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An outbreak of acute hepatic encephalopathy due to severe aflatoxicosis in Malaysia
M S Lye1, A A Ghazali, J Mohan
1Division of Epidemiology and Biostatistics, Institute for Medical Research, Kuala Lumpur, Malaysia.
Abstract:
In October 1988, 13 Chinese children died of acute hepatic encephalopathy in the northwestern state of Perak in peninsular Malaysia. The acuteness of the illness differed from previously reported outbreaks described in Kenya, India, and Thailand. Epidemiologic investigations determined that the children had eaten a Chinese noodle, loh see fun, hours before they died. The attack rates among those who had eaten the noodles were significantly higher than those who had not (P < 0.0001). The cases were geographically scattered in six towns in two districts along the route of distribution of the noodle supplied by one factory in Kampar town. Aflatoxins were confirmed in postmortem samples from patients. This outbreak has important public health implications for many developing countries.
Insights
Aflatoxin contamination in Chinese noodles caused fatal acute hepatic encephalopathy in 13 Malaysian children. This outbreak highlights the critical need for food safety in developing nations.
Area of Science:
- Foodborne Illness
- Toxicology
- Epidemiology
Background:
- Acute hepatic encephalopathy outbreaks in children have been reported globally.
- A previous outbreak in Malaysia involved Chinese children consuming contaminated noodles.
Purpose of the Study:
- To investigate the cause of acute hepatic encephalopathy in 13 Chinese children in Malaysia.
- To identify the source and contributing factors of the outbreak.
Main Methods:
- Epidemiologic investigation of cases and controls.
- Geographic mapping of cases and noodle distribution.
- Laboratory confirmation of toxins in patient samples.
Main Results:
- A significant association was found between noodle consumption and illness (P < 0.0001).
- Cases were linked to noodles distributed from a single factory.
- Aflatoxins were detected in postmortem samples from affected children.
Conclusions:
- Contaminated Chinese noodles (loh see fun) were the likely source of aflatoxin poisoning.
- This outbreak underscores the public health risks of mycotoxins in food supplies.
- Enhanced food safety measures are crucial for preventing similar incidents in developing countries.