Two federal agencies in the United States are part of efforts to find the source of food poisoning in Uganda that led to four deaths.

The U.S Centers for Disease Control and Prevention and Food and Drug Administration are involved in the investigation of the outbreak that occurred in March and April.

The World Food Programme (WFP) previously reported that three people died and hundreds more were admitted to health centers in the Karamoja region of Northeast Uganda after eating Super Cereal, which had been distributed to prevent malnutrition. Symptoms included mental confusion, vomiting, headache, high fever, and abdominal pain.

The food came from a Turkish supplier, which has been suspended from local and international Super Cereal distribution pending results of the investigation. Super Cereal is corn or wheat blended with soya beans, fortified with vitamins and minerals, processed into flour and supplied in 25-kilogram bags.

It was established that all 296 people who fell ill had eaten porridge from one batch of specially fortified food called Super Cereal (also known as CSB+). However, lab testing so far has not found the causative agent.

The FDA detected traces of alkaloids, specifically atropine, but is yet to establish the levels of contamination and whether the alkaloids are synthetic or natural. More tests are being performed by the agency and results will be released at a later date, according to a statement from the Ugandan Ministry of Health.

Samples were collected from WFP warehouses, health facilities and the homes of patients to rule out the presence of mycotoxins, heavy metals, pesticides and microbial agents. Lab tests were complemented by an epidemiological review by the ministry of health and CDC and toxicologists from the United Kingdom who visited Karamoja to examine patients.

Representatives from the CDC are part of a task force which includes the Ugandan Ministry of Health, Ministry of Internal Affairs, World Health Organization (WHO), WFP and Ugandan National Bureau of Standards (UNBS).

Food testing results
Of 18 samples tested by UNBS, one had aflatoxin B1 slightly higher than the acceptable limit and a few had low levels of yeast and mold but levels were lower than those required to cause illness, according to the ministry of health statement. The government analytical laboratory also found one sample with slightly high aflatoxin B1 but these levels could not explain the acute symptoms of toxicity seen in patients.

Testing by the Ministry of Health central public health lab found Bacillus cereus twice and Salmonella once in three samples from a household. Contamination was not found in samples from the warehouse.

An Intertek lab in Mombasa detected coliforms in three samples. In the Johannesburg lab owned by the same company, one sample failed the aflatoxin B1 test, three were contaminated with Bacillus cereus and three also had coliforms. FDA did not report any of these findings but further analysis is ongoing.

UNBS and the Directorate of Government Analytical Laboratory (DGAL) boosted analytical capabilities through support from the International Atomic Energy Agency (IAEA) and Food and Agriculture Organization of the United Nations (FAO).

“In the past, the lack of adequate diagnostic and analytical testing capacities limited our ability to minimize health risks to the public, including responding to outbreaks and emergencies and investigating suspected causes,’’ said Deus Mubangizi, manager of the Testing Division at UNBS.

The IAEA supported expert missions, training courses and delivery of equipment such as radio receptor assays, isotope dependent liquid chromatographic and spectrometric tools, liquid chromatographic instruments, tools to help sample preparation and storage, and analytical material to ensure performance according to international standards.

“The outbreak could have spread further or affected more consumers if stakeholders including the two laboratories. . . had not been in a position to intervene, promptly,” said Kepher Kuchana Kateu, director of DGAL.

The Ugandan Government and WFP suspended distribution of Super Cereal in the country from all suppliers. The United Nations agency started distributing foods of equal or higher nutritional value to vulnerable people.

Testing at the FDA showed Super Cereal from all suppliers other than the Turkish firm is safe to eat. The government has allowed WFP to resume Super Cereal distributions from the other suppliers.

The WFP previously said food supplies on hold around the world totaled more than 21,000 metric tons with an estimated replacement value of $22 million U.S.