Case–Control Study of an Acute Aflatoxicosis Outbreak, Kenya, 2004

Abstract

Objectives: During January–June 2004, an aflatoxicosis outbreak in eastern Kenya resulted in 317 cases and 125 deaths. We conducted a case–control study to identify risk factors for contamination of implicated maize and, for the first time, quantitated biomarkers associated with acute aflatoxicosis.Design: We administered questionnaires regarding maize storage and consumption and obtained maize and blood samples from participants.Participants: We recruited 40 case-patients with aflatoxicosis and 80 randomly selected controls to participate in this study.Evaluations/Measurements: We analyzed maize for total aflatoxins and serum for aflatoxin B1–lysine albumin adducts and hepatitis B surface antigen. We used regression and survival analyses to explore the relationship between aflatoxins, maize consumption, hepatitis B surface antigen, and case status.Results: Homegrown (not commercial) maize kernels from case households had higher concentrations of aflatoxins than did kernels from control households [geometric mean (GM) = 354.53 ppb vs. 44.14 ppb; p = 0.04]. Serum adduct concentrations were associated with time from jaundice to death [adjusted hazard ratio = 1.3; 95% confidence interval (CI), 1.04–1.6]. Case patients had positive hepatitis B titers [odds ratio (OR) = 9.8; 95% CI, 1.5–63.1] more often than controls. Case patients stored wet maize (OR = 3.5; 95% CI, 1.2–10.3) inside their homes (OR = 12.0; 95% CI, 1.5–95.7) rather than in granaries more often than did controls.Conclusion: Aflatoxin concentrations in maize, serum aflatoxin B1–lysine adduct concentrations, and positive hepatitis B surface antigen titers were all associated with case status.Relevance: The novel methods and risk factors described may help health officials prevent future outbreaks of aflatoxicosis.

Longitudinal evaluation of aflatoxin exposure in two cohorts in south-western Uganda

“…Highly significant associations between AFB-Lys adduct level and dietary AFB 1 exposure have been found in human populations from several regions of the world. In addition, AFB-Lys adduct has been used as a biological response indicator of acute and chronic human diseases, such as aflatoxicosis in Africa, risks of HCC in Taiwan, China and Africa, and infectious disease-linked immune suppression (Wang et al 1996(Wang et al , 1998Wang, Huang, et al 2001;Turner et al 2003;Azziz-Baumgartner et al 2005;Lewis et al 2005). Moreover, the AFB-Lys adduct has been used as the primary biomarker to assess the efficacy of several human chemoprevention and intervention trials ;W i l d&H a l l2000; Wang, Abubaker, et al 2001;W angetal.2008).…”

“…Aflatoxin B 1 (AFB 1 ) is a potent hepatotoxic and genotoxic agent (Essigmann et al 1977;Wang & Groopman 1999), and has been evaluated as a Group I human carcinogen (sufficient evidence of carcinogenicity to humans) by the IARC, WHO (IARC 1993(IARC , 2002. Exposure to high levels of AFB 1 via the diet causes acute hepatotoxicity (aflatoxicosis) and death in humans, as demonstrated by recent outbreaks in Kenya, which were responsible for the deaths of more than 150 people (Azziz-Baumgartner et al 2005;Lewis et al 2005). Chronic exposure to low levels of AFB 1 is a risk factor in the aetiology of human hepatocellular carcinoma (HCC) in several regions of Africa and Southeast Asia, particularly in conjunction with hepatitis B virus infection (IARC 1993(IARC , 2002Wild & Hall 2000;Wogan et al 2012).…”

Characterization of small RNA populations in non-transgenic and aflatoxin-reducing-transformed peanut

“…It is estimated that 4.5 billion people are chronically exposed to aflatoxins in the developing world [4]. Periodic outbreaks of aflatoxicosis occur due to ingestion of contaminated food and result in hundreds of human deaths in Asia and Africa [5,6]. Furthermore, 58% of liver biopsies in cases of hepatocellular carcinoma have shown presence of aflatoxin B 1 (AfB 1 ) [7,8].…”

Occurrence of aflatoxin in agricultural produce from local markets in Burundi and Eastern Democratic Republic of Congo

“…The poor storage of agricultural produce can also lead to accelerated aflatoxin contamination as a result of proliferation of aflatoxin‐producing fungi. This has been demonstrated by many authors (Azziz‐Baumgartner et al., 2005; Mwalwayo & Thole, 2016). Some socioeconomic factors may also contribute to aflatoxins contamination, including informal marketing systems, inadequate transportation modes, unavailability of needed materials, tools, and equipment, lack of information and knowledge on appropriate pre‐ and postharvest managements, and poor governmental regulations and legislations.…”

“…In another severe aflatoxicosis outbreak, Azziz‐Baumgartner et al. (2005) also reported that aflatoxin contamination was found to be the cause of over 125 deaths during 2004–2005 in Eastern province of Kenya. Williams et al.…”