Background: Cutaneous anthrax is an endemic disease in Georgia with approximately 50 human cases reported each year. In 2011 the number of reported cases increased to 78. We conducted a retrospective investigation to determine the reasons for the increased incidence in 2011. Methods: We reviewed all existing records for human and animal anthrax cases for the years 2002-2011. We reviewed laboratory records from 75 cases in 2011 that included 69 ulcer aspirates, 14 ulcer swabs, 29 blood samples, 1 stool, and 8 samples from soil and animal body parts. We reviewed all laboratory testing protocols and results. Results: Of the 78 human cutaneous anthrax cases reported in 2011, 55 (70.5%) were laboratory confirmed and 23(29.5%) were reported as probable. One case resulted in death. Human Incidence rate of 1.75 per 100,000 in 2011 was 2.2 times higher than the average for the years 2002-2010 (0.78/100,000). In 2011, 57 blood and tissue samples were submitted from cattle which represented an increase of 3.4 times over the numbers for the previous 5 years for which records are available. 42% of these samples were positive representing a rise of 4.7 times over the 2010 rate (9% positive). Human cases age ranged from 10 to 75 years with a median of 42 years. 71 (91%) cases were in males, 37 cases (47.4%) were from Kvemo Kartli region. We detected 10 outbreaks with 28 cases. 8 outbreaks (with 23 cases) were from Kvemo Kartli region. 69 (88.5%) patients took part in slaughtering infected animals. 61 human cases were PCR positive, 34 were culture positive and PCR positive, 26 were PCR positive and culture negative, 15 were culture negative and PCR negative. Conclusion: Slaughtering sick animals is the major mechanism for human infections and outbreaks in Georgia. The increased incidence in human cases in 2011 may be related to contact with a larger number of sick or infected cattle. We recommend stronger veterinary control measures for animal slaughtering especially in the Kvemo Kartli region.
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