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1.
MMWR Recomm Rep. 2019 Dec 13;68(4):1-14. doi: 10.15585/mmwr.rr6804a1.

Use of Anthrax Vaccine in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2019.

Author information

1
Emory University School of Medicine, Atlanta, Georgia.
2
Baylor College of Medicine, Houston, Texas.
3
St. Louis University Medical School, St. Louis, Missouri.
4
Biomedical Advanced Research and Development Authority, Washington, DC.
5
Department of Defense, Atlanta, Georgia.
6
Food and Drug Administration, Washington, DC.
7
National Institutes of Health, Bethesda, Maryland.
8
National Institutes of Health, Bethesda, Maryland., American College of Obstetricians and Gynecologists.
9
Pittsburgh, Pennsylvania, Infectious Diseases Society of America.
10
Baltimore, Maryland, American Academy of Pediatrics.
11
Golden, Colorado, National Association of County and City Health Officials.
12
Orange, California.
13
United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland.
14
University of Utah, Salt Lake City, Utah.
15
Louisiana Office of Public Health, New Orleans, Louisiana.
16
CDC, Atlanta, Georgia.
17
CDC, Cincinnati, Ohio.

Abstract

This report updates the 2009 recommendations from the CDC Advisory Committee on Immunization Practices (ACIP) regarding use of anthrax vaccine in the United States (Wright JG, Quinn CP, Shadomy S, Messonnier N. Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices [ACIP)], 2009. MMWR Recomm Rep 2010;59[No. RR-6]). The report 1) summarizes data on estimated efficacy in humans using a correlates of protection model and safety data published since the last ACIP review, 2) provides updated guidance for use of anthrax vaccine adsorbed (AVA) for preexposure prophylaxis (PrEP) and in conjunction with antimicrobials for postexposure prophylaxis (PEP), 3) provides updated guidance regarding PrEP vaccination of emergency and other responders, 4) summarizes the available data on an investigational anthrax vaccine (AV7909), and 5) discusses the use of anthrax antitoxins for PEP. Changes from previous guidance in this report include the following: 1) a booster dose of AVA for PrEP can be given every 3 years instead of annually to persons not at high risk for exposure to Bacillus anthracis who have previously received the initial AVA 3-dose priming and 2-dose booster series and want to maintain protection; 2) during a large-scale emergency response, AVA for PEP can be administered using an intramuscular route if the subcutaneous route of administration poses significant materiel, personnel, or clinical challenges that might delay or preclude vaccination; 3) recommendations on dose-sparing AVA PEP regimens if the anthrax vaccine supply is insufficient to vaccinate all potentially exposed persons; and 4) clarification on the duration of antimicrobial therapy when used in conjunction with vaccine for PEP.These updated recommendations can be used by health care providers and guide emergency preparedness officials and planners who are developing plans to provide anthrax vaccine, including preparations for a wide-area aerosol release of B. anthracis spores. The recommendations also provide guidance on dose-sparing options, if needed, to extend the supply of vaccine to increase the number of persons receiving PEP in a mass casualty event.

PMID:
31834290
PMCID:
PMC6918956
DOI:
10.15585/mmwr.rr6804a1
[Indexed for MEDLINE]
Free PMC Article
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2.
BMC Infect Dis. 2019 Nov 7;19(1):940. doi: 10.1186/s12879-019-4508-z.

Different mechanisms of two anti-anthrax protective antigen antibodies and function comparison between them.

Author information

1
Epidemiological Department, Huadong Medical Institute of Biotechniques, Nanjing, 210002, China.
2
Key Laboratory of Antibody Technique of Ministry of Health, Nanjing Medical University, Nanjing, 210029, China.
3
Department of Pathology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, Guangdong, China.
4
National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
5
Key Laboratory of Antibody Technique of Ministry of Health, Nanjing Medical University, Nanjing, 210029, China. qitang@njmu.edu.cn.
6
Epidemiological Department, Huadong Medical Institute of Biotechniques, Nanjing, 210002, China. zhujin1968@njmu.edu.cn.
7
Key Laboratory of Antibody Technique of Ministry of Health, Nanjing Medical University, Nanjing, 210029, China. zhujin1968@njmu.edu.cn.

Abstract

BACKGROUND:

Bacillus anthracis causes a highly lethal infectious disease primarily due to toxin-mediated injury. Antibiotics are no longer effective to treat the accumulation of anthrax toxin, thereby new strategies of antibody treatment are essential. Two anti- anthrax protective antigen (PA) antibodies, hmPA6 and PA21, have been reported by our lab previously.

METHODS:

The mechanisms of the two antibodies were elucidated by Electrophoresis, Competitive Enzyme-linked immune sorbent assay, Western blot analysis and immunoprecipitation test, and in vitro, in vivo (F344 rats) treatment test. The epitopes of the two antibodies were proved by Western blot and Enzyme-linked immune sorbent assay with different domains of PA.

RESULTS:

In this study, we compared affinity and neutralization of these two antibodies. PA21 was better in protecting cells and rats, whereas hmPA6 had higher affinity. Furthermore, the neutralization mechanisms of the two antibodies and their recognition domains of PA were studied. The results showed that hmPA6 recognized domain IV, thus PA could not bind to cell receptors. Conversely, PA21 recognized domain II, thereby limiting heptamer oligomerization of PA63 in cells.

CONCLUSIONS:

Our studies elucidated the mechanisms and epitopes of hmPA6 and PA21. The present investigation can advance future use of the two antibodies in anthrax treatment or prophylaxis, and potentially as a combination treatment as the antibodies target different epitopes.

KEYWORDS:

Anthrax; Lethal toxin; Mechanism; Neutralizing antibody; Protective antigen

PMID:
31699037
PMCID:
PMC6836657
DOI:
10.1186/s12879-019-4508-z
[Indexed for MEDLINE]
Free PMC Article
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3.
Ann Agric Environ Med. 2019 Sep 19;26(3):392-395. doi: 10.26444/aaem/99669. Epub 2018 Dec 5.

Protective antigen domain 4 of <i>Bacillus anthracis</i> as a candidate for use as vaccine for anthrax.

Author information

1
Biological Threats Identification and Countermeasure Center of the General Karol Kaczkowski Military Institute of Hygiene and Epidemiology, Puławy, Poland.
2
Department of Didactics and Medical Simulation, Medical University, Lublin, Poland.

Abstract

Existing research for using the protective antigen (PA) of <i>Bacillus anthracis</i> as a vaccine component shows that protection against anthrax may be obtained using fragments of this protein. The aim of the research is to check whether the selected protein fragment of the protective antigen (domain 4) encoded by an appropriate nucleotide sequence of gene pag of <i>B. anthracis</i>, was expressed in the bacterial system of <i>E. coli</i>. In order to examine the selected sequence of the pag gene, a PCR reaction and a highly effective TOPO cloning strategy were used, followed by purification of the recombinant proteins and their detection by a western-blot method. In the planning of the PA4 antigen expression a higher level of effectiveness in production of small protein - domain 4 - was anticipated. As a result, the 139 amino acids protein fragment of <i>B. anthracis</i> PA (domain 4) was isolated. The research may have found the basis for in vivo research aimed at finding potential anthrax vaccine components.

KEYWORDS:

Bacillus anthracis; cloning pag gene; domain 4; protective antigen; protein; recombinant; vaccine

PMID:
31559791
DOI:
10.26444/aaem/99669
[Indexed for MEDLINE]
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4.
PLoS Negl Trop Dis. 2019 Aug 20;13(8):e0007644. doi: 10.1371/journal.pntd.0007644. eCollection 2019 Aug.

Development of a multiple-antigen protein fusion vaccine candidate that confers protection against Bacillus anthracis and Yersinia pestis.

Author information

1
Center for Vaccine Development and Global Health, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States of America.
2
BIOMET, University of Maryland School of Medicine, Baltimore, MD, United States of America.
3
Department of Pediatrics, University of Virginia School of Medicine, Box, Charlottesville, VA, United States of America.
4
The Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, United Kingdom.

Abstract

Bacillus anthracis and Yersinia pestis are zoonotic bacteria capable of causing severe and sometimes fatal infections in animals and humans. Although considered as diseases of antiquity in industrialized countries due to animal and public health improvements, they remain endemic in vast regions of the world disproportionally affecting the poor. These pathogens also remain a serious threat if deployed in biological warfare. A single vaccine capable of stimulating rapid protection against both pathogens would be an extremely advantageous public health tool. We produced multiple-antigen fusion proteins (MaF1 and MaF2) containing protective regions from B. anthracis protective antigen (PA) and lethal factor (LF), and from Y. pestis V antigen (LcrV) and fraction 1 (F1) capsule. The MaF2 sequence was also expressed from a plasmid construct (pDNA-MaF2). Immunogenicity and protective efficacy were investigated in mice following homologous and heterologous prime-boost immunization. Antibody responses were determined by ELISA and anthrax toxin neutralization assay. Vaccine efficacy was determined against lethal challenge with either anthrax toxin or Y. pestis. Both constructs elicited LcrV and LF-specific serum IgG, and MaF2 elicited toxin-neutralizing antibodies. Immunizations with MaF2 conferred 100% and 88% protection against Y. pestis and anthrax toxin, respectively. In contrast, pDNA-MaF2 conferred only 63% protection against Y. pestis and no protection against anthrax toxin challenge. pDNA-MaF2-prime MaF2-boost induced 75% protection against Y. pestis and 25% protection against anthrax toxin. Protection was increased by the molecular adjuvant CARDif. In conclusion, MaF2 is a promising multi-antigen vaccine candidate against anthrax and plague that warrants further investigation.

PMID:
31430284
PMCID:
PMC6716679
DOI:
10.1371/journal.pntd.0007644
[Indexed for MEDLINE]
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5.
Indian J Med Microbiol. 2019 Jan-Mar;37(1):116-119. doi: 10.4103/ijmm.IJMM_19_111.

Molecular confirmation of the circulating Bacillus anthracis during outbreak of anthrax in different villages of Simdega District, Jharkhand.

Author information

1
Department of Microbiology, RIMS, Ranchi, Jharkhand, India.
2
Rajiv Gandhi Super Speciality Hospital, New Delhi, India.

Abstract

Aims and Objectives:

Molecular confirmation of the circulating Bacillus anthracis during outbreak of anthrax in different villages of Simdega district, Jharkhand, India.

Materials and Methods:

Blood samples with swabs from skin lesions (eschar) were collected from the suspected cases of Anthrax from October 2014 to June 2016 from Simdega district, Jharkhand. All the swabs were inoculated on polymyxin lysozyme EDTA thallous acetate media, nutrient agar media as well as 5% sheep blood agar media. Gamma-phage lysis was done. DNA extraction was done using a QIAamp DNA Mini Kit (QIAGEN, Valencia, CA, USA) and subjected to polymerase chain reaction (PCR) using anthrax-specific primers.

Results:

On Gram and acid fast staining, purple rods and pink-coloured anthrax spores were detected. Capsular and M'Fadyean staining was done. Gamma-phage lysed B. anthracis culture. Of 39 suspected cases, 8 were culture and PCR positive and showed gamma-phage lysis. 3 deaths were reported.

Discussion and Conclusion:

The conventional and real-time PCR methods are suitable for both the clinical and the epidemiological practice.

KEYWORDS:

Bacillus anthracis; gamma-phase; outbreak; polymerase chain reaction

PMID:
31424022
DOI:
10.4103/ijmm.IJMM_19_111
[Indexed for MEDLINE]
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6.
BMC Vet Res. 2019 Jul 29;15(1):265. doi: 10.1186/s12917-019-1996-4.

An unusual case of bovine anthrax in the canton of Jura, Switzerland in 2017.

Author information

1
Institute of Veterinary Bacteriology, University of Bern, Bern, Switzerland.
2
Institute of Veterinary Bacteriology, University of Bern, Bern, Switzerland. sonja.kittl@vetsuisse.unibe.ch.
3
Institute of Animal Pathology, University of Bern, Bern, Switzerland.
4
Animal Health, General Management of Agriculture, Viticulture and Veterinary Affairs (DGAV), Canton of Vaud, Switzerland.
5
Vétérinaires Mont-Terri Sàrl, Courgenay, Switzerland.
6
Spiez Laboratory, Federal Office for Civil Protection, Spiez, Switzerland.
7
Interfaculty Bioinformatics Unit, University of Bern, Bern, Switzerland.
8
Institute of Geography and Centre for Development and Environment, University of Bern, Bern, Switzerland.

Abstract

BACKGROUND:

Anthrax caused by Bacillus anthracis is a zoonotic disease mainly affecting herbivores. The last Swiss outbreak was over 20 years ago. We describe a recent anthrax outbreak involving two cows from the same herd. One cow was designated as a peracute clinical case with sudden death and typical lung lesions, while the other cow presented with protracted fever and abortion.

CASE PRESENTATION:

On April 29th 2017, a 3.5-year-old Montbéliard dairy cow was found dead while out at pasture with haemorrhage from the nose. The veterinarian suspected pneumonia and performed a necropsy on site. Subsequently, a lung and liver sample were sent to the laboratory. Unexpectedly, Bacillus anthracis was isolated, a pathogen not found in Switzerland for decades. Several days later, a second cow from the same farm showed signs of abortion after protracted fever. Since these symptoms are not typical for anthrax, and the bacteria could not be demonstrated in blood samples from this animal, a necropsy was performed under appropriate biosafety measures. Subsequently, Bacillus anthracis could be isolated from the placenta and the sublumbal lymph nodes but not from the blood, liver, spleen and kidney. The outbreak strain (17OD930) was shown to belong to the lineage B.Br.CNEVA, the same as Swiss strains from previous outbreaks in the region. We speculate that the disease came from a temporarily opened cave system that is connected to an old carcass burial site and was flushed by heavy rainfall preceding the outbreak.

CONCLUSION:

Even in countries like Switzerland, where anthrax is very rare, new cases can occur after unusual weather conditions or ground disturbance. It is important for public officials to be aware of this risk to avoid possible spread.

KEYWORDS:

Abortion; Anthrax; Bovine; Cave; Switzerland

PMID:
31357988
PMCID:
PMC6664520
DOI:
10.1186/s12917-019-1996-4
[Indexed for MEDLINE]
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7.
EMBO J. 2019 Jul 1;38(13):e102494. doi: 10.15252/embj.2019102494. Epub 2019 Jun 12.

NLRP1 - One NLR to guard them all.

Author information

1
Department of Microbiology and Immunology, Center for Gastrointestinal Biology and Disease, and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Abstract

Microbial pathogens can be detected by inflammasomes that induce inflammation and programmed cell death. Inflammasomes are sensors that survey cells for signs of compromise. One of these sensors, NLRP1, detects anthrax lethal toxin; however, the mechanism of NLRP1 activation has remained unknown. Here, Xu et al discover NLRP1 cleavage by lethal toxin induces the N-end rule, which targets NLRP1 for degradation. Surprisingly, the active inflammasome fragment escapes the proteasome and becomes an activate inflammasome itself.

PMID:
31268605
PMCID:
PMC6600648
[Available on 2020-07-01]
DOI:
10.15252/embj.2019102494
[Indexed for MEDLINE]
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8.
Emerg Infect Dis. 2019 Jul;25(7):1261-1270. doi: 10.3201/eid2507.181493.

Bacillus cereus-Attributable Primary Cutaneous Anthrax-Like Infection in Newborn Infants, India.

Abstract

During March 13-June 23, 2018, anthrax-like cutaneous lesions attributed to the Bacillus cereus group of organisms developed in 12 newborns in India. We traced the source of infection to the healthcare kits used for newborn care. We used multilocus sequence typing to characterize the 19 selected strains from various sources in hospital settings, including the healthcare kits. This analysis revealed the existence of a genetically diverse population comprising mostly new sequence types. Phylogenetic analysis clustered most strains into the previously defined clade I, composed primarily of pathogenic bacilli. We suggest that the synergistic interaction of nonhemolytic enterotoxin and sphingomyelinase might have a role in the development of cutaneous lesions. The infection was controlled by removing the healthcare kits and by implementing an ideal housekeeping program. All the newborns recovered after treatment with ciprofloxacin and amikacin.

KEYWORDS:

Bacillus cereus; India; anthrax-like infections; bacteria; cutaneous; infants; nosocomial; toxins

PMID:
31211665
PMCID:
PMC6590766
DOI:
10.3201/eid2507.181493
[Indexed for MEDLINE]
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9.
PLoS One. 2019 May 22;14(5):e0209140. doi: 10.1371/journal.pone.0209140. eCollection 2019.

Insights from Bacillus anthracis strains isolated from permafrost in the tundra zone of Russia.

Author information

1
State Research Center for Applied Microbiology & Biotechnology (FBIS SRCAMB), Obolensk, Russia.
2
Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Univ. Paris-Sud, Université Paris-Saclay, Gif-sur-Yvette cedex, France.

Abstract

This article describes Bacillus anthracis strains isolated during an outbreak of anthrax on the Yamal Peninsula in the summer of 2016 and independently in Yakutia in 2015. A common feature of these strains is their conservation in permafrost, from which they were extracted either due to the thawing of permafrost (Yamal strains) or as the result of paleontological excavations (Yakut strains). All strains isolated on the Yamal share an identical genotype belonging to lineage B.Br.001/002, pointing to a common source of infection in a territory over 250 km in length. In contrast, during the excavations in Yakutia, three genetically different strains were recovered from a single pit. One strain belongs to B.Br.001/002, and whole genome sequence analysis showed that it is most closely related to the Yamal strains in spite of the remoteness of Yamal from Yakutia. The two other strains contribute to two different branches of A.Br.008/011, one of the remarkable polytomies described so far in the B. anthracis species. The geographic distribution of the strains belonging to A.Br.008/011 is suggesting that the polytomy emerged in the thirteenth century, in combination with the constitution of a unified Mongol empire extending from China to Eastern Europe. We propose an evolutionary model for B. anthracis recent evolution in which the B lineage spread throughout Eurasia and was subsequently replaced by the A lineage except in some geographically isolated areas.

PMID:
31116737
PMCID:
PMC6530834
DOI:
10.1371/journal.pone.0209140
[Indexed for MEDLINE]
Free PMC Article
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10.
Nat Microbiol. 2019 Aug;4(8):1337-1343. doi: 10.1038/s41564-019-0435-4. Epub 2019 May 13.

The global distribution of Bacillus anthracis and associated anthrax risk to humans, livestock and wildlife.

Author information

1
National Socio-Environmental Synthesis Center, University of Maryland, Annapolis, MD, USA.
2
Department of Biology, Georgetown University, Washington, Washington DC, USA.
3
Spatial Epidemiology & Ecology Research Lab, Department of Geography, University of Florida, Gainesville, FL, USA.
4
Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
5
EcoHealth Alliance, New York, NY, USA.
6
Department of Fish and Wildlife Conservation, Virginia Tech, Blacksburg, VA, USA.
7
School of the Coast and Environment, Louisiana State University, Baton Rouge, LA, USA.
8
AgriBio, Centre for Agribiosciences, Biosciences Research, Department of Economic Development, Jobs, Transport and Resources, Bundoora, Victoria, Australia.
9
Department of Environment and Natural Resources, Government of the Northwest Territories, Yellowknife, Northwest Territories, Canada.
10
Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
11
Parks Canada Agency, Saskatoon, Saskatchewan, Canada.
12
Center for Disease Surveillance & Research, Institute of Disease Control and Prevention of PLA, Beijing, China.
13
Scientific Research Veterinary Institute, Baku, Azerbaijan.
14
Department of Environmental Science, Policy, and Management, University of California, Berkeley, Berkeley, CA, USA.
15
Spatial Epidemiology & Ecology Research Lab, Department of Geography, University of Florida, Gainesville, FL, USA. jkblackburn@ufl.edu.
16
Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA. jkblackburn@ufl.edu.

Abstract

Bacillus anthracis is a spore-forming, Gram-positive bacterium responsible for anthrax, an acute infection that most significantly affects grazing livestock and wild ungulates, but also poses a threat to human health. The geographic extent of B. anthracis is poorly understood, despite multi-decade research on anthrax epizootic and epidemic dynamics; many countries have limited or inadequate surveillance systems, even within known endemic regions. Here, we compile a global occurrence dataset of human, livestock and wildlife anthrax outbreaks. With these records, we use boosted regression trees to produce a map of the global distribution of B. anthracis as a proxy for anthrax risk. We estimate that 1.83 billion people (95% credible interval (CI): 0.59-4.16 billion) live within regions of anthrax risk, but most of that population faces little occupational exposure. More informatively, a global total of 63.8 million poor livestock keepers (95% CI: 17.5-168.6 million) and 1.1 billion livestock (95% CI: 0.4-2.3 billion) live within vulnerable regions. Human and livestock vulnerability are both concentrated in rural rainfed systems throughout arid and temperate land across Eurasia, Africa and North America. We conclude by mapping where anthrax risk could disrupt sensitive conservation efforts for wild ungulates that coincide with anthrax-prone landscapes.

PMID:
31086311
DOI:
10.1038/s41564-019-0435-4
[Indexed for MEDLINE]
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11.
PLoS One. 2019 May 2;14(5):e0215228. doi: 10.1371/journal.pone.0215228. eCollection 2019.

Risk factors associated with the occurrence of anthrax outbreaks in livestock in the country of Georgia: A case-control investigation 2013-2015.

Author information

1
Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, United States of America.
2
Centers for Disease Control and Prevention (CDC), Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Atlanta, Georgia, United States of America.
3
National Food Agency (NFA) of Ministry of Environmental Protection and Agriculture of Georgia (MEPA), Tbilisi, Georgia.
4
Department of Rural Development and Vocational Education (DRDVE) of Georgian Institute of Public Affairs (GIPA), Tbilisi, Georgia.
5
National Center for Disease Control and Prevention, Tbilisi, Georgia.
6
Laboratory of the Ministry of Agriculture (LMA), Tbilisi, Georgia.
7
CDC One Health Office, NCEZID, Atlanta, Georgia, United States of America.

Abstract

INTRODUCTION:

Anthrax is considered endemic in livestock in Georgia. In 2007, the annual vaccination became the responsibility of livestock owners, while contracting of private veterinarians was not officially required. Six years later, due to increase in human outbreaks associated with livestock handling, there is a need to find out the risk factors of livestock anthrax in Georgia.

OBJECTIVE:

To identify exposures and risk factors associated with livestock anthrax.

METHODS:

A matched case-control study design was used to recruit the owners of individual livestock anthrax cases that occurred between June 2013 and May 2015, and owners of unaffected livestock from within ("village control") and outside the village ("area control"). We collected data about the case and control livestock animals' exposure and risk factors within the one-month prior to the disease onset of the case livestock (or matched case for the controls). We used logistic regression analysis (univariate and multivariable) to calculate the odds ratios of exposures and risk factors.

RESULTS:

During the study period, 36 anthrax cases met the case definition and were enrolled in the study; 67 matched village control livestock and 71 matched area control livestock were also enrolled. The findings from multivariable logistic regression analysis demonstrate that vaccination within the last two years significantly reduced the odds of anthrax in cattle (OR = 0.014; 95% Confidence interval = <0.001, 0.99). The other factors that were significantly protective against anthrax were 'animals being in covered fence area/barn' (OR = 0.065; p-value = 0.036), and 'female animal being pregnant or milking compared to heifer' (OR = 0.006; p-value = 0.037).

CONCLUSIONS:

The information obtained from this study has involved and been presented to decision makers, used to build technical capacity of veterinary staff, and to foster a One Health approach to the control of zoonotic diseases which will optimize prevention and control strategies. Georgia has embedded the knowledge and specific evidence that vaccination is a highly protective measure to prevent anthrax deaths among livestock, to which primary emphasis of the anthrax control program will be given. Education of livestock keepers in Georgia is an overriding priority.

PMID:
31048838
PMCID:
PMC6497231
DOI:
10.1371/journal.pone.0215228
[Indexed for MEDLINE]
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12.
Emerg Infect Dis. 2019 May;25(5):947-950. doi: 10.3201/eid2505.180867.

Anthrax Epizootic in Wildlife, Bwabwata National Park, Namibia, 2017.

Abstract

In late September 2017, Bwabwata National Park in Namibia experienced a sudden die-off of hippopotamuses and Cape buffalo. A multiorganizational response was initiated, involving several ministries within Namibia and the US Centers for Disease Control and Prevention. Rapid interventions resulted in zero human or livestock cases associated with this epizootic.

KEYWORDS:

Africa; Bacillus anthracis; Namibia; anthrax; bacteria; control; epizootic; wildlife; zoonoses

PMID:
31002072
PMCID:
PMC6478215
DOI:
10.3201/eid2505.180867
[Indexed for MEDLINE]
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13.
Clin Dermatol. 2019 Mar - Apr;37(2):99-108. doi: 10.1016/j.clindermatol.2018.12.003. Epub 2018 Dec 5.

The rash that leads to eschar formation.

Author information

1
Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA.
2
Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA. Electronic address: vampireted@aol.com.

Abstract

When confronted with an existent or evolving eschar, the history is often the most important factor used to put the lesion into proper context. Determining whether the patient has a past medical history of significance, such as renal failure or diabetes mellitus, exposure to dead or live wildlife, or underwent a recent surgical procedure, can help differentiate between many etiologies of eschars. Similarly, the patient's overall clinical condition and the presence or absence of fever can allow infectious processes to be differentiated from other causes. This contribution is intended to help dermatologists identify and manage these various dermatologic conditions, as well as provide an algorithm that can be utilized when approaching a patient presenting with an eschar.

[Indexed for MEDLINE]
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14.
ACS Appl Mater Interfaces. 2019 May 1;11(17):15998-16005. doi: 10.1021/acsami.9b01123. Epub 2019 Apr 17.

Multiporous Terbium Phosphonate Coordination Polymer Microspheres as Fluorescent Probes for Trace Anthrax Biomarker Detection.

Author information

1
Shanghai Key Laboratory of Functional Materials Chemistry, School of Chemistry and Molecular Engineering , East China University of Science and Technology , Shanghai 200237 , China.
2
Department of Pharmacy , Anhui Medical College , Hefei 230601 , China.

Abstract

Lanthanide coordination polymers have been recently regarded as attractive sensing materials because of their selectivity, high sensitivity, and rapid response ability. In this research, the multiporous terbium phosphonate coordination polymer microspheres (TbP-CPs) were prepared as a novel fluorescent probe, which showed a fluorescence turn-on response capability for the detection of the trace anthrax biomarker dipicolinate acid (DPA). The morphology and chemical composition of as-prepared TbP-CPs were characterized in detail. The TbP-CPs have the vegetable-flower-like structure and microporous surface. In addition, the as-prepared TbP-CPs not only possess the merits of convenience and simple preparation with high yield but also have the excellent characters as fluorescent probes, such as high stability, good selectivity, and rapid detection ability within 30 s. This proposed sensor could detect DPA with a linear relationship in concentrations ranging from 0 to 8.0 μM and a high detection sensitivity of 5.0 nM. Furthermore, the successful applications of DPA detection in urine and bovine serum were demonstrated. As a result, the recovery ranged from 93.93-101.6%, and the relative standard deviations (RSD) were less than 5%.

KEYWORDS:

Biomarker; Coordination Polymers; Dipicolinate Acid; Fluorescent Probe; Terbium Phosphonate

PMID:
30951283
DOI:
10.1021/acsami.9b01123
[Indexed for MEDLINE]
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15.
Vet Med Sci. 2019 Aug;5(3):419-427. doi: 10.1002/vms3.168. Epub 2019 Mar 28.

Risk mapping and eco-anthropogenic assessment of anthrax in the upper Zambezi basin.

Author information

1
Department of Disease Control, School of Veterinary Medicine, The University of Zambia, Lusaka, Zambia.
2
Centre International de Recherche Agricole pour le Dévelopement, UPR AGIRs, Montpellier, France.
3
Department of Biological Sciences, RP-PCP, University of Zimbabwe, Harare, Zimbabwe.
4
Department of Para Clinical Studies, School of Veterinary Medicine, The University of Zambia, Lusaka, Zambia.

Abstract

In Zambia, anthrax has emerged as a serious disease decimating humans, livestock and wildlife with devastating effects on eco-tourism resulting in the destabilization of major pristine wildlife sanctuaries. Consequently, the thrust of this study was to establish the spatial distribution of anthrax and determine ecological drivers of its recurrence, maintenance and epidemiological linkage to anthropogenic activities. Environmental and biological samples were collected within the livestock production and conservation areas (n = 80). Each sample was serially tested for Bacillus anthracis positivity through blood agar culture and Gram stain technique, and then confirmation by multiplex polymerase chain reaction (MPCR). Questionnaires (n = 113) were conducted at independently distinct villages in terms of space and time. Most respondents showed that animals that died from anthrax were not properly disposed off. More likely than not, poverty being the main driver for anthrax carcass dressing and meat distribution contributed to environmental contamination with anthrax spores in areas where the animals subsequently died resulting in further environmental contamination, which is the major source of primary infection for livestock and wildlife. From the samples, 15 pure isolates of anthrax were obtained which were spatially distributed across four districts. Twelve, biologically plausible variables were found to be highly significant on multivariable logistic regression analysis model for questionnaires which included herd size (odds = 10.46; P = 0.005; CI 8.8-16), carcass disposal method (odds = 6.9; P = 0.001; CI = 3.4-9.8), access to veterinary services (odds = 10.87; P = 0.004; CI = 4.8-15.9) and management system (odds = 2.57; P = 0.001; CI = 1.3-7.5). In summary, the majority (78.7%) of anthrax outbreaks were observed in areas with low veterinary services (χ2  = 8.6162, P = 0.013) within the newly created districts of Nalolo, Mwandi and Luampa.

KEYWORDS:

Zambia; anthrax; eco-anthropology; recurrence; risk mapping

PMID:
30920176
PMCID:
PMC6682801
DOI:
10.1002/vms3.168
[Indexed for MEDLINE]
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16.
Anal Bioanal Chem. 2019 May;411(12):2493-2509. doi: 10.1007/s00216-019-01730-4. Epub 2019 Mar 26.

Zeptomole per milliliter detection and quantification of edema factor in plasma by LC-MS/MS yields insights into toxemia and the progression of inhalation anthrax.

Author information

1
Battelle Atlanta Analytical Services, 2987 Clairmont Road NE, Suite 450, Atlanta, GA, 30329, USA.
2
Centers for Disease Control and Prevention, 4770 Buford Highway Mailstop F-50, Atlanta, GA, 30341, USA. aboyer@cdc.gov.
3
Centers for Disease Control and Prevention, 4770 Buford Highway Mailstop F-50, Atlanta, GA, 30341, USA.
4
Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA.
5
Laboratory of Parasitic Diseases, NIAID, NIH, 9000 Rockville Pike, Bethesda, MD, 20892, USA.
6
Center for Innovation in Advanced Development and Manufacturing, Texas A&M University Health Science Center, 8441 Riverside Parkway, Suite 3200, Bryan, TX, 77807, USA.
7
Laboratory of Infectious Diseases, National Institute for Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, MD, 20892, USA.

Abstract

Inhalation of Bacillus anthracis spores can cause a rapidly progressing fatal infection. B. anthracis secretes three protein toxins: lethal factor (LF), edema factor (EF), and protective antigen (PA). EF and LF may circulate as free or PA-bound forms. Both free EF (EF) and PA-bound-EF (ETx) have adenylyl cyclase activity converting ATP to cAMP. We developed an adenylyl cyclase activity-based method for detecting and quantifying total EF (EF+ETx) in plasma. The three-step method includes magnetic immunocapture with monoclonal antibodies, reaction with ATP generating cAMP, and quantification of cAMP by isotope-dilution HPLC-MS/MS. Total EF was quantified from 5PL regression of cAMP vs ETx concentration. The detection limit was 20 fg/mL (225 zeptomoles/mL for the 89 kDa protein). Relative standard deviations for controls with 0.3, 6.0, and 90 pg/mL were 11.7-16.6% with 91.2-99.5% accuracy. The method demonstrated 100% specificity in 238 human serum/plasma samples collected from unexposed healthy individuals, and 100% sensitivity in samples from 3 human and 5 rhesus macaques with inhalation anthrax. Analysis of EF in the rhesus macaques showed that it was detected earlier post-exposure than B. anthracis by culture and PCR. Similar to LF, the kinetics of EF over the course of infection were triphasic, with an initial rise (phase-1), decline (phase-2), and final rapid rise (phase-3). EF levels were ~ 2-4 orders of magnitude lower than LF during phase-1 and phase-2 and only ~ 6-fold lower at death/euthanasia. Analysis of EF improves early diagnosis and adds to our understanding of anthrax toxemia throughout infection. The LF/EF ratio may also indicate the stage of infection and need for advanced treatments.

KEYWORDS:

Adenylyl cyclase; Anthrax; Cyclic AMP; Edema toxin; HPLC; Mass spectrometry

PMID:
30911800
DOI:
10.1007/s00216-019-01730-4
[Indexed for MEDLINE]
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17.
Ann Intern Med. 2019 Apr 16;170(8):521-530. doi: 10.7326/M18-1817. Epub 2019 Mar 19.

Development and Performance of a Checklist for Initial Triage After an Anthrax Mass Exposure Event.

Author information

1
Centers for Disease Control and Prevention, Atlanta, Georgia, and Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York (N.H.).
2
Centers for Disease Control and Prevention, Atlanta, Georgia (M.P., R.M.T., W.A.B., K.H.).
3
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, George Washington University, Washington, DC, and Inova Fairfax Hospital, Falls Church, Virginia (D.H.).

Abstract

Background:

Population exposure to Bacillus anthracis spores could cause mass casualties requiring complex medical care. Rapid identification of patients needing anthrax-specific therapies will improve patient outcomes and resource use.

Objective:

To develop a checklist that rapidly distinguishes most anthrax from nonanthrax illnesses on the basis of clinical presentation and identifies patients requiring diagnostic testing after a population exposure.

Design:

Comparison of published anthrax case reports from 1880 through 2013 that included patients seeking anthrax-related care at 2 epicenters of the 2001 U.S. anthrax attacks.

Setting:

Outpatient and inpatient.

Patients:

408 case patients with inhalation, ingestion, and cutaneous anthrax and primary anthrax meningitis, and 657 control patients.

Measurements:

Diagnostic test characteristics, including positive and negative likelihood ratios (LRs) and patient triage assignation.

Results:

Checklist-directed triage without diagnostic testing correctly classified 95% (95% CI, 93% to 97%) of 353 adult anthrax case patients and 76% (CI, 73% to 79%) of 647 control patients (positive LR, 3.96 [CI, 3.45 to 4.55]; negative LR, 0.07 [CI, 0.04 to 0.11]; false-negative rate, 5%; false-positive rate, 24%). Diagnostic testing was needed for triage in up to 5% of case patients and 15% of control patients and improved overall test characteristics (positive LR, 8.90 [CI, 7.05 to 11.24]; negative LR, 0.06 [CI, 0.04 to 0.09]; false-negative rate, 5%; false-positive rate, 11%). Checklist sensitivity and specificity were minimally affected by inclusion of pediatric patients. Sensitivity increased to 97% (CI, 94% to 100%) and 98% (CI, 96% to 100%), respectively, when only inhalation anthrax cases or higher-quality case reports were investigated.

Limitations:

Data on case patients were limited to nonstandardized, published observational reports, many of which lacked complete data on symptoms and signs of interest. Reporting bias favoring more severe cases and lack of intercurrent outbreaks (such as influenza) in the control populations may have improved test characteristics.

Conclusion:

A brief checklist covering symptoms and signs can distinguish anthrax from other conditions with minimal need for diagnostic testing after known or suspected population exposure.

Primary Funding Source:

U.S. Department of Health and Human Services.

PMID:
30884525
DOI:
10.7326/M18-1817
[Indexed for MEDLINE]
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18.
Pan Afr Med J. 2018 May 18;30(Suppl 1):12. doi: 10.11604/pamj.supp.2018.30.1.15279. eCollection 2018.

Investigation of anthrax in an endemic region in Kenya: a mixed methods approach.

Author information

1
Kenya Field Epidemiology and Laboratory Training Program, Kenya.
2
Rollins School of Public Health, Emory University, USA.
3
Nambia Field Epidemiology and Laboratory Training Program, Nambia.
4
School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Rwanda.

Abstract

In Kenya, human anthrax cases most often occur linked to animal anthrax. In most cases, human behaviors, especially slaughter and consumption of meat from animal anthrax cases, has been implicated. This case study is based on an anthrax outbreak investigation conducted in an endemic region in Kenya in May 2016.The case study simulates how a mixed methods approach can be used in epidemiologic research.To fully benefit from this case study, participants should have had prior lectures or other instruction in quantitative and qualitative study designs and sampling approachesused in epidemiologic research. The case study is ideally suited for trainees at intermediate or advance level training in field epidemiology who should be able to complete the case study in approximately 3 hours.

KEYWORDS:

Kenya; Outbreak investigation; anthrax; mixed methods

[Indexed for MEDLINE]
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19.
BMC Infect Dis. 2019 Feb 27;19(1):197. doi: 10.1186/s12879-019-3836-3.

Fatal community-acquired Bacillus cereus pneumonia in an immunocompetent adult man: a case report.

Author information

1
Department of Emergency and Critical Care Medicine, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan. r-ishida@med.shimane-u.ac.jp.
2
Department of Emergency and Critical Care Medicine, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan.
3
Department of Pathology, Shimane Prefectural Central Hospital, Izumo, Japan.
4
Department of Molecular Oncology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
5
Department of Pathology, Haruhi Respiratory Medical Hospital, Kiyosu, Aichi, Japan.
6
Department of Cardiology, Shimane Prefectural Central Hospital, Izumo, Japan.

Abstract

BACKGROUND:

Bacillus cereus is a gram-positive rod bacterium that is responsible for food poisoning. It is naturally widely distributed, and thus often contaminates cultures. Although it is rarely considered responsible, it can cause serious infections under certain conditions. However, lethal infections, especially in immunocompetent patients, are rare.

CASE PRESENTATION:

A healthy 60-year-old man developed community-acquired B. cereus pneumonia and alveolar hemorrhage unveiled by abrupt chest pain and hemoptysis with no other advance symptoms. B. cereus induced silent alveolar destruction without any local or systemic inflammatory response. Although the lesion resembled lung anthrax, there was no evidence of Bacillus anthracis toxin.

CONCLUSIONS:

Some isolates of B. cereus can cause anthrax-like fulminant necrotizing pneumonia in immunocompetent patients. If this type of B. cereus were used as a means of bioterrorism, it may be quite difficult to recognize as bioterrorism. We should keep B. cereus in mind as a potential pathogen of fulminant human infectious disease.

KEYWORDS:

Anthrax-like toxin; Bacillus cereus; Community-acquired infection

PMID:
30813918
PMCID:
PMC6391836
DOI:
10.1186/s12879-019-3836-3
[Indexed for MEDLINE]
Free PMC Article
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20.
J Forensic Sci. 2019 Sep;64(5):1304-1311. doi: 10.1111/1556-4029.14034. Epub 2019 Feb 22.

An Overview of Zoonotic Disease Outbreaks and its Forensic Management Over Time.

Author information

1
CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Avenida da Universidade Técnica, 1300-477, Lisbon, Portugal.
2
Faculdade de Ciências da Universidade de Lisboa e Centro de Estudos do Ambiente e do Mar (CESAM), Campo Grande, 1749-016, Lisboa, Portugal.

Abstract

Most emerging or re-emerging infections are vector-borne or zoonotic and can be disseminated worldwide by infected humans or animals. They are a major public health problem and cause a great impact on economy. Zoonotic outbreaks began to be characterized in the 90s, after the creation of Europol and the FBI. Such investigations are carried by forensic pathologists and other specialists to determine whether an outbreak is natural or deliberate. This review will discuss ten zoonotic outbreaks nonrelated to wars focusing on forensic management. In conclusion, some points should be highlighted in the management of a zoonotic outbreak: (i) its diagnosis and detection by forensic pathologists and the coordination of efforts between other specialists are key factors; (ii) communication guidelines and an efficient healthcare system are crucial for any emergency response; (iii) biosafety of all specialists involved must be guaranteed.

KEYWORDS:

biocrime; biosafety; biosurveillance; bioterror; communication; forensic science; investigation agencies; management; zoonoses

PMID:
30801721
DOI:
10.1111/1556-4029.14034
[Indexed for MEDLINE]
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