The toxin works by attacking the central nervous system. It blocks the release of acetylcholine, a neurotransmitter that acts between cells. Without acetylcholine, muscles are unable to contract, and paralysis results. Patients affected with botulism may require weeks or even months on mechanical ventilation to breathe. Antitoxin can reduce the severity of botulism, but the disease has to be recognized and treated early.
Botulism is so rare that it is often misdiagnosed.
Health professionals need to be aware of the symptoms and know how to report them to their local public health authorities. While antitoxins are a useful treatment, supplies are limited and the current process of production is difficult. Dr. Inglesby says existing technologies could be employed to develop large reserves of human antibody therapy, but sufficient resources would need to be invested to get this process initiated. A botulism vaccine is available, but mass immunization would eliminate the medicinal uses of the botulinum toxin. Over the past two years, The Hopkins Working Group for Civilian Biodefense has published recommendations in JAMA for responding to potential terrorist use of smallpox, anthrax, and plague bioweapons.