Cutaneous Anthrax Outbreak, Erbil, September, 2012

Cutaneous Anthrax Outbreak, Erbil, September, 2012 DR. Karim A. K. Muftin Al- Zadawi Assistant Zoonotic Diseases Section,CDC IHR NFP MoH , Iraq Dr. S. Badri Dr. J.Kamil B.Alnaamy A. Mahedi T.Alkair Dr . S. Adin Dr. F. Al-Lami Zoonotic section CDC Bag. FETP 2nd cohort PhD Community Medicine

Introduction • Anthrax is a deadly life-threatening zoonotic disease due to Bacillus anthracis, which is a large gram-positive, spore-forming, non-motile bacillus. • The spores are extremely resistant in the environment and may survive for decades in certain soil conditions. They eventually ingested by cattle, sheep or wild animals such as deer when they grazing on contaminated land.

Cont.. • Naturally, humans acquired the disease through contact with infected animal or dealing with its products. • Anthrax infection in humans occurs by three major routes: • Skin. • Respiratory tract. • Gastro-intestinal tract.

Cont.. • Cutaneous anthrax in humans usually results from direct contact with infected animals or animal products, and is generally an occupational hazard. • The disease may occur among: veterinarians, agricultural workers and butchers, resulting from exposure to contaminated sheep wool or goat hair. • The head, forearms and hands are the most common sites of infection. • The case fatality rate of cutaneous anthrax usually is about 20% if untreated.

Cont.. • In Turkey, 926 cases were recorded between 1995 and 2005. • In England and Wales, only 21 possible cases of anthrax were notified between 1981 and 2009. • In Scotland, between December 2009 and December 2010, there were 119 drug-using patients who were classed as anthrax cases (CFR = 14%).

Cont.. • In Iraq: • 2008, reported 42 cutaneous anthrax in Dohuk province. • 2009, another 3 cases were reported in the same province.

On 28/September/2012 : • CDC Erbil notified suspected 9 cases of cutaneous anthrax in small village in Chomandistrict, Erbil province. The initial diagnosis was depended on clinical case definition. • Combined team from CDC Baghdad , FETP 2nd cohort , CDC Erbil and Veterinary doctor visited the village and investigate the outbreak from 28/10/2012 to 30/10/2012

Objective: • Searching for other un-reported cases within the village. • Identify the probable risk factors. • Provide recommendations to avoid further outbreak.

Methods • Standard case definition was developed. • Prepared demographic questionnaire were distributed among population at risk and interviewed them.

Case definition: Cont. … • Suspected: Epidemiologically linked to a confirmed or suspected animal cases or contaminated animal products. • Confirmed Cases clinically ill with laboratory confirmation of infection.

Cont. • Samples from animals were collected for Lab. exam. • The team visited Erbil Fever Teaching Hospital and interview the staff dealing with patients about the personnel protective measures.

Findings • Mean age of cases was 27.2 years with SD ±12.5

Age group distribution

Sex distribution

All cases were exposed during butchering of sick animal and handling raw meat. • Sick animals were imported from Dohuk province. • 77 pop. (of 11 families) were at risk. • Nine of them had sign and symptoms of anthrax.

All cases presented with painless papules, ulcers with vesicles. • All cases were initially diagnosed clinically. • All cases were cured with treatment.

Recommendation • A single case of anthrax should be considered as an outbreak and should be managed with great urgency. • Active case finding by active surveillance is recommended where there is a continuing risk of exposure. • It is important to recognize the clinical aspects of anthrax in routine practice since any delay in treatment may be fatal.

Cont.. • Control of contacts including field workers (although there is no person to person transmission and anyone who may have been exposed to the same source as the case should be traced and followed-up, and it may be recommended that they take prophylactic antibiotics. • Coordination with other related sector including the veterinary sector. • Release of appropriate public information and raise community awareness. • Protective Personnel Measures should be considered within the health care facilities dealing with suspected cases of Anthrax.

Conclusion • It was found that persons who were involved in slaughtering or handling raw meat or sick animal had the manifestations of the disease.

Thank you for your listening

Cutaneous Anthrax Outbreak, Erbil, September, 2012