An Outbreak of Hepatic Veno-Occlusive Disease in Western Afghanistan Associated with Exposure to Wheat Flour Contaminated with Pyrrolizidine Alkaloids

Pyrrolizidine alakloids (PAs) are known to cause hepatic veno-occlusive disease (VOD). Outbreaks have occurred in Western Afghanistan since 1974, the latest in February 2008. We conducted an outbreak investigation using a case-control design. Sixty-seven cases of VOD were compared with 199 community...

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Bibliographic Details
Published in:Journal of Toxicology 2010-01, Vol.2010 (2010), p.21-27
Main Authors: Mofleh, Jawad, van Egmond, Hans P., Watson, John, Omar, Mohammad Fahim, Mustafa, Mir Lais, Leslie, Toby, Kakar, Faizullah, Akbarian, Zarif
Format: Article
Language:English
Subjects:
Climate change
Disease
Farmers
Food contamination & poisoning
Herbal medicine
Households
Mortality
Public health
Triticum aestivum
Tropical diseases
Water shortages
Wheat
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Summary:Pyrrolizidine alakloids (PAs) are known to cause hepatic veno-occlusive disease (VOD). Outbreaks have occurred in Western Afghanistan since 1974, the latest in February 2008. We conducted an outbreak investigation using a case-control design. Sixty-seven cases of VOD were compared with 199 community controls. Consumption of bread was strongly associated with disease (adjusted odds ratio: 35.8 [95%CI: 7.6–168.2]). Toxic doses of PA were found in plant extracts and in samples of wheat flour taken from the study area. Compared to wheat flour there was 1000 times less PA in milk and whey and in water samples the PA content was zero. Although direct analysis was not possible, contaminated wheat flour used to make bread was the likely source of PA causing the outbreak. Eating a more varied diet including meat and fruit may be protective. Prevention and control measures will rely on community awareness and agricultural interventions to ensure safety of the food supply.
ISSN:1687-8191
1687-8205
DOI:10.1155/2010/313280