Botulism Outbreak Linked to Baby Formula Just Got Even Bigger—Now in 13 States

A multistate outbreak of infant botulism linked to baby formula has expanded, with federal health officials identifying another batch of cases.

The Centers for Disease Control and Prevention and the Food and Drug Administration issued the latest update over the weekend. Officials have documented eight new cases since early last week, bringing the total to 23 cases across 13 states, all of whom have been hospitalized. The outbreak appears to be associated with infant formula produced by the company ByHeart Whole Nutrition, prompting a widescale recall of all its products.

Infant botulism

Botulism is the illness caused by the botulinum toxin, produced by the bacteria Clostridium botulinum. Botulism is often linked to foods contaminated with C. botulinum, though the route of illness differs between infants and everyone else.

Generally, botulism is caused when C. botulinum inside food awaken from their spore form and start making botulinum toxin. Most people then get sick when they ingest food laced with the toxin. But in infants, botulism usually happens when the child consumes these spores, which then activate inside their guts and make the toxin.

It’s not exactly clear why these bacteria can only germinate inside infants, but likely factors include the lack of a robust microbiome. The symptoms of infant botulism, which include constipation, poor feeding, and trouble swallowing, also tend to develop more slowly, making it harder for parents and doctors to identify the cause. In severe cases, infant botulism can lead to a progressive, life-threatening paralysis that affects a child’s breathing.

Honey is the only food clearly tied to a higher risk of infant botulism, which is why health agencies routinely recommend that families not feed their children honey until age one at the earliest. But C. botulinum spores are ubiquitous in the environment and can end up in many different foods, including baby formula.

The baby formula link

According to the CDC, the first known case of this outbreak occurred in early August, while the latest was reported on November 11.

Several parents reported feeding their children ByHeart Whole Nutrition infant formula products prior to their illness. When federal health officials first reported the outbreak in early November, the company issued a recall of the two lots reportedly consumed by sickened infants. After more parents reported cases tied to other lots of the baby formula, the company issued a blanket recall of its products.

As of last week, at least 15 infants had consumed these products just before they became sick. And officials have not yet identified any other formula brand or other shared exposure that seems to pose a risk to the general public.

As frightening as infant botulism can be for families, most children do survive their bout with it, especially with prompt medical attention. Though all infants in the 23 cases so far have been hospitalized, they’ve also all received the antitoxin BabyBIG, the standard treatment. And no deaths have been reported to date.

Officials are telling the public to immediately stop using any ByHeart Whole Nutrition infant formula products they purchased. If people did buy the formula, they should wash and sanitize any surfaces that may have been touched by it. They should also store the formula in a secluded, safe space and throw it out after a month if their children don’t develop any illness (in the event of a suspected case, keeping the product will allow investigators to test it for confirmation). And of course, families should seek immediate medical care if their infants consumed the formula and start experiencing potential symptoms of infant botulism.