Epidemiology of Human Anthrax in China, 1955-2014

Using national surveillance data for 120,111 human anthrax cases recorded during 1955−2014, we analyzed the temporal, seasonal, geographic, and demographic distribution of this disease in China. After 1978, incidence decreased until 2013, when it reached a low of 0.014 cases/100,000 population. The case-fatality rate, cumulatively 3.6% during the study period, has also decreased since 1990. Cases occurred throughout the year, peaking in August. Geographic distribution decreased overall from west to east, but the cumulative number of affected counties increased during 2005−2014. The disease has shifted from industrial to agricultural workers; 86.7% of cases occurred in farmers and herdsmen. Most (97.7%) reported cases were the cutaneous form. Although progress has been made in reducing incidence, this study highlights areas that need improvement. Adequate laboratory diagnosis is lacking; only 7.6% of cases received laboratory confirmation. Geographic expansion of the disease indicates that livestock control programs will be essential in eradicating anthrax.

Genotype Analysis of Bacillus anthracis Strains Circulating in Bangladesh

In Bangladesh, anthrax, caused by the bacterium Bacillus anthracis, is considered an endemic disease affecting ruminants with sporadic zoonotic occurrences in humans. Due to the lack of knowledge about risks from an incorrect removal of infected carcasses, the disease is not properly monitored, and because of the socio-economic conditions, the situation is under-reported and under-diagnosed. For sensitive species, anthrax represents a fatal outcome with sudden death and sometimes bleeding from natural orifices. The most common source of infection for ruminants is ingestion of spores during grazing in contaminated pastures or through grass and water contaminated with anthrax spores. Domestic cattle, sheep and goats can also become infected through contaminated bone meal (used as feed) originating from anthrax-infected carcasses. The present investigation was conducted to isolate B. anthracis organisms from 169 samples (73 soil, 1 tissue, 4 bone and 91 bone meal samples) collected from 12 different districts of Bangladesh. The sampling was carried out from 2012 to 2015. Twelve samples resulted positive for B. anthracis. Biomolecular analyses were conducted starting from the Canonical Single Nucleotide Polymorphism (CanSNP) to analyze the phylogenetic origin of strains. The analysis of genotype, obtained through the Multiple Locus Variable Number Tandem Repeat Analysis (MLVA) with the analysis of 15 Variable Number Tandem Repeats (VNTR), demonstrated four different genotypes: two of them were previously identified in the district of Sirajganj. The sub-genotyping, conducted with Single Nucleotide Repeats analysis, revealed the presence of eight subgenotypes. The data of the present study concluded that there was no observed correlation between imported cattle feed and anthrax occurrence in Bangladesh and that the remarkable genetic variations of B. anthracis were found in the soil of numerous outbreaks in this country.

Classification and management of animal anthrax outbreaks based on the source of infection

Anthrax is a non-contagious infectious disease; it primarily affects herbivores, but all mammals, including humans, can be affected. Humans may contract anthrax directly or indirectly from infected animals. Veterinary surveillance systems, providing information about animal and human cases, should increase the efficacy of the animal anthrax management in order to protect population. Any aspect of the disease should be carefully monitored to implement effective prevention and control strategies. In this paper we propose a new, detailed classification of anthrax outbreaks, based on the source of the infection and the risk level for humans. We describe three different types of animal outbreaks and suggest the most effective procedures for their management and prevention.

Bacillus anthracis Diversity and Geographic Potential across Nigeria, Cameroon and Chad: Further Support of a Novel West African Lineage

Zoonoses, diseases affecting both humans and animals, can exert tremendous pressures on human and veterinary health systems, particularly in resource limited countries. Anthrax is one such zoonosis of concern and is a disease requiring greater public health attention in Nigeria. Here we describe the genetic diversity of Bacillus anthracis in Nigeria and compare it to Chad, Cameroon and a broader global dataset based on the multiple locus variable number tandem repeat (MLVA-25) genetic typing system. Nigerian B. anthracis isolates had identical MLVA genotypes and could only be resolved by measuring highly mutable single nucleotide repeats (SNRs). The Nigerian MLVA genotype was identical or highly genetically similar to those in the neighboring countries, confirming the strains belong to this unique West African lineage. Interestingly, sequence data from a Nigerian isolate shares the anthrose deficient genotypes previously described for strains in this region, which may be associated with vaccine evasion. Strains in this study were isolated over six decades, indicating a high level of temporal strain stability regionally. Ecological niche models were used to predict the geographic distribution of the pathogen for all three countries. We describe a west-east habitat corridor through northern Nigeria extending into Chad and Cameroon. Ecological niche models and genetic results show B. anthracis to be ecologically established in Nigeria. These findings expand our understanding of the global B. anthracis population structure and can guide regional anthrax surveillance and control planning.

Anthrax, caused by the soil-borne bacterium Bacillus anthracis, is a disease with important public health and national security implications globally. Understanding the global genetic diversity of the pathogen is important for epidemiological and forensic investigations of anthrax events. Toward this, we describe B. anthracis genetic diversity in Nigeria and confirm it belongs to a unique West African genetic group not yet reported beyond neighboring Cameroon and Chad and Mali. This refines the global phylogeny of B. anthracis, allowing the development of more accurate diagnostics. We coupled these efforts with ecological niche modeling to map the geographic distribution of this strain group across the region. Suitable habitat for the pathogen is predicted across central Nigeria from west to east into Cameroon and Chad. Understanding the geography of B. anthracis plays an important role in informing public health by targeting disease control to high risk regions. This is particularly important in resource limited areas where intervention strategies are constrained and zoonotic disease risk is high.

Ground Anthrax Bacillus Refined Isolation (GABRI) method for analyzing environmental samples with low levels of Bacillus anthracis contamination

Background

In this work are reported the results of a qualitative analytical method capable of detecting Bacillus anthracis spores when they are present in very low concentration in the soil. The Ground Anthrax Bacillus Refined Isolation (GABRI) method, assessed in our laboratory, was compared with the classic method. The comparison involved artificially anthrax-contaminated soil samples (500 spores/7.5 grams soil) and naturally contaminated soil samples collected in Bangladesh during a field investigation.

Results

The results indicated that, in contrast to the classic method, the GABRI method was able to detect B.anthracis in all contaminated samples. The GABRI method produces a more sensitive measure of anthrax spore presence significantly different from the standard method. In particular, the latter is more sensitive to the presence of normal soil contaminants.

Conclusion

The main feature of the GABRI method is its ability to strongly reduce the presence of the environmental contaminants, which being much more numerous than B. anthracis tend to inhibit their germination and growth making it extremely difficult to visualize any colonies. The reduction of the microbial environment also allows one to be able to culture and test a larger quantity of potentially contaminated soil and to isolate B. anthracis when the spores are present in very low concentrations in the soil.

Historical distribution and molecular diversity of Bacillus anthracis, Kazakhstan

This study provides useful baseline data for guiding future disease control programs.

To map the distribution of anthrax outbreaks and strain subtypes in Kazakhstan during 1937–2005, we combined geographic information system technology and genetic analysis by using archived cultures and data. Biochemical and genetic tests confirmed the identity of 93 archived cultures in the Kazakhstan National Culture Collection as Bacillus anthracis. Multilocus variable number tandem repeat analysis genotyping identified 12 genotypes. Cluster analysis comparing these genotypes with previously published genotypes indicated that most (n = 78) isolates belonged to the previously described A1.a genetic cluster, 6 isolates belonged to the A3.b cluster, and 2 belonged to the A4 cluster. Two genotypes in the collection appeared to represent novel genetic sublineages; 1 of these isolates was from Krygystan. Our data provide a description of the historical, geographic, and genetic diversity of B. anthracis in this Central Asian region.

The ecology of Bacillus anthracis

The global distribution of anthrax is largely determined by soils with high calcium levels and a pH above 6.1, which foster spore survival. It is speculated that the spore exosporium probably plays a key part by restricting dispersal and thereby increasing the probability of a grazing animal acquiring a lethal dose. 'Anthrax Seasons' are characterized by hot-dry weather which stresses animals and reduces their innate resistance to infection allowing low doses of spores to be infective. Necrophagic flies act as case-multipliers and haemophagic flies as space-multipliers; the latter are aided by climatic factors which play a key part in whether epidemics occur. Host death is a function of species sensitivity to the toxins. The major function of scavengers is to open the carcass, spill fluids, and thereby aid bacilli dispersal and initiate sporulation. In the context of landscape ecology viable spore distribution is a function of mean annual temperature, annual precipitation, elevation, mean NDVI, annual NDVI amplitude, soil moisture content, and soil pH.

Inhalation anthrax: dose response and risk analysis

The notion that inhalation of a single Bacillus anthracis spore is fatal has become entrenched nearly to the point of urban legend, in part because of incomplete articulation of the scientific basis for microbial risk assessment, particularly dose-response assessment. Risk analysis (ie, risk assessment, risk communication, risk management) necessitates transparency: distinguishing scientific facts, hypotheses, judgments, biases in interpretations, and potential misinformation. The difficulty in achieving transparency for biothreat risk is magnified by misinformation and poor characterization of both dose-response relationships and the driving mechanisms that cause susceptibility or resistance to disease progression. Regrettably, this entrenchment unnecessarily restricts preparedness planning to a single response scenario: decontaminate until no spores are detectable in air, water, or on surfaces-essentially forcing a zero-tolerance policy inconsistent with the biology of anthrax. We present evidence about inhalation anthrax dose-response relationships, including reports from multiple studies documenting exposures insufficient to cause inhalation anthrax in laboratory animals and humans. The emphasis of the article is clarification about what is known from objective scientific evidence for doses of anthrax spores associated with survival and mortality. From this knowledge base, we discuss the need for future applications of more formal risk analysis processes to guide development of alternative non-zero criteria or standards based on science to inform preparedness planning and other risk management activities.

First Detection of Bacillus anthracis in Feces of Free-ranging Raptors from Central Argentina

Prevalence of anthrax spores in feces of raptors was determined from samples collected in November-December 2000 and April-May 2001 in an agricultural region of Santa Fé province, Argentina. Feces were tested from 48 birds of six raptor species. One of 14 chimango caracaras (Milvago chimango) and one of eight road-side hawks (Buteo magnirostris) tested positive. The prevalence of Bacillus anthracis spores in feces for the six species was 4% (n=48). The prevalence was 7% (n=14) for chimango caracaras, 13% for road-side hawks (n=8), and 0% for the remaining species (Burrowing owl [Speotyto cunicularia] [n=17], Swainson's hawk [Buteo swainsoni] [n=3], Aplomado falcon [Falco femoralis] [n=2], and American kestrel [Falco sparverius] [n=4]). Grouped by their feeding habits, prevalence for scavenger species was not significantly different than for predators (7% vs. 3%, P>0.999). This study provides evidence that in central Argentina scavenger and non-scavenger raptors may have a role in the epidemiology of anthrax. Long-term studies to determine the extent of this potential involvement in the epidemiology of anthrax in central Argentina are required.

Distinguishing between natural and unnatural outbreaks of animal diseases

An intentional outbreak of disease among livestock, or agricultural crops, will share a number of characteristics with those aimed at humans - unexpected pattern of disease in season or place, possible explosive incidence, unusual pathogen either in itself or of its genetic structure, difficult diagnosis - but there will also be notable differences: human cases, if they occur, will be coincidental and the major impacts will be delayed and of severe economic consequence. An investigative and analytical protocol is proposed for identifying such an event. Unless the nature of the event is self-declaring, such investigations necessitate a very thorough and careful investigation by a dedicated and experienced epidemiologic team. Atthe same time a country should take steps in advance of such an event to be prepared and to save time later, such as determining possible targets, identifying early warning indicators, establishing molecular biologic expertise and reference collections of possible pathogens, and preparing a tactical and forensic response.

Retrospective characterization of Newcastle Disease Virus Antrim '73 in relation to other epidemics, past and present

In November 1973 Newcastle disease suddenly appeared in Northern Ireland, where the viscerotropic disease had not been seen in 3 1/2 years and the two Irelands had been regarded as largely disease free for 30 years. It was successfully controlled with only 36 confirmed affected layer flocks, plus 10 more slaughtered as 'dangerous contacts'. Contemporary investigations failed to reveal the source of the Irish epidemic. Using archival virus samples from most of the affected flocks, RT PCR was conducted with primers selected for all six NDV genes. Phylogenetic analyses of three genes, HN, M and F, confirmed vaccine as the cause of one of the outbreaks. The other six samples were identical and closely related to previous outbreaks in the United States and western Europe initiated by infected imported Latin American parrots. The probable cause of the epidemic followed from the importation from The Netherlands of bulk feed grains contaminated with infected pigeon faeces.

Geographical information systems as a tool in epidemiological assessment and wildlife disease management

Geographical information systems (GIS) facilitate the incorporation of spatial relationships into epidemiological investigations of wildlife diseases. Consisting of data input, management, analysis and presentation components, GIS act as an integrative technology in that a range of very varied data sources can be combined which describe different aspect of the environment of wild animals. The analytical functionality of GIS is still evolving, and ranges from visual to exploratory and modelling methods. Output generated by GIS in map format has the particular advantage of allowing implicit representation of spatial dependence relationships in an intuitive manner. The technology is becoming an essential component of modern disease surveillance systems.

Geographic information system-aided analysis of factors associated with the spatial distribution of Echinococcus multilocularis infections of foxes

To investigate the influence of environmental factors on the spatial epidemiology of infections with Echinococcus multilocularis, foxes were sampled in a focal endemic region in the Northwest of Brandenburg, Germany, and examined for infection by the parasite. The locations where foxes were obtained were recorded in a geographic information system database. Positions of infected and uninfected foxes were analyzed on the background of geographic vector data of water, settlements, streets, forests, crop, and pasture. Fox positions were allocated to different land-use classes by use of a Landsat Thematic Mapper (TM) satellite image. Infected foxes were more frequently shot near water, in areas of high soil humidity, and on pastures, suggesting that dryness may limit the tenacity of E. multilocularis oncospheres. Thus open landscapes with humid soil seem to be favorable for the life cycle of the parasite. In contrast, infected foxes were significantly underrepresented in forest areas.

The statistical analysis of truncated data: application to the Sverdlovsk anthrax outbreak

An outbreak of anthrax occurred in the city of Sverdlovsk in Russia in the spring of 1979. The outbreak was due to the inhalation of spores that were accidentally released from a military microbiology facility. In response to the outbreak a public health intervention was mounted that included distribution of antibiotics and vaccine. The objective of this paper is to develop and apply statistical methodology to analyse the Sverdlovsk outbreak, and in particular to estimate the incubation period of inhalational anthrax and the number of deaths that may have been prevented by the public health intervention. The data available for analysis from this common source epidemic are the incubation periods of reported deaths. The statistical problem is that incubation periods are truncated because some individuals may have had their deaths prevented by the public health interventions and thus are not included in the data. However, it is not known how many persons received the intervention or how efficacious was the intervention. A likelihood function is formulated that accounts for the effects of truncation. The likelihood is decomposed into a binomial likelihood with unknown sample size and a conditional likelihood for the incubation periods. The methods are extended to allow for a phase-in of the intervention over time. Assuming a lognormal model for the incubation period distribution, the median and mean incubation periods were estimated to be 11.0 and 14.2 days respectively. These estimates are longer than have been previously reported in the literature. The death toll from the Sverdlovsk anthrax outbreak could have been about 14% larger had there not been a public health intervention; however, the confidence intervals are wide (95% CI 0-61%). The sensitivity of the results to model assumptions and the parametric model for the incubation period distribution are investigated. The results are useful for determining how long antibiotic therapy should be continued in suspected anthrax cases and also for estimating the ultimate number of deaths in a new outbreak in the absence of any public health interventions.

What and how do we communicate?

The rapid, inexpensive transmission of words and data, brought about by the internet and cheap computers, is changing the world faster than anything mankind has ever experienced, reaching into nearly every aspect of our lives, public and private, commercial and governmental. We are in an Information Age with an essentially instantaneous availability of large volumes of information and data. Technological pressures have their own momentum. The changes and improvements in data handling and information sharing will take place, however much or little we do in veterinary medicine, whether at the international or national levels. In addition, there are new superpowers emerging in the world. These are the small and medium third world countries that are gradually gaining democracy through political restructuring and involving the civil society in decision making. There are also the marginal pressure groups, once too small and insignificant to be noticed. These are changing the rules by which the way the world is governed and they are doing it now by the internet and banding together to serve their common interests. The rapid provision of accurate information on animal diseases is desirable goal from a public health as well as an economic viewpoint.

1996-97 Global Anthrax Report

While there is a general decrease in the number of anthrax outbreaks, and thus of human cases, worldwide this is still a disease that is extensively under-diagnosed and under-reported. However, it is now very infrequent to rare in Canada, the United States, and many countries in Europe. An increasing number of countries are now free. At the other extreme, it is a significant problem in West Africa, Spain, Greece, Turkey, Albania, Romania and in Central Asia. In spite of the textbooks, livestock and wildlife deaths do occur, sometimes commonly, without any 'diagnostic' extravasation of blood and, if not realised, infected carcasses get recycled into meat and bone meals for feed.

Genetic diversity in the protective antigen gene of Bacillus anthracis

Bacillus anthracis is a gram-positive spore-forming bacterium that causes the disease anthrax. The anthrax toxin contains three components, including the protective antigen (PA), which binds to eucaryotic cell surface receptors and mediates the transport of toxins into the cell. In this study, the entire 2,294-nucleotide protective antigen gene (pag) was sequenced from 26 of the most diverse B. anthracis strains to identify potential variation in the toxin and to further our understanding of B. anthracis evolution. Five point mutations, three synonymous and two missense, were identified. These differences correspond to six different haploid types, which translate into three different amino acid sequences. The two amino acid changes were shown to be located in an area near a highly antigenic region critical to lethal factor binding. Nested primers were used to amplify and sequence this same region of pag from necropsy samples taken from victims of the 1979 Sverdlovsk incident. This investigation uncovered five different alleles among the strains present in the tissues, including two not seen in the 26-sample survey. One of these two alleles included a novel missense mutation, again located just adjacent to the highly antigenic region. Phylogenetic (cladistic) analysis of the pag corresponded with previous strain grouping based on chromosomal variation, suggesting that plasmid evolution in B. anthracis has occurred with little or no horizontal transfer between the different strains.

Characterization of the variable-number tandem repeats in vrrA from different Bacillus anthracis isolates

PCR analysis of 198 Bacillus anthracis isolates revealed a variable region of DNA sequence differing in length among the isolates. Five polymorphisms differed by the presence of two to six copies of the 12-bp tandem repeat 5'-CAATATCAACAA-3'. This variable-number tandem repeat (VNTR) region is located within a larger sequence containing one complete open reading frame that encodes a putative 30-kDa protein. Length variation did not change the reading frame of the encoded protein and only changed the copy number of a 4-amino-acid sequence (QYQQ) from 2 to 6. The structure of the VNTR region suggests that these multiple repeats are generated by recombination or polymerase slippage. Protein structures predicted from the reverse-translated DNA sequence suggest that any structural changes in the encoded protein are confined to the region encoded by the VNTR sequence. Copy number differences in the VNTR region were used to define five different B. anthracis alleles. Characterization of 198 isolates revealed allele frequencies of 6.1, 17.7, 59.6, 5.6, and 11.1% sequentially from shorter to longer alleles. The high degree of polymorphism in the VNTR region provides a criterion for assigning isolates to five allelic categories. There is a correlation between categories and geographic distribution. Such molecular markers can be used to monitor the epidemiology of anthrax outbreaks in domestic and native herbivore populations.

Molecular evolution and diversity in Bacillus anthracis as detected by amplified fragment length polymorphism markers

Bacillus anthracis causes anthrax and represents one of the most molecularly monomorphic bacteria known. We have used AFLP (amplified fragment length polymorphism) DNA markers to analyze 78 B. anthracis isolates and six related Bacillus species for molecular variation. AFLP markers are extremely sensitive to even small sequence variation, using PCR and high-resolution electrophoresis to examine restriction fragments. Using this approach, we examined ca. 6.3% of the Bacillus genome for length mutations and ca. 0.36% for point mutations. Extensive variation was observed among taxa, and both cladistic and phenetic analyses were used to construct a phylogeny of B. anthracis and its closest relatives. This genome-wide analysis of 357 AFLP characters (polymorphic fragments) indicates that B. cereus and B. thuringiensis are the closest taxa to B. anthracis, with B. mycoides slightly more distant. B. subtilis, B. polymyxa, and B. stearothermophilus shared few AFLP markers with B. anthracis and were used as outgroups to root the analysis. In contrast to the variation among taxa, only rare AFLP marker variation was observed within B. anthracis, which may be the most genetically uniform bacterial species known. However, AFLP markers did establish the presence or absence of the pXO1 and pXO2 plasmids and detected 31 polymorphic chromosomal regions among the 79 B. anthracis isolates. Cluster analysis identified two very distinct genetic lineages among the B. anthracis isolates. The level of variation and its geographic distribution are consistent with a historically recent African origin for this pathogenic organism. Based on AFLP marker similarity, the ongoing anthrax epidemic in Canada and the northern United States is due to a single strain introduction that has remained stable over at least 30 years and a 1,000-mile distribution.

The Sverdlovsk anthrax outbreak of 1979

In April and May 1979, an unusual anthrax epidemic occurred in Sverdlovsk, Union of Soviet Socialist Republics. Soviet officials attributed it to consumption of contaminated meat. U.S. agencies attributed it to inhalation of spores accidentally released at a military microbiology facility in the city. Epidemiological data show that most victims worked or lived in a narrow zone extending from the military facility to the southern city limit. Farther south, livestock died of anthrax along the zone's extended axis. The zone paralleled the northerly wind that prevailed shortly before the outbreak. It is concluded that the escape of an aerosol of anthrax pathogen at the military facility caused the outbreak.

Satellite imaging as a technique for obtaining disease-related data

Because of its initial expense, remote sensing imagery has been frequently ignored in studying the epidemiology and ecology of human and animal diseases. However, these digital images have many advantages when the theoretical restrictions and constraints on the data are understood. Remote sensing imagery has the potential significantly to improve the effectiveness and delivery of disease control programmes. As soon as it can be integrated into the operational aspects of programmes, remote sensing imagery will pass from being a data-driven research tool to being need-driven.

Applications of remote sensing to the identification of the habitats of parasites and disease vectors

Remote sensing has been largely ignored in the identification of parasite and disease vector habitats. It has a number of advantages, both in improved control and understanding, and should be considered by more field-orientated scientists. Successful and potential applications involving mosquitoes, ticks, trematodes, and tsetse flies are briefly reviewed by Martin Hugh-Jones.

Evaluation of biosecurity in broiler breeders

The economic impact of management practices designed to limit the introduction of disease into a parent broiler breeder flock (biosecurity) was evaluated using benefit-cost analysis. Equations were developed to quantify the losses resulting from infection with one of four alternative categories of disease representing incremental levels of pathogenicity. Realistic costs and assumed values relating to the probability of infection were used to evaluate the ameliorative effect of three alternative levels of biosecurity. A microcomputer spreadsheet program was used to confirm that expenditure on protective measures can be justified by both the risk of introducing a disease and the magnitude of losses that may occur following infection.

The evidence for the airborne spread of Newcastle disease

Newcastle disease virus has been shown to survive when airborne in small particles, both in the laboratory and in the open air. Field outbreaks have been studied and viable virus has been recovered from the open air short distances downwind of infected premises. Vaccination of birds leads to a great reduction in the amount of virus liberated into the air.