<unk>  has been reported in outbreaks mainly among women and children in remote rural populations in DR Congo, Mozambique (where it is known as mantakassa), Tanzania, Central African Republic, Cameroon and Angola. The first reported outbreak occurred in Bandundu Province in present-day DR Congo in 1936–1937 and the second in Nampula Province of Northern Mozambique in 1981. Each of these outbreaks numbered more than 1000 cases. Familial clustering is common. Outbreaks typically occur in the dry season in households living in absolute poverty that have sustained themselves for weeks or months on insufficiently processed bitter cassava. Both smaller outbreaks and sporadic cases have been reported from all the countries above.
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