World Mycotoxin Journal, 2018; 11 (3): 311-320 Wageningen Academic Publisher s SPECIAL ISSUE: Mycotoxins in Africa ISSN 1875-0710 print, ISSN 1875-0796 online, DOI 10.3920/WMJ2018.2344 311 Outbreak of an acute aflatoxicosis in Tanzania during 2016 A. Kamala 1,2 , C. Shirima 1 , B. Jani 3 , M. Bakari 4 , H. Sillo 1 , N. Rusibamayila 4 , S. De Saeger 5 , M. Kimanya 6 , Y.Y.Gong 7 , A. Simba 4* and the investigation team # 1 Tanzania Food and Drugs Authority, P.O. Box 77150, Dar es Salaam, Tanzania; 2 Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium; 3 World Health Organization, P.O. Box 9292, Dar es Salaam, Tanzania; 4 Ministry of Health, Community Development, Gender, Elderly and Children, University of Dodoma, P.O. Box 743, 40478 Dodoma, Tanzania; 5 Laboratory of Food Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Gent Belgium; 6 Nelson Mandela African Institution of Science and Technology, P.O. Box 447, Arusha, Tanzania; 7 School of Food Science & Nutrition, University of Leeds, Leeds LS2 9JT, United Kingdom; asimba@moh.go.tz Received: 5 April 2018 / Accepted: 21 August 2018 © 2018 Wageningen Academic Publishers RESEARCH ARTICLE 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 μg/kg and 2.4-285 μg/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 μg/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 μg/kg set for AFB 1 or total aflatoxins and 2,000 μg/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 1 # Members of the outbreak investigation team include: R. Wigenge, I. Justin, F. Kyombo, V. Tarimo, D. Hipolite, R. Mziray, K. Kaiza (Tanzania Food and Drugs Authority, Dar es Salaam, Tanzania), C. Mutabuzi, M. Muita (World Health Organization, Dar es Salaam, Tanzania), J. Mghamba, M.A. Mohamed, M. Kitambi, A. Nyanga (Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania), M. De Boevre (Laboratory of Food Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Gent, Belgium), Y. Xu, M.N. Routledge (School of Food Science & Nutrition, University of Leeds, Leeds, UK), N. Mtui (Food and Agriculture Organization, Dar es Salaam, Tanzania), F. Mosha (National Health Laboratory, Quality Assurance Training Centre, Dar es Salaam, Tanzania), J. Charles (Regional Secretariat, Dodoma, Tanzania), G. Manase, F. Lyamuya (Dodoma Regional Referral Hospital, Dodoma, Tanzania), O.P. Ngassa (Chemba District Council, Dodoma, Tanzania), Z. Ikaji (Kondoa District Council, Dodoma, Tanzania), C. Lyimo, W. Mchwampaka, E. Masumbuko, R. Magodi, A. Abade (Tanzania Field Epidemiology and Laboratory Training Programme, Dar es Salaam, Tanzania), C. Josephat, J. Omolo (Ministry of Agriculture and Food security, Dar es Salaam, Tanzania), M. Ruheta (Ministry of Livestock and Fisheries, Dar es Salaam, Tanzania) and I. Mengele (Tanzania Veterinary Laboratory Agency, Dodoma, Tanzania). https://www.wageningenacademic.com/doi/pdf/10.3920/WMJ2018.2344 - Friday, August 28, 2020 1:14:00 AM - Cornell University Library IP Address:132.174.252.179