Anthrax Outbreaks in Bangladesh, 2009-2010

Centre for Communicable Diseases, Bangladesh, Dhaka, Bangladesh.
The American journal of tropical medicine and hygiene (Impact Factor: 2.7). 04/2012; 86(4):703-10. DOI: 10.4269/ajtmh.2012.11-0234
Source: PubMed


During August 2009-October 2010, a multidisciplinary team investigated 14 outbreaks of animal and human anthrax in Bangladesh to identify the etiology, pathway of transmission, and social, behavioral, and cultural factors that led to these outbreaks. The team identified 140 animal cases of anthrax and 273 human cases of cutaneous anthrax. Ninety one percent of persons in whom cutaneous anthrax developed had history of butchering sick animals, handling raw meat, contact with animal skin, or were present at slaughtering sites. Each year, Bacillus anthracis of identical genotypes were isolated from animal and human cases. Inadequate livestock vaccination coverage, lack of awareness of the risk of anthrax transmission from animal to humans, social norms and poverty contributed to these outbreaks. Addressing these challenges and adopting a joint animal and human health approach could contribute to detecting and preventing such outbreaks in the future.

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    • "A recent study in the country of Georgia hypothesized that an increase of human cutaneous anthrax in urban areas may be linked to contaminated meat sold in informal meat markets (which have little to no regulation) (Kracalik, Malania, et al., 2014). A similar phenomenon has also been documented in other countries (Chakraborty et al., 2012). In Ukraine, individual household livestock owners often sell contaminated meat along the roadsides; this is an illegal and unregulated enterprise, thereby the meat is not tested and could be contaminated. "
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    ABSTRACT: Anthrax is a severe, under-reported zoonosis, caused by the bacterium Bacillus anthracis, that affects livestock, wildlife, and humans nearly worldwide. Humans most often contract anthrax from animal products, including meat, bones, and hide. In the early 20th century, a large number of livestock anthrax outbreaks in the Russian Empire were in Ukrainian territories. During the past century, as a part of the Soviet Union and as an independent nation, Ukraine has continually experienced livestock and human anthrax outbreaks. Here, we used georeferenced livestock outbreak data from 1913 to 2012 to report spatio-temporal patterns and use spatial analysis to define hotspots of livestock anthrax from historical to contemporary times in Ukraine. We were most interested in comparing changes in anthrax reporting over the past century, and to identify areas where anthrax persists in modern times. Historically (1913–1978), anthrax reporting sites were widely distributed across the country with relatively large hotspots. In the contemporary period (1979–2012), there were 72× fewer initial anthrax reporting sites. Weighted hotspot analysis identified multiple anthrax foci, though these were smaller than historical hotspots. Space time analysis of moving polygons (STAMP) showed that expanding and stable anthrax foci overlapped historical reporting areas, and newly generated foci that were located near recently reported wildlife outbreaks. These findings may help better direct future control and mitigation efforts, and indicate that alternative detection methods (e.g. wildlife surveillance and predictive ecological models) may be helpful.
    Applied Geography 10/2014; 54:129-138. DOI:10.1016/j.apgeog.2014.07.016 · 3.08 Impact Factor
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    • "Since 1980s, researchers have reported 590 animals with laboratory-confirmed B. anthracis (10, 11). A few epidemiological studies were conducted during animal anthrax outbreaks between 1980 and 2010 in Bangladesh, but they were limited to quantitative investigations of individual-level risk factors (11–13). To develop a context-appropriate intervention for preventing animal infections and zoonotic transmission, we require an understanding of the broader context of these outbreaks that enable them to recur (14). "
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    ABSTRACT: From August 2009 to October 2010, International Centre for Diarrheal Disease Research, Bangladesh and the Institute of Epidemiology, Disease Control and Research together investigated 14 outbreaks of anthrax which included 140 animal and 273 human cases in 14 anthrax-affected villages. Our investigation objectives were to explore the context in which these outbreaks occurred, including livestock rearing practices, human handling of sick and dead animals, and the anthrax vaccination program. Field anthropologists used qualitative data-collection tools, including 15 hours of unstructured observations, 11 key informant interviews, 32 open-ended interviews, and 6 group discussions in 5 anthrax-affected villages. Each cattle owner in the affected communities raised a median of six ruminants on their household premises. The ruminants were often grazed in pastures and fed supplementary rice straw, green grass, water hyacinth, rice husk, wheat bran, and oil cake; lactating cows were given dicalcium phosphate. Cattle represented a major financial investment. Since Islamic law forbids eating animals that die from natural causes, when anthrax-infected cattle were moribund, farmers often slaughtered them on the household premises while they were still alive so that the meat could be eaten. Farmers ate the meat and sold it to neighbors. Skinners removed and sold the hides from discarded carcasses. Farmers discarded the carcasses and slaughtering waste into ditches, bodies of water, or open fields. Cattle in the affected communities did not receive routine anthrax vaccine due to low production, poor distribution, and limited staffing for vaccination. Slaughtering anthrax-infected animals and disposing of butchering waste and carcasses in environments where ruminants live and graze, combined with limited vaccination, provided a context that permitted repeated anthrax outbreaks in animals and humans. Because of strong financial incentives, slaughtering moribund animals and discarding carcasses and waste products will likely continue. Long-term vaccination coverage for at-risk animal populations may reduce anthrax infection.
    11/2013; 3. DOI:10.3402/iee.v3i0.21356
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    ABSTRACT: Background Human cutaneous anthrax results from skin exposure to B. anthracis, primarily due to occupational exposure. Bangladesh has experienced a number of outbreaks of cutaneous anthrax in recent years. The last episode occurred from April to August, 2011 and created mass havoc due to its dreadful clinical outcome and socio-cultural consequences. We report here the clinico-demographic profile and treatment outcome of 15 cutaneous anthrax cases attended at the Dermatology Outpatient Department of Rajshahi Medical College Hospital, Bangladesh between April and August, 2011 with an aim to create awareness for early case detection and management. Findings Anthrax was suspected primarily based on cutaneous manifestations of typical non-tender ulcer with black eschar, with or without oedema, and a history of butchering, or dressing/washing of cattle/goat or their meat. Diagnosis was established by demonstration of large gram-positive rods, typically resembling B. anthracis under light microscope where possible and also by ascertaining therapeutic success. The mean age of cases was 21.4 years (ranging from 3 to 46 years), 7 (46.7%) being males and 8 (53.3%) females. The majority of cases were from lower middle socioeconomic status. Types of exposures included butchering (20%), contact with raw meat (46.7%), and live animals (33.3%). Malignant pustule was present in upper extremity, both extremities, face, and trunk at frequencies of 11 (73.3%), 2 (13.3%), 1 (6.7%) and 1 (6.7%) respectively. Eight (53.3%) patients presented with fever, 7 (46.7%) had localized oedema and 5 (33.3%) had regional lymphadenopathy. Anthrax was confirmed in 13 (86.7%) cases by demonstration of gram-positive rods. All cases were cured with 2 months oral ciprofloxacin combined with flucoxacillin for 2 weeks. Conclusions We present the findings from this series of cases to reinforce the criteria for clinical diagnosis and to urge prompt therapeutic measures to treat cutaneous anthrax successfully to eliminate the unnecessary panic of anthrax.
    BMC Research Notes 08/2012; 5(1):464. DOI:10.1186/1756-0500-5-464
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