Cutaneous anthrax outbreak associated with use of cattle hides and handling carcasses, Amudat District, Uganda, 2023–2024
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Date
2025-11
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Public Library of Science
Abstract
Anthrax is a zoonotic disease that remains endemic in Uganda, particularly in cattle-keeping areas. On December 28, 2023, the first suspected human case of anthrax was detected in Amudat District. We investigated to determine the outbreak's magnitude, identify risk factors, and recommend prevention and control measures. We defined a suspected cutaneous anthrax case as acute onset of [greater than or equal to]2 of the following: skin lesions (papule, vesicle, or eschar) on exposed areas such as the hands, forearms, shoulders, back, thighs or face, localized itching, redness, swelling, or regional lymphadenopathy, in Amudat residents from December 2023-June 2024. We identified 102 cutaneous anthrax cases, including 7 confirmed cases; none died. The outbreak lasted 7 months, peaking in March 2024, with an overall attack rate of 169/100,000 (males: 196/100,000; females: 138/100,000). Use of cattle hides as bedding (OR=12; 95% CI:2.7-52) and butchering cattle carcasses (OR=6; 95% CI:1.8-19) were significantly associated with anthrax. The highest infection risk was observed among individuals with multiple exposures: butchered only (OR = 6.9, 95% CI:2.6-18), butchered and carried cattle parts (OR = 11, 95% CI:1.2-96), butchered and skinned (OR = 14, 95% CI:3.5-56), and butchered, carried, and skinned (OR = 17, 95% CI:1.6-219). No livestock had been vaccinated prior to the outbreak. The outbreak was associated to use of cattle hides as bedding and the butchering of cattle carcasses. We recommended community education, livestock vaccination, and safe carcass handling to prevent future outbreaks.
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Kwizera P, Migisha R, Katumba H, Nabatta E, Gidudu S, Kwesiga B, et al. (2025) Cutaneous anthrax outbreak associated with use of cattle hides and handling carcasses, Amudat District, Uganda, 2023–2024. PLoS One 20(11): e0336769. https://doi.org/10.1371/journal.pone.0336769