Musewa Angella, Mirembe Bernadette Basuta, Monje Fred, Birungi Doreen, Nanziri Carol, Aceng Freda Loy, Kabwama Steven N, Kwesiga Benon, Ndumu Deo Birungi, Nyakarahuka Luke, Buule Joshua, Cossaboom Caitlin M, Lowe David, Kolton Cari B, Marston Chung K, Stoddard Robyn A, Hoffmaster Alex R, Ario Alex Riolexus, Zhu Bao-Ping
Uganda Public Health Fellowship Program, Kampala, Uganda.
National Animal Disease Diagnosis and Epidemiology Centre, Ministry of Agriculture, Animal Industry and Fisheries, Entebbe, Uganda.
Trop Med Health. 2022 Aug 6;50(1):52. doi: 10.1186/s41182-022-00445-0.
Anthrax is a zoonotic infection caused by the bacteria Bacillus anthracis. Humans acquire cutaneous infection through contact with infected animals or animal products. On May 6, 2018, three cows suddenly died on a farm in Kiruhura District. Shortly afterwards, a sub-county chief in Kiruhura District received reports of humans with suspected cutaneous anthrax in the same district. The patients had reportedly participated in the butchery and consumption of meat from the dead cows. We investigated to determine the magnitude of the outbreak, identify exposures associated with illness, and suggest evidence-based control measures.
We conducted a retrospective cohort study among persons whose households received any of the cow meat. We defined a suspected human cutaneous anthrax case as new skin lesions (e.g., papule, vesicle, or eschar) in a resident of Kiruhura District from 1 to 26 May 2018. A confirmed case was a suspected case with a lesion testing positive for B. anthracis by polymerase chain reaction (PCR). We identified cases through medical record review at Engari Health Centre and active case finding in the community.
Of the 95 persons in the cohort, 22 were case-patients (2 confirmed and 20 suspected, 0 fatal cases) and 73 were non-case household members. The epidemic curve indicated multiple point-source exposures starting on May 6, when the dead cows were butchered. Among households receiving cow meat, participating in slaughtering (RR = 5.3, 95% CI 3.2-8.3), skinning (RR = 4.7, 95% CI = 3.1-7.0), cleaning waste (RR = 4.5, 95% CI = 3.1-6.6), and carrying meat (RR = 3.9, 95% CI = 2.2-7.1) increased the risk of infection.
This cutaneous anthrax outbreak was caused by handling infected animal carcasses. We suggested to the Ministry of Agriculture, Animal Industry and Fisheries to strengthen surveillance for possible veterinary anthrax and ensure that communities do not consume carcasses of livestock that died suddenly. We also suggested that the Ministry of Health equip health facilities with first-line antibiotics for community members during outbreaks.
炭疽是由炭疽杆菌引起的一种人畜共患感染病。人类通过接触受感染动物或动物产品而感染皮肤炭疽。2018年5月6日，基鲁胡拉区的一个农场里三头奶牛突然死亡。此后不久，基鲁胡拉区的一位副县长收到了该地区有人疑似感染皮肤炭疽的报告。据报道，这些患者参与了对死牛的屠宰和食用。我们进行调查以确定疫情的规模，识别与疾病相关的暴露因素，并提出基于证据的控制措施。
我们对其家庭收到任何牛肉的人员进行了一项回顾性队列研究。我们将疑似人类皮肤炭疽病例定义为2018年5月1日至26日期间基鲁胡拉区居民出现的新皮肤病变（如丘疹、水疱或焦痂）。确诊病例是指病变经聚合酶链反应（PCR）检测炭疽杆菌呈阳性的疑似病例。我们通过恩加里健康中心的病历审查和社区的主动病例发现来识别病例。
在该队列的95人中，22人为病例患者（2例确诊，20例疑似，无死亡病例），73人为非病例家庭成员。流行曲线表明，从5月6日屠宰死牛开始出现多个点源暴露。在收到牛肉的家庭中，参与屠宰（相对危险度=5.3，95%可信区间3.2 - 8.3）、剥皮（相对危险度=4.7，95%可信区间=3.1 - 7.0）、清理废弃物（相对危险度=4.5，95%可信区间=3.1 - 6.6）和搬运肉类（相对危险度=3.9，95%可信区间=2.2 - 7.1）会增加感染风险。
这次皮肤炭疽疫情是由处理受感染动物尸体引起的。我们建议农业、畜牧业和渔业部加强对可能的兽医炭疽的监测，并确保社区不食用突然死亡牲畜的尸体。我们还建议卫生部在疫情暴发期间为社区成员卫生设施配备用于社区成员的一线抗生素。
