title: Case-control study of an acute aflatoxicosis outbreak, Kenya, 2004.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  We administered questionnaires regarding maize storage and consumption and obtained maize and blood samples from participants.
  
  
  METHODS
  We recruited 40 case-patients with aflatoxicosis and 80 randomly selected controls to participate in this study.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Aflatoxin concentrations in maize, serum aflatoxin B1-lysine adduct concentrations, and positive hepatitis B surface antigen titers were all associated with case status.
  
  
  CONCLUSIONS
  The novel methods and risk factors described may help health officials prevent future outbreaks of aflatoxicosis.
authors.affiliation: National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3717, USA. eha9@cdc.gov
authors.forename: Eduardo
authors.initials: E
authors.lastname: Azziz-Baumgartner
authors.forename: Kimberly
authors.initials: K
authors.lastname: Lindblade
authors.forename: Karen
authors.initials: K
authors.lastname: Gieseker
authors.forename: Helen Schurz
authors.initials: HS
authors.lastname: Rogers
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kieszak
authors.forename: Henry
authors.initials: H
authors.lastname: Njapau
authors.forename: Rosemary
authors.initials: R
authors.lastname: Schleicher
authors.forename: Leslie F
authors.initials: LF
authors.lastname: McCoy
authors.forename: Ambrose
authors.initials: A
authors.lastname: Misore
authors.forename: Kevin
authors.initials: K
authors.lastname: DeCock
authors.forename: Carol
authors.initials: C
authors.lastname: Rubin
authors.forename: Laurence
authors.initials: L
authors.lastname: Slutsker
mesh_terms: D000293:Adolescent; D000328:Adult; D000348:Aflatoxins / Q000032:analysis*; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D018736:DNA Adducts / Q000097:blood; D004196:Disease Outbreaks; D005260:Female; D005506:Food Contamination / Q000032:analysis*; D005511:Food Handling / Q000706:statistics & numerical data; D005517:Foodborne Diseases / Q000453:epidemiology*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D003313:Zea mays / Q000737:chemistry*; D000096702:Aflatoxin Poisoning
chemical_list: D000348:Aflatoxins; D018736:DNA Adducts; D006514:Hepatitis B Surface Antigens