antitoxin,
authorities said.

Inmates at Ironwood State Prison near Blythe, CA illicitly fermented the
brew known as pruno from bread crusts, fruit scraps and potato peels, said
Margot Bach, a spokeswoman for the California Department of Corrections.

An inmate complained of feeling ill on 30 Jun 2004 after drinking it at an
inmate birthday party, Ironwood prison Lt. Dale Dorman said. 4 other
inmates began to develop compatible symptoms and were also treated with the
antitoxin. One inmate remains hospitalized. One inmate given the antitoxin
subsequently tested negative for botulism. The cost of medical care for the
inmates was more than US$ 352 000, Dorman said.

Botulism is a food-borne, potentially lethal paralytic condition.
Nationally, 263 people contracted the illness between 1990 and 2000 and 11
died, the CDC said. A supply of antitoxin for the southwestern USA is kept
at US Public Health Service quarantine stations at 8 airports, including
Los Angeles International Airport (LAX).

The outbreak at Ironwood used up the regional antitoxin supply for a day,
Riverside County disease control chief Barbara Cole said.

The LAX station receives a half-dozen requests a month for the antitoxin
from as far away as Texas and Colorado. It typically keeps 10 or more doses
but only had 3 on hand to meet the Riverside County request, a duty officer
speaking on condition of anonymity told the Press-Enterprise of
Riverside. 2 more doses were supplied from San Francisco International
Airport.

Los Angeles received more doses the next day, the duty officer said.

—
ProMED-mail

******
[2]
Date: Thu, 5 Aug 2004
From: Douglas E. Beeman – The Press-Enterprise of Riverside
[edited]

Toxin drug runs short
———————-
Treating 5 inmates at Ironwood State Prison near Blythe temporarily wiped
out the botulism antitoxin supply for the southwestern USA. The inmates
contracted botulism from pruno, an illegal prison-made alcoholic drink,
said Barbara Cole, Riverside County’s disease control chief.

1 of the 5 prisoners given the antitoxin in late June 2004 later tested
negative for botulism, Cole said. One inmate remains hospitalized,
according to the California Department of Corrections. None has died.

Food-borne botulism is a rare but potentially lethal paralytic illness that
can rob its victims of their ability to breathe. Nationally, 263 people
contracted food-borne botulism between 1990 and 2000, according to the CDC.
11 died.

Cole said this is the largest food-borne botulism case she’s seen.

Illicit alcohol is a persistent problem in state prisons, but officials
said this is the first instance they can recall of botulism in prison
alcohol. Inmates fermented the pruno from bread crusts, fruit scraps and
potato peels, said California Department of Corrections spokeswoman Margot
Bach. [from the free dictionary online: pruno – a liquor concocted from a
mixture of ingredients (such as prunes and raisins and milk and sugar) that
can be fermented to produce alcohol; made by prison inmates
– Mod.MPP]

Prison officials first discovered the outbreak 30 Jun 2004 when an inmate
complained of feeling ill after drinking pruno at an inmate birthday party,
said Ironwood Prison Lt. Dale Dorman. Prison staff thought the man had food
poisoning and monitored him for several hours. But when the man grew
sicker, he was transferred to a hospital, Dorman said.

After guards alerted prisoners to the man’s plight, 3 more inmates from his
housing unit said they also were ill, Dorman said. The 5th inmate sought
care the next day. Dorman said the cost of medical care for the 5 has
exceeded $352,000, including helicopter transport for the sickest inmates.

—
Douglas E. Beeman The Press-Enterprise of Riverside

[The botulinum antitoxin, in uncontrolled studies, has been associated with
lower mortality rates and, if administered early after onset of symptoms, a
shorter course of illness. A licensed trivalent antitoxin (includes
antitoxin against A, B, and E only) is available. Contrary to the package
insert directions, current recommendations are to administer 1 10-mL vial
of antitoxin per patient, intravenously in a normal saline solution over 20
minutes. Antitoxin need not be repeated, since the circulating antibodies
have a half-life of 5 to 8 days.

The antitoxin is of equine origin and requires skin testing for
hypersensitivity before administration of the antitoxin. About 9-21 percent
of patients will develop either acute or delayed-type sensitivity
reactions. Serum sickness reactions appear to be dose-related and may be
less likely with the newer dosing recommendations. A human-derived
antitoxin for infant botulism is available from the California Health
Department.

This cluster demonstrates how easy it can be to overwhelm the surge
capacity for any illness when there is a large increase in cases, whether
related to acute care bed capacity, operating room availability, medication
availability, or mortuary space.- Mod.LL]