Addressing the Widespread Anthrax Outbreak in Zambia: A Call for Integrated Public Health Action

Abstract

The recent anthrax outbreak in Zambia, declared by the World Health Organization (WHO) on December 8, 2023, represents a significant public health concern that demands immediate attention and action. 1 The outbreak began in June in the Sinazongwe district in the southern province, where 26 people developed sores on their face, arms, and fingers after consuming meat from three wild hippopotamus carcasses. 2 This incident coincided with reports of cattle, goats, and hippos dying from unknown causes in the surrounding areas. 2 Notably, this outbreak was the first major occurrence spanning nine of Zambia's 10 provinces, marking a sharp deviation from previous instances, which were primarily confined to the Northwestern and Western provinces. 1 As of December 12, 2023, 684 suspected human cases, including four deaths, had been reported, with the Sinazongwe district emerging as the epicenter of the outbreak. 2 Anthrax, a zoonotic disease that primarily affects ruminants, is caused by the spore-forming bacterium Bacillus anthracis. Human infections can occur through direct contact with infected animals, ingestion of contaminated animal products, or exposure to spores in the environment. 1 As highlighted in a recent study by Madhumathi Jayaprakasam et al., the lethality and persistence of anthrax spores contribute significantly to their biowarfare potential. 3 Therefore, it is important to understand the spatiotemporal distribution and risk factors associated with anthrax to develop effective control strategies. The disease manifests in cutaneous, gastrointestinal, or pulmonary forms, with symptoms ranging from skin lesions to severe respiratory distress depending on the mode of transmission. 1,4,5 The unprecedented scale of the current outbreak in Zambia raises critical concerns regarding its control and prevention measures. Most human cases have been epidemiologically linked to confirmed cases, highlighting the need for enhanced surveillance and diagnostic capabilities. 1 In response, the Zambian government, supported by the WHO and Food and Agriculture Organization of the United Nations (FAO), has undertaken substantial measures, including widespread livestock vaccination, enhanced meat inspection, and public health education initiatives. 1,5