Case-Control Study of Gastrointestinal Anthrax, Cayapa Village, Lagangilang, Abra, Philippines, March 2017

  • Water or foodborne
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Background:
On March 21, 2017, FETP team was sent to Cayapa Village, Abra due to increasing cases of foodborne illness. Epidemiological investigation was conducted to verify the diagnosis, establish existence of outbreak, identify risk factors, and recommend control and prevention measures.

Methods:
We conducted a 1:2 case-control study. A suspect case was a previously well resident of Cayapa Village who developed abdominal pain or diarrhea and one of the following: fever, vomiting, sore throat, difficulty swallowing, lymphadenopathy from February 27-March 14, 2017. Confirmed case was a suspect case positive for Bacillus anthracis on bacterial culture or rt-PCR test. A control was a well resident negative for Bacillus anthracis. We collected serum specimens and soil samples for laboratory confirmation. We conducted environmental survey and key informant interview. We used Stata ver.13 to analyze data.

Results:
Twenty-nine suspect cases were identified. All ate meat of dead water buffalo. Majority (15, 52%) were males. Age range from 6-77 years (Median: 17). Clinical manifestations were abdominal pain (26, 90%), fever (16, 55%), and diarrhea (14, 48%). One (3%) had lymphadenopathy. Interview revealed that a dead water buffalo was butchered and sold amongst the villagers. All 11 serum specimens and five soil samples were negative for Bacillus anthracis. After multivariate analysis, eating uncooked meat of dead animal (Adj.OR=6, 95% CI:1.7-18.4) was a risk factor.

Conclusion:
The epidemic curve indicates a point source outbreak of gastrointestinal Anthrax. We found valid statistical and temporal association of eating by-product of dead carabao and gastrointestinal Anthrax. The clinical manifestations were consistent with Bacillus anthracis rather than other foodborne bacterial pathogens. Hence, we conducted massive information education campaign sick or dead animal by-product should not be sold or eaten and properly handled and disposed.

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