An Outbreak of Human Cutaneous Anthrax in a Village of Inner Mongolia Autonomous Region, China, 2018

  • Zoonotic
  • Animal health
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Background:
Inner Mongolia is an epidemic focus of anthrax disease; animal and human epidemics are reported annually. 10 suspected anthrax cases were reported in a village from August 6th to 11th, 2018. We responded and conducted an investigation to assess health impacts, identify risk factors, and implement control measures.

Methods:
A suspected case was defined as a resident developed at least one of the following skin symptoms; erythema, papules, blisters, swelling, and ulcerative eschar during July 15th-August 29th, 2018. A confirmed case was a suspected case who tested positive by PCR or isolated bacillus anthracis through culture. Descriptive epidemiological Methods: and a case-control study were conducted, to analyze the epidemiological and clinical characteristics and to identify possible risk factors. Controls who had exposed to sick or dead cows were selected and the results were analyzed by Multi-Logistic Regression.

Results:
26 cutaneous anthrax cases including 25 males and one female were identified in the same village, with no severe or dead case. Cases’ median age is 45 years (20 to 63), The onset of cases was July 27th
to August 17th . The main clinical symptoms included skin carbuncle (100%), swelling (88%), headache (80%), blisters (69%) and ulcerative eschar (69%). 25 cases and 71 controls were selected, the Multi-Logistic Regression shows that 13(50%) of 26 cases and 14(20%) of 71 controls slaughtered or skinned the dead cows (OR=153, 95%C1=6.2-3763), 14(54%) of 26 cases and 4(5.6%) of 71 controls carried dead cows (OR=391, 95%C1=24-6285), 9(35%) of 26 cases and 47(66%) of 71 controls fed sick cows (OR=6.2, 95%C1=0.5-75), 9(35%) of 26 cases and 10(14%) of 71 controls consumed the meat (OR=3.0, 95%C1=0.6-15). 76 family and hospital contacts were monitored, and none developed symptoms.

Conclusion:
The source of infection was the ill cows. Skinning, slaughtering or carrying dead cows without any protection gear were the main risk factors. When there is a cow dead with unknown reason, villagers should inform to health or agricultural departments timely instead of selling or slaughtering. The local government was suggested to implementing control measures including health education and risk communication for villagers to reduce the risk of anthrax infection.

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