Outbreaks and Emergencies Bulletin, Week 21: 20 - 26 May 2019
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Anthrax Guinea
5 Cases
1 Death
20% CFR
EVENT DESCRIPTION
On 9 May 2019, the Prefectural Health Directorate of Koubia, Guinea
was informed of the admission of four suspected anthrax cases at the
Prefectural Hospital located in Lab? region in the northern part of the
country. Three of the case-patients presented to the hospital with skin
lesions typical of a cutaneous anthrax infection (black crusts on either the
face, the hands, the head, or the neck with swelling around the affected
parts). The fourth case-patient, a 2-year-old male, son to one of the three
case-patients who presented with skin lesions, was admitted with fever,
fatigue and body aches. The four suspected cases, coming from the same
family in the same community, reportedly developed symptoms five to
12 days after consuming meat from a sick goat that was slaughtered on
28 April 2019. Half of the goat meat was sent to a neighbouring village,
located nine kilometers from that of the case-patients. No case has been
reported from the second village to date. Blood specimens and/or swab
samples from the skin lesions were collected from the four case-patients
and tested at Conakry National Institute of Public Health. One of the four
suspected cases was confirmed by reverse transcription-polymerase
chain reaction (RT-PCR). Retrospective investigation established that the
index case was a 13-year-old male from the same family who developed
clinical features of gastrointestinal anthrax (abdominal pain and bloating,
body aches, headache, and fever) on 2 May 2019 after consuming meat
from the sick goat on 28 April 2019, and who died in the community on
5 May 2019. No biological specimen was collected.
As of 15 May 2019, a total of five human cases of anthrax including one
death (case fatality ratio 20%) have been reported. Sixty percent (3/5) of
the cases were in the age-group of 0-9 years, with a male predominance
(4/5; 80%).
In the same village, two goats were reportedly sick between 28 April
and 11 May 2019. One of them was slaughtered on 28 April 2019 and
consumed by the five human cases before symptom onset and the other
goat died on 11 May 2019. Both animals mixed with a 380-head-cattle
herd, of which 174 (46%) were vaccinated against anthrax in January
2019.
PUBLIC HEALTH ACTIONS
A preliminary outbreak investigation has been conducted by the
Koubia prefecture health team.
Active case search enabled identification of 52 community
members (including 37 from the case-patients village and 15 from
the second village) who reportedly consumed meat or handled the
carcass of the dead goat.
The outbreak case definition has been finalized and is being
distributed to health facilities in the affected areas.
An environmental investigation identified two areas in the affected
village where the two sick goats used to graze. Burning and
isolation of these areas have been approved by the prefectural
veterinary services.
Case management is ongoing in the Prefectural Hospital with administration of
antipyretics, antibiotics and dressing the skin lesions.
A mission intended to assess the health status of the cattle in Koubia prefecture, is
being planned by the National Livestock Service with the support of the Food and
Agricultural Organisation (FAO) and planning for vaccination of cattle is ongoing.
SITUATION INTERPRETATION
Recurrent anthrax outbreaks have been notified in Koubia prefecture in the past and the
deadliest outbreak in the prefecture was reported from the same village in 2014, with
11 human deaths. Several factors may account for the recurrence of anthrax outbreaks
in this locality. More than 30 pastures in this village are suspected to be contaminated
with anthrax spores that can infect cattle. The poor hygiene conditions and low livestock
immunization coverage could have contributed to increase the risk of transmission of the
disease in animals, as well as humans.
An integrated preparedness and response contingency plan, based on a One Health
approach, needs to be developed and tested to control the current outbreak and prevent
future occurrence of cases in the affected and non-affected areas. Therefore, heightened
animal and human health surveillance, coupled with a mass livestock vaccination
campaign and environmental investigation, as well as risk communication and community
engagement activities need to be implemented to avert any large outbreak.
https://apps.who.int/iris/bitstream/handle/10665/324950/OEW21-2026052019.pdf
https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-21-20-26-may-2019
