Food poisoning outbreak caused by consumption of humanitarian relief food contaminated with Jimsonweed (Datura stramonium): Napak and Amudat Districts, Uganda, March 2019

  • Water or foodborne
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Background:
Jimsonweed (Datura stramonium) grows in fields together with leguminous crops, such as soybeans. It contains toxic alkaloids, and can cause gastrointestinal and central nervous system symptoms when ingested. Due to persistent famine, Karamoja region in Uganda receives routine humanitarian relief food, including corn-soy blend (CSB+). On 16 March 2019, the Uganda Ministry of Health was alerted of a suspected foodborne outbreak in Karamoja. Patients reportedly developed symptoms soon after eating CSB+. We investigated to determine the cause and scope of the outbreak, and recommend control measures.

Methods:
A suspected case was onset of confusion, dizziness, convulsions, hallucinations, diarrhea, or vomiting in a resident of affected districts from 1 March–30 April 2019. We identified cases by reviewing health facility records and active case-finding. We conducted a retrospective cohort study with all 211 residents of villages receiving relief food, interviewed them about dietary history during 11-15 March, and
used Poisson regression to identify risk factors. Food samples underwent microbiological (bacteria, mold, yeast), chemical (heavy metals), and DNA tests at three international laboratories.

Results:
We identified 293 suspected cases; five (1.7%) died. Symptoms included confusion (62%), dizziness (38%), diarrhea (22%), nausea/vomiting (18%), convulsions (12%), and hallucinations (8%). The outbreak started on 12 March, 2-12 hours after Batch X of CSB+ was distributed at health facilities. Eighty-nine (66%) of 134 persons who ate CSB+ developed illness compared to two (2.2%) of 75 who didn’t (RR=22, 95%CI=6.0-81). Samples of Batch X distributed 11-15 March contained 14 tropane alkaloids, including atropine (25-50 ppm) and scopolamine (1-10 ppm). Jimsonweed DNA was identified from Batch X samples tested.

Conclusions:
Consumption of food contaminated with toxic levels of tropane alkaloids caused this outbreak. Implicated food was immediately recalled. Contamination may have occurred during mass harvesting. Humanitarian food safety and quality checks should include tropane alkaloids.

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