An Outbreak of Deadly Anthrax in Bangladesh

Bangladesh has now issued a red alert in the country as the cases of deadly anthrax continue to climb. So far, according to the latest report, 327 people have been infected with anthrax just since the middle of August. Anthrax was first detected in Bangladesh on August 20 in Sirajganj district, about 90 miles (150 km) north-west of Dhaka (capital of Bangladesh). Despite efforts by the local government to contain the infection, the disease has now spread to two more districts in the north and east, taking the total of the number of districts affected to six. Close to 150 cows have died thus far due to the infection. Anthrax bacterium is naturally found in the soil and it usually infects the livestock via inhalation or ingestion of spores while grazing. Without prompt treatment, an anthrax infection is often fatal in both humans and cattle. The WHO explains: "Humans generally acquire the disease directly or indirectly from infected animals, or occupational exposure to infected or contaminated animal products. Control in livestock is therefore the key to reduced incidence. There are no documented cases of person to person transmission. The disease's impact on animal and human health can be devastating. 

There are 3 types of anthrax in humans: cutaneous anthrax, acquired when a spore enters the skin through a cut or an abrasion; gastrointestinal tract anthrax, contracted from eating contaminated food, primarily meat from an animal that died of the disease; and pulmonary (inhalation) anthrax from breathing in airborne anthrax spores. The cutaneous form accounts for 95% or more of human cases globally. All 3 types of anthrax are potentially fatal if not treated promptly.

Vaccines (for prevention) are available for animals and humans. However in humans their use should be confined to high-risk groups, such as those occupationally exposed, in some military settings and in situations where known or suspected inhalation of anthrax spores has taken place. Patient isolation is not required and there are no quarantine requirements. 

Antibiotic therapy usually results in dramatic recovery of the individual or animal infected with anthrax if given before onset or immediately after onset of illness. Late-stage inhalation anthrax is often fatal despite the use of antibiotics. Antibiotic therapy may be also used for prophylaxis in asymptomatic patients believed to have been exposed to anthrax spores, possibly in conjunction with vaccination. Anthrax spores may remain in the lungs for as long as 100 days prior to germination.

Accordingly, in cases where known or suspected inhalation of anthrax spores has taken place, it is prudent to consider the administration of an anthrax vaccine simultaneously with antibiotic treatment. The antibiotic treatment should be continued for 60 days to allow for development of adequate vaccine induced immunity. Following the first detection of anthrax in a herd, the remaining animals should be removed immediately from the field and checked regularly for signs of illness. In endemic areas, or if there is concern that the outbreak may spread, the herd should be vaccinated."

All of the cases detected in Bangladesh so far have been of the cutaneous variety. Bangladesh has ordered half a million ampoules of the vaccine for the cattle, which are in the process of being distributed right now. Mosaddek Hossain, a Bangladeshi official said to the AFP, "This is the biggest outbreak of anthrax in the country's history. We are very concerned. The government has set up surveillance teams in all the affected areas so that the disease cannot spread to other places. We are battling hard to contain the disease. Still, we are receiving reports of new infections in almost every day".