UK Health Security Agency (UKHSA) is warning people to be aware of the signs and symptoms of botulism after a small number of individuals presented to NHS healthcare settings following adverse reactions after receiving cosmetic procedures involving botulinum toxin.

The cases are in addition to those recently diagnosed in the North East region and relate to procedures carried out in the East of England and East Midlands. To date, 38 cases of iatrogenic botulism have been reported between 4 June and 14 July 2025.

As yet there are no known links between the newly diagnosed cases and those in the North East.

Investigations are ongoing but evidence so far suggests the use of an unlicensed Botox-like product. It is understood that those practitioners involved in this latest incident have ceased the procedure and are co-operating with the ongoing investigation.

Reactions have included:

• difficulty swallowing
• slurred speech
• breathing difficulty requiring respiratory support

UKHSA has issued national advice to clinicians to ensure that they look out for botulism in people who may have had a recent aesthetic procedure, in order to provide them appropriate treatment which includes giving anti-toxin.

UKHSA is also advising people to take precautions when seeking aesthetic procedures, including checking if the product being used is licensed.

Dr Gauri Godbole, Consultant Medical Microbiologist at UKHSA, said:

We are working closely with our partners to reduce the public health risk and would advise people to make sure they take precautions when seeking aesthetic procedures.

Botulism related to aesthetic procedures is rare, but it can be serious. It is caused by toxins produced by the bacterium Clostridium botulinum. These toxins (but not the bacteria) are the active ingredient in ‘Botox’ and similar products.

Symptoms of botulism can take up to 4 weeks to develop and if you have had a recent botulinum toxin (Botox-like) treatment and are having symptoms such as difficulty swallowing or breathing, contact NHS 111 for further advice and seek treatment.

If you are considering having a cosmetic procedure, please make sure to check that your practitioner is using a licensed product. On the NHS website there is more information on what sensible steps you can take when finding a practitioner.

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.

If you decide to undergo a cosmetic procedure like Botox or lip fillers, there is advice on the NHS.uk website on the questions to ask, including making sure that the person administering it is trained to do it.

Dr Alison Cave, MHRA Chief Safety Officer said:

Public safety is a top priority for the MHRA. Botulinum toxin is a prescription-only medicine and should only be sold or supplied in accordance with a prescription given by an appropriate practitioner such as a doctor or other qualified healthcare professional.

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.

Our Criminal Enforcement Unit works hard to identify those involved in the illegal trade in medicines and takes robust enforcement action where necessary. This can include criminal prosecution.

source: GOV