Botulism From Home-Canned Peas: A New York City Family, 2018

On June 6, 2018, at 1:30 p.m., New York City’s health department was told of three related women who had arrived at a hospital four hours earlier with sudden nausea, dizziness, blurred vision, slurred speech, drooping eyelids, a thick-feeling tongue and shortness of breath. Two went into respiratory failure and were put on ventilators in the emergency department; the third was intubated at 7 p.m. that evening.

Several patients at once with cranial nerve palsies and breathing failure pointed to botulism, a paralyzing illness caused by botulinum neurotoxin (BoNT), most often made by the bacterium Clostridium botulinum.

The meal

About 14 hours before reaching the hospital, the women had shared a homemade potato salad containing home-canned peas. When the family’s freezer broke, one of them had canned some commercially frozen peas to save them, 1–2 weeks before the meal.

After consulting CDC, doctors received botulinum antitoxin from CDC and gave it to all three within approximately 12 hours of arrival. All three survived, but needed long stays in intensive care — 34 to 54 days — followed by rehabilitation.

Confirming the source

Tests at the city’s Public Health Laboratory and the New York State Wadsworth Center found:

• all three stool samples positive for BoNT type A with a silent B gene, “type A(B)”
• the same toxin type in a wash of the empty pea jar and in leftovers from the salad bowl
• bacteria from two patients genetically indistinguishable from the salad-bowl isolate by whole genome sequencing
• other home-canned vegetables from the same batch negative — confirming the peas as the source

What went wrong

The cook was a novice home canner. She used a recipe for peach preserves with a boiling-water method, simply swapping in frozen vegetables. She didn’t know that low-acid foods such as vegetables must be processed in a pressure canner — boiling water does not destroy C. botulinum spores.

She did correctly check the jars for a seal. One jar hadn’t sealed, so she covered it and refrigerated it, and that was the jar the family ate. U.S. Department of Agriculture guidance does say that a single unsealed jar can be refrigerated and eaten within several days — but only if it was correctly processed. Without pressure canning, the spores survived, and the closed jar gave them the oxygen-free conditions to germinate and make toxin.

Lessons for home canners

• Home-canned food can cause serious illness or death if canned incorrectly — even when made from commercially processed ingredients.
• Follow safe home-canning guidelines, especially for low-acid foods: vegetables need a pressure canner.
• When a processing error happens, discard the food or reprocess it according to the guidelines within 24 hours.

Sources

Based on Bergeron G, Latash J, Da Costa-Carter CA, et al., "Notes from the Field: Botulism Outbreak Associated with Home-Canned Peas — New York City, 2018," MMWR Vol. 68, No. 10, CDC; a work of the United States government in the public domain.