5f - Exploring global trends in botulism neurotoxin A usage: implications for iatrogenic botulism surveillance and management

Background : Iatrogenic botulism received minimal attention in Europe until a notification from Germany to WHO/Europe on 7 March 2023 as part of 101 cases identified that year. Despite this, little is known about the global trends and correlations between cosmetic use of BoNT/A, the number of iatrogenic botulism cases cited in literature, and severe adverse events (SAEs) reported in the past decade leading up to this most recent outbreak. This study aimed to understand global trends of iatrogenic botulism.

Methods : An eight-language systematic review of peer-reviewed articles and databases was conducted  for iatrogenic botulism cases reported 2013-2023. SAEs associated with BoNT/A were collected during this timeframe from EudraVigilance's database. Global counts of BoNT/A for cosmetic use were obtained from the International Society of Aesthetic Plastic Surgery (ISAPS) and compared to SAE notifications and cited iatrogenic botulism cases in the literature. This comparison was performed using jackknifed datasets and least squares regression analyses.

Results : ISAPS reports revealed a total of 59,686,020 procedures from 2013-2022, with an annual upward trend from 2015. EudraVigilance SAE notifications associated with BoNT/A totaled 4,902 cases, and a systematic literature review revealed 45 iatrogenic botulism citations. Positive correlation was shown between EudraVigilance SAE notifications and worldwide cosmetic BoNT/A use (Pearson CC: r= 0.598, P<0.05) but with wide variation in yearly reporting (least squares regression: r=0.3577). No correlation was found between BoNT/A use and iatrogenic botulism cases cited in the literature.

Conclusions : The annual numbers of SAEs associated with BoNT/A usage captured by EudraVigilance was positively correlated with the global rise in cosmetic BoNT/A procedures. Enhanced monitoring of iatrogenic botulism is advisable to bolster national readiness in response to the expanding availability and utilization of BoNT/A.