Infant Botulism and Honey Exposure: Global Epidemiology, Prevention Policies, and Communication Strategies

AIM: This study summarised the global epidemiology, prevention policies, and public health communication strategies related to infant botulism and exposure to honey. METHODS: A narrative review of epidemiological data was carried out from 1976 to 2024, using surveillance reports, national health agency documents, and peer-reviewed literature. RESULTS: Cases were rare, but honey was the only consistently confirmed dietary source of infant botulism. The median age at onset was 3-4 months, and mortality was below 1% if the infants received intensive care support and specific therapy with human botulism immune globulin. A global review from 2007 to 2021 reported that the USA had approximately 130 cases of infant botulism per year, while Europe, Canada, Japan, and Australia reported markedly lower incidences. Italy had 36 cases between 2001-2020, which represented 8% of all confirmed botulism cases in the country during that period. We found that health authorities uniformly advised against consuming honey before 12 months of age, but warning labels remained voluntary in many regions, and caregiver awareness varied. CONCLUSION: Strengthened paediatric counselling, harmonised labelling policies, and culturally tailored communication strategies are needed to reduce infant botulism by preventing infants under 12 months of age from consuming honey.