Cutaneous Anthrax Outbreak and Unknown Death Case Investigation in Pabna and Sirajganj, Bangladesh, 2017

Abstract Background: Anthrax, a zoonotic disease, predominantly presenting in its cutaneous forms, primarily affecting individuals living in rural, livestock-rearing communities in Bangladesh. In June 2017, an outbreak of suspected cutaneous anthrax was reported from Bhangura Upazila Health Complex of Pabna District. The national rapid response team initiated a field investigation following One Health approach to identify the source, extent of the outbreak and implement control measures. Methods: A descriptive outbreak investigation was conducted from 2-7 June 2017 in Jontihar and Kaliakoir villages of Pabna and Sirajganj district, respectively. Suspected anthrax cases were defined as individuals with a painless skin lesion progressing to a black eschar, with or without systemic symptoms, between 25 May and 7 June 2017. Data were collected through interviews, clinical examinations, and environmental assessment. Swab and soil samples were collected for microbiological analysis. Descriptive statistics were used to summarize findings. Results: A total of 67 cutaneous anthrax cases were identified—37 from Pabna and 30 from Sirajganj. Most patients (56.7%) were male, and 63% cases were from aged 16–45 years. Cases had history of eexposure to sick cattle slaughtered on 25, 27, and 29 May, 2017. Common exposures were slaughtering animals, handling raw meat, or washing contaminated items. In addition to cutaneous lesions, 62.7% of cases presented with systemic symptoms. A 12-year-old boy, who had a history of processing and distributing meat of the slaughtered cattle, was found dead after 5 days of exposure in Rajshahi Medical College Hospital, with emphysema and respiratory distress. Approximately 800 cattle were vaccinated against anthrax in those villages. Conclusion: The investigation emphasized the critical roles of community awareness and education in anthrax transmission, the importance of livestock vaccination in prevention, and the need for intersectoral collaboration between the human and animal health sectors to reduce the risk of anthrax outbreaks.