First PCR Confirmed anthrax outbreaks in Ethiopia-Amhara region, 2018-2019.
First PCR Confirmed anthrax outbreaks in Ethiopia-Amhara region, 2018-2019.
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DOI：
10.1371/journal.pntd.0010181
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发表时间：
2022-03
影响因子：
3.8
通讯作者：
Mor SM
中科院分区：
文献类型：
--
作者：
Ashenefe Wassie B;Fantaw S;Mekonene Y;Teshale AM;Yitagesu Y;Tsige E;Getahun D;Tasew G;Abichu G;Moges B;Abate E;Abayneh T;Zeru T;Belay Z;Mor SM
炭疽病是一种影响人类和动物的疾病。在埃塞俄比亚，炭疽病是一种可报告的疾病，并被认为是地方性疾病，尽管直到最近才常规进行实验室确认。我们描述了对阿姆哈拉地区两起疫情的调查结果。在Wag Hamra区(暴发1)和南冈达尔区(暴发2)报告疑似疫情后，部署了涉及动物和公共卫生官员的多部门小组进行调查和制定控制方案。疑似病例被定义为：猝死，伴有不凝结的血液(动物)的开口(S)迅速肿胀或出血；以及在接触可疑动物(人)7天后出现与皮肤、摄入或吸入炭疽≤相容的体征。使用标准问卷对疑似人类病例进行了访谈。样本采集自疑似炭疽病患者(暴发1和暴发2)以及疑似动物病例的干肉(暴发2)。如果使用实时聚合酶链式反应(QPCR)返回阳性检测，则确认病例。在第一次暴发中，共有49头奶牛死于疑似炭疽病，22人出现与皮肤炭疽病一致的症状(发病率为40%)，其中两人死于疑似摄入炭疽病。经定量聚合酶链式反应证实有3人感染炭疽热。在第二次暴发中，炭疽病被怀疑导致两只牲畜和一名人类死亡。随后的调查发现了18例人类皮肤炭疽病疑似病例(发病率为27%)。在收集的12个人类样本中，没有一份检测呈阳性，但从一例动物病例(山羊)的干肉中提取的拭子经qPCR检测呈阳性。我们报告了埃塞俄比亚第一次经qPCR确认的炭疽暴发。通过积极发现病例、身体管理、牲畜环状疫苗接种、培训卫生专业人员和与牲畜主人进行接触，两次暴发都得到了控制。人类和动物卫生当局应共同努力，采用“一个健康”的办法，改进病例报告和疫苗覆盖率。炭疽病是一种细菌性疾病，会导致牲畜，特别是牛的迅速死亡。当人类触摸或食用动物身体或动物产品时，或者当他们吸入从环境中雾化的细菌孢子时，他们可能会被感染。根据细菌进入人体的方式，它会导致人类的皮肤、胃肠道/口咽部或呼吸系统疾病；皮肤炭疽病很少死亡，但更常见的是摄入和吸入形式的疾病。炭疽病在全球分布，但世界上的一些地区--如埃塞俄比亚--每年都会在动物和人类中爆发。在这份报告中，我们介绍了埃塞俄比亚第一批经聚合酶链式反应确认的疫情的发现。在这两次疫情中，由于缺乏农民意识和牲畜的内在经济价值，农民不得不打捞死亡动物的身体，以获取肉类和兽皮。参与剥皮和屠宰、食用或处理疑似动物病例或加工兽皮/兽皮的社区成员出现了与炭疽病一致的临床症状(第一次暴发中有22人，包括两例疑似死亡；第二次暴发中有18人，包括一例疑似死亡)。此外，指示病例(一次暴发中的一头牛；二次暴发中的一头牛和一只山羊)的动物器官被不当丢弃在环境中，导致另有48头牛在第一次暴发中受到感染并死亡。第一次暴发中有三个人的炭疽热聚合酶链式反应检测呈阳性。此外，从一只在疫情2中死亡的动物的干肉中提取的拭子经PCR检测呈阳性。在这两次暴发中，通过召回和处置剩余的动物产品、在周围地区为牲畜接种疫苗和社区教育来控制疫情。
Anthrax is a disease that affects humans and animals. In Ethiopia, anthrax is a reportable disease and assumed to be endemic, although laboratory confirmation has not been routinely performed until recently. We describe the findings from the investigation of two outbreaks in Amhara region. Following reports of suspected outbreaks in Wag Hamra zone (Outbreak 1) and South Gondar zone (Outbreak 2), multi-sectoral teams involving both animal and public health officials were deployed to investigate and establish control programs. A suspect case was defined as: sudden death with rapid bloating or bleeding from orifice(s) with unclotted blood (animals); and signs compatible with cutaneous, ingestion, or inhalation anthrax ≤7 days after exposure to a suspect animal (humans). Suspect human cases were interviewed using a standard questionnaire. Samples were collected from humans with suspected anthrax (Outbreak 1 and Outbreak 2) as well as dried meat of suspect animal cases (Outbreak 2). A case was confirmed if a positive test was returned using real-time polymerase chain reaction (qPCR). In Outbreak 1, a total of 49 cows died due to suspected anthrax and 22 humans developed symptoms consistent with cutaneous anthrax (40% attack rate), two of whom died due to suspected ingestion anthrax. Three people were confirmed to have anthrax by qPCR. In Outbreak 2, anthrax was suspected to have caused the deaths of two livestock animals and one human. Subsequent investigation revealed 18 suspected cases of cutaneous anthrax in humans (27% attack rate). None of the 12 human samples collected tested positive, however, a swab taken from the dried meat of one animal case (goat) was positive by qPCR. We report the first qPCR-confirmed outbreaks of anthrax in Ethiopia. Both outbreaks were controlled through active case finding, carcass management, ring vaccination of livestock, training of health professionals and outreach with livestock owners. Human and animal health authorities should work together using a One Health approach to improve case reporting and vaccine coverage. Anthrax is a bacterial disease that causes rapid death in livestock, particularly cattle. Humans can be infected when they touch or eat animal carcasses or animal products, or when they inhale bacterial spores that have been aerosolized from the environment. Depending on how the bacterium enters the body, it causes cutaneous, gastrointestinal/oropharyngeal or respiratory disease in humans; death is rare for cutaneous anthrax but is more common with ingestion and inhalation forms of the disease. Anthrax has a global distribution but some areas of the world–such as Ethiopia–experience annual outbreaks in animals and humans. In this report, we present the findings from the first PCR-confirmed outbreaks in Ethiopia. In both outbreaks, the lack of farmer awareness and inherent economic value of livestock led farmers to salvage carcasses of animals that died, for meat and hides. Community members who participated in skinning and butchering of carcasses, eating or handling the meat, or processing hides/skins of suspect animal cases developed clinical signs consistent with anthrax (22 humans in Outbreak 1 including two suspected deaths; and 18 in Outbreak 2 including one suspected death). Further, animal parts from index cases (one cow in Outbreak 1; and one cow and one goat from Outbreak 2) were improperly discarded around the environment, leading a further 48 cows to become infected and die in Outbreak 1. Three humans in Outbreak 1 tested positive for anthrax on PCR. In addition, a swab taken from the dried meat of an animal that died in Outbreak 2 was positive by PCR. In both outbreaks, control was enacted through recalling and disposing remaining animal products, vaccination of livestock in surrounding areas and community education.