Volume 77, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


More cutaneous anthrax cases were noted at Hospital Albert Schweitzer (HAS) in the Artibonite Valley of Haiti. We examine the incidence of anthrax in the Artibonite between 1992 and 2002, describe the clinical presentation of cutaneous anthrax, and determine risk factors for anthrax. In 1992 HAS reported 1 case of anthrax for an incidence of 4 cases per million persons/year. In 2002, there were 20 cases of anthrax for an incidence of 72 cases per million persons/year. This is a 17-fold increase ( = 0.0002). Causes of death from anthrax included asphyxiation from edema of the neck with tracheal compression and concurrent gastrointestinal anthrax. Butchering cattle that had died of illness was identified as a risk factor. The incidence of human anthrax has increased in the Artibonite Valley and is a cause of significant mortality. Control of anthrax in humans depends on improved animal vaccination programs.


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  1. Freedman A, Afonja O, Chang MW, Mostashari F, Blaser M, Perez-Perez G, Lazarus H, Schacht R, Guttenberg J, Traister M, Borkowsky W, 2002. Cutaneous anthrax associated with microangiopathic hemolytic anemia and coagulopathy in a 7-month-old infant. JAMA 287 : 869–874.
  2. Swartz MN, 2001. Recognition and management of anthrax—an update. N Engl J Med 345 : 1621–1626.
  3. Inglesby TV, O’Toole T, Henderson DA, Bartlett JG, Ascher MS, Eitzen E, Friedlander AM, Gerberding J, Hauer J, Hughes J, McDade J, Osterholm MT, Parker G, Perl TM, Russell PK, Tonat K, Working Group on Civilian Biodefense, 2002. Anthrax as a biological weapon. JAMA 287 : 2236–2251.
  4. Morens DM, 2002. Epidemic anthrax in the eighteenth century, the Americas. Emerg Infect Dis 8 : 1160–1162.
  5. World Health Organization Collaborating Center for Remote Sensing and Geographic Information Systems for Public Health, World anthrax data site. Available at: www.vetmed.lsu.edu/whocc. Accessed September 20, 2006.
  6. Bales ME, Dannenberg AL, Brachman PS, Kaufmann AF, Klatsky PC, Ashford DA, 2002. Epidemiologic response to anthrax outbreaks: field investigations, 1950–2001. Emerg Infect Dis 8 : 1163–1174.
  7. Coreil J, 1980. Traditional and western responses to an anthrax epidemic in rural Haiti. Med Anthropol 4 : 79–104.
  8. Smego RA Jr, Gebrian B, Desmangels G, 1998. Cutaneous manifestations of anthrax in rural Haiti. Clin Infect Dis 26 : 97–102.
  9. Davies JC, 1985. A major epidemic of anthrax in Zimbabwe. Cent Afr J Med 31 : 176–180.
  10. Berggren WL, Ewbank DC, Berggren GG, 1981. Reduction of mortality in rural Haiti through a primary-health-care program. N Engl J Med 304 : 1324–1330.
  11. Beggren W, Berggren G, 1971. Changing incidence of fatal tetanus of the newborn. A retrospective study in a defined rural Haitian population. Am J Trop Med Hyg 20 : 491–494.
  12. Perry H, Berggren W, Berggren G, Dowell D, Menager H, Bottex E, Dortonne JR, Philippe F, Cayemittes M, 2007. Long-term reductions in mortality among children under age 5 in rural Haiti: effects of a comprehensive health system in an impoverished setting. Am J Public Health 97 : 240–246.
  13. Long R, Scalcini M, Olle-Goig J, 2002. Treatment of tuberculosis in Haiti. Am J Public Health 91 : 1546–1547.
  14. Long R, Scalcini M, Manfreda J, Jean-Baptiste M, Hershfield E, 1991. The impact of HIV on the usefulness of sputum smears for the diagnosis of tuberculosis. Am J Public Health 81 : 1326–1328.
  15. Long R, Maycher B, Scalcini M, Manfreda J, 1991. The chest roentgenogram in pulmonary tuberculosis patients seropositive for human immunodeficiency virus type 1. Chest 99 : 123–127.
  16. Thacker SB, Music SI, Pollard RA, Berggren G, Boulos C, Nagy T, Brutus M, Pamphile M, Ferdinand RO, Joseph VR, 1980. Acute water shortage and health problems in Haiti. Lancet 1 : 471–473.
  17. Fitzgerald DW, Behets F, Caliendo A, Roberfroid D, Lucet C, Fitzgerald JW, Kuykens L, 2000. Economic hardship and sexually transmitted diseases in rural Haiti. Am J Trop Med Hyg 62 : 496–501.
  18. Guidelines for the Surveillance and Control of Anthrax in Humans and Animals, WHO website. Available at: http://www.who.int/csr/resources/publications/anthrax/whoemczdi986text.pdf. Accessed July 11, 2007.
  19. USAID, 1996. Latin American and the Caribbean Selected Economic and Social Data Social Indicators. Available at: http://lanic.utexas.edu/la/region/aid/aid96/Social/pop952.html. Accessed July 11, 2007.
  20. The CIA World Factbook, http://www.faqs.org/docs/factbook/fields/2002.html. Accessed on July 11, 2007.
  21. Aide MT, Grau R, 2004. Globalization, migration, and Latin American ecosystems. Science 305 : 1915–1916.
  22. Dragon DC, Rennie RP, 1995. The ecology of anthrax spores: tough but not invincible. Can Vet J 36 : 295–301.
  23. Parkinson R, Rajic A, Jenson C, 2003. Investigation of an anthrax outbreak in Alberta in 1999 using a geographic information system. Can Vet J 44 : 315–318.
  24. Kolbe AR, Hutson RA, 2006. Human rights abuse and other criminal violations in Port-au-Prince, Haiti: a random survey of households. Lancet 368 : 864–873.
  25. Webber RH, 1985. Anthrax in Lake Rukwa Valley, Tanzania: a persistent problem. J Trop Med Hyg 88 : 327–331.
  26. Kaufmann AF, Dannenberg AL, 2002. Age as a risk factor for cutaneous human anthrax: evidence from Haiti, 1973–1974. Emerg Infect Dis 8 : 874–875.
  27. Kaya A, Tasyaran MA, Erol S, Ozkurt Z, Ozkan B, 2002. Anthrax in adults and children: a review of 132 cases in Turkey. Eur J Clin Microbiol Infect Dis 21 : 258–261.
  28. Carucci JA, McGovern TW, Norton SA, Daniel CR, Elewski BE, Fallon-Friedlander S, Lushniak BD, Taylor JS, Warschaw K, Wheeland RG, 2002. Cutaneous anthrax management algorithm. J Am Acad Dermatol 47 : 766–769.
  29. Wu AG, Alibek D, Li YL, Bradburne C, Bailey CL, Alibek K, 2003. Anthrax toxin induces hemolysis: an indirect effect through polymorphonuclear cells. J Infect Dis 188 : 1138–1141.
  30. Sirisanthana T, Brown AE, 2002. Anthrax of the gastrointestinal tract. Emerg Infect Dis 8 : 649–651.
  31. Beatty ME, Ashford DA, Griffin PM, Tauxe RV, Sobel J, 2003. Gastrointestinal anthrax: review of the literature. Arch Intern Med 163 : 2527–2531.
  32. MacDonald WD, 1942. Anthrax: report of a fatal case involving the cutaneous and gastrointestinal systems. N Engl J Med 226 : 949–951.
  33. Harrison LH, Ezzell JW, Abshire TG, Kidd S, Kaufmann AE, 1989. Evaluation of serologic tests for diagnosis of anthrax after an outbreak of cutaneous anthrax in Paraguay. J Infect Dis 160 : 706–710.
  34. Mwenye KS, Siziya S, Peterson D, 1996. Factors associated with human anthrax outbreak in the Chikupo and Ngandu villages of Murewa District in Mashonaland East Province, Zimbabwe. Cent Afr J Med 42 : 312–315.
  35. Woods CW, Ospanov k, Myrzabekov A, Favorov M, Pilikaytis B, Ashford DA, 2004. Risk factors for human anthrax among contacts of anthrax infected livestock in Kazakhstan. Am J Trop Med Hyg 71 : 48–52.
  36. World Bank, 2007. Haiti country profile. Available at: http://www.worldbank.org/ Accessed March 27, 2007.
  37. Dixon T, Meselson M, Guillemin J, Hanna P, 1999. Anthrax. N Engl J Med 341 : 815–826.

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  • Received : 29 Mar 2007
  • Accepted : 01 Aug 2007

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