title: Genetic source tracking of an anthrax outbreak in Shaanxi province, China.
abstract: BACKGROUND
  Anthrax is an acute zoonotic infectious disease caused by the bacterium known as Bacillus anthracis. From 26 July to 8 August 2015, an outbreak with 20 suspected cutaneous anthrax cases was reported in Ganquan County, Shaanxi province in China. The genetic source tracking analysis of the anthrax outbreak was performed by molecular epidemiological methods in this study.
  
  
  METHODS
  Three molecular typing methods, namely canonical single nucleotide polymorphisms (canSNP), multiple-locus variable-number tandem repeat analysis (MLVA), and single nucleotide repeat (SNR) analysis, were used to investigate the possible source of transmission and identify the genetic relationship among the strains isolated from human cases and diseased animals during the outbreak.
  
  
  RESULTS
  Five strains isolated from diseased mules were clustered together with patients' isolates using canSNP typing and MLVA. The causative B. anthracis lineages in this outbreak belonged to the A.Br.001/002 canSNP subgroup and the MLVA15-31 genotype (the 31 genotype in MLVA15 scheme). Because nine isolates from another four provinces in China were clustered together with outbreak-related strains by the canSNP (A.Br.001/002 subgroup) and MLVA15 method (MLVA15-31 genotype), still another SNR analysis (CL10, CL12, CL33, and CL35) was used to source track the outbreak, and the results suggesting that these patients in the anthrax outbreak were probably infected by the same pathogen clone.
  
  
  CONCLUSIONS
  It was deduced that the anthrax outbreak occurred in Shaanxi province, China in 2015 was a local occurrence.
authors.affiliation: Shaanxi Provincial Center for Disease Control and Prevention, Shaanxi province, China.
authors.forename: Dong-Li
authors.initials: DL
authors.lastname: Liu
authors.affiliation: National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.|State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Hangzhou, China.
authors.forename: Jian-Chun
authors.initials: JC
authors.lastname: Wei
authors.affiliation: Division of Infectious Disease, China CDC, Beijing, China.
authors.forename: Qiu-Lan
authors.initials: QL
authors.lastname: Chen
authors.affiliation: Institute of Military Veterinary, AMMS, Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun, Jilin, China.
authors.forename: Xue-Jun
authors.initials: XJ
authors.lastname: Guo
authors.affiliation: National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.|State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Hangzhou, China.
authors.forename: En-Min
authors.initials: EM
authors.lastname: Zhang
authors.affiliation: Yan'an Prefecture Center for Disease Control and Prevention, Yan'an, Shaanxi Province, China.
authors.forename: Li
authors.initials: L
authors.lastname: He
authors.affiliation: National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.|State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Hangzhou, China.
authors.forename: Xu-Dong
authors.initials: XD
authors.lastname: Liang
authors.affiliation: Shaanxi Provincial Center for Disease Control and Prevention, Shaanxi province, China.
authors.forename: Guo-Zhu
authors.initials: GZ
authors.lastname: Ma
authors.affiliation: Division of Infectious Disease, China CDC, Beijing, China.
authors.forename: Ti-Cao
authors.initials: TC
authors.lastname: Zhou
authors.affiliation: Division of Infectious Disease, China CDC, Beijing, China.
authors.forename: Wen-Wu
authors.initials: WW
authors.lastname: Yin
authors.affiliation: Yan'an Prefecture Center for Disease Control and Prevention, Yan'an, Shaanxi Province, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Division of Infectious Disease, China CDC, Beijing, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Liu
authors.affiliation: Shaanxi Provincial Center for Disease Control and Prevention, Shaanxi province, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Yan'an Prefecture Center for Disease Control and Prevention, Yan'an, Shaanxi Province, China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Ji
authors.affiliation: National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.|State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Hangzhou, China.
authors.forename: Hui-Juan
authors.initials: HJ
authors.lastname: Zhang
authors.affiliation: Shaanxi Provincial Center for Disease Control and Prevention, Shaanxi province, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Ma
authors.affiliation: Yan'an Prefecture Center for Disease Control and Prevention, Yan'an, Shaanxi Province, China.
authors.forename: Fa-Xin
authors.initials: FX
authors.lastname: Zhang
authors.affiliation: National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.|State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Hangzhou, China.
authors.forename: Zhi-Kai
authors.initials: ZK
authors.lastname: Zhang
authors.affiliation: Division of Infectious Disease, China CDC, Beijing, China.
authors.forename: Hang
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Division of Infectious Disease, China CDC, Beijing, China.
authors.forename: Hong-Jie
authors.initials: HJ
authors.lastname: Yu
authors.affiliation: National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.|State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Hangzhou, China.
authors.forename: Biao
authors.initials: B
authors.lastname: Kan
authors.affiliation: National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.|State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Hangzhou, China.
authors.forename: Jian-Guo
authors.initials: JG
authors.lastname: Xu
authors.affiliation: Shaanxi Provincial Center for Disease Control and Prevention, Shaanxi province, China. myjshy@163.com.
authors.forename: Feng
authors.initials: F
authors.lastname: Liu
authors.affiliation: National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China. liwei@icdc.cn.|State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China. liwei@icdc.cn.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Hangzhou, China. liwei@icdc.cn.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
mesh_terms: D000818:Animals; D000881:Anthrax / Q000453:epidemiology* / Q000382:microbiology* / Q000635:transmission; D001408:Bacillus anthracis / Q000235:genetics*; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D017422:Sequence Analysis, DNA; D017192:Skin Diseases, Bacterial / Q000453:epidemiology* / Q000382:microbiology* / Q000635:transmission; D015047:Zoonoses / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission
keywords: Anthrax; Bacillus anthracis; China; MLVA; Molecular typing; Outbreak; SNR; Shaanxi province; canSNP