title: An Aggregate of Four Anthrax Cases during the Dry Summer of 2011 in Epirus, Greece.
abstract: BACKGROUND
  Human anthrax is currently a sporadic disease in Europe, without significant regional clustering.
  
  
  OBJECTIVE
  To report an unexpected aggregate of anthrax cases and correlate local climatic factors with yearly anthrax admissions.
  
  
  METHODS
  Clinical description of a geographical-temporal anthrax aggregate, correlation of disease admissions with local weather data in the period 2001-2014 and literature reports of anthrax clusters from Europe in the last 20 years.
  
  
  RESULTS
  We identified 5 cases, all cutaneous: an unexpected aggregate of 4 cases in mid-summer 2011 (including a probable human-to-human transmission) and a sporadic case in August 2005, all in relatively dry periods (p < 0.05). Remarkably, 3/6 reports of human anthrax aggregates from Europe were observed in Balkan Peninsula countries in the year 2011.
  
  
  CONCLUSIONS
  In the light of the predicted climatic change, unexpected anthrax aggregates during dry periods in southern Europe underscore the risk of future anthrax re-emergence on this continent.
authors.affiliation: Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gaitanis
authors.forename: Christos J
authors.initials: CJ
authors.lastname: Lolis
authors.forename: Antonios
authors.initials: A
authors.lastname: Tsartsarakis
authors.forename: Chris
authors.initials: C
authors.lastname: Kalogeropoulos
authors.forename: Stamatina
authors.initials: S
authors.lastname: Leveidiotou-Stefanou
authors.forename: Aristidis
authors.initials: A
authors.lastname: Bartzokas
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Bassukas
mesh_terms: D000328:Adult; D000368:Aged; D000881:Anthrax / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D002980:Climate; D005260:Female; D006115:Greece; D006801:Humans; D008297:Male; D008875:Middle Aged; D017192:Skin Diseases, Bacterial / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy