A weeks-old potato added to a batch of pruno—an illicit alcoholic drink that prison inmates make and share—has been implicated in the largest US botulism outbreak linked with the prison brew.
Federal health officials reported in today’s Morbidity and Mortality Weekly Report (MMWR) that the October 2011 outbreak affected 8 maximum security prisoners at Utah State Prison in Salt Lake County. All 8 were hospitalized in a neuro-critical care unit; 3 began receiving mechanical ventilation within 24 hours of being admitted. None of the inmates died, but most had ongoing health problems 11 months after the outbreak, including weakness, decreased muscle mass, difficulty breathing, and trouble swallowing.
Food-borne botulism is rare because the conditions needed for Clostridium botulinum spores to produce botulinum toxin are uncommon. The toxins thrive in an anaerobic, low-salt, low-acid, low-sugar environment maintained at room temperature. Botulism symptoms usually include blurred or double vision, trouble swallowing, weakness, and impaired gag reflex.
Health officials said inmates typically make pruno by mixing fruit, sugar, and water and fermenting it in resealable plastic bags or jars from food products and other items they buy in the prison commissary. In the Utah outbreak, 1 of several pruno batches the inmates made contained a baked potato taken from a meal tray and kept for weeks in a jar or a sealed plastic bag. An inmate added the potato to a bag of fermenting pruno ingredients several days before sharing the brew.
Health officials noted that potato-containing pruno is suspected in 4 botulism cases reported last August at a federal prison in Arizona and in outbreaks in 2 California prisons in 2004 and 2005. Only pruno with potatoes, which can have botulinum spores from the soil on their skin, has been implicated in any of these outbreaks.
Inmates in the Utah prison received heptavalent botulinum antitoxin (HBAT), an investigational new drug available only from the Centers for Disease Control and Prevention. Health officials said HBAT is the mainstay of noninfant botulism treatment. Rapid diagnosis and treatment are needed to prevent severe illness and death, they added.
The MMWR called pruno consumption “an ingrained part of prison culture” nationwide and indicated that it may be an underrecognized source of botulism cases. In additional to severe illness, the outbreak cost Utah taxpayers $500 000 in hospital charges as well as costs for secure emergency transport; security measures at the hospital; and local, state, and federal resources used to investigate the outbreak.