Is there a risk of botulism transmission to a 4-month-old infant after being kissed by a toddler who consumed a refrigerated bar containing honey?

From the Guidelines

There is a minimal risk of botulism transmission to a 4-month-old infant after being kissed by a toddler who consumed a refrigerated bar containing honey. The primary concern with honey and infants is the risk of infant botulism, which occurs when babies ingest C. botulinum spores that can germinate in their immature digestive system and produce toxins 1. However, the scenario of a toddler consuming honey and then kissing an infant presents a negligible risk for several reasons:

• The amount of honey transferred through a kiss would be extremely small.
• The bacteria require specific conditions to grow and produce toxins, including anaerobic conditions, low acidity, and suitable temperatures, which are unlikely to be met in this context 1.
• The botulinum toxins are the most potent biologic toxins known, but the lethal dose for humans is unknown, and the amount transferred through a kiss would be far below any estimated lethal dose 1. Key considerations in this scenario include:
• Infant botulism typically occurs when infants ingest C. botulinum spores directly, not through secondary contact like a kiss.
• Symptoms of botulism, such as constipation, weakness, poor feeding, or a weak cry, would typically appear within a few days if the infection were present, but the risk in this scenario is very low. As a precaution, wiping the baby's face after such contact could be considered, but there is no need for medical intervention unless the baby shows unusual symptoms. The risk of botulism transmission through a kiss after consuming honey is extremely low, and the focus should be on general hygiene practices rather than specific botulism prevention in this context.

From the Research

Risk of Botulism Transmission

• The risk of botulism transmission to a 4-month-old infant after being kissed by a toddler who consumed a refrigerated bar containing honey is not directly addressed in the provided studies.
• However, according to 2, infantile botulism is the result of ingestion of Clostridium botulinum spores, and 90% of cases occur in infants <6 months old.
• The studies suggest that botulism is typically caused by ingestion of contaminated food or growth of Clostridium botulinum bacteria in the infant gastrointestinal tract or within a wound 3, 4, 5.
• There is no evidence to suggest that botulism can be transmitted through kissing, as it is not a contagious disease 3, 4, 5.
• The primary concern with honey is that it can contain spores of Clostridium botulinum, which can produce the botulinum toxin in the infant's gastrointestinal tract 2, 5.
• It is essential to note that the toddler's consumption of a refrigerated bar containing honey may pose a risk to the toddler themselves, rather than the infant, as the spores can only produce the toxin in the gastrointestinal tract of the individual who ingested the contaminated food.

Prevention and Treatment

• To prevent botulism, it is crucial to avoid feeding honey to infants under 12 months old, as their gastrointestinal tract is not mature enough to handle the spores 2, 5.
• If a child is suspected to have botulism, it is essential to seek medical attention immediately, as early treatment with antitoxin and supportive care can significantly improve outcomes 3, 4, 5, 6.
• The use of human-derived botulinum immune globulin (BIG) has been shown to be effective in treating infant botulism, reducing the duration of hospitalization, mechanical ventilation, and tube or parenteral feeding 6.