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A retrospective cohort analysis was conducted in Kazakhstan to define modifiable risk factors during seven outbreaks of human anthrax. Fifty-three cases and 255 non-ill persons with an epidemiologic link to an infected animal were enrolled. Cases were 58% male and had a median age of 35 years (range = 5–71). Nearly all cases had cutaneous disease (96%). Two patients (4%) were diagnosed with gastrointestinal disease. Although all cases had some contact with an infected animal other than consumption, in multivariable analysis the act of butchering an animal (relative risk [RR] = 3.6, 95% confidence interval [CI] = 1.5–9.6) and the presence of visible cuts on the hands were associated with anthrax (RR = 3.0, 95% CI = 0.9–9.6). Contact with infected livestock, in particular butchering, is associated with developing anthrax. The risk may be exacerbated by the presence of cuts on the hands at the time of contact with the animal or animal products.
Received November 12, 2003. Accepted for publication January 4, 2004.
Acknowledgments: We gratefully acknowledge Terence Chorba, Susan Lloyd, Gulzhan Muratbayeva, Larissa Vakhmistrova, Eugene Greenberg, and Nancy Rosenstein (Centers for Disease Control and Prevention), the Almaty City SES, the Akmola Rayon SES, the Zhambyl Oblast SES, the Zhambyl Rayon SES, the Atyrau Oblast SES, the East Kazakhstan Oblast SES, and the Veterinary Border Patrol for their efforts in this study.
Financial support: All authors were employees of either the U.S. Centers for Disease Control and Prevention or the Kazakhstan SES at the time of the study.
Disclaimer: Use of trade names and commercial sources is for identification purposes only and does not imply endorsement by the U.S. Public Health Service or the U.S. Department of Health and Human Services.
Authors’ addresses: Christopher W. Woods, Division of Infectious Diseases, Duke University Medical Center, Service 113, 508 Fulton Street, Durham, NC 27705. Kenes Ospanov, Republican Sanitary Epidemiologic Station, 84 Auezov Street, Almaty, Kazakhstan 480008, Telephone: 7-3272-432-655, Mobile Telephone: 8-300-312-2234, E-mail: rses{at}netmail.kz. Akylbek Myrzabekov, Republican Sanitary Epidemiologic Station, 84 Auezov Street, Almaty, Kazakhstan 480008. Michael Favorov, 41 Kazybek bi Street, Almaty, Kazakhstan 480100, Telephone: 7-3272-507612/7, extension 450, E-mail: mfavorov{at}usaid.gov. Brian Plikaytis, National Center for Infectious Diseases, Mailstop C-09, Centers for Disease Control and Prevention, Atlanta, GA 30033, Telephone: 404-639-4711, Fax: 404-639-2780, E-mail: bdp1{at}cdc.gov. David A. Ashford, National Center for Environmental Health, Mailstop F-38, Centers for Disease Control and Prevention, Atlanta, GA 30030, Telephone: 770-488-7446, Fax: 770-488-4127, E-mail: dba4{at}cdc.gov.
Reprint requests: Christopher W. Woods, Division of Infectious Diseases, Duke University Medical Center, Service 113, 508 Fulton Street, Durham, NC 27705, Telephone: 919-286-0411 extension 6681, Fax: 919-286-6818, E-mail: woods004{at}mc.duke.edu.
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