title: Suspected outbreak of cutaneous anthrax in Kasese district, the investigation and response, April to May 2007.
abstract: BACKGROUND
  A report of suspected anthrax was submitted by the Kasese District Health Office to the Epidemiology Surveillance Division of Ministry of Health. A joint team comprising officers from MOH, IPH and MPH officers proceeded to the district to investigate the reported threat of anthrax. The investigations were conducted in Bwera HSD, Bukonjo West County, in communities bordering Queen Elizabeth National Park.
  
  
  OBJECTIVE
  The main objectives of the study were to verify the existence of anthrax and assess the risk factors for the suspected outbreak of anthrax in Kasese district.
  
  
  METHODS
  The methods involved discussion with the DHT members; reviewing the surveillance data and hospital records, and reorienting the case definitions to the specific type of anthrax. In addition tracing the reported cases in the community in order to establish exposure to the risk factors and sensitize the community.
  
  
  RESULTS
  Cutaneous anthrax was clinically diagnosed as the cause of the reported anthrax, both from the medical records and observation of cases found during the investigation. The index case was a 44 year old male, from Hurukungu village, Kyempara parish, a household with one wife and 4 children. This case skinned a goat that had died under mysterious circumstances and the meat was eaten with family members. Two other cases were members of the same family and the fourth case was from the same community and bought meat from the index case. All the four cases presented with a history of blister like lesions that eventually ulcerated with swelling of surrounding skin in different parts of the body. There were no other systemic symptoms reported in all the cases. All the suspected cases received antibiotics to which anthrax is sensitive. There were no laboratory investigations done by the time of the investigations since many of the cases identified were already on treatment and recovering from the infection, therefore no samples were taken from them. Review of records revealed that reporting of anthrax has continued since the year 2005 with cases ranging from I to 4 from villages that shares a common boarder with Queen Elizabeth National Game Park. This particular outbreak was associated with eating of meat from a goat that had died of unknown cause. The health workers from the health units where cases were reported were found to have the basic knowledge and skills to suspect anthrax. However, they had no guidelines to help them identify cases of anthrax accurately. The available Standard Case Definition (SCD) booklets, IDSR Technical Guidelines, and laboratory SOPs have no information on anthrax. No samples have ever been removed from suspected cases for laboratory investigation. The health units have the appropriate antibiotics for treatment of suspected case. The Local Council Chairpersons, Veterinary extension workers, and the health educators have sensitized the community in the past against eating dead animals and that they should notify the authorities, and bury all dead animals immediately. However this hasn't yet been done for the current outbreak.
  
  
  CONCLUSIONS
  The outbreak of anthrax in Bwera sub-county followed eating of meat from a goat which had died from unknown causes. Suspected cases have not been confirmed by laboratory but treated empirically with antibiotics. All new cases of suspected anthrax that report at the lower health units without laboratory facilities should be referred to hospital for investigation to confirm the diagnosis. There is need to include guidelines on anthrax in the SCD Booklets, laboratory SOPs and IDSR technical guidelines. Resensitization of the affected communities about the prevention of anthrax should be done immediately.
authors.affiliation: Makerere University School of Public Health, P.O. Box 7072, Kampala.
authors.forename: William
authors.initials: W
authors.lastname: Bazeyo
authors.forename: Luswa
authors.initials: L
authors.lastname: Lukwago
authors.forename: Joseph
authors.initials: J
authors.lastname: Wamala
authors.forename: Siraj
authors.initials: S
authors.lastname: Obayo
authors.forename: John
authors.initials: J
authors.lastname: Bua
authors.forename: John
authors.initials: J
authors.lastname: Ecumu
authors.forename: Pedson
authors.initials: P
authors.lastname: Baluku
authors.forename: Peter
authors.initials: P
authors.lastname: Mukobi
mesh_terms: D000328:Adult; D000881:Anthrax / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D016358:Contact Tracing; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008460:Meat / Q000382:microbiology; D012307:Risk Factors; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult