1. ANTHRAX KNOW THE FACTS and Your Role for Prevention Bangladesh CO Focal Point/Emergency Health Management Sep 6, 2010

2. Questions About Anthrax  What is Anthrax?  What are the symptoms and effects of Anthrax?  What is the treatment for Anthrax?  What is Bangladesh situation & Responses ?  How to prevent and way forward?

3. What is Anthrax ?  Anthrax is a bacterial, zoonotic disease caused by Bacillus Anthracis.  Anthrax occurs in domesticated and wild animals, including goats, sheep, cattle, horses and deer.  In humans it is an acute bacterial infection of the skin, lungs or gastrointestinal tract.  Infection occurs most commonly via the skin.

4. History  Anthrax is one of the oldest diseases of grazing animals such as sheep and cattle  Is believed to be the Fifth Plague mentioned in the Book of Exodus in the Bible.FifthPlagueBook of ExodusBible  Anthrax is also mentioned by Homer in The IliadHomer Iliad  Biological weapon – in 2001, envelops powders containing Anthrax spores were posted through USA Postal department

5. How Transmitted ?  The skin form of the disease is contracted by handling contaminated hair, wool, hides, flesh, blood or excreta of infected animals.  Infection is introduced through scratches or abrasions of the skin, wounds, inhalation of spores, eating insufficiently cooked infected meat or from flies.

6. Anthrax Cycle

7. What is the route of Anthrax transmission?  Cuteneous (skin)  Pulmonary (inhalation of spores)  Gastrointestinal (ingestion)

8.  The cutaneous or skin form of the infection occurs most frequently on the hands and forearms of persons working with infected livestock or contaminated animal products and represents 95% of cases of human Anthrax.

9.  It is initially characterized by a small solid elevation of the skin, which progresses to a fluid-filled blister with swelling at the site of infection.  The scab that typically forms over the lesion can be black as coal, hence the name Anthrax, which is the Greek word for coal

10. Eschar Formation Day 2

11. Pulmonary (through inhalation)  The inhaled form of Anthrax is contracted by inhalation of the spores and occurs mainly among workers handling infected animal hides, wool and furs.  Under natural conditions, inhaled Anthrax is rare.

12. Pulmonary  After an incubation period of 1-7 days, the onset of inhalation Anthrax is gradual.  Symptoms include:  Fever  Malaise  Fatigue  Cough  Mild chest discomfort followed by severe respiratory distress.

13. Gastrointestinal (ingestion)  Gastrointestinal infection in humans is most often caused by eating anthrax-infected meat  characterized by  serious gastrointestinal difficulty  vomiting of blood, severe diarrhea, acute inflammation of the intestinal tract, and loss of appetite vomiting

14. Sign symptoms in animals  Fever  Excitement followed by depression  Difficulty in breathing  Convulsion  Death

15. Bangladesh situation and response  298 infected till Sunday (Sep 5, 2010)  44 new cases in last two days  All infected with Cuteneous Anthrax  Have history of consuming or come in contact of meat of animals that were slaughtered after fallen ill on different occasions.

16. Bangladesh situation and response  Six districts affected.  Sirajganj on August 20 (first district) and then it spread out into  Pabna on August 22,  Tangail on August 31,  Kushtia on September 1 and  Meherpur and Chuadanga on September 4.

17. Bangladesh situation and response  RED ALERT –issued by government after spreading to newer districts  HIGH ALERT : Civil Surgeons and Livestock Dept  Cattle vaccines have been sent to the affected areas.  Public awareness planned by GOB

18. What is the Treatment for Anthrax?  Early treatment with the appropriate antibiotics ( Penicillin, doxycycline, ciprofloxacin, are effective against most strains of the disease).  Symptomatic management with proper consultation with doctors/health workers  Anthrax does not spread from one person to another.

19. Prevention  Not to be panicked – Take precautions  Avoidance of contaminated meat.  Disposal of any material soiled by the infected animals by burning  Anthrax does not spread from one person to another but decontamination of used clothes of the infected persons should be done.

20. Prevention  Strong vigilance that the infected animals are not slaughtered or not transferred to the non infected areas.  The dead body of the infected animal should be buried by digging 2 meters from the surface  The body openings of the dead animals should be closed by using gloves  A cattle vaccine is available.

21. What SC should be doing?  For SC staff Staff awareness  Orientation package development with basic facts, prevention methods, treatment and reference in handout in Bangla and English  Circulate materials and its updates  Establish Information tree and emergency contact for IAOs and staff (need to form a Core team including CO, IAOs) Collaboration and liaison with Government/MOH  For SC Partners and Target populations Share materials and information for onward dissemination Reporting to SC

22. Conclusions  May spread across a large area and need public awareness  Need a great deal of planning to protect the public health  Cooperation between the Health and Livestock departments  Need to be part of planning and responses with Government

23. References  WHO website  CDC website fact sheet  Government of Bangladesh