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CHP investigates two additional cases of suspected botulism

     The Centre for Health Protection (CHP) of the Department of Health (DH) is today (June 22) investigating two additional suspected cases of botulism after receiving injections of botulinum toxin, and again urged the public that such injections should only be prescribed and performed by registered doctors.

     The first patient is a 39-year-old woman with good past health, who has developed dry mouth, swallowing difficulties as well as face and neck muscle weakness since May 24. She sought medical attention from a private doctor on June 20 and was advised to seek medical attention from Accident and Emergency Department (AED). She attended Queen Elizabeth Hospital AED on June 21 and was admitted on the same day. She was found to have muscle weakness over the neck during admission. Her clinical diagnosis was suspected iatrogenic botulism and she is currently in stable condition.

     According to information provided by the patient, the patient's friend brought botulinum toxin from the Mainland and performed the injection on her face on May 20 at her home.

     "As illegal practice of medicine and possession of Part 1 poison were suspected, this case has been referred to the Police for their necessary action," a spokesman for the DH said.

     The other female patient aged 33 with good past health, has presented with generalised weakness, shortness of breath and swallowing difficulties since June 15. She subsequently sought medical attention twice in Dongguan, Guangdong. She returned to Hong Kong on June 21 and attended the AED of Kwong Wah Hospital where she was admitted on the same day. She was found to have weakness of both shoulders and 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 had received injections to both upper arms for slimming purpose in a beauty shop in Shenzhen, Guangdong on May 15 but she was uncertain whether the injections received were botulinum toxin.

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

     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/Wednesday, June 22, 2016
Issued at HKT 20:12


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