Anthrax

Question 1

Is anthrax nationally notifiable?

Answer 1

Yes - urgent, labs and doctors

Question 2

What is the organism that causes anthrax?

Answer 2

Bacillus anthracis

Spore-forming bacterium that can survive in harsh conditions.

Question 3

What is the reservoir for anthrax?

Answer 3

• Present in soil
• Infects grazing animals including livestock in Australia (several cases per year)
• Persists in processed skin/hides of infected animals

Question 4

What are the transmission routes of anthrax?

Answer 4

Via infectious animals and their products.

• Percutaneous (through cuts/abrasions when contact with infected live/dead animals, products e.g. hides / wool, rarely soil)
• Inhalation (inhaling spores)
• Ingestion (eating undercooked meat)

Question 5

What are the clinical features of antrax?

Answer 5

• Cutaenous
• Respiratory
• Gastrointestinal

Question 6

What are the clinical features of cutaneous anthrax?

Answer 6

Papule 🡪 vesicle 🡪 erosion 🡪 necrotic ulcer, LA, sepsis.

Cutaneous anthrax is characterized by a skin lesion that progresses through several stages.

Question 7

What is the case fatality rate (CFR) for untreated cutaneous anthrax?

Answer 7

20%

Death is rare if treated.

Question 8

What are the clinical features of respiratory anthrax?

Answer 8

ILI 🡪 respiratory failure/shock; almost always fatal.

Respiratory anthrax is most severe and has a high mortality rate.

Question 9

What are the clinical features of gastrointestinal anthrax?

Answer 9

Vomiting, fever, abdo pain, diarrhoea, haematemesis. CFR 25-60%.

Question 10

What is the incubation period for anthrax?

Answer 10

Approx 1 week but varies by disease site:
* Cutaneous - 3-10 days
* Pulmonary - 1-7 days
* Gastro - 3-7 days

Incubation periods can vary based on the route of infection.

Question 11

What high-risk groups are prone to anthrax exposure?

Answer 11

• Handlers of processed hides
• Goat hair and bone products
• Wool and infected wildlife handlers
• Abbatoir/knackery/pet food factory workers

These groups are at increased risk due to their occupational exposure to infected materials.

Question 12

How is anthrax diagnosed?

Answer 12

• Culture from blood, CSF, sputum, nasal, wound, other
• PCR also available

Ref lab MDU

Question 13

What are the case definitions for anthrax?

Answer 13

Confirmed only:
* Isolation of organisms/ spores OR
* PCR/smear + one of four clinical syndromes

Question 14

What is the outbreak definition for anthrax?

Answer 14

Single case could indicate outbreak.

Anthrax is highly infectious, and even one case warrants investigation.

Question 15

T / F: anthrax is rare in Australia

Answer 15

True - 3 cases since 2001.

“Anthrax belt” - central-East QLD into Vic

Question 16

When was anthrax used as a bioterrorism agent?

Answer 16

USA 2001 via mail - 22 cases

Question 17

How is anthrax prevented?

Answer 17

• Use of PPE (gloves, overalls, rubber boots)
• Proper care of skin abrasions
• Proper ventilation in hazardous industries
• Sterilization of hides/wool/bone meal
• Hand hygiene
• Thoroughly cooking meat

Preventive measures are crucial for individuals at risk of exposure.

Question 18

What is the current status of human vaccines for anthrax in Australia?

Answer 18

No human vaccine currently available in Aus.

However, an animal vaccine exists.

Question 19

What should be done if a suspected animal case of anthrax is identified?

Answer 19

• Report to Ag Vic for testing
• Quarantine affected properties
• Nil animal/product movement
• Vaccinate at-risk animals
• Dispose of dead animals/products

These steps are crucial for controlling potential outbreaks.

Question 20

What is the role of the clinician in an anthrax case?

Answer 20

Treatment responsibility (ABx).

Clinicians should also assess history of exposure to infected animals/products.

Question 21

What is the CFR for gastrointestinal anthrax?

Answer 21

25-60%

Gastrointestinal anthrax can lead to severe symptoms and high mortality.

Question 22

What are the resources mentioned for managing anthrax cases?

Answer 22

• DH protocol
• AUSVETPLAN

These resources provide guidelines for handling anthrax outbreaks and treatment.

Question 23

True or False: Anthrax is common in Australia.

Answer 23

False

Anthrax is very rare in Australia, with only three cases since 2001.

Question 24

How are cases of anthrax managed?

Answer 24

Interview - exposure to infected animal products (hides, wool, hair) or vaccines; consider intentional release if no exposure to animals - CMO, AHPC, NIR

T - clinician responsibility (ABx); standard precautions
I - N/A
E - sx, transmission, handling contaminated clothing / potentially infected animals

Question 25

How are contacts of anthrax managed?

Answer 25

Urgently identify co-exposed T - ABx as PEP e.g. inhalational, cutaneous without PPE I - NA E - sx, transmission

Question 26

What environmental investigation / management should be considered?

Answer 26

* Manufacturing plant - inspect for adequacy of prevention measures * Report suspected animal case to Ag Vic for testing (rapid + confirmatory) * Quarantine affected properties - nil animal/product movement; vaccinate at-risk animals, dispose of dead animals / products (AUSVETPLAN) * Ag / Chief Vet liase with knackeries, vets, dairy industry, emergency services, health services, local gov * Environmental decontamination - contaminated items - incinerate / sterilise / chemically decontaminate; for site / facility equipment liaise with Ag / Chief Vet

Question 27

Who are key stakeholders?

Answer 27

* Manufacturers - animal products, hides, wool e.g. knackeries * Agriculture e.g. dairy farmers * Vets * Chief Vet

Question 28

What is the key document that outlines how to deal with animal cases?

Answer 28

AUSVETPLAN