Outbreak of Human Anthrax Associated with Handling and Eating Meat from a Cow that Died from Unknown Causes: Kween District, Uganda, April 2018

  • Animal health
  • Zoonotic
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Background: On 20 April 2018, District health officials in Kween District, Uganda reported to the Ministry of Health 7 suspected cases of cutaneous anthrax among persons who had handled and eaten meat from 1 of 4 cows that died of unknown causes in April in one cattle pen. We investigated to determine the scope of and possible exposures for the outbreak, and recommend evidence-based control measures.
Methods: We defined a suspected cutaneous anthrax case as acute onset of painless, papulo-vesicular skin lesion, and a suspected gastrointestinal anthrax case as abdominal pain plus ≥1 of the following: diarrhea, vomiting, abdominal swelling, pharyngitis, and oropharygeal lesions, in a Kween District resident during April 2018. A confirmed case was a suspected case with a sample testing positive for Bacillus anthracis by polymerase chain reaction (PCR). We reviewed medical records and conducted active community case-finding. We collected lesion swabs and blood samples for PCR testing at Uganda Virus Research Institute. We conducted a retrospective cohort study to identify potential exposures.
Results: Among 234 persons who handled or ate the cow’s meat, we identified 48 cases (3 confirmed and 45 suspected; 15 cutaneous, 15 gastrointestinal, 18 both) (attack rate=21%), with no deaths. Skinning (RR=4.2, 95%CI=2.6-6.7), cutting (RR=4.9, 95%CI=3.2-7.5) or carrying the meat (RR=4.9, 95%CI=2.7-9.0), and cleaning the processing site (RR=4.2, 95%CI=2.6-6.7) increased the risk of cutaneous infection. Eating the meat increased the risk of gastrointestinal anthrax (RR=∞, 95%CI=4.3–∞). Among persons who ate meat, boiling meat for >60m was protective (RR=0.49, 95%CI=0.26-0.92).
Conclusions: This outbreak of mixed cutaneous and gastrointestinal anthrax was caused by handling and eating meat from a cow that died of unknown causes. We recommended treating all cases, vaccinating healthy animals, and conducting community education on avoiding eating meat from, and safe burial of, animals that died of unknown causes.

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