Detection and management of the first human anthrax outbreak in Togo

et al. 2020

Preprint

Abstract Background: In Zimbabwe, anthrax continues to be a disease of public health importance with sporadic outbreaks reported in many parts of the country annually. A human anthrax outbreak occurred in Makoni District Ward 22 and 23 between June 2013 and February 2014. The human anthrax outbreak followed cattle deaths in the wards, which were laboratory confirmed to be due to anthrax. We report the clinical characteristics, distribution of anthrax cases (places, person and time), risk factors for contracting the disease, environmental assessment, district preparedness and response and outbreak prevention and control measures.Methods: We conducted an outbreak investigation with the design of a 1:1 case-control study. Cases and controls were frequency matched against sex. Data were collected using a structured interviewer-administered questionnaire. Environmental assessment, district preparedness and response and outbreak prevention and control measures were assessed using a checklist, observations and key informant interviews. Multivariable logic regression analysis was performed to identify independent risk factors associated with contracting anthrax. Results: Of the 64 cases, 37 cases and 37 controls were interviewed. All the cases had cutaneous anthrax with the commonest site of eschar being the hand (43%). Most of the cases (89%) were managed according to national guidelines. On multivariable analysis, source of meat from other villagers [vs butchery, OR = 15.21, 95% CI (2.32-99.81)], skinning [OR = 4.32, 95% CI (1.25-14.94)] and belonging to a religion which permits eating meat from cattle slaughtered due to unknown illness or butchered after an unobserved death [OR = 6.12, 95% CI (1.28-29.37)] were associated with contracting anthrax. The district was poorly resourced and delayed to respond to the outbreak.Conclusion: The described anthrax outbreak resulted from contact and consumption of infected cattle meat. The district office response was delayed and was not prepared to control the outbreak. However, the outbreak was eventually controlled through cattle vaccination; health education and awareness campaigns. The district should strengthen its emergency preparedness and response capacity, revive zoonotic committees, conduct awareness campaign during the high-risk period and improve the surveillance of anthrax during high-risk periods.

Section: Discussionsupporting

confidence: 92%

An investigation of an anthrax outbreak in Makoni District, Zimbabwe

et al. 2020

Preprint

Section: Discussionsupporting

confidence: 92%

An investigation of an anthrax outbreak in Makoni District, Zimbabwe

et al. 2020

Preprint

Background: In Zimbabwe, anthrax continues to be a disease of public health importance with sporadic outbreaks reported in many parts of the country annually. A human anthrax outbreak occurred in Makoni District Ward 22 and 23 between June 2013 and February 2014. The human anthrax outbreak followed cattle deaths in the wards, which were laboratory confirmed to be due to anthrax. We report the clinical characteristics, distribution of anthrax cases (places, person and time), risk factors for contracting the disease, environmental assessment, district preparedness and response and outbreak prevention and control measures. Methods: We conducted an outbreak investigation with the design of a 1:1 case-control study. Cases and controls were frequency matched against sex. Data were collected using a structured interviewer-administered questionnaire. Environmental assessment, district preparedness and response and outbreak prevention and control measures were assessed using a checklist, observations and key informant interviews. Multivariable unconditional logic regression analysis was performed to identify independent risk factors associated with contracting anthrax. Results: Of the 64 cases, 37 cases and 37 controls were interviewed. All the cases had cutaneous anthrax with the commonest site of eschar being the hand (43%). Most of the cases (89%) were managed according to the national guidelines. On multivariable analysis, source of meat from other villagers [vs butchery, OR = 15.21, 95% CI (2.32-99.81)], skinning [OR = 4.32, 95% CI (1.25-14.94)] and belonging to a religion which permits eating meat from cattle slaughtered due to unknown illness or butchered after an unobserved death [OR = 6.12, 95% CI (1.28-29.37)] were associated with contracting anthrax. The district was poorly resourced and delayed to respond to the outbreak. Conclusion: The described anthrax outbreak resulted from contact and consumption of infected cattle meat. The district office response was delayed and was not prepared to control the outbreak. However, the outbreak was eventually controlled through cattle vaccination; health education and awareness campaigns. The district should strengthen its emergency preparedness and response capacity, revive zoonotic committees, conduct awareness campaign during the high-risk period and improve the surveillance of anthrax during high-risk periods.

“…The anthrax eschar was more commonly found on the hands than other body parts, a nding that was consistent with other studies [12,15]. Since hands are used for handling meat, they are at higher risk of developing abrasions, bruises, and cuts, thereby creating a route of entry for the anthrax spores.…”

Section: Discussionsupporting

confidence: 88%

Investigation of an anthrax outbreak in Makoni District, Zimbabwe

et al. 2020

Preprint

Background: Anthrax continues to be a disease of public health importance in Zimbabwe, with sporadic outbreaks reported annually in many parts of the country. A human anthrax outbreak occurred in wards 22 and 23 of Makoni District from mid-June 2013 to end of January 2014, following cattle deaths in the wards. Laboratory tests confirmed anthrax as the cause for the cattle deaths. This study aims to investigate the clinical characteristics, distribution of anthrax cases (places, person and time), risk factors for contracting the disease, environmental assessment, district preparedness and response, and outbreak prevention and control measures.Methods: We conducted an outbreak investigation using a mixed-methods design. A 1:1 case-control study was used to assess risk factors for contracting anthrax. The controls were frequency matched to cases by sex. Data were collected using a structured interviewer-administered questionnaire. Environmental assessment, district preparedness and response, and outbreak prevention and control measures were assessed using a checklist, observations, and key informant interviews. Multivariable unconditional logic regression analysis was performed to identify independent risk factors associated with contracting anthrax.Results: We interviewed 37 of the 64 cases, along with 37 controls. All the cases had cutaneous anthrax, with the hand being the most common site of the eschar (43%). Most of the cases (89%) were managed according to the national guidelines. Multivariable analysis demonstrated that meat sourced from other villages [vs butchery, OR = 15.21, 95% CI (2.32-99.81)], skinning [OR = 4.32, 95% CI (1.25-14.94)], and belonging to religions that permit eating meat from cattle killed due to unknown causes or butchered after unobserved death [OR = 6.12, 95% CI (1.28-29.37)] were associated with contracting anthrax. The poor availability of resources in the district caused a delayed response to the outbreak.Conclusion: The described anthrax outbreak was caused due to contact with infected cattle meat. Although the outbreak was eventually controlled through cattle vaccination and health education and awareness campaigns, the response of the district office was initially delayed and insufficient. The district should strengthen its emergency preparedness and response capacity, revive zoonotic committees, conduct awareness campaigns and improve surveillance, especially during outbreak seasons.