In the 2000s, outbreaks occurred in countries such as Angola, Zimbabwe, and Nepal. In Angola specifically, recent reports show a similar incidence of pellagra since 2002, with clinical pellagra in 0.3% of women and 0.2% of children, and niacin deficiency in 29.4% of women and 6% of children related to high untreated corn consumption.

In other countries such as the Netherlands and Denmark, even with sufficient intake of niacin, cases have been reported. In this case, deficiency might happen not just because of poverty or malnutrition,