TUESDAY, April 16, 2024 (HealthDay News) -- Counterfeit or mishandled Botox shots have triggered harmful reactions in 19 people in nine states, U.S. health officials warned Monday.

In its alert, the U.S. Centers for Disease Control and Prevention said nine people had been hospitalized and four were treated with an antitoxin because of concerns that the botulinum toxin had spread beyond the injection site.

The reactions occurred in Colorado, Florida, Illinois, Kentucky, Nebraska, New Jersey, New York, Tennessee and Washington.

All 19 patients were female and ranged in age from 25 to 59, the CDC said. All but one received the injection for cosmetic purposes.

How can women protect themselves when seeking Botox shots?

The CDC advises asking clinics or spas if they are licensed and trained to give the injections. It also suggests asking if the product is FDA-approved and obtained from a reliable source. If in doubt, don't get the shots.

Botox, which is often used to treat facial wrinkles but has been approved for a myriad of medical uses, uses a purified form of a neurotoxin called botulinum toxin that paralyzes muscles. When the same toxin is found in food, it can lead to widespread paralysis and even death, the CDC noted.

Botulism is a rare but serious illness caused by toxins released by bacteria that attack the nervous system. Symptoms can include blurry or double vision, droopy eyelids, difficulty breathing, fatigue, slurred speech or hoarse voice. Muscle paralysis may progress if left untreated and can be fatal, the CDC says.

The Clostridium botulinum bacteria is an ingredient in Botox and similar cosmetic substances. The purified form is approved by the U.S. Food and Drug Administration for use as a cosmetic treatment.

More information

The Illinois Department of Health has more on botulism.

SOURCE: U.S. Centers for Disease Control and Prevention, news release, April 16, 2024