Aflatoxin: A Synthesis of the Research in Health, Agriculture and Trade

“Aflatoxin
contamination is a
serious health concern
rooted throughout
the entire food chain,
thus necessitating
a multidisciplinary
approach to analysis,
action, and solution.”
heAlth SectoR cAPAcity to ReSPonD
Aflatoxin contamination is a serious health concern rooted throughout the entire
food chain, thus necessitating a multidisciplinary approach to analysis, action,
and solution. in 2005, an expert Group Meeting on Aflatoxin and health held
in Brazzaville, Republic of congo, recommended that African countries take
concrete measures to address this issue that negatively impacts livelihoods
and lives, particularly those of poor people, who have limited freedom in food
choices. 91
d.1 diAGnoSiS And treAtMent
A broad range of signs and symptoms can be used to diagnose aflatoxicosis,
depending upon the level of exposure. 92 Signs and symptoms include vomiting,
abdominal pain and hemorrhaging, pulmonary edema, acute liver damage
including fatty change, loss of digestive tract function, convulsions, cerebral
edema, and coma. other symptoms include yellow eyes, vomiting, abdominal
swelling, water in the abdomen, leg swelling, general weakness, and
drowsiness. 93 the onset of symptoms is relatively slow-acting, occurring about
8 hours after exposure. in cases of ingestion, feeding large quantities of an
adsorbent, such as clay additives like novaSil, may be used. 94
d.2 Prevention And control
hepatitis B vaccinations, education through awareness campaigns, and
chemoprevention measures such as competitive displacement, plant extract
applications, or methyleugenol sprays (see Section 3) have been shown to be
effective in preventing and controlling the adverse health effects of aflatoxin.
Hepatitis vaccinations
hepatocellular carcinoma, liver cancer, is the fifth most common cancer in the
world, with 80 percent of cases occurring in developing countries. the major
risk factors for this cancer have been identified as chronic viral infections,
such as hepatitis B and hepatitis c, and dietary exposure to aflatoxin. Given
estimates that approximately 70 percent of liver cancer in developing countries
is attributable to hepatitis B, a safe and effective vaccination to prevent chronic
hepatitis B infection could prevent more than 250,000 cases per year. 95
hepatitis B vaccination has not been formally considered as an aflatoxin control
intervention, as the vaccine itself has no impact on actual aflatoxin levels in
diets. however, it reduces the synergistic impact of hepatitis B and aflatoxin in
inducing liver cancer. 96
Studies have put the reduction in liver cancer cases attributable to hepatitis B
vaccination from 30 to 50 percent. Perz 97 estimated that 50 to 80 percent of
global liver cancer cases are attributable to hepatitis B and postulated that the
corresponding reduction of hepatocellular carcinoma risk due to hepatitis B
vaccination ranges from 45 to 50 percent. According to estimates by Kuniholm
et al., lowering the risk of chronic hepatitis B infection through vaccination
could reduce the risk of aflatoxin-induced liver cancer by as much as 30 times.
Vaccination may also play some role in reducing aflatoxin-induced cirrhosis. 98
More recently, Khlangwiset estimated that the hepatitis B vaccine reduces total
liver cancer by about 50 percent. 99
With improved recognition of causal factors and understanding of the mechanics
of the disease, interventions to reduce hepatocellular carcinoma incidence and
morbidity can be designed and implemented. Vaccination against hepatitis B
25