Archive Number 20090814.2888
Published Date 14-AUG-2009
Subject PRO/MBDS> Anthrax, human, bovine - Laos: Saravan
ANTHRAX, HUMAN, BOVINE - LAOS: SARAVAN
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Wed 12 Aug 2009
Source: Vientiane Times [edited]
<http://www.vientianetimes.org.la/FreeContent/Free_Anthrax.htm>
Anthrax kills 9 [people] in Saravan
-----------------------------------
Nine people in the southern province of Saravan have died and a
further 66 are receiving treatment after eating beef from cattle,
which died of anthrax, a top provincial health official has confirmed.
Saravan Health Department Director, Dr Khoutdara Vongsaravan said
yesterday [11 Aug 2009] the victims were from the villages of Kha
Dub, Khieng Khong, and Baengoudom, some 20 km from the provincial capital.
"The villagers ate raw beef from cattle which had died of anthrax so
they became sick, and those who failed to receive medical treatment
in time died," he told Vientiane Times.
[Dr Khoutdara] said the provincial authorities had collected samples
from the animals and sent them to be tested in Vientiane. The tests
found that the cattle died from anthrax, and this was the main cause
of the human casualties.
Anthrax is an acute infectious disease caused by the spore-forming
bacterium _Bacillus anthracis_. It most commonly occurs in wild and
domestic animals such cattle, sheep, goats, and camels. The disease
can also occur in humans when they are exposed to infected animals or
tissue from infected animals.
Dr Khoutdara said the provincial authorities had launched a health
campaign in the outbreak area, urging the villagers to avoid eating
animals that died of disease. The health officials also urged the
villagers to cook beef and wash their hands before eating food.
[Dr Khoutdara] said anthrax could not be transmitted between humans
[transmission of anthrax from human to human is very rare], adding
the infected people had consumed infected beef or came into contact
with infected animals and failed to wash their hands. Provincial
authorities are providing treatment to about 60 patients, adding that
most of them have since recovered from the illness. He said
provincial authorities had medicine, medical equipment, and
sufficient doctors to respond to the disease outbreak.
Dr Khoutdara said this was not the 1st case of such fatalities in the
area. Last year [2008], people also died of the disease but villagers
did not make an official report to the authorities.
He [Dr Khoutdara] said the major reason people in the village
contracted the disease was because they did not listen to health
advice on how to eat cooked, clean and disease-free food.
"We have been campaigning on the danger of the disease and urge
people to stop eating the meat of all animals that die from disease,
but they do not listen," he said. He said some villagers had eaten or
sold the meat of diseased animals because they did not want to lose
money on their investment.
--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>
[Anthrax is an acute bacterial enzootic disease, caused by _Bacillus
anthracis_. Depending on the route of exposure, anthrax can occur in
3 forms: pulmonary, cutaneous, or gastrointestinal. More than 95
percent of naturally acquired human cases worldwide are cutaneous
anthrax. Ingestion anthrax may take the form of oropharyngeal anthrax
or, more commonly, gastrointestinal anthrax. Ingestion anthrax is not
invariably fatal, but, even with treatment mortality can be high,
with development of septicemia, shock, coma, and death. The
incubation period is from one to 7 days. However, in the 1979 USSR
outbreak, incubation periods extended to 43 days.
Anthrax can be transmitted by contact with tissues of any parts of
livestock or wild animals (cattle, sheep, goats, horses, pigs, and
others) dying of the disease. Anthrax may also occur through
deliberate release of spores. In 2001, spores deliberately released
through the postal system in the USA resulted in 11 cutaneous and 11
inhalation cases, including 5 fatalities. Person-to-person
transmission is very rare. It has not been reported for inhalation or
gastrointestinal forms of anthrax (1).
Outbreaks in livestock may be an occupational hazard of animal
husbandry, with the consequent risk to humans. Outbreaks related to
handling and consuming meat from infected cattle have occurred in
Africa, Asia, and Russia, see reference (1) below. For example, an
intestinal anthrax outbreak was reported in 4 cases in a small hamlet
of Mysore district of Karnataka, after consuming diseased deer meat (2).
Also an outbreak with 24 cases of human oral-oropharyngeal anthrax
was described in Chiang Mai, northern Thailand in 1982. All patients
with oropharyngeal anthrax had history of having recently eaten raw
or undercooked water buffalo meat in which anthrax was found (3).
The clinical features of oropharyngeal anthrax include fever and
toxemia, inflammatory lesion(s) in the oral cavity or oropharynx,
enlargement of cervical lymph nodes associated with edema of the soft
tissue of the cervical area, and a high case-fatality rate (4,5).
Laboratory confirmation is through demonstration of the causative
organism in blood, lesion, or discharges by direct polychrome
methylene blue (M'Fadyean)-stained smears, or by culture on sheep
blood agar. Ciprofloxacin is the recommended 1st line of treatment.
Alternatives are doxycycline and amoxicillin (if isolate is susceptible)(1).
According to the newswire above, this is the 1st gastrointestinal
anthrax outbreak in Laos in 2009. The last outbreaks of animal
anthrax in Laos (5 cases in cattle and 2 cases in goats) were
reported to the World Organization for Animal Health (OIE) on 20 Oct
2008 (see prior PRO/MBDS posting Anthrax - Laos: OIE 20081025.3365).
References
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1. Control of Communicable Diseases Manual. David L Heymann, MD,
Editor 2008. 19th Edition, APHA/WHO.
2. Ichhpujani RL, Rajagopal V, Bhattacharya D, Rana UV, Mittal V, Rai
A, Ravishankar AG, Pasha ST, Sokhey J, Biswas S: An outbreak of human
anthrax in Mysore (India). J Commun Dis. 2004 Sep; 36(3): 199-204.
Erratum in: J Commun Dis. 2005 Sep; 37(3): 261 (abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/16509258>).
3. Sirisanthana T, Navachareon N, Tharavichitkul P, Sirisanthana V,
Brown AE: Outbreak of oral-pharyngeal anthrax: an unusual
manifestation of human infection with _Bacillus anthracis_. Am J Trop
Med Hyg 1984; 33: 144-50 (abstract available at
<http://www.ajtmh.org/cgi/content/abstract/33/1/144>).
4. Sirisanthana T, Brown AE: Anthrax of the Gastrointestinal Tract.
Journal of Emerg Infec Dis July 2002. 8 (7): 650-1 (full article
available at <http://www.cdc.gov/ncidod/eid/vol8no7/pdf/02-0062.pdf>).
5. Doganay M, Almac A, Hanagasi R: Primary throat anthrax. A report
of six cases. Scand J Infect Dis 1986; 18(5): 415-9, 1986 (abstract
available at <http://www.ncbi.nlm.nih.gov/pubmed/3775269>).
For a map of Laos with provinces, see
<http://www.un.org/Depts/Cartographic/map/profile/laos.pdf>. For the
interactive HealthMap/ProMED map of Laos with links to other recent
ProMED-mail and PRO/MBDS reports on events in Laos and surrounding
areas, see <http://healthmap.org/r/00Gg>. - Mod.SCM]
[see also:
Anthrax, human, bovine - Myanmar: (Kachin) RFI 20090325.1159
2008
----
Anthrax - Laos: OIE 20081025.3365
Anthrax, human, livestock - Viet Nam (02): RFI 20080719.2192
Anthrax, human, livestock - Viet Nam: RFI 20080708.2063
Anthrax, ovine - Mongolia: (Selenge) 20080226.0781]
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