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Botulism cases linked to Botox injections under investigation in Massachusetts
Massachusetts health officials are investigating four recent cases of suspected botulism connected to cosmetic injections of Botox. The outbreak on the South Shore prompted the Department of Public Health to warn health care providers to be alert about symptoms. Botulism, though rare, can be fatal. It occurs when botulinum toxin enters the bloodstream and can produce effects far from the injection site.
The outbreak on the South Shore prompted the Department of Public Health to warn health care providers to be alert about symptoms. consistent with botulism occurring after botulinum toxin injections.
Botox is widely used for cosmetic purposes to reduce wrinkles and fine lines.
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“While generally safe when administered by trained professionals, improper dosing, administration technique, or use of non-FDA-approved products may increase the risk of systemic botulism symptoms,” the DPH advisory said.
Botulism, though rare, can be fatal. It occurs when botulinum toxin enters the bloodstream and can produce effects far from the injection site, according to the advisory.
Initial botulism symptoms include double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing and breathing problems, according to state health officials. These symptoms may progress to muscle weakness that worsens over hours to days.
Anybody who is experiencing any symptoms should go to an emergency room.
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“This is very rare,” South Shore Hospital infectious disease specialist Dr. Todd Ellerin told WCVB. “We call it iatrogenic botulism, which means you get it as a complication of an injection. It is very rare.”
The DPH has not released details about the condition of the four individuals involved in the South Shore cases or information about the provider or facility where they received their injections.
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Read the original article on MassLive.
Two states issue warning against botox injector due to ‘imminent’ risk to public
Victoria and NSW regulators have issued public safety warnings about an unregistered cosmetic injector. The warnings come after the ABC revealed more cases of a deadly paralysing illness linked to dodgy botox injections. Three women who were allegedly injected by Ms Zakaria at a Western Sydney home earlier this month became unwell with symptoms of the rare but potentially fatal nerve-paralyseding illness last week. One woman, who was being treated in intensive care, remains in hospital, while two others have been discharged. NSW health authorities are investigating whether recent cases of suspected botulism caused by unregulated anti wrinkle products, and injected in an unlicensed premises, were linked to another case in Victoria last year, that was not publicly announced at the time. The Therapeutic Goods Administration (TGA) said it was aware of the cases in NSW, plus one other in the last 12 months, and was liaising with state authorities and other regulators. The TGA said detecting and disrupting unlawful supply and advertising of unapproved and high-risk medicines and medical devices, including cosmetic injectables, was a priority.
The Victorian Health Complaints Commissioner and the NSW Health Care Complaints Commission (HCCC) on Friday afternoon issued a public warning about Ms Norsafiza Binti Zakaria, who they say operates under several aliases, including Natasha Scha, Zakaria Scha, and Scha Zakaria Beauty Spa.
It comes after the ABC reported that NSW health authorities were investigating whether recent cases of suspected botulism caused by unregulated anti wrinkle products, and injected in an unlicensed premises, were linked to another case in Victoria last year, that was not publicly announced at the time.
Three women who were allegedly injected by Ms Zakaria at a Western Sydney home earlier this month became unwell with symptoms of the rare but potentially fatal nerve-paralysing illness last week.
One woman, who was being treated in intensive care, remains in hospital, while two others have been discharged, NSW Health has confirmed.
What is botulism? Botulism is a serious illness that can lead to nerve damage and is caused by a toxin found in bacteria spores present in soil dust and some foods.
Cases have also been reported by people injected with counterfeit or contaminated botox, or by accidental injection of the toxin into the bloodstream.
The condition can be fatal, but is rare, usually only affecting around one person per year in Australia.
Symptoms can take up to two weeks to develop and include weakness, difficulty breathing, blurred vision and may require intensive care.
The ABC revealed on Friday morning the unannounced case of suspected botulism in Victoria.
That suspected case, which followed the injection of an unregistered botulinum toxin product allegedly connected to Ms Zakaria, was reported to the Victorian Department of Health in September.
That patient also required treatment in hospital before being discharged.
An alert was not issued in 2024 because at the time it was thought to be an isolated incident.
The Victorian Department of Health is now co-ordinating with the NSW HCCC, which on Friday issued an urgent prohibition order against Ms Zakaria amid its investigation as well as a public warning.
The HCCC says the commission has obtained evidence that:
Ms Zakaria advertised cosmetic injections via WhatsApp and other social media platforms
She performed these procedures in residential premises in NSW and Victoria without the involvement of a registered health practitioner
The substances she injected may pose an immediate risk to anyone undergoing treatment
In January 2025, Ms Zakaria attended a residential address in Sydney and injected at least three people with substances she claimed were botulinum toxin
All three people suffered severe complications consistent with botulism, requiring hospitalisation — one of whom was admitted to intensive care.
Victorian Health Complaints Commissioner, Adjunct Professor Bernice Redley said she was deeply concerned about the multiple reported cases of botulism allegedly caused by Ms Zakaria.
“As such, I believe that it is necessary to publish this warning statement to avoid an imminent and serious risk to the life, health safety or welfare of the public,” she said.
The Therapeutic Goods Administration (TGA) — which is responsible for regulating approved brand name anti-wrinkle injections — said it was aware of the cases in NSW, plus one other in the last 12 months, and was liaising with state authorities and other regulators.
The TGA also said detecting and disrupting unlawful supply and advertising of unapproved and high-risk medicines and medical devices, including cosmetic injectables, was a priority.
As of Thursday, the TGA’s database recording adverse events showed only three reported cases of suspected botulism linked to registered brand name anti wrinkle injections, in 2011, 2021 and 2023.
There is no register of the number of cases linked to unregulated products.
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Federal Health Minister Mark Butler said state and federal authorities were alive to the risks of unregulated products and practitioners.
“We’re deeply concerned about the potential in this market of cosmetic surgery and injectables that some Australians are vulnerable to poor quality products and practitioners who might not be properly qualified to deliver them,” he told reporters on Friday.
NSW Health’s Dr Jeremy McAnaulty told ABC News last week anti-wrinkle products must be approved and administered by a registered health practitioner.
“Cosmetic injections, if used incorrectly, could result in serious harm and even death in the most serious of cases,” he said.
“Which is why it is so important that anyone receiving cosmetic injections does so under the supervision of an appropriately registered health practitioner.”
Patients have been encouraged to check if a health practitioner is registered on the Australian Health Practitioners Regulation Agency website.
Any members of the public with information or who have been treated by Ms Zakaria are urged to contact the Victorian Health Complaints Commissioner by calling 1300 582 113 or by completing an online complaint via their website, or to contact the NSW HCCC by emailing: prohibitionorders@hccc.nsw.gov.au.
The HCCC can also be contacted via their website.
31-year-old woman hospitalised with botulism after receiving unregulated botulinum toxin injections in Mainland
The case involves a female patient who received injections purportedly containing botulinum toxin on 13th January. A few days later, she began to experience troubling symptoms, including limb weakness, difficulty swallowing, and shortness of breath. She sought medical attention at Tseung Kwan O Hospital and was admitted on 20th January, where she was clinically suspected of having botulism. Fortunately, she is currently in stable condition.
The case involves a female patient with no prior health issues who received injections purportedly containing botulinum toxin on 13th January. Unfortunately, she could not confirm the qualifications of the individual who administered the injections. A few days later, she began to experience troubling symptoms, including limb weakness, difficulty swallowing, and shortness of breath. She sought medical attention at Tseung Kwan O Hospital and was admitted on 20th January, where she was clinically suspected of having botulism as a result of the injection. Fortunately, she is currently in stable condition.
The CHP has reported the incident to relevant authorities on the Mainland, and epidemiological investigations are underway to ascertain further details. A spokesperson for the CHP underscored the importance of receiving such treatments only from locally registered doctors in Hong Kong. Patients are advised to verify a doctor’s credentials against the Medical Council of Hong Kong’s list and to exercise caution when considering injections administered outside of the jurisdiction.
The spokesperson also warned that botulinum toxin can have severe complications, as it may weaken associated muscles and potentially spread beyond the injection site. Symptoms such as drooping eyelids, double or blurred vision, difficulty chewing, hoarseness, and even challenges with swallowing, speaking, or breathing may manifest hours, days, or even weeks after the injection.
State warns of botulism cases tied to bad Botox
State officials are investigating six cases of suspected botulism resulting from cosmetic Botox injections. It was unclear whether the individuals had been injected at the same location or how seriously they had been injured. Botulism can be potentially fatal, causing a variety of paralytic symptoms. The anti-toxin helps slow the progression of symptoms, but does not reverse them, and so hospitals typically also provide supportive measures. The reports are only the latest Botox problems to surface in the South Shore. In November, 38-year-old Rebecca Fadanelli, was arrested and charged with selling counterfeit Botox of Skin Beauton and Jueré Medraé Spa in East Randolph, Massachusetts. She is accused of receiving over $900,000 in client payments, but prosecutors say she wasn’t a licensed aesthetician and was a nurse, not a Botox provider. It is the most common cosmetic procedure administered worldwide, with an estimated 3 million injections done annually. The powerful toxin, produced by a bacteria, blocks the ability of the nervous system to activate muscles.
On Thursday, the Massachusetts Department of Public Health issued an advisory about four suspected cases on the South Shore. Friday the department confirmed two more cases have been found.
State officials are investigating six cases of suspected botulism resulting from cosmetic Botox injections, and are warning health providers to be on the lookout for more.
South Shore Health declined to answer questions about whether the health care system was treating suspected cases or how many it was seeing, referring instead to the Department of Public Health.
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However Dr. Jason Tracy, chief medical officer at the health system, said generally that patients are given a presumptive diagnosis made off of their clinical presentation of symptoms and history of recent injections.
From there, the hospital would involve both the Department of Public Health and the Centers for Disease Control, which has an anti-toxin that it provides on a case-by-case basis. The anti-toxin helps slow the progression of symptoms, but does not reverse them, and so hospitals typically also provide supportive measures.
“This is quite rare,“ Tracy said. ”This is different than a food-borne botulism type case. It’s not as though there is a lot body of literature to refer clinicians to to give prognosis and historical elements and time courses for what to expect.”
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South Shore Hospital in Weymouth. Pat Greenhouse/Globe Staff
Use of botulinum toxin — commonly known by the popular brand name Botox — for cosmetic procedures is widely understood to be safe. The powerful toxin, produced by a bacteria, blocks the ability of the nervous system to activate muscles. It has become known worldwide for its ability to both soften and prevent wrinkles, and it is the most common cosmetic procedure administered worldwide, with an estimated 3 million injections done annually.
Cosmetic treatments with botulinum toxin use doses much lower than for medical treatments, said Dr. Mathew M. Avram, director of the Mass. General Hospital Dermatology Laser and Cosmetic Center. With regulated, FDA-approved products in a healthy adult, the amount of the toxin is so small that it is exceedingly rare for it to cause botulism.
“I’ve never seen a patient or had a colleague of mine at Mass. General or elsewhere that has told me they have had a case of this. It is not something that happens normally,” Avram said. “Someone would have to go outside the realm of what you would typically inject to encounter these issues, for a typical patient.”
Beyond injecting far too much, poor administration technique or using counterfeit products can increase risks.
“We have seen instances where injectors have used counterfeit products or products they developed on their own,” Avram said. “These are unsafe practices that can harm patients.”
According to the advisory, botulism results when the botulinum toxin circulates in the blood. Symptoms including double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, and difficulty breathing. Such symptoms are sometimes followed by muscle weaknesses, which can progress over the course of hours or days.
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DPH has asked clinicians to warn patients interested in these cosmetic injections of the potential risks, and is advising patients to receive injections only from licensed providers.
“If someone has had a botox injection and has had those symptoms they should seek medical attention,” Tracy said. “I don’t want to create worry but someone having visual changes, slurred speech and difficulty swallowing — they should not ignore it.”
The reports are only the latest Botox problems to surface in the South Shore. In November, 38-year-old Rebecca Fadanelli, was arrested and charged with selling counterfeit Botox out of Skin Beauté Med Spa in Easton and Randolph.
Prosecutors say Fandanelli had for years imported counterfeit Botox, Sculptra, and Juvederm from China and Brazil and performed over a thousand injections, receiving over $900,000 in client payments. Though she represented to clients and employees that she was a nurse, prosecutors said she is an aesthetician and wasn’t properly licensed.
Jessica Bartlett can be reached at jessica.bartlett@globe.com. Follow her @ByJessBartlett.
‘Growing cluster’ of botulism cases tied to Botox at Milton spa
At least 10 people who received procedures at Rodrigo Beauty are thought to have contracted iatrogenic botulism. State health officials previously issued an advisory about four suspected cases on the South Shore. They did not say at the time whether the individuals had received injections at the same location. Botox and other cosmetic procedures should only be administered by licensed professionals in accredited medical settings, officials say. The website for booking appointments at the spa had been taken down by late Saturday night, officials said.
At least 10 people who received procedures at Rodrigo Beauty, at 464 Granite Ave., are thought to have contracted iatrogenic botulism, a rare but life-threatening condition, the state Department of Public Health said in a statement Saturday.
State health officials are urging people who received cosmetic Botox injections recently at a Milton spa to come forward, after the location was tied to a “growing cluster” of botulism cases.
Rodrigo Beauty did not immediately return a request for comment Saturday night. It appeared the website for booking appointments had been taken down.
State health officials previously issued an advisory about four suspected cases on the South Shore, raising the tally of cases to six on Friday. They did not say at the time whether the individuals had received injections at the same location.
Use of botulinum toxin — commonly known by the popular brand name Botox — for cosmetic procedures is widely understood to be safe. The powerful toxin blocks the ability of the nervous system to activate muscles, helping to both soften and prevent wrinkles. Botox injections are the most common cosmetic procedure administered worldwide, with an estimated 3 million injections done annually.
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Health officials stress that Botox and other cosmetic procedures should only be administered by licensed professionals in accredited medical settings.
Botulism results when the botulinum toxin circulates in the blood, causing a variety of paralytic symptoms. Those symptoms include double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, and difficulty breathing. Such symptoms are sometimes followed by muscle weaknesses, which can progress over the course of hours or days.
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In November, a Stoughton woman was arrested and charged with selling counterfeit Botox injections out of Skin Beauté Med Spa in Easton and Randolph. Prosecutors said the woman has falsely posed as a nurse and had performed over a thousand injections with the counterfeit products.
Material from previous Globe coverage was included in this report.
Camilo Fonseca can be reached at camilo.fonseca@globe.com. Follow him on X @fonseca_esq and on Instagram @camilo_fonseca.reports.
Source: https://www.golocalprov.com/news/ma-department-of-health-issues-botox-botulism-warning