The CDC issued an update on its investigation into the botulism outbreak associated with consumption of Castleberry’s chili products today in the MMWR.  Interestingly, the MMWR editorial note contains the following:

Investigators are actively seeking additional cases that might be linked to the current outbreak by issuing health alerts and examining reported botulism cases dating back to 2005. Clinicians should consider botulism in patients with symmetric cranial nerve palsies, especially if accompanied by descending flaccid paralysis. Suspected cases of botulism should be reported immediately to local or state public health officials, who should then call the 24-hour CDC Emergency Operations Center (770-488-7100); callers will be connected immediately with an on-call CDC botulism specialist. Health-care providers and public health officials are encouraged to inquire specifically about consumption of the recalled canned products as part of the food history of persons with suspected botulism.

But if people who ate contaminated product and became ill with botulism in Hawaii didn’t associate the brand of chili they had eaten with the recall, did anybody else experience symptoms of botulism and not report their illness because they also did not think they had purchased recalled product?