{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T22:33:22Z","timestamp":1792449202829,"version":"4.5.0"},"reference-count":14,"publisher":"American Chemical Society (ACS)","issue":"12","license":[{"start":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T00:00:00Z","timestamp":1514505600000},"content-version":"vor","delay-in-days":4524,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In April 2004, one of the largest aflatoxicosis outbreaks occurred in rural Kenya, resulting in 317 cases and 125 deaths. Aflatoxin-contaminated homegrown maize was the source of the outbreak, but the extent of regional contamination and status of maize in commercial markets (market maize) were unknown. We conducted a cross-sectional survey to assess the extent of market maize contamination and evaluate the relationship between market maize aflatoxin and the aflatoxicosis outbreak. We surveyed 65 markets and 243 maize vendors and collected 350 maize products in the most affected districts. Fifty-five percent of maize products had aflatoxin levels greater than the Kenyan regulatory limit of 20 ppb, 35% had levels &amp;gt; 100 ppb, and 7% had levels &amp;gt; 1,000 ppb. Makueni, the district with the most aflatoxicosis case-patients, had significantly higher market maize aflatoxin than did Thika, the study district with fewest case-patients (geometric mean aflatoxin = 52.91 ppb vs. 7.52 ppb, p = 0.0004). Maize obtained from local farms in the affected area was significantly more likely to have aflatoxin levels &amp;gt; 20 ppb compared with maize bought from other regions of Kenya or other countries (odds ratio = 2.71; 95% confidence interval, 1.12\u20136.59). Contaminated homegrown maize bought from local farms in the affected area entered the distribution system, resulting in widespread aflatoxin contamination of market maize. Contaminated market maize, purchased by farmers after their homegrown supplies are exhausted, may represent a source of continued exposure to aflatoxin. Efforts to successfully interrupt exposure to aflatoxin during an outbreak must consider the potential role of the market system in sustaining exposure.<\/jats:p>","DOI":"10.1289\/ehp.7998","type":"journal-article","created":{"date-parts":[[2005,8,10]],"date-time":"2005-08-10T12:20:58Z","timestamp":1123676458000},"page":"1763-1767","source":"Crossref","is-referenced-by-count":584,"title":["Aflatoxin Contamination of Commercial Maize Products during an Outbreak of Acute Aflatoxicosis in Eastern and Central Kenya"],"prefix":"10.1021","volume":"113","author":[{"given":"Lauren","family":"Lewis","sequence":"first","affiliation":[{"name":"National Center for Environmental Health, Centers for Disease Control and Prevention, Chamblee, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Onsongo","sequence":"additional","affiliation":[{"name":"Foreign Agricultural Service, U.S. Department of Agriculture, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Njapau","sequence":"additional","affiliation":[{"name":"Office of Plant and Dairy Foods, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Schurz-Rogers","sequence":"additional","affiliation":[{"name":"National Center for Environmental Health, Centers for Disease Control and Prevention, Chamblee, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Luber","sequence":"additional","affiliation":[{"name":"National Center for Environmental Health, Centers for Disease Control and Prevention, Chamblee, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Kieszak","sequence":"additional","affiliation":[{"name":"National Center for Environmental Health, Centers for Disease Control and Prevention, Chamblee, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Nyamongo","sequence":"additional","affiliation":[{"name":"Kenya National Public Health Laboratory, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine","family":"Backer","sequence":"additional","affiliation":[{"name":"National Center for Environmental Health, Centers for Disease Control and Prevention, Chamblee, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdikher Mohamud","family":"Dahiye","sequence":"additional","affiliation":[{"name":"Kenya Field Epidemiology and Laboratory Training Program, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambrose","family":"Misore","sequence":"additional","affiliation":[{"name":"Preventive and Promotive Health, Kenya Ministry of Health, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"DeCock","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention, Kenya Office, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Rubin","sequence":"additional","affiliation":[{"name":"National Center for Environmental Health, Centers for Disease Control and Prevention, Chamblee, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Kenya Aflatoxicosis Investigation Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2005,8,10]]},"reference":[{"key":"2026080607083501000_micit1","doi-asserted-by":"crossref","first-page":"249","DOI":"10.3109\/15563659709001208","article-title":"A food-borne disease outbreak due to consumption of moldy sorghum and maize containing fumonisin mycotoxins","volume":"35","author":"Bhat","year":"1997","journal-title":"J Toxicol Clin Toxicol"},{"key":"2026080607083501000_micit2","author":"CAST"},{"key":"2026080607083501000_micit3","author":"CDC (Centers for Disease Control and Prevention)"},{"key":"2026080607083501000_micit4","author":"Central Bureau of Statistics"},{"key":"2026080607083501000_micit5","author":"FDA (U.S. Food and Drug Administration)"},{"key":"2026080607083501000_micit6","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1081\/CLT-120030947","article-title":"Health effects of mycotoxins: a toxicological overview","volume":"42","author":"Fung","year":"2004","journal-title":"J Toxicol Clin Toxicol"},{"key":"2026080607083501000_micit7","author":"Integrated Regional Information Networks, United Nations, Office for the Coordination of Humanitarian Affairs"},{"key":"2026080607083501000_micit8","author":"Kenya Bureau of Standards"},{"issue":"7915","key":"2026080607083501000_micit9","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1016\/S0140-6736(75)91829-2","article-title":"Hepatitis due to aflatoxicosis: an outbreak in western India","volume":"1","author":"Krishnamachari","year":"1975","journal-title":"Lancet"},{"key":"2026080607083501000_micit10","doi-asserted-by":"crossref","first-page":"62S","DOI":"10.1046\/j.1365-2672.1998.0840s162S.x","article-title":"Recent studies of mycotoxins","volume":"84","author":"Moss","year":"1998","journal-title":"J Appl Microbiol"},{"issue":"8285","key":"2026080607083501000_micit11","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1016\/S0140-6736(82)92411-4","article-title":"Outbreak of acute hepatitis caused by aflatoxin poisoning in Kenya","volume":"1","author":"Ngindu","year":"1982","journal-title":"Lancet"},{"key":"2026080607083501000_micit12","author":"SAS Institute Inc"},{"key":"2026080607083501000_micit13","author":"Smith"},{"issue":"1","key":"2026080607083501000_micit14","first-page":"81","article-title":"Immunoaffinity column coupled with solution fluorometry or liquid chromatography post-column derivatization for determination of aflatoxins in corn, peanuts, peanut butter: collaborative study","volume":"74","author":"Trucksess","year":"1991","journal-title":"Assoc Off Anal Chem"}],"container-title":["Environmental Health Perspectives"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pubs.acs.org\/evhpaz\/article-pdf\/113\/12\/1763\/66434275\/ehp.7998.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/pubs.acs.org\/evhpaz\/article-pdf\/113\/12\/1763\/66434275\/ehp.7998.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:50:12Z","timestamp":1786629012000},"score":1,"resource":{"primary":{"URL":"https:\/\/pubs.acs.org\/evhpaz\/article-lookup\/doi\/10.1289\/ehp.7998"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,8,10]]},"references-count":14,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2005,8,10]]},"published-print":{"date-parts":[[2005,12,1]]}},"URL":"https:\/\/doi.org\/10.1289\/ehp.7998","relation":{},"ISSN":["0091-6765","1552-9924"],"issn-type":[{"value":"0091-6765","type":"print"},{"value":"1552-9924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,8,10]]}}}