Anthrax Crisis Sweeps East and Southern Africa: Outbreaks Hit Kenya, Malawi, Uganda, Zambia and Zimbabwe


In recent months, East and Southern Africa have been gripped by a severe anthrax outbreak that has struck multiple countries, including Kenya, Malawi, Uganda, Zambia, and Zimbabwe. Anthrax, caused by the spore-forming bacterium Bacillus anthracis, is a zoonotic disease primarily affecting ruminants like cows, sheep, and goats.

While the bacterium does not typically spread from animal to animal or human to human, it poses a significant threat when humans come into contact with contaminated animal products.

On November 1, 2023, the International Health Regulations (IHR) National Focal Point of Zambia sounded the alarm, notifying the World Health Organization (WHO) of a grave anthrax outbreak affecting both humans and animals. This devastating outbreak, which has now spread across nine of Zambia’s ten provinces, represents a significant public health crisis with far-reaching implications.

Early Cases and Suspicion

The initial human cases of anthrax were first detected at the Dengeza Health Post in the Sinazongwe District of the Southern Province on May 5, 2023. Coincidentally, during the same period, a mysterious phenomenon was unfolding: domestic livestock, including cattle and goats, as well as wild animals like hippos, were mysteriously perishing in the surrounding regions. This uncanny parallel raised suspicions of a potential zoonotic event, where diseases jump from animals to humans.

A Closer Look

The investigation into the outbreak unearthed a concerning discovery. From September 2022 to January 2023, before the official outbreak was declared, 42 suspected cases of anthrax in humans were quietly recorded at the Dengeza Health Post. These cases presented with skin sores and ulcers, while some exhibited nonspecific symptoms such as nausea, vomiting, and difficulty in breathing. Initial tests on these cases returned negative for anthrax.

June 2023: A Turning Point

In June 2023, the situation took a dire turn when both human and animal cases emerged in the Kanchindu and Siameja veterinary camps of Sinazongwe District. Shockingly, 26 individuals developed painful sores on their faces, arms, and fingers after consuming meat from three wild hippopotamus carcasses. The first confirmed human case of anthrax was reported on June 16, 2023, following laboratory confirmation at the Lusaka Central Veterinary Research Institute (CVRI). This marked the critical point when authorities recognized the gravity of the situation.

Animal Losses and Confirmation

The outbreak also took a heavy toll on livestock, with 13 domestic animals, including 10 cattle and 3 goats, succumbing to suspected anthrax in Sinazongwe district. Testing confirmed the presence of anthrax in these animals on July 17, 2023. By this point, anthrax outbreaks had already spread to other provinces, including Southern, Northwestern, and Western.

The Human Toll

As of November 20, 2023, the outbreak has left a trail of devastation, with 684 suspected human cases reported from 44 out of 116 districts in nine of Zambia’s 10 provinces. The Case Fatality Ratio (CFR) stands at 0.6%, resulting in four tragic deaths. Sinazongwe district bears the brunt of the crisis, accounting for 287 cases, which represents 42% of the total 684 cases, and two of the four reported deaths. The provinces most severely affected include Southern (370 cases; 54%), Western (84 cases; 12%), Lusaka (82 cases; 12%), Eastern (66 cases; 10%), and Muchinga (47 cases; 7%). Alarming, however, is that the majority of symptomatic cases were epidemiologically linked to confirmed cases but not formally tested.

The Animal Impact

On the animal front, the outbreak has affected 568 domestic and wild animals, with the Southern province witnessing the highest toll at 344 cases (61%), followed by Muchinga province with 132 cases (23%), and the Western Province with 62 cases (11%). Wildlife, primarily hippos, also faced significant losses in the Eastern and Southern provinces.

Historical Context

This unprecedented anthrax outbreak spans nine out of Zambia’s 10 provinces, marking a stark departure from previous occurrences that were primarily confined to the Northwest and Western provinces, with sporadic cases over the years. Notably, Zambia reported anthrax outbreaks in both humans and animals in Western Province in 2017, and in Eastern Province in 2016 and 2011.

Uganda Grapples with Anthrax Outbreak: Beef Sales Banned as Death Toll Rises

As Uganda faces a severe anthrax outbreak originating in the Kyotera district of the central region, the government has imposed a ban on the sale of beef products, underscoring the gravity of the situation. Reports have indicated that at least 17 people have tragically lost their lives, while over 20 others remain bedridden in various local villages.

Local Response and Restrictions

In response to the outbreak, the Kyotera district veterinary officer, John Mary Lutaaya, has taken immediate action to contain the disease. Restrictions have been placed on the movement of cattle in the Kabira zone, a necessary measure to prevent further transmission. This decision has, however, affected local traders who rely on cattle-related activities for their livelihoods.

Rising Animal and Human Casualties

The outbreak, which health authorities officially confirmed on November 26, 2023, has taken a heavy toll on both animals and humans. Within the past two months, more than 40 cows have succumbed to the disease, highlighting the severity of the situation. Anthrax, a rare yet highly infectious disease caused by the bacteria Bacillus anthracis, is naturally present in the soil and typically affects both wild and domestic animals.

Human Health at Risk

The public is at risk of infection through contact with infected animals or contaminated animal products. This exposure can lead to a range of distressing symptoms, including blisters, fevers, swollen limbs, and difficulty in breathing. Anthrax is a serious disease that requires prompt medical attention and treatment.

Challenges in Containment

Of growing concern is the revelation that some affected individuals are turning to shrines for solace and treatment, rather than seeking medical care. This trend is deeply troubling for health officials, as it poses a significant obstacle to efforts to contain the outbreak effectively. Early diagnosis and medical intervention are crucial in managing anthrax cases and preventing further spread.

Intensified Measures

As authorities grapple with the evolving crisis, they have intensified measures to curb the spread of the disease. These measures include:

  • The prohibition of beef sales to prevent the consumption of potentially contaminated meat products.
  • Stringent controls on cattle movement in affected areas to limit the transmission of the bacterium.

A Critical Situation

The anthrax outbreak in Uganda remains a critical public health concern, demanding immediate attention and coordinated efforts to mitigate its impact. The ban on beef sales, while necessary for public safety, underscores the gravity of the situation and the urgency of controlling its spread. Authorities are urged to continue their vigilance and to work closely with affected communities to ensure that individuals receive proper medical care and support during this challenging time.

Clinical Presentations of Anthrax

Depending on the type of exposure, individuals can present with one of three clinical forms of anthrax:

  • Cutaneous Anthrax: This is the most common form, characterized by an itchy bump that quickly develops into a black sore at the site of exposure. Some individuals may also experience headaches, muscle aches, fever, and vomiting.
  • Gastrointestinal Anthrax: Initially resembling food poisoning, gastrointestinal anthrax can progress to severe abdominal pain, vomiting of blood, and severe diarrhea.
  • Pulmonary Anthrax: This is the most severe form, often starting with common cold symptoms but rapidly progressing to severe breathing difficulties and shock.

Response Activities

Response efforts have been multifaceted, targeting both animals and humans affected by the outbreak.

For Animals:

  • Livestock vaccination campaigns, supported by the Food and Agriculture Organization of the United Nations (FAO), have distributed 338,000 doses of anthrax vaccine as of November 19, 2023. These campaigns began in the epicenter of the outbreak, Sinazongwe district, and have since expanded to other affected areas.
  • A One Health task force, comprising the Ministry of Health and the Ministry of Local Government, has been actively involved in case identification and monitoring in both animals and humans.
  • Meat inspection has been intensified, with the veterinary department playing a crucial role.
  • The Department of Wildlife and Parks is actively monitoring and controlling illegal animal movements and ensuring the proper disposal of animal carcasses.
  • WHO is collaborating with FAO and the Ministry of Agriculture on animal health activities, particularly vaccination.

For Humans:

  • Health workers have received training to enhance their capacity to identify potential cases early.
  • Event-based surveillance (EBS) and early detection mechanisms have been strengthened.
  • Essential medical supplies are being prioritized to support case management.
  • Active surveillance is ongoing across healthcare facilities and within communities, including contact tracing.
  • Extensive health promotion and Risk Communication and Community Engagement (RCCE) activities have been initiated, including press briefings, social media campaigns, radio broadcasts, and the distribution of informative materials.

WHO Risk Assessment

Anthrax is endemic in Zambia, usually peaking between May and January. However, the current outbreak is particularly concerning due to its widespread nature. Rivers that flow through affected provinces can contribute to anthrax transmission to neighboring countries, posing a regional threat.

Risk factors contributing to the outbreak’s severity include:

  • Unrestricted animal movement and carcass handling within and between provinces.
  • A low index of suspicion, socio-cultural norms, and community resistance.
  • Limited community knowledge about anthrax transmission.
  • High levels of poverty and food insecurity.
  • Shortages of vaccines and laboratory reagents.
  • Inadequate carcass disposal and decontamination practices.
  • Limited engagement with local communities involved in cattle and livestock handling.
  • Concurrent public health emergencies, such as cholera, measles, and COVID-19, straining the country’s resources.

Regional Implications

The risk at the regional level is also considered high due to the frequent movement of both animals and people between Zambia and neighboring countries. Rivers connecting to neighboring countries can facilitate the spread of the bacterium.

WHO Advice

To prevent anthrax transmission, the public is advised to:

  • Avoid handling or consuming meat from animals that died suddenly or have uncertain origins.
  • Use protective clothing and gloves when in contact with potentially infected animals or animal products.

In healthcare settings:

  • Enhance screening procedures in areas with an epidemiological risk of anthrax.
  • Implement infection prevention and control measures promptly for suspected cases.
  • Practice strict hand hygiene using soap and water.
  • Implement enhanced cleaning and disinfection protocols in areas with potential anthrax exposure.

Individuals potentially exposed to anthrax spores should receive prophylactic treatment, and antibiotics are effective in treating anthrax.

International travelers should be aware of regulations regarding the importation of prohibited animal products.

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