An outbreak of botulism originating in Türkiye due to gastric injections botulinum toxin for speed loss has reached 87 cases, as reported on Monday by the European Center for Disease Control and Prevention (ECDC).

This This represents 20 more cases than March 10, when the last update of the European body was produced. Germany is the most affected country, with 30 affected (18 more than March 10), ahead of Austria (one), France (one), Switzerland (two, one more) and Turkey (53).

All patient undergoing medical intervention between February 3 and March 1 to help them lose weight with gastric botulinum toxin injections. Currently there are mild and severe cases, despite being hospitalized several times and admitted to the Intensive Care Unit (ICU). Those who were hospitalized had received treatment with botulinum antitoxin.

Investigations carried out by the Turkish authorities have revealed that botulinum toxin, although permitted, is administered “off-label for the treatment of obesity by intragastric injections”. As a result, in early March, departmental activities at two hospitals were halted and an investigation was opened against the parties involved.

Intragastric injection of botulinum toxin in animals and humans Sometimes used as a treatment for obesity., although it is not permitted in Spain. Its effects include delayed gastric emptying and induction of early satiety, with consequent decreased intake and decreased body weight. However, it is riskier than other weight loss surgeries, because these high doses of toxins are dangerous.

Faced with this risk, the ECDC has “firmly” asked Europeans to do so avoid intragastric treatment with botulinum toxin against obesity in Turkey, because “they are currently associated with a significant risk for developing botulism”.

The European agency has advised people who have traveled to Istanbul and Izmir for this treatment and are showing symptoms compatible with botulism (weakness, difficulty breathing and/or swallowing) to see a doctor “as soon as possible”.

This is not the first time the ECDC has investigated a similar case of botulism. In 2019, France reported a suspected case of botulism in a woman aged 25-44 years after intragastric botulinum neurotoxin injection in Egypt for weight loss. Then, he had to be hospitalized on his return to France.

Additionally, a warning from World Health Organization (WHO) on Medical Products August 2022 reported five counterfeit batches of botulinum neurotoxin in five countries: Jordan (May 2022), Turkey (May 2022), Kuwait (June 2022), United Kingdom (June 2022) and Poland (July 2022). However, the ECDC “is not aware of whether this batch has been used for treatment in the cases reported so far.”

Outbreaks of iatrogenic botulism, sometimes associated with counterfeit or illegitimate botulinum neurotoxin, have also been reported in the past following different clinical procedures, for example in Egypt and Turkey.