Abstract
BackgroundAnthrax is a disease that affects humans and animals. In Ethiopia, anthrax is a reportable disease and assumed to be endemic, although laboratory confirmation has not been routinely performed until recently. We describe the findings from the investigation of two outbreaks in Amhara region.MethodsFollowing reports of suspected outbreaks in Wag Hamra zone (Outbreak 1) and South Gondar zone (Outbreak 2), multi-sectoral teams involving both animal and public health officials were deployed to investigate and establish control programs. A suspect case was defined as: sudden death with rapid bloating or bleeding from orifice(s) with unclotted blood (animals); and signs compatible with cutaneous, ingestion, or inhalation anthrax ≤7 days after exposure to a suspect animal (humans). Suspect human cases were interviewed using a standard questionnaire. Samples were collected from humans with suspected anthrax (Outbreak 1 and Outbreak 2) as well as dried meat of suspect animal cases (Outbreak 2). A case was confirmed if a positive test was returned using real-time polymerase chain reaction (qPCR).ResultsIn Outbreak 1, a total of 49 cows died due to suspected anthrax and 22 humans developed symptoms consistent with cutaneous anthrax (40% attack rate), two of whom died due to suspected ingestion anthrax. Three people were confirmed to have anthrax by qPCR. In Outbreak 2, anthrax was suspected to have caused the deaths of two livestock animals and one human. Subsequent investigation revealed 18 suspected cases of cutaneous anthrax in humans (27% attack rate). None of the 12 human samples collected tested positive, however, a swab taken from the dried meat of one animal case (goat) was positive by qPCR.ConclusionWe report the first qPCR-confirmed outbreaks of anthrax in Ethiopia. Both outbreaks were controlled through active case finding, carcass management, ring vaccination of livestock, training of health professionals and outreach with livestock owners. Human and animal health authorities should work together using a One Health approach to improve case reporting and vaccine coverage.
Highlights
Anthrax is an acute infectious disease caused by infection with the spore-forming bacterium, Bacillus anthracis
We report the first qPCR-confirmed outbreaks of anthrax in Ethiopia
Both outbreaks were controlled through active case finding, carcass management, ring vaccination of livestock, training of health professionals and outreach with livestock owners
Summary
Anthrax is an acute infectious disease caused by infection with the spore-forming bacterium, Bacillus anthracis. Animals become infected through ingestion of spores in the soil. Bacteria released in blood and body fluids form environmentally-resistant spores that can persist for decades in the soil [1]. In most (95%) cases, exposure occurs via cuts or abrasions in the skin following handling of infected animal products, such as hides or wool. This results in cutaneous lesions characterized by a raised vesicle that develops into a painless sore with black center (‘black eschar’) [1]. Inhalation of spores can lead to the respiratory form, characterized by flu-like symptoms, difficulty breathing and shock. We describe the findings from the investigation of two outbreaks in Amhara region
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