Anthrax Attacks Research Articles

THE CURRENT SITUATION ON ANTHRAX IN RUSSIA AND IN THE WORLD. MAIN TRENDS AND FEATURES

The current situation on anthrax is characterized as unstable. Instability is associated with recurring epizootic outbreaks complicated by human anthrax cases, as people contract infection mainly through contact with sick animals, their carcasses or animal products. Mentioned are new aerosol and parenteral ways of anthrax contracting. Parenteral use of contaminated heroin led to emergence of new clinical form of anthrax – injectional. Conception on anthrax agent evolution is replenished by data on pathogenic bacilli strains, that occupy an intermediate position between B. anthracis and B. cereus. Ecology of anthrax microbe is considered in view of its interaction with bacteriophages, rhizosphere and soil microflora. Research related to the environmental characteristics of habitat niches and genotypes of B. anthracis, explaining the geographical distribution of areas with a high risk of disease, may allow to optimize the program of animals immunization, which is the most effective measure for the prevention of anthrax.

Epidemiology of Human Anthrax in China, 1955-2014.

Using national surveillance data for 120,111 human anthrax cases recorded during 1955−2014, we analyzed the temporal, seasonal, geographic, and demographic distribution of this disease in China. After 1978, incidence decreased until 2013, when it reached a low of 0.014 cases/100,000 population. The case-fatality rate, cumulatively 3.6% during the study period, has also decreased since 1990. Cases occurred throughout the year, peaking in August. Geographic distribution decreased overall from west to east, but the cumulative number of affected counties increased during 2005−2014. The disease has shifted from industrial to agricultural workers; 86.7% of cases occurred in farmers and herdsmen. Most (97.7%) reported cases were the cutaneous form. Although progress has been made in reducing incidence, this study highlights areas that need improvement. Adequate laboratory diagnosis is lacking; only 7.6% of cases received laboratory confirmation. Geographic expansion of the disease indicates that livestock control programs will be essential in eradicating anthrax.

Licensure strategy for pre- and post-exposure prophylaxis of biothrax vaccine: the first vaccine licensed using the FDA animal rule

ABSTRACTIntroduction: The availability of a licensed anthrax vaccine that is safe, effective, and easy to administer for both pre- and post-exposure prophylaxis is critical to successfully manage and prevent potential anthrax attacks. BioThrax® (Anthrax Vaccine Adsorbed; AVA) is the only licensed anthrax vaccine in the US.Areas covered: Recent licensed improvements to BioThrax vaccine for pre-exposure prophylaxis (PrEP) have included an intramuscular (IM) five-dose schedule (in 2008) and a three-dose IM primary series at 0, 1 and 6 months (in 2012). Post-exposure prophylaxis (PEP) – three doses given subcutaneously (SC) at 0, 2, and 4 weeks – was licensed in 2015. We review the anthrax disease and vaccine literature that supported these licensure efforts.Expert commentary: This PEP licensure is the first time the FDA’s Animal Rule has been used to license a vaccine. Additional improvements such as fewer vaccine doses and reduced time to protection are desirable for a PEP vaccine and are being pursued with next generation vaccine candidates.

The Humoral Immune Response to Various Domains of Protective Antigen of Bacillus anthracis in Cutaneous Anthrax Cases in India

Anthrax, caused by Bacillus anthracis is known to occur globally since antiquity. Besides being an important biothreat agent, it is an important public health importance pathogen also in countries like India. B. anthracis secretes three distinct toxins, namely protective antigen (PA), lethal factor (LF) and edema factor (EF). PA is the central moiety of the anthrax toxin complex and therefore has been a molecule of choice for vaccine development. PA has four different domains with different functions. In this study, the major domains of PA were cloned and expressed in bacterial system. The purified recombinant proteins were used to determine the humoral immune response by ELISA using 43 human cutaneous anthrax serum samples. The maximum immunoreactivity was observed with the whole PA protein followed by domain 2, 4 and 1. The study corroborated that in addition to full PA, individual domain 2 and 4 can also be good target for vaccine development as well as for serodiagnostic assays for cutaneous anthrax

Comparative genomics of Bacillus anthracis from the wool industry highlights polymorphisms of lineage A.Br.Vollum

BackgroundWith the advent of affordable next-generation sequencing (NGS) technologies, major progress has been made in the understanding of the population structure and evolution of the B. anthracis species. Here we report the use of whole genome sequencing and computer-based comparative analyses to characterize six strains belonging to the A.Br.Vollum lineage. These strains were isolated in Switzerland, in 1981, during iterative cases of anthrax involving workers in a textile plant processing cashmere wool from the Indian subcontinent. ResultsWe took advantage of the hundreds of currently available B. anthracis genomes in public databases, to investigate the genetic diversity existing within the A.Br.Vollum lineage and to position the six Swiss isolates into the worldwide B. anthracis phylogeny. Thirty additional genomes related to the A.Br.Vollum group were identified by whole-genome single nucleotide polymorphism (SNP) analysis, including two strains forming a new evolutionary branch at the basis of the A.Br.Vollum lineage. This new phylogenetic lineage (termed A.Br.H9401) splits off the branch leading to the A.Br.Vollum group soon after its divergence to the other lineages of the major A clade (i.e. 6 SNPs). The available dataset of A.Br.Vollum genomes were resolved into 2 distinct groups. Isolates from the Swiss wool processing facility clustered together with two strains from Pakistan and one strain of unknown origin isolated from yarn. They were clearly differentiated (69 SNPs) from the twenty-five other A.Br.Vollum strains located on the branch leading to the terminal reference strain A0488 of the lineage. Novel analytic assays specific to these new subgroups were developed for the purpose of rapid molecular epidemiology. ConclusionsWhole genome SNP surveys greatly expand upon our knowledge on the sub-structure of the A.Br.Vollum lineage. Possible origin and route of spread of this lineage worldwide are discussed.

2014 Anthrax epidemic in Koubia prefecture, Guinea-Conakry

Anthrax disease is an anthropozoonosis caused by a Gram-positive bacterium, Bacillus anthracis. Our objective was to describe the epidemiological, clinical and therapeutic features of the 2014 epidemic in Koubia prefecture. This retrospective study examined all of the anthrax cases reported in Fafaya, Koubia Prefecture. In March and April 2014, there were 39 cases of human anthrax reported, for an incidence of 1.135%. The mean age was 20.9 (± 18.3) with a sex ratio of 2.54 (28/11) in favor of men. Seventy-six percent (23/39) were single. More than one half were students (53.8%). The main clinical signs were fever in 71, 8% (n = 28 /), papules 59% (n = 23), vesicles of 59% (n = 23) Digestive and cutaneous signs represented 35.9 % and 64.1% respectively; 35% had ingested contaminated meat and 17.95% were in direct contact with a sick animal. We didn't find any correlation between the mode of infection and onset of signs. The fatality rate was 28.21%. The 2014 epidemic of anthrax disease in the Koubia prefecture was marked by a high incidence and lethality. Clinical manifestations were cutaneaous and digestive. These results may serve further interventions to fight against anthrax disease. They should mainly focus on an awareness of peasants, surveillance and vaccination of cattle. Other studies seem to be necessary.

Anthrax Vaccine and the Risk of Rheumatoid Arthritis and Systemic Lupus Erythematosus in the U.S. Military: A Case-Control Study.

U.S. military personnel assigned to areas deemed to be at high risk for anthrax attack receive Anthrax Vaccine Adsorbed (AVA). Few cases of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) have been reported in persons who received AVA. Using a matched case-control study design, we assessed the relationship of RA and SLE with AVA vaccination using the Defense Medical Surveillance System. We identified potential cases using International Classification of Diseases, 9th Revision, Clinical Modification codes and confirmed cases with medical record review and rheumatologist adjudication. Using conditional logistic regression, we estimated odds ratios (OR) for AVA exposure during time intervals ranging from 90 to 1,095 days before disease onset. Among 77 RA cases, 13 (17%) had ever received AVA. RA cases were no more likely than controls to have received AVA when looking back 1,095 days (OR: 1.03; 95% confidence interval [CI]: 0.48-2.19) but had greater odds of exposure in the prior 90 days (OR: 3.93; 95% CI: 1.08-14.27). Among the 39 SLE cases, 5 (13%) had ever received AVA; no significant difference in receipt of AVA was found when compared with controls (OR: 0.91; 95% CI: 0.26-3.25). AVA was associated with recent onset RA, but did not increase the risk of developing RA in the long term.

After Amerithrax: The state of modern biodefense

The ringing woke him up. It was years ago, but Tom R. Slezak still remembers. The Lawrence Livermore National Lab scientist didn’t normally get phone calls in the middle of the night telling him he was needed at work. And he didn’t normally jet off aboard a military transport after arriving at the lab. When he did fly, he normally knew where he was going, how long he’d be gone, and why he was leaving. But this was October 2001. Nothing was normal in America. The weeks following the Sept. 11 attacks unleashed a new terror on the U. S. Hours before Slezak got his call, a photo editor in Florida died from anthrax caused by white powder containing Bacillus anthracis spores sent in the mail. More anthrax cases would follow, caused by letters tainted with spores from a potent strain of the bacterium and addressed to prominent politicians and

Soil geochemical parameters influencing the spatial distribution of anthrax in Northwest Minnesota, USA

Bacillus anthracis is the pathogenic bacterium that causes anthrax, which dwells in soils as highly resilient endospores. B. anthracis spore viability in soil is dependent upon environmental conditions, but the soil properties necessary for spore survival are unclear. In this study we used a range of soil geochemical and physical parameters to predict the spatial distribution of B. anthracis in northwest Minnesota, where 64 cases of anthrax in livestock were reported from 2000 to 2013. Two modeling approaches at different spatial scales were used to identify the soil conditions most correlated to known anthrax cases using both statewide and locally collected soil data. Ecological niche models were constructed using the Maximum Entropy (Maxent) approach and included 11 soil parameters as environmental inputs and recorded anthrax cases as known presences. One ecological niche model used soil data and anthrax presences for the entire state while a second model used locally sampled soil data (n = 125) and a subset of anthrax presences, providing a test of spatial scale. In addition, simple logistic regression models using the localized soil data served as an independent measure of variable importance. Maxent model results indicate that at a statewide level, soil calcium and magnesium concentrations, soil pH, and sand content are the most important properties for predicting soil suitability for B. anthracis while at the local level, clay and sand content along with phosphorous and strontium concentrations are most important. These results also show that the spatial scale of analysis is important when considering soil parameters most important for B. anthracis spores. For example, at a broad scale, B. anthracis spores may require Ca-rich soils and an alkaline pH, but may also concentrate in microenvironments with high Sr concentrations. The study is also one of the first ecological niche models that demonstrates the major importance of soil texture for defining the ecological niche of B. anthracis. These results will help improve our understanding of the soil geochemical conditions most suitable for B. anthracis as well as more reliably identify areas where anthrax may be found to focus prevention and remediation efforts.

A retrospective chart review study to describe selected zoonotic and arboviral etiologies in hospitalized febrile patients in the Republic of Armenia.

BackgroundScant information is available on the infectious causes of febrile illnesses in Armenia. The goal of this study was to describe the most common causes, with a focus on zoonotic and arboviral infections and related epidemiological and clinical patterns for hospitalized patients with febrile illnesses of infectious origin admitted to Nork Infectious Diseases Clinical Hospital, the referral center for infectious diseases in the capital city, Yerevan.MethodA chart review study was conducted in 2014. Data were abstracted from medical charts of adults (≥18 years) with a fever (≥38 °C), who were hospitalized (for ≥24 h) in 2010–2012.ResultsOf the 600 patients whose charts were analyzed, 76 % were from Yerevan and 51 % were male; the mean age (± standard deviation) was 35.5 (±16) years. Livestock exposure was recorded in 5 % of charts. Consumption of undercooked meat and unpasteurized dairy products were reported in 11 and 8 % of charts, respectively. Intestinal infections (51 %) were the most frequently reported final medical diagnoses, followed by diseases of the respiratory system (11 %), infectious mononucleosis (9.5 %), chickenpox (8.3 %), brucellosis (8.3 %), viral hepatitis (3.2 %), and erysipelas (1.5 %). Reviewed medical charts included two cases of fever of unknown origin (FUO), two cutaneous anthrax cases, two leptospirosis cases, three imported malaria cases, one case of rickettsiosis, and one case of rabies. Engagement in agricultural activities, exposure to animals, consumption of raw or unpasteurized milk, and male gender were significantly associated with brucellosis.ConclusionOur analysis indicated that brucellosis was the most frequently reported zoonotic disease among hospitalized febrile patients. Overall, these study results suggest that zoonotic and arboviral infections were not common etiologies among febrile adult patients admitted to the Nork Infectious Diseases Clinical Hospital in Armenia.

Clinical characteristics of 21 cases with human cutaneous anthrax in Yan′an city, Shaanxi province

Objective To investigate the epidemiology and clinical characteristics of 21 cases with human cutaneous anthrax. Methods The clinical manifestations and epidemic data of twenty-one human cutaneous anthrax cases from July to December in 2015 in Yan′an City, Shaanxi Province were reviewed. Their demographic data, epidemic features, clinical manifestations, laboratory results, treatment regimen and outcomes were retrospectively analyzed. Results All the 21 patients had previous contact history with the dead mules or donkeys before the onset of crater-like skin ulcer, and some of them presented with fever, headache, diarrhea and lymphadenoma. Gram-positive bacillus, which had squared ends and endospores, was found in the skin secretions of two patients and positive aerobic culture of spore-forming bacillus was found in one patient, with positive phage test and penicillin G susceptibility test. All patients cured after individualized penicillin treatment. Conclusions When the patient presents with crater-like skin ulcers and eschar after contacting with the dead livestock, anthrax infection should be carefully ruled out. Timely sample collection and etiological examination can help make the diagnosis of human cutaneous anthrax. Early administration of penicillin is important for infection control and disease cure. Early disease reporting and relevant knowledge propaganda are the key measures to prevent and control the transmission of the disease. Key words: Bacillus anthracis; Human cutaneous anthrax; Diagnosis; Treatment

Introduction to the Special Issue: Best Papers Presented at the OLC 21st International Conference on Online Learning and Innovate 2016

The Online Learning Consortium (OLC) traces its roots to the Alfred P. Sloan Consortium (Sloan-C) that emerged in the 1990s when a cadre of early adapters of online learning began to coalesce into a professional community. Funded by the Alfred P. Sloan Foundation, this community embarked on a number of activities designed to promote quality in the design and implementation of online and blended learning applications. In 1995, a one-day meeting of grantees of the Alfred P. Sloan Foundation’s Anytime, Anyplace Learning Program met in Philadelphia to discuss their work and share their experiences. Ninety individuals attended this first event. This meeting grew into an annual event for the next five years. In 2001, it was decided that the event be expanded into a full conference with paper submissions and reviews, workshops, and exhibit areas. The University of Central Florida agreed to host the conference in Orlando in November. That was a fateful decision as the attack on the World Trade Center on 9/11 followed by the anthrax scare in Florida in October of that year severely limited the number of people willing to fly to Orlando to attend the conference. Still, three hundred and sixty participants attended to share and discuss research, effective practices, student services, and administrative support for online learning. Since 2001, the conference has grown and has evolved into the premiere event for presenting current ideas, research, and best practices in online learning. 
 
 In 2015, the Online Learning Consortium celebrated the 21st anniversary of the International Conference on Online Learning. The theme of the conference, Shaping the Future of Online Learning, focused on the latest developments in online and blended learning. Almost 3,000 individuals attended this conference either in person or virtually. Six hundred and sixty-eight proposals were submitted for presentation. 
 
 In April, 2016, the Online Learning Consortium initiated a new conference, OLC Innovate: Innovations in Blended and Online Learning. Almost 2,000 individuals attended this conference and 506 individuals submitted presentation proposals. Of the 1,172 proposals submitted for both conferences, the nine articles selected for this special edition represent the best presentations as determined by the conference track chairs and editorial staff of the Online Learning Journal.

Is there an infection risk when playing drums contaminated with Bacillus anthracis?

This study aims to investigate the aerosol release of a Bacillus anthracis spore surrogate from two different types of drums while playing, by; (i) quantifying the number of spores aerosolized during playing; (ii) investigating spore recovery from drums over long time periods, and (iii) measuring differences between (i) and (ii) for two different drums types. Two African drums were contaminated with Bacillus atrophaeus spores then sampled and played by hand over a number of days. During playing three air samplers were used to collect any aerosols generated, the choice of air samplers (Casella slit sampler, all glass impinger and six-stage Andersen sampler) allowed for characterization of the aerosols produced. Spore contamination of drums was found to be long-lasting with a small percentage of the spores being detached and aerosolized during drumming. The results of these studies have been used for a quantitative risk assessment of playing drums contaminated with B.anthracis spores. This demonstrates that the risk of inhalational exposure while playing drums contaminated with the levels linked to the US and UK cases is very low and that the resulting cases of inhalational anthrax can be explained by being unusual events involving highly susceptible persons.

Microbial forensics: next-generation sequencing as catalyst: The use of new sequencing technologies to analyze whole microbial communities could become a powerful tool for forensic and criminal investigations.

When Antonie van Leeuwenhoek experimented with his microscopes in the late 17th century, he observed, among many other small things, bacteria from the mouth cavity. van Leeuwenhoek's detailed descriptions of bacteria, spermatozoa, and cells marked the beginning of microbiology; his successors Robert Koch and Louis Pasteur stoked further interest in the microbial world with their discoveries of the role of bacteria in disease and fermentation. The light microscope was eventually augmented by ever more powerful tools—electron microscopes, fluorescence microscopy, RNA arrays, and DNA sequencers—to study the members of the microbial world and their interactions with each other and their host organisms, particularly humans. One technique in particular has revolutionized microbiology: next‐generation sequencing (NGS) or massive parallel sequencing [1]. The ability to sequence a mixture of millions of DNA molecules within one analytical run has created new opportunities to analyze whole communities of microbes rapidly and efficiently, including many species that cannot be cultured in the laboratory. New methods for RNA analysis have also tremendously improved microbiologists' ability to look at the molecular activities not just within single cells but whole bacterial communities. In addition to inspiring new research in microbiology, NGS will likely have a major impact on forensic science and eventually become a new tool in police work and court cases. The forensic value of microbiology became apparent during the investigation of the anthrax attacks 1 week after the terrorist attack on September 11, 2001. Letters that contained spores of Bacillus anthracis were mailed to two US Democratic senators and various media offices in the USA. Twenty‐two persons who opened these letters were infected with B. anthracis and five people died. The major challenge for forensic science, as part of the FBI's investigation, was to attribute the source of the bacterial spores in order to identify …

Phylogenetic Characteristics of Anthrax Outbreaks in Liaoning Province, China, 2001-2015.

Anthrax is a continuous threat in China, especially in rural regions. In July 2015, an anthrax outbreak occurred in Xifeng County, Liaoning Province. A total of 10 cutaneous anthrax cases were reported, with 210 people under medical observation. In this study, the general characteristics of human anthrax outbreak occurred in Liaoning Province were described, and all cases were caused by butchering and contacting sick animal. Meanwhile, the phylogenetic relationship between outbreak-related isolates/samples of the year 2015 and previous Bacillus anthracis strains was analyzed by means of canonical single nucleotide polymorphisms (canSNP), multiple-locus variable-number tandem repeat analysis (MLVA) with 15 markers and single-nucleotide repeats (SNR) analysis. There are two canSNP subgroups found in Liaoning, A.Br.001/002 and A.Br.Ames, and a total of six MLVA 15 genotypes and five SNR genotypes were observed. The strain collected from anthrax outbreak in Xifeng County in 2015 was classified as A.Br.001/002 subgroup and identified as MLVA15-29 genotype, with same SNR profile (CL10: 17, CL12: 15, CL33: 29, and CL35: 13). So we conclude that the same clone of B.anthracis caused the anthrax outbreak in Xifeng County in 2015, and this clone is different to previous isolates. Strengthening public health education in China is one of the most important measures to prevent and control anthrax.

Source and risk factors of a cutaneous anthrax outbreak, Jiangsu, Eastern China, 2012.

Anthrax is still a severe public health problem and threat to human health. A cutaneous anthrax outbreak occurred in Jiangsu Province, a non-endemic anthrax region of eastern China, from July to August 2012. Epidemiological and laboratory investigation were initiated to trace the source of infection and identify the risk factors of the outbreak. On 25 July 2012, 17 persons were exposed to a sick cow, which had been imported from northeast China a few days previously. Of the 17 exposed, eight developed symptoms between 1 and 8 days and were diagnosed as cutaneous anthrax cases. Three main genes of Bacillus anthracis were detected from both human and cow meat samples, indicating that the outbreak was associated with this infected cow. A retrospective cohort study showed that contact with blood and presence of skin damage contributed to the case infection with B. anthracis. The outbreak highlights the need to enhance quarantine for imported livestock, which should have been vaccinated prior to importation, the significance of education for high-risk individuals, and training for primary healthcare workers even in anthrax-free areas.

Сибирская язва: эпидемиологическая и эпизоотологическая ситуация в 2015 г., прогноз на 2016 г.

Outlined are the results of assessment of epidemiological and epizootiological situation on anthrax across the globe in 2015. Three human cases of cutaneous anthrax were registered in the Russian Federation. Detected were two epizootic foci with three cases of live-stock animal disease. 1-20 cases of anthrax in humans are forecasted in the Russian Federation in 2016. Adverse as regards anthrax situation is created in a number of near and far abroad counties. The highest morbidity rates among animals and humans are reported from Asian and African countries. Discussed are the results of investigation into the blunder of the US Department of Defense laboratory system, resulted in distribution of ineffectively decontaminated samples of anthrax agent to the US laboratories, as well as of other states within the past twenty years.

Making Communication Strategy Choices in a Fast Evolving Crisis Situation—Results from a Table-Top Discussion on an Anthrax Scenario

This paper aims at clarifying a timely topic of how communication strategy choices are made in evolving, complex crises, such as those caused by terrorism involving chemical, biological, radiological, or nuclear (CBRN) agents. This is done by examining data gathered from a table-top discussion among crisis communication experts, focusing on a scenario of an anthrax attack and analysed qualitatively. The communication experts followed the evolving crisis situation by gathering inputs from various actors in the crisis management network, thereby creating situational understanding, and interpreted these inputs for decision-making on communication strategies. The underlying process of coping with complexity in evolving CBRN terrorism crises can be described as a continuous, dynamic process that can best be explained with a combination of traditional and more modern crisis communication approaches. Strategy-making in crisis situations by communication experts is still largely a black box. In this study, a novel approach of decomposing strategy-making by observing a table-top discussion is chosen to clarify the process. By identifying the core elements involved, a more detailed picture of communication strategy-making is created, thus promoting preparedness and professional resilience in the field.

Multigeneration Cross-Contamination of Mail with Bacillus anthracis Spores.

The release of biological agents, including those which could be used in biowarfare or bioterrorism in large urban areas, has been a concern for governments for nearly three decades. Previous incidents from Sverdlosk and the postal anthrax attack of 2001 have raised questions on the mechanism of spread of Bacillus anthracis spores as an aerosol or contaminant. Prior studies have demonstrated that Bacillus atrophaeus is easily transferred through simulated mail handing, but no reports have demonstrated this ability with Bacillus anthracis spores, which have morphological differences that may affect adhesion properties between spore and formite. In this study, equipment developed to simulate interactions across three generations of envelopes subjected to tumbling and mixing was used to evaluate the potential for cross-contamination of B. anthracis spores in simulated mail handling. In these experiments, we found that the potential for cross-contamination through letter tumbling from one generation to the next varied between generations while the presence of a fluidizer had no statistical impact on the transfer of material. Likewise, the presence or absence of a fluidizer had no statistically significant impact on cross-contamination levels or reaerosolization from letter opening.

Modeling the logistics response to a bioterrorist anthrax attack

As a bioterrorist anthrax attack has serious consequences, an emergency management plan that can reduce the number of casualties should be studied. However, the papers studying this area are still few. This paper proposes a model which links the disease progression, the related medical intervention actions and the logistics deployment together to help crisis managers to extract crucial insights on emergency logistics management from a strategic level standpoint. This model is a multi-period one with the consideration of the period when the patients transfer into the different disease stages, the period when the medical intervention begins and the change of the recovery rate because of the time lag between the two aforementioned periods. Our model can support the decision making process in case of a real anthrax attack and evaluate the important factors, which can have a great impact on the number of casualties.