Cutaneous anthrax associated with handling carcasses of animals that died suddenly of unknown cause: Arua District, Uganda, January 2015–August 2017
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS Neglected Tropical Diseases
Abstract
Anthrax is a zoonotic disease that can be transmitted to humans from infected animals. During
May–June 2017, three persons with probable cutaneous anthrax were reported in Arua
District, Uganda; one died. All had recently handled carcasses of livestock that died suddenly
and a skin lesion from a deceased person tested positive by PCR for Bacillus anthracis.
During July, a bull in the same community died suddenly and the blood sample tested
positive by PCR for Bacillus anthracis. The aim of this investigation was to establish the
scope of the problem, identify exposures associated with illness, and recommend evidencebased
control measures.
Methods
A probable case was defined as acute onset of a papulo-vesicular skin lesion subsequently
forming an eschar in a resident of Arua District during January 2015–August 2017. A confirmed
case was a probable case with a skin sample testing positive by polymerase chain
reaction (PCR) for B. anthracis. Cases were identified by medical record review and active
community search. In a case-control study, exposures between case-patients and frequency-
and village-matched asymptomatic controls were compared. Key animal health
staff were interviewed to learn about livestock deaths.
Results
There were 68 case-patients (67 probable, 1 confirmed), and 2 deaths identified. Cases
occurred throughout the three-year period, peaking during dry seasons. All cases occurred following sudden livestock deaths in the villages. Case-patients came from two neighboring
sub-counties: Rigbo (attack rate (AR) = 21.9/10,000 population) and Rhino Camp (AR = 1.9/
10,000). Males (AR = 24.9/10,000) were more affected than females (AR = 0.7/10,000).
Persons aged 30–39 years (AR = 40.1/10,000 population) were most affected. Among all
cases and 136 controls, skinning (ORM-H = 5.0, 95%CI: 2.3–11), butchering (ORM-H = 22,
95%CI: 5.5–89), and carrying the carcass of livestock that died suddenly (ORM-H = 6.9, 95%
CI: 3.0–16) were associated with illness.
Conclusions
Exposure to carcasses of animals that died suddenly was a likely risk factor for cutaneous
anthrax in Arua District during 2015–2017. The recommendations are investigation of
anthrax burden in livestock, prevention of animal infections through vaccinations, safe disposal
of the carcasses, public education on risk factors for infection and prompt treatment of
illness following exposure to animals that died suddenly.
Description
Keywords
Cutaneous anthrax, Carcasses of animals, Arua District, Uganda
Citation
Aceng FL, Ario AR, Alitubeera PH, Neckyon MM, Kadobera D, Sekamatte M, et al. (2021) Cutaneous anthrax associated with handling carcasses of animals that died suddenly of unknown cause: Arua District, Uganda, January 2015–August 2017. PLoS Negl Trop Dis 15(8): e0009645. https://doi.org/10.1371/journal. pntd.0009645