CDC and Aflatoxin: The Human

Health Perspective

Abigael Awuor

Aflatoxin Project Coordinator

Technical Advisor, Nutrition and Aflatoxin

Centers for Disease Control and Prevention

Outline

• Introduction

• CDC’s Involvement

• Aflatoxin outbreak response – 2010 results

• Kenya Aflatoxin Sero-survey- objectives &

results

• Benefits of results to other projects

• Interventional study- ACCS 100

About CDC• Centers for Disease Control and

Prevention – Federal Agency (1946)

• Headquarters – Atlanta, Georgia.

• Focus – Infectious diseases & research to

provide info on non infectious diseases

like aflatoxin

• Coverage – various country offices

including Kenya, Uganda, Rwanda among

others

• Kenya- Nairobi and Kisumu-Kisian

CDC’s Involvement• Started with the 2004 outbreak

• Activities were more reactive (outbreak response

with MoH- 2004, 2005, 2006, 2008, 2010, 2014)-

527 cases and 210 deaths, CFR 40%

• 2006- to date focus is on proactive activities

Aflatoxin sero surveys (Kenya, Uganda, TZ,

Rwanda)

Clinical trial on acceptability, palatability and

efficacy of ACCS 100

1. Aflatoxicosis Outbreak Response

-2010 Results

• Eastern province

• 13 households where a suspected case

resided were visited.

• Questionnaire data from 15 suspected

aflatoxicosis cases and 47 asymptomatic

family members.

Cont.• Symptoms experienced in the previous 30 days

by suspected cases :-

- Jaundice (100%)

- Abdominal pain (87%),

- Distended abdomen (87%),

- Vomiting (80%),

- Fever (73%).

- Suspected cases were younger (mean=7.0

years, range=2–14 years) compared with family

members (mean=33.2 years, range=4–72

years).

2. Kenya Aflatoxin sero-survey-

Objectives

• Assess the level of exposure to aflatoxin in

Kenya in a subset of sera identified

• Identify the populations most at risk for

chronic low dose exposure

• Compare aflatoxin exposure by relevant

geographic and demographic

characteristics

• Sample and compare the Aflatoxin

exposure levels with other countries.

Kenya Aflatoxin serum analysis

results (2007)

• Over three-quarters (78%) of participants

had detectable levels of aflatoxin

exposure.

• LOD was 0.02 ng/mL.

• There were some regional differences.

- Highest in Eastern Province (median=7.87

pg/mg albumin)

Results- Lowest in Rift Valley (median=0.70 pg/mg

albumin) and Nyanza (median <LOD)

Provinces.

- Every participant in Meru North, Makueni,

Thika, Busia, and Mombasa had

detectable aflatoxin exposure.

• High detection persisted across the

spectrum of sex, age, gender, and socio-

economic status

• Aflatoxin exposure was associated with

health status.

AFB-lys levels (pg/mg albumin) by geographic

characteristics, 2007 Kenya AIDS Indicator Survey

Characteristic (n) % ˃LOD Range Median (95% CI)

Overall (n=597) 78% <LOD–211 1.78 (1.46–2.12)

Province*

Eastern (n=75) 100% 0.75–186 7.87 (5.94–11.7)

Coast (n=73) 99% <LOD–211 3.70 (2.44–5.81)

Nairobi (n=75) 92% <LOD–179 2.44 (1.63–3.10)

Central (n=76) 92% <LOD–49.2 2.33 (1.60–3.26)

North-Eastern

(n=73) 70% <LOD–35.5 1.40 (0.85–2.25)

Western (n=74) 80% <LOD–36.2 1.28 (0.91–1.60)

Rift Valley (n=75) 59% <LOD–76.7 0.70 (0.42–10.3)

Nyanza (n=74) 34% <LOD–35.1 <LOD

AFB-lys levels (pg/mg albumin) by geographic

characteristics, 2007 Kenya AIDS Indicator Survey

Characteristic (n) % ˃LOD Range Median (95% CI)

District*

Meru North (n=20) 100% 1.19–186 11.9 (6.58–19.5)

Makueni (n=17) 100% 1.40–23.4 7.21 (4.29–13.3)

Thika (n=17) 100% 0.51–49.2 6.38 (3.26–11.8)

Busia (n=19) 100% 0.57–36.2 4.32 (1.33–10.6)

Garissa (n=30) 97% <LOD–35.5 3.96 (2.31–5.12)

Mombasa (n=23) 100% 0.89–14.0 2.91 (1.95–5.22)

Nairobi (n=75) 92% <LOD–179 2.44 (1.63–3.10)

Mandera (n=35) 49% <LOD–10.5 0.34 (0.31–1.25)

Central Kisii (n=46) 39% <LOD–35.1 0.33 (0.31–0.68)

Benefits

• Data from this analysis will allow the

MOH/MoA/partners/donors to:

Help target public health and agricultural

interventions to provinces and districts at

greatest risk of exposure

Justify resources to enhance a country’s

capacity to reduce aflatoxin contamination of

food

3. Interventional studies- ACCS 100• Objective: Evaluate the effectiveness,

acceptability, and palatability of ACCS100 clay

• Safety study in Lubbock, Texas & a 3-month

clinical trial in Ghana - no significant side effects

or toxicities were observed

• Cross-over clinical trial (ACCS100 and placebo)

• Acceptability focused on specific organoleptic

characteristics (taste, aftertaste, smell, texture),

appearance and color

• Sample size of 50 healthy volunteers

• The volunteers ≥ 18 years

Observation and preliminary results

• 78% of the baseline urines had detectable levels

of aflatoxin

• There was 100% compliance of intake of

ACCS100

• We anticipate that ACCS100 can be used as a

primary intervention to bind AFB1, thereby

decreasing the external dose of toxins from the

diet and reducing the incidence of toxicity in

vulnerable communities

Thank You!

The findings and conclusions in this presentation are those

of the authors and do not necessarily represent the official

position of the Centers for Disease Control and Prevention.

Next projects

• Prevalence studies

• Urine tests for early warning – assessing for

M1 in urine

• KAP studies

• Health assessment of aflasafe users