Botox-like jabs linked to wave of botulism cases

Botulism is caused by toxins produced by Clostridium botulinum and can impact swallowing, speech and breathing, as well as proving life-threatening in rare cases

The UK Health Security Agency (UKHSA) is warning the public to be aware of the signs of botulism following reports of iatrogenic botulism in England. This rare form can be associated with unlicensed Botox-like jabs.

A total of 38 cases were reported between June 4th and July 14th 2025, firstly in the north-east, with further instances in the east of England and East Midlands. It’s unknown whether the cases are linked.

Several cases in Peterborough were thought to be linked to an unlicensed or counterfeit Botox-like product administered by private practitioners working in their own or clients’ homes, rather than beauty or cosmetic salons.

Investigations are ongoing, but evidence suggests the use of an imported or unlicensed Botox-like product, says UKHSA. It is understood the practitioners involved in incidents in the east of England and East Midlands have ceased the procedure and are co-operating with the investigation.

Botulism is caused by toxins produced by Clostridium botulinum, a bacterium that attacks the nervous system. A purified form of these toxins – not the bacteria – is the active ingredient in Botox and similar products used for cosmetic purposes to paralyse the movement of muscles.

“…it's not uncommon for [Botulinum toxin] to be prescribed to a third party and then given to the patient by unqualified practitioners…”

Ash Mosahebi, Professor of Plastic Surgery at Royal Free Hospitals, University College London said: “Botulinum toxin is a prescription-only medicine. Therefore, only a qualified and experienced practitioner with the appropriate prescribing permit can administer it. However, it's not uncommon for this medication to be prescribed to a third party and then given to the patient by unqualified practitioners, effectively bypassing the need for a direct prescription.”

Professor Mosahebi added that botulism occurs when a massive dose of toxins is administered. “This is highly unlikely with toxins obtained from a bona fide manufacturer. However, the use of fake or non-approved toxins can indeed cause botulism.”

Symptoms can take up to four weeks to develop after treatment and include difficulty swallowing, slurred speech and breathing difficulties that require respiratory support. While rare, botulism can be life-threatening, and treatment includes the use of anti-toxins alongside interventions to support the body.

The UKHSA has advised medical professionals to look out for botulism among people who have recently had the cosmetic injections; they also urged the public to take care when seeking such procedures to ensure that they are conducted by a qualified practitioner using licensed products.

Professor Meghana Pandit, Co-National Medical Director secondary care at NHS England, said, “When these procedures go wrong, there is a risk of serious infections and permanent scarring, which is why only registered professionals like a doctor, a nurse or pharmacy prescriber should be prescribing these treatments.”

Dr Alison Cave, MHRA Chief Safety Officer added: “Buying botulinum toxin in any other circumstances significantly increases the risk of getting a product which is either falsified or not licensed for use in the UK. This means that there are no safeguards to ensure products meet the MHRA’s standards for quality and safety. As such, they can endanger the health of the people who take them.”