Around fifteen cases of botulism, including one death, were recorded in connection with the consumption, between September 4 and 10, of poorly sterilized canned sardines in the “Tchin Tchin Wine bar” restaurant in Bordeaux. We have few tools to combat this extremely rare poisoning which generates on average 15 to 20 cases per year in France. Botulinum antitoxin can “help shorten hospitalization time”, cautiously specifies the Ministry of Health. But, to use it, the protocol is very regulated.
A potential biological weapon
“The risk of bioterrorism by botulinum toxin exists, so it is the army which is responsible for the stock of anti-toxin, located in Marseille”, specified on September 13 Benjamin Clouzeau, resuscitation doctor and head of division in the medicine department. intensive care unit (MIR) of Bordeaux University Hospital, during a press conference on collective poisoning. The “Bichat Recommendations on the clinical management of patients with botulism linked or not to an act of bioterrorism” were written in 2004 by experts gathered in a task force on biological and chemical threats and intended for the European Commission. We can read that “in aerosolized form, botulinum toxin could be used as a biological weapon”.
In this report, the specialists specify that in the early 1990s, the Japanese sect Aum Shinrikyo tried three times to spread it in this form in Tokyo without succeeding, finally opting for sarin gas. “It is likely that several countries have developed and possess weapons containing botulinum toxin,” says this task force. However, she concludes that although the production of the toxin has been reported in several countries “its use has never been proven”.
An exceptional “medicine”
In view of the collective poisoning that occurred in the Gironde capital, a prepositioning of the antidote was carried out at the Bordeaux University Hospital, under the leadership of Santé Publique France, the national public health agency under the supervision of the Ministry of Health. No pharmacy, city or hospital, has its own stock, everything is centralized in Marseille and it is the pharmaceutical establishment of Public Health France which manages, for the State, the stock of botulinum antitoxin.
“The authorization to inject botulinum antitoxin is given by the National Medicines Safety Agency (ANSM) requested for each patient in order to verify the conformity of the request, explains to 20 minutes the communications department of Santé Publique France. This is a request for compassionate access authorization (AAC) because there is no marketing authorization (AMM) for botulinum antitoxins. » We understand that outside of this normal marketing authorization circuit, the protocol is very rigorous to secure the use of this antitoxin.
It is crucial to administer the antidote as quickly as possible after symptoms appear. “Public Health France organizes mobilization and transport to the health establishment in times of less than 12 hours between request and delivery throughout the national territory as was done recently to the Bordeaux University Hospital. » Sending by air makes it possible to meet this deadline “in all territories, even the most distant (Overseas and Corsica) thanks to punctual prepositioning of these treatments”, specifies the agency.
Neither the army nor the Bordeaux University Hospital pharmacy, requested by 20 minutesdid not wish to answer our questions, for reasons of confidentiality.