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Botulism

Warning About Counterfeit (Fake) “Botox” or Mishandled Injections

There have been several reports of people in the United States, including in California, having harmful reactions to injections of counterfeit (fake) or mishandled botulinum toxin (“Botox”). Botox injections should be done only by a licensed medical professional using an FDA-approved product. Learn more:

What You Need to Know

  • Botulism is a rare but serious disease caused by a toxin (poison) that attacks the nervous system and causes paralysis. Anyone can get botulism.

  • There are different forms of botulism, including foodborne botulism, wound botulism, infant botulism, and iatrogenic botulism (caused by medical injections). Botulism doesn't spread from person to person.

  • People with botulism usually have weakness or paralysis that starts in the head and face and spreads down to the rest of the body.

  • Without medical care, botulism can lead to death. If you or someone you know has symptoms of botulism, call 911 or go to the emergency room immediately.

  • You can help reduce your risk of botulism by properly storing and preserving food, and by not injecting street drugs (like black tar heroin). If you choose to get injections of botulinum toxin for cosmetic or medical reasons (Botox), make sure injections are done by a licensed medical professional using an FDA-approved product. To help reduce the risk of botulism in babies, do not feed babies honey.

  • If you are a healthcare provider and suspect your patient (non-infant) may have botulism, please contact the local health department (LHD). If unable to reach the LHD, providers may contact the CDPH Duty Officer at (916) 328-3605.


What is botulism?

Botulism is a rare but serious disease caused by a toxin (poison) that is made by bacteria called Clostridium botulinum (C. botulinum). This botulinum toxin attacks the nervous system and causes paralysis.

​What are the symptoms of botulism?

A person who becomes sick with botulism may have:

      • Droopy eyelids
      • Double or blurry vision
      • Muscle weakness in the face
      • Trouble swallowing
      • Slurred speech or trouble speaking
      • Weakness in the arms and legs

A person with botulism might not have all of these symptoms at the same time. Botulism can also weaken the muscles that control breathing. Without medical care, botulism can lead to death.

Babies younger than 15 months old can get infant botulism and may appear tired, show little facial expression, have a weak cry or poor head control, and appear “floppy” because they can’t control their muscles. 

If you or someone you know has symptoms of botulism, call 911 or go to the emergency room immediately.

Botulism symptoms include trouble swallowing, droopy eyelids, blurry vision, slurred speech, weak muscles, and trouble breathing

How can a person get botulism? 

Bacteria called Clostridium botulinum make spores, which are dormant (or inactive) cells resistant to extreme conditions (such as hot temperatures). C. botulinum spores are common in the environment, including in the soil and dust. Most of the time, C. botulinum spores do not make people sick.
But under certain conditions (especially in low-oxygen, low-acid, and low-sugar environments), the spores can grow and make the harmful botulinum toxin which causes paralysis.

A person can get botulism in different ways. The different types of botulism are determined by how a person is infected:

Botulism is not contagious, which means it cannot be spread from person to person.


  • Foodborne botulism is caused by eating or drinking something that is contaminated with the botulinum toxin.

    • Home-canned foodsFoods that aren’t properly processed, fermented, pickled, preserved, stored, or refrigerated can create the right environment for C. botulinum spores to grow and make the botulinum toxin. 


      Foods that can be risky for botulism are usually low in acid, salt, or sugar and may include: 

      • Home-canned or home-pickled foods, especially meat or vegetables that aren’t properly preserved

      • Fermented tofu in glass jarHome-fermented foods, including fermented fish and fermented tofu (also called chao or furu) that aren’t fermented properly

      • Perishable, store-bought foods that aren’t properly refrigerated (such as soups and chowders)


  • Wound botulism is caused by C. botulinum spores getting into a wound or opening in the skin and making the botulinum toxin.

    • People who inject street drugs like black tar heroin are more likely to get wound botulism than people who do not because C. botulinum spores can get in through the injection site and make the botulinum toxin.

    • Rarely, a traumatic injury (like an open fracture) where dirt or soil gets into the wound can cause wound botulism.


  • Infant botulism is caused by C. botulinum spores that get into an infant’s intestines and grow and make the botulinum toxin.

    • Honey can contain C. botulinum spores and should not be fed to babies younger than 12 months.

  • Adult intestinal toxemia (adult intestinal colonization) is similar to infant botulism and is caused by C. botulinum spores that get into an adult’s intestines and grow and make the toxin.

    • People with severe gut illnesses or past intestinal surgery are more at risk for this type of botulism, but it is very rare.


Although botulism is rare, all forms of botulism can cause death and are considered medical emergencies. ​​​

What can happen if someone has botulism?

If not treated quickly, paralysis from botulism starts in the head and face and usually moves down the body, causing breathing problems, full paralysis, and even death. About 1 in 20 people who get botulism die from respiratory failure or the result of long-term paralysis.

Symptoms of foodborne botulism usually begin about 18 to 36 hours after eating or drinking something that is contaminated with the botulinum toxin, but symptoms can occur as early as 6 hours or as late as 10 days.

People with wound botulism may not have symptoms until several days after the wound is infected or injecting contaminated drugs.

How is botulism treated?

Botulism is a very serious disease that can be deadly if not treated. If caught early, botulism can be treated with botulinum antitoxin, which blocks the toxin from causing more harm in the body. But the antitoxin can’t undo any muscle paralysis that has already happened, so it can take weeks or even months for a person to get better. A person with severe botulism may need help breathing and may need to be on a breathing machine (ventilator) for weeks with intensive medical care.

Botulinum antitoxin for patients 15 months of age and older in California is available by working with the local public health department, CDPH, and the U.S. Centers for Disease Control and Prevention (CDC). If the diagnosis of botulism is suspected, healthcare providers can ask for the botulinum antitoxin through their local health department, which will work with CDPH and CDC to release the antitoxin. For infant botulism, healthcare providers should contact the CDPH Infant Botulism Treatment and Prevention Program to obtain the licensed human botulinum antitoxin, BabyBIG. ​


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