Botulism Associated with Home-Fermented Tofu in Two Chinese Immigrants — New York City, March–April 2012

In March 2012, the New York City Department of Health and Mental Hygiene (DOHMH) received two reports of recent immigrants from China admitted to the same hospital 23 days apart for suspected foodborne botulism. Patient 1 had a laboratory-confirmed case of foodborne botulism, and patient 2 had a probable case; patient 1's case was definitively associated with home-fermented tofu, and patient 2's case might have been associated with home-fermented tofu. Both patients had purchased fresh tofu from the same Chinese grocery in Queens, a New York City borough, in January 2012, and each had prepared home-fermented tofu using similar recipes. Similar fermentation practices at the two homes might have facilitated toxin production. Testing confirmed botulinum toxin type B in home-fermented tofu consumed by patient 1. Bulk tofu at the grocery in Queens was found to be sold in unrefrigerated, uncovered, water-filled bins. Traceback revealed that the grocery's fresh bulk tofu supplier at the time of the patients' purchases had gone out of business. DOHMH advised the grocery's manager of the need to properly store bulk tofu. Public health responders and clinicians should be aware of the association between botulism and fermented tofu.