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Published Date: 2019-06-07 13:38:46
Subject: PRO/AH/EDR> Foodborne illness - Uganda: fatal, cereal susp.
Archive Number: 20190607.6505372
FOODBORNE ILLNESS - UGANDA: FATAL, CEREAL SUSPECTED
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International Society for Infectious Diseases
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[1]
Date: Wed 5 Jun 2019
Source: Food Safety News [edited]
https://www.foodsafetynews.com/2019/06/fda-and-cdc-helping-with-ugandan-outbreak-investigation/


Two federal agencies in the USA are part of efforts to find the source of food poisoning in Uganda that led to 4 deaths. The US Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) are involved in the investigation of the outbreak that occurred in March and April [2019].

The World Food Programme (WFP) previously reported 3 people died and hundreds more were admitted to health centers in the Karamoja region of northeast Uganda after eating Super Cereal, which had been distributed to prevent malnutrition. Symptoms included mental confusion, vomiting, headache, high fever, and abdominal pain.

The food came from a Turkish supplier, which has been suspended from local and international Super Cereal distribution pending results of the investigation. Super Cereal is corn or wheat blended with soya beans, fortified with vitamins and minerals, processed into flour and supplied in 25 kg [55 lb] bags.

It was established all 296 people who fell ill had eaten porridge from one batch of specially fortified food called Super Cereal (also known as CSB+). However, lab testing so far has not found the causative agent.

The FDA detected traces of alkaloids, specifically atropine, but is yet to establish the levels of contamination and whether the alkaloids are synthetic or natural. More tests are being performed by the agency, and results will be released at a later date, according to a statement from the Ugandan Ministry of Health.

Samples were collected from WFP warehouses, health facilities, and the homes of patients to rule out the presence of mycotoxins, heavy metals, pesticides, and microbial agents. Lab tests were complemented by an epidemiological review by the ministry of health and CDC, as well as toxicologists from the UK who visited Karamoja to examine patients.

Representatives from the CDC are part of a task force that includes the Ugandan Ministry of Health, Ministry of Internal Affairs, World Health Organization (WHO), WFP, and Ugandan National Bureau of Standards (UNBS).

Of 18 samples tested by UNBS, one had aflatoxin B1 slightly higher than the acceptable limit and a few had low levels of yeast and mold, but levels were lower than those required to cause illness, according to the ministry of health statement. The government analytical laboratory also found one sample with slightly high aflatoxin B1, but these levels could not explain the acute symptoms of toxicity seen in patients.

Testing by the Ministry of Health central public health lab found _Bacillus cereus_ twice and _Salmonella_ spp. once in 3 samples from a household. Contamination was not found in samples from the warehouse.

An Intertek lab in Mombasa detected coliforms in 3 samples. In the Johannesburg lab owned by the same company, one sample failed the aflatoxin B1 test, 3 were contaminated with _B. cereus_ and 33 also had coliforms. The FDA did not report any of these findings, but further analysis is ongoing.

UNBS and the Directorate of Government Analytical Laboratory (DGAL) boosted analytical capabilities through support from the International Atomic Energy Agency (IAEA) and Food and Agriculture Organization of the United Nations (FAO). "In the past, the lack of adequate diagnostic and analytical testing capacities limited our ability to minimize health risks to the public, including responding to outbreaks and emergencies and investigating suspected causes," said Deus Mubangizi, manager of the Testing Division at UNBS.

The IAEA supported expert missions, training courses, and delivery of equipment such as radio receptor assays, isotope-dependent liquid chromatographic and spectrometric tools, liquid chromatographic instruments, tools to help sample preparation and storage, and analytical material to ensure performance according to international standards.

"The outbreak could have spread further or affected more consumers if stakeholders including the 2 laboratories...had not been in a position to intervene, promptly," said Kepher Kuchana Kateu, director of DGAL.

The Ugandan Government and WFP suspended distribution of Super Cereal in the country from all suppliers. The United Nations agency started distributing foods of equal or higher nutritional value to vulnerable people.

Testing at the FDA showed Super Cereal from all suppliers other than the Turkish firm is safe to eat. The government has allowed WFP to resume Super Cereal distributions from the other suppliers. The WFP previously said food supplies on hold around the world totaled more than 21 000 metric tons [23 150 US tons] with an estimated replacement value of USD 22 million.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The clinical signs described above are somewhat general and could fit a number of contaminants. However, they are not a very good match to the contaminants found thus far. In fact finding coliforms in the cereal/flour substance may result from a lack of hygiene by the workers or in the processing plant in general. Either way, it is a nauseating thought.

Alkaloids are mentioned, specifically atropine. Tropane alkaloids are known to produce clinical signs including dilated eyes, flushed skin or a feverish feeling and is often associated with the inability to sweat.

While there have been some bacterial contaminants found, it has not been wide spread, nor have levels been noted as being very high.

Aflatoxin most often causes liver damage and may first be noticed as jaundice or yellowing of the whites of the eyes. This has not been mentioned.

It would seem the causative agent of the death and illnesses is either multifactorial or has not yet been uncovered. - Mod.TG]

******
[2]
Date: Mon 18 Mar 2019 [please note this situation has been occurring for some time]
Source: Africa Times [edited]
https://africatimes.com/2019/03/18/food-aid-suspected-in-hundreds-of-uganda-poisoning-cases/


The World Food Program (WFP) has stopped distributing a fortified food project used in its humanitarian aid programs after more than 200 people became sick, 3 of them dying, according to a Uganda International Red Cross & Red Crescent spokeswoman.

The cases of people with suspected food poisoning were reported [Sat 16 Mar 2019] at Lotome Health Centre in Napak, a day after food distribution to families. Other people including children were admitted to Karita and Lokales health centres in Amudat district, the WFP said in a statement.

"The Government and WFP are investigating and have submitted samples of Super Cereal for laboratory tests to determine whether there is a link between eating blended food and people falling sick after distributions," the United Nations-affiliated aid agency said. "From the outset, WFP has treated this as a matter of extreme urgency."

The situation began nearly a week ago [week of 12 Mar 2019] in Alakas, where 9 patients quickly became 24. They reported high fever, headaches, dizziness, and showed signs of severe mental confusion. All of those patients recovered and were discharged from the hospital.

WFP ordered the suspension of the food on [Fri 15 Mar 2019] to immediate affected districts and expanded the ban on Super Cereal distribution to the whole country on [Sat 16 Mar 2019].

"WFP is supporting local governments in communicating with communities on the situation and is urging them to stop eating Super Cereal as a precaution in case a link is found," the agency said.

Super Cereal is provided by WFP through government health centers and community sites to improve nutrition among pregnant or breastfeeding women and prevent stunting and malnutrition in children.

The UN agency said in February [2019] it was investigating quality issues with Super Cereal stocks because they found up to 50 000 tons of the mix were too low in fats and proteins. The WFP said the problem was not a safety issue.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Clearly from the 2nd article this situation in Uganda with Super Cereal has been going on for several months.

The clinical signs in the article above are listed as: high fever, headaches, dizziness, and signs of severe mental confusion. All of those patients recovered and were discharged from the hospital. However, the article does not explicitly state how long before they were discharged. It seems to convey they were not held in the hospital for long.

High fever may indicate an infectious disease, such as resulting from bacterial or viral contamination. Headaches may indicate blood pressure changes, which may also go along with dizziness. Low blood sugar can also cause people to experience dizziness and some people report headaches at this time too. - Mod.TG]

HealthMap/ProMED-mail map of Uganda: http://healthmap.org/promed/p/97]

See Also

2017
----
Food poisoning, fatalities - Ghana: (TV) puffer fish susp. 20170819.5260336
Fake food poisoning, human fatalities - India RFI 20170212.4834229
2015
----
Rodenticide, food poisoning - China: (SA) correction 20150623.3460069
Rodenticide, food poisoning - China: (SA) 20150620.3452028
2014
----
Undiagnosed food poisoning, fatal - Madagascar: turtle meat 20140518.2479997
Food poisoning - Japan: malathion 20140110.2160513
2012
----
Food poisoning - Comoros: turtle meat 20121228.1472131
Undiagnosed food poisoning, human - Russia: (KD) sea food 20121227.1470764
Food poisoning, contamination - France: datura 20121014.1343212
2011
----
Undiagnosed food poisoning - South Africa, organophos. susp., RFI 20110918.2837
2010
----
Staphylococcal food poisoning, bakery - USA: (IL), alert, recall 20101224.4534
Food poisoning, mussels - Italy: (TO) RFI 20100923.3437
Food poisoning - Russia (PE): sodium nitrite 20100910.3261
Clenbuterol food poisoning, meat - Mexico: (JA) 20100624.2104
Food poisoning, wild yams - Philippines 20100409.1143
Food poisoning, staphylococcal - France: (enterotoxin E) 1st rep. 20100402.1060
Food poisoning, pesticide, dumplings - Japan, China: 2007 20100331.1014
2009
----
Food poisoning, fried rice - Malaysia (02): (KH) 20090408.1360
Food poisoning, fried rice - Malaysia: (Kedah), nitrate susp., RFI 20090406.1326
Food poisoning, cassava - Cameroon, CAR 20090312.1027
Food poisoning, histamine, silkworms - Thailand (Sa Kaeo) 20090129.0397
Food poisoning, pesticide - China: (HB), RFI 20090124.0320
Food poisoning - Russia: (SVE) sodium nitrate susp. 20090123.0289
Clenbuterol food poisoning - Mexico 20090118.0215
2008
----
Clenbuterol food poisoning - China 20081118.3635
Food poisoning, liquid sweets - India: (MH) toxin susp., RFI 20081014.3261
Food poisoning, frozen fish - Norway ex Viet Nam: RFI 20080727.2298
Food poisoning, _Bacillus cereus_ - Australia: NSW (Sydney) 20080328.1164
Food poisoning, dumplings - Japan ex China (03) 20080216.0623
Food poisoning, dumplings - Japan ex China (02) 20080208.0519
Food poisoning, dumplings - Japan ex China 20080205.0471
2007
----
Food poisoning, malabsorption syndrome, fish - Spain (Aragon) 20070326.1052
Food poisoning, staphylococcal, dessert - Canada: alert, recall 20070222.0653
amnd other items in the archives
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