Botulism in Ouarzazate, what the "case" of the unnamed company reveals...

It has been lit­tle report­ed in the news­pa­pers, but the month of Ramadan 2017 has seen sev­er­al deaths from food poi­son­ing. In one case, the prod­uct respon­si­ble was one of those indus­tri­al mille-feuilles found in every hanout and also dis­trib­uted by many street vendors.
With the heat of May, and haz­ardous stor­age con­di­tions, the cream had devel­oped enough to send a fam­i­ly to hos­pi­tal and kill some of its members.

The oth­er case is much more seri­ous, espe­cial­ly because of what it reveals about the func­tion­ing of Moroccan soci­ety and its food industry.

What happened

Deaths from botulism in Ouarzazate

What hap­pened … or at least what we know. During the month of Ramadan, sev­er­al mem­bers of a fam­i­ly were hos­pi­talised in Ouarzazate, and the moth­er and a three-year-old child died of bot­u­lism. The ONSSA (the body that con­trols, among oth­er things, the qual­i­ty of food­stuffs offered in the shops) issued a some­what impre­cise press release, speak­ing of canned food and remind­ing peo­ple that they should not con­sume prod­ucts bought "in the infor­mal sector".

Koutoubia's involvement

But very quick­ly, on social net­works, the rumour spread that the cul­prit was not a fam­i­ly pre­serve or a food bought from a street ven­dor, but a "kosher" Koutoubia of the Migusta brand (kosher, for those who do not live in Morocco, is a kind of vile sausage made of turkey or beef meat, com­pact, dry, with no ten­der­ness, flavoured with weird stuff. The name itself is a mys­tery, per­haps a ref­er­ence to pastrami…).

The silence of the media

Only Maroc Hebdo goes beyond the com­mu­ni­ca­tion of the ONSSA, by indi­rect­ly des­ig­nat­ing Koutoubia. Indeed, the first arti­cle is enti­tled "Tahar Bimezzagh's group at the heart of a big scan­dal". Koutoubia denies this and even threat­ens a law­suit, which leads the news­pa­per to pub­lish, in anoth­er arti­cle, a copy of an inter­nal ONSSA doc­u­ment request­ing in-depth analy­ses on the batch in ques­tion. The arti­cle in Maroc Hebdo states that the analy­ses detect­ed the pres­ence of bot­u­linum toxin.

Koutoubia has nothing to do with it, but still...

The range of Koutoubia prod­ucts is chang­ing in super­mar­kets: beef sausages, whose pro­duc­tion con­di­tions are less favourable to the appear­ance of bot­u­lism, are becom­ing more present. The kosher in ques­tion dis­ap­pears from the shelves. And that's it (well, almost every­thing, hav­ing par­tic­i­pat­ed in a Ramadan "F'tour", I can con­firm that we were con­trolled in a very com­plete way, and that the con­troller him­self told us "If you didn't have Koutoubia prod­ucts, we wouldn't have con­trolled anything).

But that's it in terms of pub­lic infor­ma­tion. No batch recall, nothing…

But if the bot­u­linum tox­in was real­ly present in this kosher, it can only have occurred dur­ing the man­u­fac­ture of the pre­served food, in the Koutoubia factories.

Botulism

Botulism is a rare dis­ease, under good food hygiene con­di­tions, and dan­ger­ous. If the patient is not tak­en care of, the tox­in will paral­yse the ner­vous sys­tem and lead to death by asphyx­i­a­tion. It is nec­es­sary to under­stand the mech­a­nism of devel­op­ment of the tox­in, to see that, what­ev­er one can claim about the con­di­tions of con­ser­va­tion, if there is bot­u­linum tox­in, it is because the can­ning was not well done.

Clostridium botulinum, a widespread bacterium

Clostridium bot­u­linum is a very com­mon bac­teri­um, which is found in the soil, among oth­er things, and can there­fore be found on veg­eta­bles, espe­cial­ly roots, fruit and any food han­dled with­out exces­sive hygiene. It is also found in riv­er water. Animals will there­fore ingest it, and the bac­te­ria can be found in their stom­achs, whether it is meat, fish or shellfish.

In its bac­te­r­i­al state, it is harm­less as such. However, under cer­tain con­di­tions (absence of oxy­gen, humid envi­ron­ment) it will release a very pow­er­ful tox­in, bot­u­lin.

Moreover, our lit­tle clostrid­i­um bot­u­linum is a sur­vivor. Heated to 120°, it will hold out for ten to twen­ty min­utes. Frozen, it falls asleep and wakes up fresh and ready as soon as the tem­per­a­ture ris­es again. And above all, its tox­in does not dis­ap­pear when it dies.

In unfavourable con­di­tions, it will emit spores, which will enable it to repro­duce lat­er, when con­di­tions are bet­ter, and thus gen­er­ate tox­in again. The spores of clostrid­i­um bot­u­linum are resis­tant to cold (they are not destroyed by freez­ing, for exam­ple), to heat, below a cer­tain tem­per­a­ture and for a cer­tain time.

In addi­tion, Clostridium bot­u­linum hates acidic envi­ron­ments. Below a pH of 4.6, it dies. The pH of the intes­tine and gas­tric juices being 2 on aver­age for a healthy adult, the bac­te­ria, if ingest­ed with­out hav­ing been able to pro­duce a tox­in before con­sump­tion, will be evac­u­at­ed by the body's nat­ur­al defences.

(It does not like salt either, which explains why salt­ing — done prop­er­ly — is an effec­tive method of preservation.)

Botulinum toxin, one of the most powerful poisons available

On the oth­er hand, very lit­tle bot­u­linum tox­in is enough to trig­ger seri­ous dis­or­ders. Botulinum tox­in paral­y­ses the nerves (which is why it is used in very small dos­es in med­i­cine and even in aes­thet­ics, under the name Botox). It even destroys the nerve end­ings.

The result is a pro­gres­sive paral­y­sis, espe­cial­ly of the lungs: vic­tims of bot­u­lism usu­al­ly die of asphyx­i­a­tion.

When patients are treat­ed in time, they will be put on res­pi­ra­to­ry assis­tance, for one to sev­er­al months, while the nerve end­ings rebuild. This can even last for a year. In some cas­es, the bot­u­lism attack will leave after-effects.

By way of com­par­i­son, the tetrodotox­in in the famous fugu fish has a lethal dose of 8 to 20 μg/ kg (one micro­gram = one gram x 10 pow­er ‑6) and bot­u­linum tox­in between 1.3 and 2.1 ng/kg (one nanogram = one gram x 10 pow­er ‑9), i.e. 4,000 times less!

How to avoid botulism toxin?

Beyond the sim­ple rules of hygiene (wash­ing fruit and veg­eta­bles, keep­ing cooked dish­es in the fridge, cook­ing food thor­ough­ly), the strat­e­gy for pro­tect­ing one­self from bot­u­lism will dif­fer depend­ing on whether one is deal­ing with fresh prod­ucts that are con­sumed imme­di­ate­ly or canned food. As the tox­in takes some time to be pro­duced, the main risk con­cerns canned and pre­served food.

Cook at a sufficiently high temperature for a sufficiently long time to eliminate the toxins

The tem­per­a­ture and dura­tion will depend on the time of consumption.

For canned food, it is essen­tial to reach 120° for ten min­utes. This is not pos­si­ble by sim­ply boil­ing the can­ning jar. A spe­cial machine, called an auto­clave, must be used or, pos­si­bly, for small jars in small quan­ti­ties, a pres­sure cooker.

For food intend­ed to be eat­en imme­di­ate­ly, an inter­nal tem­per­a­ture of over 85° for five min­utes is suf­fi­cient to destroy the toxin.

Attention: we are talk­ing about inter­nal tem­per­a­ture, which means that you have to heat more, gen­er­al­ly boil for about ten min­utes. It all depends on the food: a nice piece of meat or a large pota­to will require more time than peas.

If these tem­per­a­tures are respect­ed, any tox­ins already pro­duced will be destroyed, as will the bac­te­ria, but not the spores. Care must there­fore also be tak­en dur­ing stor­age to avoid the time need­ed to repro­duce bac­te­ria and toxins.

Avoid anaerobic (oxygen-free), damp or warm environments

Foods cooked in air­tight wrap­pers, such as jack­et pota­toes wrapped in alu­mini­um foil, or vac­u­um cook­ing are a favourite tar­get for Clostridium bot­u­linum: lack of oxy­gen, heat and pos­si­bly humidity.

These foods should there­fore be eat­en quick­ly, or put in the fridge, with­in less than four hours.

For industrial canning

Industrial can­ning (such as kosher can­ning) must use very high tem­per­a­tures, which are the only ones capa­ble of destroy­ing the spores in addi­tion to the bac­te­ria and tox­in. This elim­i­nates all risk: there is no longer any pos­si­bil­i­ty of find­ing bot­u­linum tox­in in a prod­uct, unless there is a new con­t­a­m­i­na­tion under favourable conditions.

In oth­er words, if Clostridium bot­u­linum had been effec­tive­ly destroyed dur­ing the prepa­ra­tion of kosher food, the pack­ag­ing would have had to be removed, the prod­uct recon­t­a­m­i­nat­ed and repack­aged her­met­i­cal­ly by stor­ing it in a place that was "not cold" so that the tox­in could be present.

Did you say "traceability"?

What shocked me the most in this sto­ry is that, despite the very strong "sus­pi­cions" of the ONSSA, there was no offi­cial com­mu­ni­ca­tion or prod­uct recall.

Digging deep­er, how­ev­er, shows the lim­its of trace­abil­i­ty in Morocco.

Lot tracking in department stores

I exam­ined (under the wor­ried eye of the sales­man), two kosher shelves in two dif­fer­ent super­mar­kets, one Acima and one Carrefour.

In both cas­es, the batch num­bers were not homogeneous.

I asked their cus­tomer ser­vice: "can you track the batch­es that go from your cen­tral ware­hous­es to your shops", but I didn't get an answer. Even if the logis­tics sys­tems allow it, you have to remem­ber that this is Morocco, where "man­u­al repro­cess­ing" is the law.

Tracking batches in hanouts

This is even worse. Indeed, if we imag­ine that the whole­saler can fol­low the batch num­bers deliv­ered to each hanout (know­ing that the quan­ti­ties deliv­ered are some­times very small, less than the semi-wholesale pack­ag­ing), we know that when a hanout runs out of stock, it goes to buy from its neighbour-competitor, or even from Acima or Marjane…

There is there­fore a large pro­por­tion of the kosher prod­ucts mar­ket­ed (80% ? a Marjane man­ag­er esti­mat­ed the share of large-scale dis­tri­b­u­tion in Morocco at 15% of the mar­ket) which are, de fac­to, untrace­able.

As an ironic conclusion, the history of the Koutoubia group

Koutoubia was orig­i­nal­ly a small butcher's shop in decline, bought from a Franco-Moroccan by a young butch­er from the Sous. It took off at the end of the 1990s, when a sim­i­lar scan­dal broke over taint­ed char­cu­terie prod­ucts, but of Spanish ori­gin. Smuggled in with­out any con­trols, these mor­tadel­las were the cause of around a hun­dred cas­es of poisoning.

Koutoubia then com­mu­ni­cat­ed on the "Made in Morocco" qual­i­ty while hav­ing its pro­duc­tion lines cer­ti­fied. It also com­mu­ni­cat­ed on the halal aspect of its pro­cess­ing lines, while the ani­mals were slaugh­tered by electro-narcosis.

The com­pa­ny man­aged to con­quer about 75% of the mar­ket in just a few years. An eco­nom­ic weight that would be worth not recall­ing a batch con­t­a­m­i­nat­ed by bot­u­linum toxin?