title: Evidence of local persistence of human anthrax in the country of georgia associated with environmental and anthropogenic factors.
abstract: BACKGROUND
  Anthrax is a soil-borne disease caused by the bacterium Bacillus anthracis and is considered a neglected zoonosis. In the country of Georgia, recent reports have indicated an increase in the incidence of human anthrax. Identifying sub-national areas of increased risk may help direct appropriate public health control measures. The purpose of this study was to evaluate the spatial distribution of human anthrax and identify environmental/anthropogenic factors associated with persistent clusters.
  
  
  RESULTS
  A database of human cutaneous anthrax in Georgia during the period 2000-2009 was constructed using a geographic information system (GIS) with case data recorded to the community location. The spatial scan statistic was used to identify persistence of human cutaneous anthrax. Risk factors related to clusters of persistence were modeled using a multivariate logistic regression. Areas of persistence were identified in the southeastern part of the country. Results indicated that the persistence of human cutaneous anthrax showed a strong positive association with soil pH and urban areas.
  
  
  CONCLUSIONS
  Anthrax represents a persistent threat to public and veterinary health in Georgia. The findings here showed that the local level heterogeneity in the persistence of human cutaneous anthrax necessitates directed interventions to mitigate the disease. High risk areas identified in this study can be targeted for public health control measures such as farmer education and livestock vaccination campaigns.
authors.affiliation: Spatial Epidemiology and Ecology Research Lab, Department of Geography, University of Florida, Gainesville, Florida, United States of America ; Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Ian T
authors.initials: IT
authors.lastname: Kracalik
authors.forename: Lile
authors.initials: L
authors.lastname: Malania
authors.forename: Nikoloz
authors.initials: N
authors.lastname: Tsertsvadze
authors.forename: Julietta
authors.initials: J
authors.lastname: Manvelyan
authors.forename: Lela
authors.initials: L
authors.lastname: Bakanidze
authors.forename: Paata
authors.initials: P
authors.lastname: Imnadze
authors.forename: Shota
authors.initials: S
authors.lastname: Tsanava
authors.forename: Jason K
authors.initials: JK
authors.lastname: Blackburn
mesh_terms: D000881:Anthrax / Q000453:epidemiology* / Q000382:microbiology; D001408:Bacillus anthracis / Q000302:isolation & purification*; D016000:Cluster Analysis; D005846:Georgia (Republic) / Q000453:epidemiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015994:Incidence; D012307:Risk Factors; D017192:Skin Diseases, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D012987:Soil / Q000737:chemistry; D019371:Topography, Medical; D014505:Urban Population
chemical_list: D012987:Soil
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