South Dakota Health Alert Network Communication
The message below was provided on June 18, 2026 by the South Dakota Department of Health’s Division of Disease Prevention and Control.
Situation: As of June 13, 2026, 3 cases of infant botulism have been identified in a multistate outbreak of infant botulism linked to recalled powder infant formula. States reporting cases include California (1), Pennsylvania (1), and Washington (1). Cases range in age from 86 to 153 days old and the earliest illness onset was reported in April 2026. All 3 infants were hospitalized and treated with BabyBIG®. No deaths have been reported. In South Dakota, no cases have been reported at this time.
FDA has issued communication about the recall of all Nara Organics Whole Milk Organic Powdered Infant Formula. Infants should not be fed the recalled formula. Parents and caregivers who have recalled product that has been opened should take a picture and record the lot number and use-by date before throwing away. Consider retaining any opened formula for possible product testing later if the infant develops signs and symptoms of botulism. Label it “DO NOT USE” and keep it stored in a safe place away from other items used to feed the infant for at least a month. If no symptoms appear after a month, throw the leftover formula away.
The South Dakota Department of Health (SD-DOH) is asking providers to maintain heightened suspicion for the possibility of infant botulism in any infant presenting with compatible symptoms who was fed Nara Organics Whole Milk Organic Powdered Infant Formula. Additionally, providers should ask which formula brand is fed to their infant patients, alert parents/guardians to the Nara Organics Powdered Infant Formula recall, and ensure recalled formula is not consumed.
Clinical presentation: Patients with infant botulism may present with some or all of the following signs and symptoms: constipation, poor feeding, ptosis (drooping eyelids), sluggish pupils, flattened facial expression, diminished suck and gag reflexes, and weak/ altered cry. If untreated, the disease can lead to a progressive, flaccid paralysis that can cause difficulty breathing and respiratory arrest.
Infants become infected by ingestion of Clostridium botulinum spores that germinate in the colon, rather than ingestion of preformed toxin. It can take up to 30 days from the date of exposure to develop signs and symptoms.
If you suspect botulism: Initial diagnosis of infant botulism is based on clinical symptoms. Consultation with the Infant Botulism Treatment and Prevention Program is available for suspected cases. If you suspect your patient has infant botulism, immediately call 510-231-7600 for case consultation. Consultation is available 24/7.
Infant botulism is a reportable disease in South Dakota. Report all suspected cases to the SD-DOH at 800-592-1861.
For information on lot numbers and products involved in the recall, visit the FDA’s website. For more information on infant botulism and the current outbreak, visit the CDC’s webpage.
