Foodborne botulism has a distinct epidemiological pattern tied to the conditions C. botulinum requires to grow and produce toxin.
Home-canned vegetables are the leading cause in the United States. Low-acid vegetables like green beans, corn, beets, and asparagus are the most common vehicles. If the canning process does not reach a high enough temperature for sufficient time to destroy spores, and if the canned product is not subsequently heated before eating to denature any toxin, the risk is present.
Fermented, salted, and smoked fish are a traditional cause, especially in Alaska Native communities where fermented fish heads, seal flippers, and beaver tail are part of traditional foodways. The Ma Cohen's recall fits this category: a smoked fish product in a low-oxygen package.
Commercially prepared foods in hermetically sealed containers are a smaller but persistent risk category. The commercial canning industry operates under strict thermal processing standards designed to achieve a "botulinum cook," a heat treatment sufficient to reduce the probability of spore survival to one in a trillion. Sporadic commercial outbreaks still occur, most often traced to processing failures, damaged containers, or products that are not heated before consumption.
Garlic in oil and herb-infused oils present a special risk. Raw garlic is a low-acid food that commonly harbors C. botulinum spores. When submerged in oil, which creates an oxygen-free environment, and stored at room temperature, the conditions are ideal for toxin production. Several outbreaks have been traced to homemade or improperly commercial garlic-infused oil stored without refrigeration.
Baked potatoes wrapped in aluminum foil have caused outbreaks when left at room temperature for extended periods. The foil creates an anaerobic microenvironment, and baked potatoes are low-acid.
Infant botulism is caused by ingestion of spores, not pre-formed toxin, and is most commonly associated with honey. The spores germinate in the infant's immature gut and produce toxin in the body. Infant botulism is the most common form of the disease in the United States, with approximately 100 cases reported annually.