Botulism cases in Europe following medical procedures in Turkey

The European Centre for Disease Prevention and Control (ECDC) have reported cases of botulism in travellers returning from Turkey after undergoing medical procedures aimed at helping them lose weight.

Between late February and 10 March 2023, there have been 67 cases reported from Turkey (53), Germany (12), Austria (1) and Switzerland (1). It has been confirmed that 63 of these cases underwent medical treatment in Turkey; 60 cases from a private hospital in Istanbul, Turkey and 3 cases from a private hospital in Izmir, Turkey. All 63 cases received intragastric BoNT treatment (an injection of the botulism neurotoxin (BoNT) into the stomach).

Botulism is a serious neuroparalytic illness caused by neurotoxins produced by Clostridium botulinum bacteria. The disease can occur naturally (e.g., foodborne botulism or wound botulism), or can be iatrogenic (induced unintentionally) following administration of BoNTs for therapeutic or cosmetic reasons.

Symptoms of botulism include generalised weakness, fatigue, breathing and/or swallowing difficulties.

Treatment includes administration of botulinum anti-toxin, and severe cases often require intensive care treatment. If treatment is successful, complete recovery can take weeks to months.

There is limited data on the fatality rate from botulism caused by medical procedures, but the fatality rate following food-borne botulism is 5-10%.

The ECDC are urging travellers to avoid intragastric treatments with BoNT in Turkey due to the significant risk of developing botulism and advise anyone who travelled to Istanbul and Izmir between 22 February and 1 March 2023 for intragastric BoNT treatment to seek medical advice, particularly if they experience any symptoms of botulism.

See the TRAVAX Medical Tourism page for advice for travellers wishing to seek medical care abroad.

For further information on Botulism, see the World Health Organization website