From late February 2023 to 10 March 2023, 67 cases of botulism, probably of iatrogenic origin, related to intragastric injection of botulinum toxin (BTX) were reported in Germany (12), Austria (1), Switzerland (1) and Turkey (53).
Information currently available indicates that all patients underwent medical intervention to reduce body weight between February 22 and March 1, 2023.
Among the 63 cases with available detailed information, 60 cases are reported in an epidemiological context with treatment administered by a private hospital in Istanbul, and another three cases are related to treatment in a private hospital in Izmir, Turkey. Due to the varying severity of the clinical picture of botulism, it is possible that some cases may still be identified.
The severity of patients’ symptoms ranged from mild to severe, and several cases required hospitalization (many of them in intensive care units – ICU) and treatment with botulinum antitoxin due to their clinical condition.
The European Center for Disease Prevention and Control (ECDC) strongly urges EU/EEA citizens not to undergo intragastric obesity treatment with BTX in Turkey, as this procedure is currently associated with a significant risk of developing botulism.
At this time, it is not clear whether the resulting health problems are related only to the therapeutic or procedural process in the hospitals concerned, or whether the problem is with the product being administered. An investigation by the Turkish authorities found that licensed BTX products were administered in the treatment, but these products are not approved for this particular type of obesity treatment by intragastric injection. The activities of the relevant departments of both hospitals were therefore suspended and an investigation was launched against those involved. Currently, there is no indication that the treatment would be organized commercially by a travel agency.
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