Anthrax Outbreaks among Domestic Ruminants Associated with Butchering Infected Livestock and Improper Carcass Disposal: Three Districts, Uganda, 2016-2018

  • Water or foodborne
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Background:
During 2017-2018, human anthrax outbreaks (mostly cutaneous type) occurred in Arua, Kween and Kiruhura districts, Uganda, which were associated with eating and handling meat from unvaccinated domestic ruminants that died of anthrax. We investigated to determine the existence of anthrax outbreaks in domestic ruminants, identify exposures, and recommend control measures
Methods:
We defined a suspected case-animal as sudden death of a domestic ruminant with unclotted blood oozing from body orifices in the three districts, 2016-2018. A probable case-animal was positive to rapid diagnostic test using the Active Anthrax Detect (AAD) Rapid Test, and/or the identification of Gram positive rods. A case-kraal (i.e., enclosure of cattle/sheep or mixed species) had ≥1 suspected case-animal. We reviewed district veterinary records and actively searched for case-animals. We conducted case-control studies separately to compare exposures among case-kraals and control-kraals (i.e., with no suspected case-animals during the same time-period), frequency-matched by village, with ratios of 1:1 in Arua, 1:4 in Kiruhura and 1:2 in Kween. We estimated the overall associations using meta- analysis.
Results:
We identified 1971 suspected case-animals (attack rate [AR] =1.4/1000) in 229 of 31500 kraals (7.3/1000). Cattle (AR=2.3/1000), goats (AR/1000=0.39/1000) and sheep (AR=0.094/1000) were all affected. 14 (67%) of the 21 animal carcasses tested were positive by both AAD and Gram stain. Arua was the most affected district (AR=14/1000), fol- lowed by Kween (AR=2.5/1000) and Kiruhura (AR=0.095/1000). The epidemic curves showed a point-source outbreak in Kiruhura, and continuous common-source in the other districts. Butchering dead livestock of suspected anthrax near the kraal (OR=8.0; 95%CI=5.2-12) and improper carcass disposal on/near the pastureland (OR=1.7, 95%CI=1.1- 2.4) were significant risk factors for being a case-kraal.
Conclusion
In districts with human outbreaks, animal outbreaks occurred, which were associated with butchering of livestock with suspected anthrax and improper carcass disposal. We recommended anthrax-vaccination of domestic ruminants at greater risk, increased surveillance for sudden animal deaths, proper carcass disposal (i.e 6 feet deep carcass burial and disinfection), and sensitization to livestock keepers about anthrax control.

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