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CHP investigates additional case of suspected botulism following botulinum toxin injections

     The Centre for Health Protection (CHP) of the Department of Health (DH) is today (June 10) investigating an additional suspected case of botulism after receiving injections of botulinum toxin in the Mainland, and again urged the public that such injections should only be prescribed and performed by registered doctors.

     The female patient, aged 21 with good past health, has developed shortness of breath, difficulty in swallowing, double vision and generalised muscle weakness since May 25. She attended a hospital in Shenzhen on May 25 but did not require hospitalisation. She attended the University of Hong Kong - Shenzhen Hospital where she was admitted on June 9, but she was discharged against medical advice on the same day. She subsequently came to Hong Kong on the same day and was admitted to Prince of Wales Hospital on June 10. She was found to have muscle weakness over four limbs and bilateral ptosis during admission. Her clinical diagnosis was suspected iatrogenic botulism and she is currently in stable condition.

     According to information provided by the patient, she received injections of botulinum toxin on May 23 to her bilateral calves at a residential premises in Guangzhou. She was accompanied by a colleague, who received botulinum toxin injections to her face but has remained asymptomatic so far.

     "We have no evidence at this stage that patients of the five recent cases so far had received injections in the same premises. Epidemiological investigations are ongoing," a spokesman for the DH said.

     Anyone who develops compatible symptoms following botulinum toxin injections is urged to immediately seek medical attention for prompt management, and call the DH's hotline (2125 1133), operating from 9am to 6pm from Monday to Friday, to provide details for epidemiological investigations. No abnormalities have been detected so far.

     Botulism is a statutorily notifiable infectious disease. Clinicians must report to the CHP in case of patients with symptoms or histories of suspected botulism.

     "We are very concerned about these cases and recent reports of consultations following botulinum toxin injections in the Mainland. We have been maintaining close liaison with the Hong Kong Poison Information Centre of the Hospital Authority, relevant medical professionals, and Mainland health and drug regulatory counterparts to identify if there are similar cases. We acknowledged that the health authority of the Mainland had taken follow-up measures," the spokesman said.

     "Due to the weakening of associated muscles, patients receiving the injection may have problems with chewing or even swallowing, speaking or breathing. These problems may happen in hours, days or weeks. Botulinum toxin may spread and affect other areas beyond the injection site, resulting in hoarseness, drooping of the eyelids, double vision or blurred vision," the spokesman said.

     The DH urged the public to observe the health advice below before receiving botulinum toxin injections:

* Injections should only be performed by locally registered doctors;
* Understand the procedure, potential risks and complications before receiving botulinum toxin injections. Consult a doctor for an informed decision;
* Do not receive an injection in case of a history of allergy to botulinum toxin, or infection or inflammation on the injection site;
* Request the full name of the doctor in writing if referred by a beauty service provider for the procedure, as well as the professional qualifications and relevant experience; and
* If symptoms develop, such as fever or feeling unwell, seek medical attention immediately.

     "Those who must receive injections outside Hong Kong should pay special attention to ensure that practitioners are qualified or registered with relevant jurisdictions. If in doubt, stop using or receiving the injection immediately. Promptly consult qualified healthcare professionals if feeling unwell," the spokesman added.

     The public may visit the DH's pages below for more information:

* The differentiation between medical procedures and beauty services (;
* The Drug Database of the Drug Office (; and
* The CHP's botulism page (

Ends/Friday, June 10, 2016
Issued at HKT 18:01


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