There are seven known serotypes of botulism, designated A through G; almost all 
human cases of botulism are caused by types A, B, and E. Botulism type E is the 
predominant serotype causing disease associated with native Arctic foods. In the 
circumpolar regions of the world, the coastal soils are rich in botulism type E, 
and consumption of fish and marine animals in these areas are the sources of 
clusters of botulism. Unlike spores of type A and B, botulism type E can 
withstand freezing down to 3.5°C. Alaskan native fermentation of fish heads, 
fish eggs, and beaver tail allow proper anaerobic conditions for botulinum toxin 
to be elaborated from Clostridium botulinum. The consumption of whale meat, 
"muktuk" has also been associated with outbreaks of botulism in Alaska and the 
Canadian Arctic. Elsewhere in the Arctic regions, type E botulism has been 
associated with Norwegian "rakfisk" prepared by a process similar to fermented 
Alaskan foods. Outbreaks in Egypt with the salted gray mullet "faseikh", in 
Israel and New York linked to salted uneviscerated whitefish "kapchunka", in 
Iran from eating "ashbal" an uncooked salmon, and in Japan with "izushi" a 
traditional fermented fish preserved in rice have occurred. Importation of 
vacuum-packed whitefish from Alaska and Canada has also been associated with 
sporadic cases of botulism type E in Europe. In March 2010, the Center for 
Disease Control and Prevention released the heptavalent antitoxin (H-BAT) for 
use in the USA, under an Investigational New Drug program, as the preferred 
treatment for food-borne botulism, including type E, which had not been covered 
by the bivalent antitoxin, the prior approved antitoxin product in the USA.