Investigating a Public Health Emergency in Kenya

In May 2004, health officials reported an outbreak of jaundice in two districts in Kenya with a high case-fatality rate. This outbreak was caused by widespread contamination with aflatoxin of locally grown maize. Aflatoxin is the name given to any group of toxic compounds produced by certain molds. In this case, fungus had grown on the grain and produced a toxin. The Environmental Health Laboratory played a major role in the success of this investigation through its use of sophisticated laboratory techniques to provide the best possible evidence that people in the two affected areas had been exposed to aflatoxin. These techniques, which had never before been used in an outbreak, directly measured toxins in blood samples from people who had eaten the maize. As a result, officials had a much more accurate assessment of exposure than would have been possible by estimating exposure on the basis of measuring toxins in food samples. These efforts not only helped stem the outbreak in Kenya, but will also be key to developing strategies for preventing future tragedies caused by people's exposure to aflatoxin.