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.

• Authors: Eduardo Azziz-Baumgartner, Kimberly Lindblade, Karen Gieseker, Helen Schurz Rogers, Stephanie Kieszak, Henry Njapau, Rosemary Schleicher, Leslie F McCoy, Ambrose Misore, Kevin DeCock, Carol Rubin, Laurence Slutsker, Aflatoxin Investigative Group
• Journal: Environmental health perspectives (Environ Health Perspect) Vol. 113 Issue 12 Pg. 1779-83 (Dec 2005) ISSN: 0091-6765 [Print] United States
• PMID: 16330363 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Aflatoxins
• DNA Adducts
• Hepatitis B Surface Antigens

Topics

• Adolescent
• Adult
• Aflatoxins (analysis, poisoning)
• Aged
• Case-Control Studies
• Child
• Child, Preschool
• DNA Adducts (blood)
• Disease Outbreaks
• Female
• Food Contamination (analysis)
• Food Handling (statistics & numerical data)
• Foodborne Diseases (epidemiology)
• Hepatitis B Surface Antigens (blood)
• Humans
• Infant
• Kenya (epidemiology)
• Male
• Middle Aged
• Regression Analysis
• Risk Assessment
• Surveys and Questionnaires
• Survival Analysis
• Zea mays (chemistry)