Background: Human anthrax is currently a sporadic disease in Europe, without significant regional clustering. Objective: To report an unexpected aggregate of anthrax cases and correlate local climatic factors with yearly anthrax admissions. Methods: Clinical description of a geographical-temporal anthrax aggregate, correlation of disease admissions with local weather data in the period 2001-2014 and literature reports of anthrax clusters from Europe in the last 20 years. Results: We identified 5 cases, all cutaneous: an unexpected aggregate of 4 cases in mid-summer 2011 (including a probable human-to-human transmission) and a sporadic case in August 2005, all in relatively dry periods (p < 0.05). Remarkably, 3/6 reports of human anthrax aggregates from Europe were observed in Balkan Peninsula countries in the year 2011. Conclusion: In the light of the predicted climatic change, unexpected anthrax aggregates during dry periods in southern Europe underscore the risk of future anthrax re-emergence on this continent.

Keywords:
Cutaneous anthrax, Anthrax, Clusters, Human-to-human transmission, Climatic change, Europe, Greece
1.
Turnbull PCB: WHO Anthrax Working Group. Anthrax in Humans and Animals, ed 4. Geneva, World Health Organization, 2008. www.who.int/csr/resources/publications/anthrax_webs.pdf (accessed November 13, 2012).
2.
Keim P, Smith KL: Bacillus anthracis evolution and epidemiology. Curr Top Microbiol Immunol 2002;271:21-32.
3.
Schmid G, Kaufmann A: Anthrax in Europe: its epidemiology, clinical characteristics, and role in bioterrorism. Clin Microbiol Infect 2002;8:479-481.
4.
Bohm R: Resistance, survival, sterilization and disinfection of spores of Bacillus anthracis. Salisbury Med Bull 1991;68(special suppl):99-101.
5.
Swartz MN: Recognition and management of anthrax - an update. N Engl J Med 2001;345:1621-1626.
6.
Munang'andu HM, Banda F, Siamudaala VM, Munyeme M, Kasanga CJ, Hamududu B: The effect of seasonal variation on anthrax epidemiology in the upper Zambezi floodplain of western Zambia. J Vet Sci 2012;13:293-298.
7.
European Centre for Disease Prevention and Control: Annual epidemiological report 2012. Reporting on 2010 surveillance data and 2011 epidemic intelligence data. Stockholm, ECDC, 2013. http://www.ecdc.europa.eu/en/publications/Publications/Annual-Epidemiological-Report-2012.pdf.
8.
European Centre for Disease Prevention and Control: Annual epidemiological report 2014 - food- and waterborne diseases and zoonoses. Stockholm, ECDC, 2014. http://ecdc.europa.eu/en/publications/Publications/food-waterborne-diseases-annual-epidemiological-report-2014.pdf.
9.
Berger T, Kassirer M, Aran AA: Injectional anthrax - new presentation of an old disease. Eur Surveill 2014;19(32), pii: 20877. http://www.eurosurveillance.org/viewArticle.aspx?ArticleId=20877.
10.
Velimirovic B: Anthrax in Europe. Rev Sci Tech Off Int Epiz 1984;3:527-559.
11.
Turner AJ, Galvin JW, Rubira RJ, Miller GT: Anthrax explodes in an Australian summer. J Appl Microbiol 1999;87:196-199.
12.
Hugh-Jones M, Blackburn J: The ecology of Bacillus anthracis. Mol Asp Med 2009;30:356-367.
13.
Nicoll A: Interim European surveillance case definition for anthrax. Eur Surveill 2001;5(44), pii: 2045. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2045.
14.
Bossi P, Tegnell A, Baka A, Van Loock F, Hendriks J, Werner A, Maidhof H, Gouvras G; Task Force on Biological and Chemical Agent Threats, Public Health Directorate, European Commission, Luxembourg: Bichat guidelines for the clinical management of anthrax and bioterrorism-related anthrax. Eur Surveill 2004;9:E3-E4. http://www.eurosurveillance.org/em/v09n12/0912-231.asp.
15.
Quinn CP, Turnbull PC: Anthrax; in Collier L, Balows A, Sussman M (eds): Topley and Wilson's Microbiology and Microbial Infections, ed 9. London, Arnold, 1998, vol 3, pp 799-818.
16.
Pugh AO, Davies JC: Human anthrax in Zimbabwe. Salisbury Med Bull 1990;68S:32-33.
17.
Van Ness GB: Ecology of anthrax. Science 1971;172:1303-1307.
18.
Dragon DC, Rennie RP: The ecology of anthrax spores: tough but not invincible. Can Vet J 1995;36:295-301.
19.
Joyner TA, Lukhnova L, Pazilov Y, Temiralyeva G, Hugh-Jones ME, Aikimbayev A, Blackburn JK: Modeling the potential distribution of Bacillus anthracis under multiple climate change scenarios for Kazakhstan. PLoS One 2010;5:e9596.
20.
Đurić P, Ćosić G, Rajčević S, Petrovic V, Tomković M, Subić Z, Dimitrić M: Three probable cases of cutaneous anthrax in autonomous province of Vojvodina, Serbia, June 2011. Eur Surveill 2012;17, pii: 20050. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=200509.
21.
Popescu R, Pistol A, Miltaru L, Caplan D, Cucuiu R, Popovici F: Two cases of infection with Bacillus anthracis, Romania, October 2011. Eur Surveill 2011;16(45), pii: 20008. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20008.
22.
Fasanella A, Garofolo G, Galante D, Quaranta V, Palazzo L, Lista F, Adone R, Jones MH: Severe anthrax outbreaks in Italy in 2004: considerations on factors involved in the spread of infection. New Microbiol 2010;33:83-86.
23.
Forzieri G, Feyen L, Rojas R, Flörke M, Wimmer F, Bianchi A: Ensemble projections of future stream flow droughts in Europe. Hydrol Earth Syst Sci 2014;18:85-108.
25.
Epstein PR: Climate change and emerging infectious diseases. Microbes Infect 2001;3:747-754.
26.
Patra G, Vaissaire J, Weber-Levy M, Le Doujet C, Mock M: Molecular characterization of Bacillus strains involved in outbreaks of anthrax in France in 1997. J Clin Microbiol 1998;36:3412-3414.
27.
Fasanella A, Palazzo L, Petrella A, Quaranta V, Romanelli B, Garofolo G: Anthrax in red deer (Cervus elaphus), Italy. Emerg Infect Dis 2007;13:1118-1119.
28.
Cinquetti G, Banal F, Dupuy A-L, Girault P-Y, Courdec A, Guyot P, et al: Three related cases of cutaneous anthrax in France. Medicine 2009;88:371-375.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.