A brand of almond milk behind a case of botulism in Australia was missing storage information, according to investigators.

Inside Out Nutritious Goods has expanded a recall because products are not labeled with instructions to keep refrigerated.

Authorities said failure to refrigerate the products can lead to microbial growth and biotoxin contamination which may cause illness if consumed. Botulism is a rare but life-threatening condition caused by toxins produced by Clostridium botulinum bacteria.

Initially, the company recalled JS Health x ​​Inside Out Unsweetened Almond Milk Collagen + Calcium + Prebiotics sold in Woolworths stores in New South Wales (NSW).

Now, 1-liter JS Health x ​​Inside Out Unsweetened Oat Milk Collagen + Calcium + Prebiotics and the Barista version are affected. Drinks were sold at Woolworths outlets nationally and have a use-by date up to and including May 18, 2023.

The earlier recall was updated following a NSW Department of Primary Industries inspection of the Inside Out manufacturing facility which found the plant was in compliance with regulations and relevant standards.

The product is sold chilled and must be kept refrigerated. Consumers should not drink the beverage if it has not been kept refrigerated and stored below 4 degrees C (39.2 degrees F).

One person sick

One person suffered severe symptoms of botulism after drinking the dairy alternative. This person was hospitalized and they are continuing to receive treatment.

Investigations by authorities have confirmed the presence of botulinum toxin in a sample of the product. The NSW Food Authority is investigating the manufacturing process to determine the possible cause of contamination.

Growth of the bacteria and formation of toxins occurs in products with low oxygen content and certain combinations of storage temperature and preservation methods. Refrigeration temperatures combined with salt content or acidic conditions will prevent the growth of the bacteria and the formation of toxins, according to the World Health Organization (WHO).

Botulism is extremely rare in Australia with 26 cases recorded since 1992. Only three of these have been foodborne.

Inside Out Nutritious Goods said it takes food safety, labeling, storage and handling instructions seriously.

“Our thoughts are with the affected customer and we wish them a speedy recovery. As soon as we were informed of a potential contamination issue, we commenced a voluntary recall and have been providing every assistance to the relevant authorities. We are working with NSW Health and the NSW Food Authority to investigate what has happened. Inside Out is also engaging independent experts to investigate the matter,” said a company statement.

About botulism
While a variety of illnesses can result from eating under-processed food, one of the most dangerous is botulism poisoning. Untreated, botulism can paralyze the muscles needed for breathing, resulting in sudden death.

Anyone who has consumed any recalled products and developed signs of botulism poisoning should immediately seek medical attention, according to the U.S. Centers for Disease Control and Prevention (CDC). 

In foodborne botulism, symptoms generally begin 18 to 36 hours after eating contaminated food. However, symptoms can begin as soon as 6 hours after or up to 10 days later.

The symptoms of botulism may include some or all of the following: double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, difficulty breathing, a thick-feeling tongue, dry mouth, and muscle weakness. People with botulism poisoning may not show all of these symptoms at once.

These symptoms result from muscle paralysis caused by the toxin. If untreated, the disease may progress, and symptoms may worsen to cause paralysis of specific muscles, including those used in breathing and those in the arms, legs, and the body from the neck to the pelvis area.

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