The burden of anthrax in wildlife is demonstrated through high numbers of sudden mortalities among herbivore species, including endangered animal species. East Africa is home of multiple species of faunal wildlife numbering in the millions but there are limited disease surveillance programmes, resulting in a paucity of information on the role of anthrax and other infectious diseases on declining wildlife populations in the region. We reviewed historical data on anthrax outbreaks from Kenya Wildlife Service (KWS) spanning from 1999 to 2017 in Kenya to determine the burden, characteristics and spatial distribution of anthrax outbreaks. A total of 51 anthrax outbreaks associated with 1014 animal deaths were reported across 20 of 60 wildlife conservation areas located in six of the seven agro-ecological zones. Overall, 67% of the outbreaks were reported during the dry seasons, affecting 24 different wildlife species. Over 90% (22 of 24) of the affected species were herbivore, including 12 grazers, five browsers and five mixed grazers and browsers. Buffaloes (23.5%), black rhinos (21.6%) and elephants (17.6%) were the most frequently affected species. Our findings demonstrate the extensive geographic distribution of wildlife anthrax in the country, making it one of the important infectious diseases that threaten wildlife conservation.

Two fatal drumming-related inhalational anthrax incidents occurred in 2006 and 2008 in the UK. One individual was a drum maker and drummer from the Scottish Borders, most likely infected whilst playing a goat-skin drum contaminated with Bacillus anthracis spores; the second, a drummer and drum maker from East London, likely became infected whilst working with contaminated animal hides.

We have collated epidemiological and environmental data from these incidents and reviewed them alongside three similar contemporaneous incidents in the USA. Sampling operations recovered the causative agent from drums and drum skins and from residences and communal buildings at low levels. From these data, we have considered the nature of the exposures and the number of other individuals likely to have been exposed, either to the primary infection events or to subsequent prolonged environmental contamination (or both).

Despite many individual exposures to widespread low-level spore contamination in private residences and in work spaces for extended periods of time (at least 1 year in one instance), only one other individual acquired an infection (cutaneous). Whilst recognising the difficulty in making definitive inferences from these incidents to specific residual contamination levels, and by extending the risk to public health, we believe it may be useful to reflect on these findings when considering future incident management risk assessments and decisions in similar incidents that result in low-level indoor contamination.

Anthrax is an important disease caused by the bacterium Bacillus anthracis affecting both domestic and wild animals at the wildlife/livestock interface, defined here as a physical space in which wild and domestic species overlap in range and potentially interact. In endemic regions, sporadic anthrax outbreaks occur, causing significant deaths of both wildlife and livestock and sporadically, humans. However, it may also occur as isolated outbreaks with a few animals affected. Such isolated anthrax outbreaks maybe missed. High seroprevalence among carnivores suggests either regular non-fatal exposure to the pathogen circulating in a given environment, or contact with missed cases through consumption of anthrax carcases. To investigate the relevance of this potential indicator, a cross-sectional study was conducted to determine anthrax seroprevalence in domestic dogs (Canis lupus familiaris) from selected interface and non-interface areas of Zimbabwe with known history of anthrax outbreaks. Based on past anthrax outbreaks in the respective areas, the sites were further classified as high or low risk areas for anthrax outbreaks. Sera were collected from domestic dogs (n = 186) and tested for antibodies against B. anthracis protective antigens (PA) using an ELISA test. The overall seroprevalence was 51.6% (96/186; 95% CI 44.2–59.0). Sites from the non-interface areas recorded a significantly (P < 0.001) higher (72.1%) anthrax seroprevalence compared with those from the wildlife –livestock interface (41.5%). The results demonstrated a strong association (χ2 = 14.3; OR = 3.2, 1.6 < OR < 6.2, P < 0.001) between anthrax seropositivity and interface type. Low-risk sites (42.5%) had a significantly (P = 0.044) lower seroprevalence compared with high-risk sites (58.5%) but still demonstrated high seroprevalence for areas where anthrax was last reported more than 20 years back. Dogs from Tsholotsho South were more than 90-times (OR = 96.5, 13.5 < OR < 690.8) more likely to be seropositive compared with those from Hwange. The study demonstrated the potential to use domestic dogs as indicators of anthrax in the study areas to survey anthrax circulation in supposed low-risk areas and calls for a redefinition of both low and high risk areas for anthrax in Zimbabwe based on an improved surveillance.

Human anthrax cases reported in the country of Georgia increased 75% from 2011 (n = 81) to 2012 (n = 142). This increase prompted a case-control investigation using 67 culture- or PCR-confirmed cases and 134 controls matched by residence and gender to investigate risk factor(s) for infection during the month before case onset. Independent predictors most strongly associated with disease in the multivariable modelling were slaughtering animals [odds ratio (OR) 7·3, 95% confidence interval (CI) 2·9–18·1, P < 0·001] and disposing of dead animals (OR 13·6, 95% CI 1·5–119·8, P = 0·02). Participants owning or working with livestock (n = 131) were additionally interviewed about livestock management practices during the previous 6 months: 53 (44%) of 121 respondents vaccinated livestock against anthrax; 19 (16%) of 116 moved livestock >1 km; 15 (12%) of 125 had sick livestock; and 11 (9%) of 128 respondents reported finding dead livestock. We recommend joint public health and veterinary anthrax case investigations to identify areas of increased risk for livestock anthrax outbreaks, annual anthrax vaccination of livestock in those areas, and public awareness education.

This retrospective, descriptive case-series reviews the clinical presentations and significant laboratory findings of patients diagnosed with and treated for injectional anthrax (IA) since December 2009 at Monklands Hospital in Central Scotland and represents the largest series of IA cases to be described from a single location. Twenty-one patients who fulfilled National Anthrax Control Team standardized case definitions of confirmed, probable or possible IA are reported. All cases survived and none required limb amputation in contrast to an overall mortality of 28% being experienced for this condition in Scotland. We document the spectrum of presentations of soft tissue infection ranging from mild cases which were managed predominantly with oral antibiotics to severe cases with significant oedema, organ failure and coagulopathy. We describe the surgical management, intensive care management and antibiotic management including the first description of daptomycin being used to treat human anthrax. It is noted that some people who had injected heroin infected with Bacillus anthracis did not develop evidence of IA. Also highlighted are biochemical and haematological parameters which proved useful in identifying deteriorating patients who required greater levels of support and surgical debridement.

Background: The public health response to an influenza pandemic or other large-scale health emergency may include mass prophylaxis using multiple points of dispensing (PODs) to deliver countermeasures rapidly to affected populations. Computer models created to date to determine “optimal” staffing levels at PODs typically assume stable patient demand for service. The authors investigated POD function under dynamic and uncertain operational environments.

Methods: The authors constructed a Monte Carlo simulation model of mass prophylaxis (the Dynamic POD Simulator, or D-PODS) to assess the consequences of nonstationary patient arrival patterns on POD function under a variety of POD layouts and staffing plans. Compared are the performance of a standard POD layout under steady-state and variable patient arrival rates that may mimic real-life variation in patient demand.

Results: To achieve similar performance, PODs functioning under nonstationary patient arrival rates require higher staffing levels than would be predicted using the assumption of stationary arrival rates. Furthermore, PODs may develop severe bottlenecks unless staffing levels vary over time to meet changing patient arrival patterns. Efficient POD networks therefore require command and control systems capable of dynamically adjusting intra- and inter-POD staff levels to meet demand. In addition, under real-world operating conditions of heightened uncertainty, fewer large PODs will require a smaller total staff than many small PODs to achieve comparable performance.

Conclusions: Modeling environments that capture the effects of fundamental uncertainties in public health disasters are essential for the realistic evaluation of response mechanisms and policies. D-PODS quantifies POD operational efficiency under more realistic conditions than have been modeled previously. The authors’ experiments demonstrate that effective POD staffing plans must be responsive to variation and uncertainty in POD arrival patterns. These experiments highlight the need for command and control systems to be created to manage emergency response successfully. (Disaster Med Public Health Preparedness. 2009;3(Suppl 2):S121–S131)

In Bangladesh from 1 July to 30 September 2010 there were 104 animal cases of anthrax and 607 associated human cases. This investigation was conducted in Sirajganj district in December 2010, on eight farms where animal cases had occurred. Bacillus anthracis was recovered from soil samples and turbinate bones on six farms. Canonical single nucleotide polymorphism (SNP) analysis showed that all the isolates belonged to the major lineage A, sublineage A.Br.001/002 of China and South East Asia while a multilocus variable-number tandem-repeat (VNTR) analysis (MLVA) with 15 VNTRs demonstrated three unique genotypes. The single nucleotide repeat (SNR) analyses showed two SNR types in 97 out of 99 isolates; nevertheless, due to its higher discriminatory power the presence of two isolates with different SNR-type polymorphisms were detected within two MLVA genotypes. The epidemic occurred during the monsoon season, a time of extensive flooding, suggesting that the source was contaminated feed, not grazing, which is supported by the genetic variance.

Unprecedented high rates of anthrax outbreaks have been observed recently in cattle and humans in Bangladesh, with 607 human cases in 2010. By enrolling 15 case and 15 control cattle smallholdings in the spatial zone in July–September 2010, we conducted a case-control study, data of which were analysed by matched-pair analysis and multivariable conditional logistic regression. Feeding animals with uprooted and unwashed grass [odds ratio (OR) 41·2, 95% confidence interval (CI) 3·7–458·8, P=0·003], and feeding water hyacinth (Eichhornia crassipes) (OR 22·2, 95% CI 1·2–418·7, P=0·039) were independent risk factors for anthrax in cattle.

In a Belgian wool-processing factory, living anthrax spores were found in raw goat hair and air dust, but confirmed anthrax cases had never been reported. Anthrax vaccines are not licensed nor recommended in Belgium. We conducted a B. anthracis seroprevalence study to investigate risk factors associated with positive serology and advise on protective measures. Overall 12·1% (8/66) employees were seropositive; 30% of persons processing raw goat hair and 20% of persons sorting raw goat hair were seropositive compared to 3% in less exposed jobs [adjusted prevalence ratio (aPR) 44·4, P=0·001; aPR 14·5, P=0·016, respectively). The number of masks used per day was protective (aPR 0·3, P=0·015). Results suggest a dose–response association for those processing raw goat hair. Host-related factors probably played a role as antibody response varied from person to person within an exposure group. Workers exposed to raw goat hair should be offered higher protection against anthrax and have access to anthrax vaccines.

Anthrax is the disease caused by the Gram-positive bacterium Bacillus anthracis. Two toxins secreted by B. anthracis – lethal toxin (LT) and oedema toxin (OT) – contribute significantly to virulence. Although these toxins have been studied for half a century, recent evidence indicates that LT and OT have several roles during infection not previously ascribed to them. Research on toxin-induced effects other than cytolysis of target cells has revealed that LT and OT influence cell types previously thought to be insensitive to toxin. Multiple host factors that confer sensitivity to anthrax toxin have been identified recently, and evidence indicates that the toxins probably contribute to colonisation and invasion of the host. Additionally, the toxins are now known to cause a wide spectrum of tissue and organ pathophysiologies associated with anthrax. Taken together, these new findings indicate that anthrax-toxin-associated pathogenesis is much more complex than has been traditionally recognised.

Before the sarin incidents in Tokyo and Matsumoto, the Aum Shinrikyo (now Aleph) had tried to conduct bioterrorism with botulinum toxin and Bacillus anthracis. Followers of the Aum could not overcome technical difficulties inherent in developing biological weapons, and the perpetrators had not been prosecuted for their failed attempts of bioterrorism. But the Aum's biological attack revealed several shortcomings in the Japanese law that regulated biological weapons. Since the missile experiment of North Korea conducted in 1998, the Japanese government has come to consider the threat posed by biological weapons more seriously. In 2001, after the 11 September 2001 terrorist attacks and the series of anthrax letter scares in the United States of America, the Japanese government established its Five Basic Principles for Chemical and Biological Weapons Terrorism and several measures were taken at the central and local levels. Activities of the Aum have been monitored by the Public Security Investigation Agency and the National Police Agency under the Anti-Aum Law since 2000.