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BRIEF RESEARCH ARTICLE
Year : 2015  |  Volume : 59  |  Issue : 4  |  Page : 302-305  

Suspected anthrax outbreak: Investigation in a rural block of west Bengal and public health response


1 Associate Professor, Department of Community Medicine, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
2 Epidemiologist Cum Assistant Professor, Department of Community Medicine, Mata Gujri Medical College, Kishanganj, Bihar, India
3 Professor and Head, Department of Community Medicine, Burdwan Medical College, Burdwan, West Bengal, India
4 Associate Professor, Department of Community Medicine, Bankura Sammilani Medical College, Bankura, West Bengal, India

Date of Web Publication17-Nov-2015

Correspondence Address:
Aditya Prasad Sarkar
31, N Bose Road, Telmarui, Burdwan - 713 101, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.169662

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   Abstract 

Anthrax is one of the top 10 diseases reported in India and also one of the major causes of death in livestock. This study was conducted to confirm the outbreak of suspected anthrax, determine the transmission mechanism, and implement control measures in Bhatar block of Burdwan district, West Bengal, India. A cross-sectional descriptive study was conducted through house-to-house visits in Oregram and Kathaldanga villages during the period from May 30, 2013 to June 8, 2013. Out of the 93 persons exposed to anthrax, 11 persons had history of slaughtering, while 82 consumed the meat. All of the 7 cases of suspected anthrax were male (mean age 41.14 ± 10.04 years) and involved in slaughtering the animal. Most cases presented with papule and vesicle over the upper extremity and the trunk. One patient among the suspected cases died. The outbreak was labeled as a suspected anthrax outbreak. A health awareness camp was organized to improve awareness of anthrax among villagers.

Keywords: Anthrax, outbreak investigation, rural block


How to cite this article:
Mondal TK, Ghosh S, Dasgupta S, Sarkar AP. Suspected anthrax outbreak: Investigation in a rural block of west Bengal and public health response. Indian J Public Health 2015;59:302-5

How to cite this URL:
Mondal TK, Ghosh S, Dasgupta S, Sarkar AP. Suspected anthrax outbreak: Investigation in a rural block of west Bengal and public health response. Indian J Public Health [serial online] 2015 [cited 2019 Sep 18];59:302-5. Available from: http://www.ijph.in/text.asp?2015/59/4/302/169662

Anthrax is primarily a disease of herbivores, although few, if any, warm-blooded species are entirely immune to it. It is a bacterial disease caused by the spore-forming Bacillus anthracis, a Gram-positive, rod-shaped bacterium. [1] As per National Animal Diseases Referral Expert System (NADRES) data, anthrax is one of the top 10 diseases reported in India and also one of the major causes of death in livestock. India has different agroclimatic zones and the occurrence of anthrax across the country depends on them. Most of the districts of Andhra Pradesh, a few districts of Karnataka, Tamil Nadu, Kerala, Gujarat, West Bengal, and Assam have been identified as "very high anthrax pathozone." [2] Soil is contaminated with anthrax spores from the carcasses of dead animals and spores can survive for decades, even under adverse conditions, to serve as a source of infection for animals. [3] Humans are relatively resistant to cutaneous invasion, but the organisms may gain access through microscopic or gross breaks in the skin on contact with infected animals or their products, such as meat, hides, hair, and bristles. There are three main forms of human anthrax, depending on the route of exposure: Cutaneous, gastrointestinal, and pulmonary or inhalational. [1] Cutaneous forms account for 95% of anthrax worldwide [4] and are characterized by rapidly developing necrotizing painless eschar (of malignant pustules) with suppurative regional adenitis. Cutaneous infection starts as one or more painless, itchy papules or vesicles on the skin, typically on exposed areas such as the face, neck, forearms, or hands. Within 7-10 days of the initial lesion, the papule forms an ulcer. The ulcer subsequently crusts over and forms a painless black eschar that is the hallmark of cutaneous anthrax. In addition, localized swelling, painful swollen regional lymph nodes, and systemic symptoms can occur. [5]

On May 29, 2013, it was reported that some patients with clinically suspected cutaneous anthrax after handling and consuming a dead cow had been admitted in the Medicine ward at Burdwan Medical College and Hospital. The cases were from Oregram and Kathaldanga villages of Bhatar block of Burdwan district. Reported symptoms in the diseased were papule, vesicle, and pustule over the upper extremity and the trunk. One died among the admitted patients in Burdwan Medical College and Hospital. It was also reported that the cow meat had been distributed to many families of that village. Following the report of the outbreak, an initial attempt was made by the Block Medical Officer of Health of Bhatar block and the Deputy Chief Medical Officer of Health-1, Burdwan to detect more cases in the affected village. Subsequently, an outbreak investigation was conducted by the Department of Community Medicine, Burdwan Medical College to confirm the outbreak, determine the transmission mechanism, and implement control measures.

A cross-sectional descriptive study was conducted from May 30, 2013 to June 8, 2013 after receiving reports of occurrence of cases during house-to-house visits in Oregram and Kathaldanga villages with the help of a local accredited social health activist (ASHA). The study was conducted by the Department of Community Medicine, Burdwan Medical College. All household members were interviewed in the villages to find out the history of exposure through contact or ingestion. The tracing of as many patients as possible was done by taking history and medical examination of patients. Sahebganj Public Health Centre (PHC), Chittaranjan Rural Hospital in Bhatar, and Burdwan Medical College and Hospital were visited regularly with the objective of finding more cases.

Discharge from the wound was collected from the only patient who had skin lesion and the specimen was sent to the Microbiology laboratory of Burdwan Medical College for confirmation.

Gram staining was done and the report was negative. No McFadyean's reaction was obtained in polychrome methylene blue. Subsequently, culture of the specimen was done in blood agar and nutrient agar. In blood agar no growth was seen but in nutrient agar visible growth was observed, which was of Gram-positive cocci, not anthrax bacilli, but perhaps Staphylococcus or any other skin contaminant. All the cases already received antibiotics (ciprofloxacin and doxycycline) before collection of samples.

In the cross-sectional survey of two villages it was known that the slaughtering of a cow was done on May 22, 2013 at village Oregram and some persons from the nearby village Kathaldanga had also been invited. No history of death in cattle was obtained. The meat of the dead cow was distributed among the residents of only Oregram. Ninety-three people had history of exposure to the suspected source either by direct contact with the suspected dead cow during handling or through consumption of meat. Out of the 93 exposed, 11 persons had the history of slaughtering the dead animal and the remaining 82 had only consumed the meat. All the 7 cases were found among those 11 people. [Table 1] shows the line listing of the cases. All cases were male (mean age 41.14 ± 10.04 years). The first symptoms appeared on May 27, 2013. The first case was diagnosed on May 29, 2013. The incubation period ranged 5-8 days. All of the cases were referred to and treated at Burdwan Medical College Hospital. There was one death among 7 cases. This patient had presented with vesicle, respiratory distress, hematuria, and convulsions. The estimated case fatality rate was 14.28%. The epidemic curve shows a sharp rise and a sharp fall [Figure 1]. Most cases were presented with papule and vesicle over the upper extremity and the trunk [Figure 2].
Figure 1: Epidemic curve of the suspected anthrax outbreak

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Figure 2: Ulcer on palm and fi nger

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Table 1: Line listing of the cases of suspected anthrax and history of contact or ingestion of suspected dead cow

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As all cases received antibiotics beforehand, polymerase chain reaction (PCR) could have detected the agent but the assay could not be done at Burdwan Medical College. Therefore, in absence of laboratory confirmation, this outbreak may be considered as suspected anthrax based on the history of contact and clinical presentations.

The outbreak was labeled as a suspected anthrax outbreak. Similar outbreaks have been recently reported in India [6] and Bangladesh. [7] In West Bengal, an outbreak of cutaneous anthrax occurred following the slaughter of a dead bullock in a small tribal village. Most cases (81.8%) were exposed to the bacteria during butchering, although the attack rate of 7% was much lower than that in Banlu village. [6] In Bangladesh, 15 cutaneous anthrax cases were reported between April and August 2011, all of which occurred after slaughtering, and with symptoms similar to those in this outbreak. [7]

Tab. ciprofloxacin 500 mg twice daily for 10 days was administered to all the villagers who had handled the suspected contaminated dead cow and those who had consumed the meat of that cow. Veterinary doctor was asked to visit the village and they had given vaccination to all the cows of that affected village. A health awareness camp was organized on 2 days following the outbreak regarding the importance of taking proper care and personal protection during handling of the dead animals, and the need for sanitary burial of a dead animal in case of suspected animal death due to anthrax. They were also alerted not to consume the meat of such an animal. They were requested to notify such events to local veterinary and health officials.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
World Health Organization. Anthrax in Humans and Animals. 4 th ed. Geneva: World Health Organization; 2008.  Back to cited text no. 1
    
2.
Indian Council of Agricultural Research. Epidemiology of Anthrax in India. Project Directorate on Animal Disease Monitoring and Surveillance. Hebbal, Bengaluru: Indian Council of Agricultural Research; 2012.  Back to cited text no. 2
    
3.
McPherson RA, Pincus MR. Henry's Clinical Diagnosis and Management by Laboratory Methods. 21 st ed. Philadelphia. PA: Saunders; 2007. p. 133-6.   Back to cited text no. 3
    
4.
Lucey D. Bacillus anthracis (Anthrax). In: Mandell GL, Bennett JE, Dolin R, editors. Principles and Practice of a Infectious Diseases. 6 th ed. Pennsylvania: Churchill Livingstone; 2005. p. 2485-91.   Back to cited text no. 4
    
5.
Irmak H, Buzgan T, Karahocagil MK, Sakarya N, Akdeniz H, Caksen H, et al. Cutaneous manifestations of anthrax in Eastern Anatolia: A review of 39 cases. Med Sci Monit 2003;9:276-83.   Back to cited text no. 5
    
6.
Chakraborty PP, Thakurt SG, Satpathi PS, Hansda S, Sit S, Achar A, et al. Outbreak of cutaneous anthrax in a tribal village: A clinico-epidemiological study. J Assoc Physicians India 2012;60:89-93.  Back to cited text no. 6
    
7.
Siddiqui MA, Khan MA, Ahmed SS, Anwar KS, Akhtaruzzaman SM, Salam MA. Recent outbreak of cutaneous anthrax in Bangladesh: Clinico-demographic profile and treatment outcome of cases attended at Rajshahi Medical College Hospital. BMC Res Notes 2012;5:464.  Back to cited text no. 7
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    Figures

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