An Investigation of an Outbreak of Cutaneous Anthrax Attributed to Butchering a Sick Cow in Jiangsu Province, China, 2012

Liangliang Cui, C. Bao, T. Shen, T. Zhang
Date published
Dec, 2012
Last updated
29 Jan 2020


Background: Approximately 300 cutaneous anthrax cases are reported in China annually: herdsmen and butchers are at high risk. On 2 August, 2012, a local hospital in Lianyungang city reported a butcher from Banlu village with 3 skin lesions, black eschars and vesicles, on his hands.

Methods: We defined a probable case as Banlu villagers exposed to a sick cow with black eschar or vesicle skin lesion(s) between 25 July and 2 August, 2012. Confirmed case was probable case with anthrax bacillus laboratory test(s) positive. We interviewed 17 villagers face-to-face and conducted a retrospective cohort-study to evaluate different exposures. We collected 16 serums, 5 eschar samples and 1 vesicle fluid.

Results: The attack rate was 47% (8/17), including 5 confirmed cases. 22 lesions were distributed on arms (41%), legs (27%), hands (23%) and face (9.1%). 100% of 3 persons with skin-cut developed disease compared with 36% of 14 persons without (relative risk[RR]=2.8; 95% confidence interval[CI]: 1.4-5.7). 2 persons exposed to bloodletting, skinning and evisceration all developed disease compared with 40% of 15 persons not so exposed (RR=2.5; 95%CI: 1.3-4.6). We identified this sick cow from north of China from a herd of 200 transported cows. One case blood was anthrax bacillus positive by blood-smear, four cases eschars and one case vesicle-fluid were anthrax bacillus positive by RT-PCR; 2 cases serums were anthrax bacillus antibody positive by colloid-gold-method.

Conclusions: This outbreak of cutaneous anthrax was likely caused by contact with the tissues of a sick cow coming from an endemic area. Skin cutting and slaughter with bloodletting, skinning, and evisceration were risk factors. We recalled all potentially infected meat and hides and educated butchers on safely slaughter.