title: Detection and management of the first human anthrax outbreak in Togo.
abstract: OBJECTIVE
  The aim of this study was to describe and define an outbreak of human anthrax in two villages in the northern savannah region of Togo.
  
  
  METHODS
  In December 2009, localised groups of deaths occurred among villagers and their livestock, confirmed to be due to anthrax at the district hospital of Dapaong in Northern Togo. The National Disease Control department undertook an investigation to describe the epidemiological, clinical and bacteriological characteristics of this outbreak.
  
  
  RESULTS
  Thirty-four individuals presented with clinical manifestations of anthrax. All patients were known to have consumed meat from cattle who had died of unknown causes or had been killed as a result of unknown illness. All patients presented with muco-cutaneous lesions; some had gastro-intestinal, neurological or meningeal symptoms, or septicaemia. One patient was co-infected with Plasmodium falciparum. Six deaths (17.6%) were reported at the beginning of the epidemic; 28 patients were successfully treated with a 10-day course of intravenous Penicillin or oral Amoxicillin. The two factors that contributed to the ultimate resolution of the anthrax outbreak were the increase of community awareness toward health promotion and vaccination of all farm animals.
  
  
  CONCLUSIONS
  Although six deaths occurred among families' members who were infected, new human anthrax cases were prevented by rapid treatment of victims as well as aggressive public health interventions. However the risk of re-emergence of infection and exposure still exists as there are no existing epidemiological mapping and no identification of infected zones; and furthermore, no functional anthrax surveillance system exists in the affected region.
authors.affiliation: Service de Maladies Infectieuses et de Pneumologie, CHU Sylvanus Olympio, Université de Lomé, Lomé, Togo patassi40@yahoo.fr.
authors.forename: Akouda Akessiwe
authors.initials: AA
authors.lastname: Patassi
authors.affiliation: Service de dermatologie et IST, CHU Sylvanus Olympio, Université de Lomé, Lomé, Togo.
authors.forename: Bayaki
authors.initials: B
authors.lastname: Saka
authors.affiliation: Division de l'épidémiologie, Ministère de la Santé, Lomé, Togo.
authors.forename: Dadja Essoya
authors.initials: DE
authors.lastname: Landoh
authors.affiliation: Laboratoire de bactériologie, CHR Dapaong, Dapaong, Togo.
authors.forename: Kodjo
authors.initials: K
authors.lastname: Agbenoko
authors.affiliation: Service de dermatologie et IST, CHU Sylvanus Olympio, Université de Lomé, Lomé, Togo.
authors.forename: Tsidi
authors.initials: T
authors.lastname: Tamekloe
authors.affiliation: Maladies infectieuses, Hôpital Cochin, APHP, Université Paris Descartes Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Salmon-Ceron
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000881:Anthrax / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001408:Bacillus anthracis / Q000302:isolation & purification*; D002417:Cattle; D002648:Child; D016358:Contact Tracing; D019468:Disease Management; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008460:Meat / Q000382:microbiology; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use; D018805:Sepsis / Q000382:microbiology; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000453:epidemiology*; D014037:Togo / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins
keywords: Human anthrax; Togo; outbreak