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Outbreak of an acute aflatoxicosis in Tanzania during 2016

(2018) WORLD MYCOTOXIN JOURNAL. 11(3). p.311-320
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Abstract
In June 2016, an outbreak of an unknown disease was reported to affect clusters of families in two regions of the central part of Tanzania. A rapid epidemiological survey was conducted in the affected villages, with a detailed house-to-house survey in selected households. A total of 68 cases occurred between 14 May and 14 November 2016, of which 20 died, making a case fatality rate of 30%. Over 50% of the cases were below the age of 15 years. The cases presented with jaundice (n=60), abdominal pain (n=59), vomiting (n=56), diarrhoea (n=34) and ascites (n=32). The responsible food item appeared to be home grown maize. The rate ratio indicated that the occurrence of illnesses was associated with ingestion of food contaminated with high levels of aflatoxins (contamination range: 10-51,100 mu g/kg and 2.4-285 mu g/kg for case and control households, respectively). Serum aflatoxin biomarker indicated that cases were more likely to have higher than 1000 pg/mg aflatoxin-albumin adduct level in their sera compared to controls (Odds Ratio = 13.5; 95% confidence intervals = 1.5-165.3; range of aflatoxin-albumin adduct level = 36-32,800 pg/mg for cases and 10-4020 pg/mg for controls). Beside aflatoxins, maize samples were also contaminated with high levels of fumonisins (range of contamination; 945-12,630 mu g/kg) with 8 of 10 samples analysed from case households co-contaminated with both toxins at levels above the maximum limit of 5 or 10 mu g/kg set for ALT, or total aflatoxins and 2,000 mu g/kg for fumonisins. Clinical presentation and high levels of aflatoxin in food samples coupled with high levels of serum aflatoxin-albumin adducts among the cases support the causal role of aflatoxins.
Keywords
acute aflatoxicosis, maize, Tanzania, FUMONISIN B-1, DEVELOPING-COUNTRIES, EXPOSURE, MYCOTOXINS, GROWTH, MAIZE, CHILDREN, CORN, CONTAMINATION, CONSUMPTION

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MLA
Kamala, Analice, C Shirima, B Jani, et al. “Outbreak of an Acute Aflatoxicosis in Tanzania During 2016.” WORLD MYCOTOXIN JOURNAL 11.3 (2018): 311–320. Print.
APA
Kamala, A., Shirima, C., Jani, B., Bakari, M., Sillo, H., Rusibamayila, N., De Saeger, S., et al. (2018). Outbreak of an acute aflatoxicosis in Tanzania during 2016. WORLD MYCOTOXIN JOURNAL, 11(3), 311–320.
Chicago author-date
Kamala, Analice, C Shirima, B Jani, M Bakari, H Sillo, N Rusibamayila, Sarah De Saeger, M Kimanya, YY Gong, and A Simba. 2018. “Outbreak of an Acute Aflatoxicosis in Tanzania During 2016.” World Mycotoxin Journal 11 (3): 311–320.
Chicago author-date (all authors)
Kamala, Analice, C Shirima, B Jani, M Bakari, H Sillo, N Rusibamayila, Sarah De Saeger, M Kimanya, YY Gong, and A Simba. 2018. “Outbreak of an Acute Aflatoxicosis in Tanzania During 2016.” World Mycotoxin Journal 11 (3): 311–320.
Vancouver
1.
Kamala A, Shirima C, Jani B, Bakari M, Sillo H, Rusibamayila N, et al. Outbreak of an acute aflatoxicosis in Tanzania during 2016. WORLD MYCOTOXIN JOURNAL. 2018;11(3):311–20.
IEEE
[1]
A. Kamala et al., “Outbreak of an acute aflatoxicosis in Tanzania during 2016,” WORLD MYCOTOXIN JOURNAL, vol. 11, no. 3, pp. 311–320, 2018.
@article{8583110,
  abstract     = {In June 2016, an outbreak of an unknown disease was reported to affect clusters of families in two regions of the central part of Tanzania. A rapid epidemiological survey was conducted in the affected villages, with a detailed house-to-house survey in selected households. A total of 68 cases occurred between 14 May and 14 November 2016, of which 20 died, making a case fatality rate of 30%. Over 50% of the cases were below the age of 15 years. The cases presented with jaundice (n=60), abdominal pain (n=59), vomiting (n=56), diarrhoea (n=34) and ascites (n=32). The responsible food item appeared to be home grown maize. The rate ratio indicated that the occurrence of illnesses was associated with ingestion of food contaminated with high levels of aflatoxins (contamination range: 10-51,100 mu g/kg and 2.4-285 mu g/kg for case and control households, respectively). Serum aflatoxin biomarker indicated that cases were more likely to have higher than 1000 pg/mg aflatoxin-albumin adduct level in their sera compared to controls (Odds Ratio = 13.5; 95% confidence intervals = 1.5-165.3; range of aflatoxin-albumin adduct level = 36-32,800 pg/mg for cases and 10-4020 pg/mg for controls). Beside aflatoxins, maize samples were also contaminated with high levels of fumonisins (range of contamination; 945-12,630 mu g/kg) with 8 of 10 samples analysed from case households co-contaminated with both toxins at levels above the maximum limit of 5 or 10 mu g/kg set for ALT, or total aflatoxins and 2,000 mu g/kg for fumonisins. Clinical presentation and high levels of aflatoxin in food samples coupled with high levels of serum aflatoxin-albumin adducts among the cases support the causal role of aflatoxins.},
  author       = {Kamala, Analice and Shirima, C and Jani, B and Bakari, M and Sillo, H and Rusibamayila, N and De Saeger, Sarah and Kimanya, M and Gong, YY and Simba, A},
  issn         = {1875-0710},
  journal      = {WORLD MYCOTOXIN JOURNAL},
  keywords     = {acute aflatoxicosis,maize,Tanzania,FUMONISIN B-1,DEVELOPING-COUNTRIES,EXPOSURE,MYCOTOXINS,GROWTH,MAIZE,CHILDREN,CORN,CONTAMINATION,CONSUMPTION},
  language     = {eng},
  number       = {3},
  pages        = {311--320},
  title        = {Outbreak of an acute aflatoxicosis in Tanzania during 2016},
  url          = {http://dx.doi.org/10.3920/WMJ2018.2344},
  volume       = {11},
  year         = {2018},
}

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