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Anthrax, caused by Bacillus anthracis, has a nearly global distribution but is understudied in Southeast Asia, including Vietnam. Here, we used historical data from 1999 to 2020 in Ha Giang, a province in northern Vietnam. The objectives were to describe the spatiotemporal patterns and epidemiology of human and livestock anthrax in the province and compare livestock vaccine coverage with human and livestock anthrax incidence. Annual incidence rates (per 10,000) for humans, buffalo/cattle, and goats were used to explore anthrax patterns and for comparison with livestock annual vaccine variations. A data subset describes anthrax epidemiology in humans by gender, age, source of infection, type of anthrax, admission site, and season. Zonal statistics and SaTScan were used to identify spatial and space-time clusters of human anthrax. SaTScan revealed space-time clusters in 1999, 2004, and 2007-2008 in the province, including in the northeastern, eastern, and western areas. Most human anthrax was reported between July and October. Most patients were male, aged 15-59 years, who had handled sick animals and/or consumed contaminated meat. High case-fatality rates were reported with gastrointestinal or respiratory cases. Our data suggest that vaccination in buffalo and cattle reduces the disease burden in humans and vaccinated animals but does not reduce the incidence in unvaccinated animals (goats). This study identified spatial areas of high risk for anthrax and can inform One Health surveillance and livestock vaccination planning in contextual settings similar to Ha Giang province.

Anthrax is a serious zoonosis caused by Bacillus anthracis, which primarily affects wild herbivorous animals with spillover into humans. The disease occurs nearly worldwide but is poorly reported in Southeast Asian countries. In Vietnam, anthrax is underreported, and little is known about its temporal and spatial distributions. This paper examines the spatio-temporal distribution and epidemiological characteristics of human and livestock anthrax from Dien Bien province, Vietnam from 2010 to 2019. We also aim to define the role of livestock vaccination in reducing human cases. Historical anthrax data were collected by local human and animal health sectors in the province. Spatial rate smoothing and spatial clustering analysis, using Local Moran's I in GeoDa and space-time scan statistic in SaTScan, were employed to address these objectives. We found temporal and spatial overlap of anthrax incidence in humans and livestock with hotspots of human anthrax in the east. We identified three significant space-time clusters of human anthrax persisting from 2010 to 2014 in the east and southeast, each with high relative risk. Most of the human cases were male (69%), aged 15-59 years (80%), involved in processing, slaughtering, or eating meat of sick or dead livestock (96.9%) but environmental and unknown exposure were reported. Animal reports were limited compared to humans and at coarser spatial scale, but in areas with human case clusters. In years when livestock vaccination was high (>~25%), human incidence was reduced, with the opposite effect when vaccine rates dropped. This indicates livestock vaccination campaigns reduce anthrax burden in both humans and livestock in Vietnam, though livestock surveillance needs immediate improvement. These findings suggest further investigation and measures to strengthen the surveillance of human and animal anthrax for other provinces of Vietnam, as well as in other countries with similar disease context., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Tan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Anthrax is a priority zoonosis for control in Vietnam. The geographic distribution of anthrax remains to be defined, challenging our ability to target areas for control. We analyzed human anthrax cases in Vietnam to obtain anthrax incidence at the national and provincial level. Nationally, the trendline for cases remained at ≈61 cases/year throughout the 26 years of available data, indicating control efforts are not effectively reducing disease burden over time. Most anthrax cases occurred in the Northern Midlands and Mountainous regions, and the provinces of Lai Chau, Dien Bien, Lao Cai, Ha Giang, Cao Bang, and Son La experienced some of the highest incidence rates. Based on spatial Bayes smoothed maps, every region of Vietnam experienced human anthrax cases during the study period. Clarifying the distribution of anthrax in Vietnam will enable us to better identify risk areas for improved surveillance, rapid clinical care, and livestock vaccination campaigns.

Anthrax is a zoonosis caused by the spore-forming bacterium Bacillus anthracis , with potential for high fatality rate, especially in herbivores. Upon host death, spores can enter the soil surrounding the carcass and be ingested by other animals feeding in the same location. Accordingly, surveillance to quickly identify and decontaminate anthrax carcasses is crucial to outbreak prevention. In endemic anthrax areas such as Texas and Africa, vultures are used as a surveillance tool for identifying presence and location of dead animals. However, many anthrax outbreaks in the United States have occurred in areas outside the ranges of both black and turkey vultures. Here, we used a longitudinal camera trap survey at carcass sites in southwestern Montana to investigate the utility of facultative avian scavengers on disease and carcass surveillance in a reemerging anthrax risk zone. From August 2016 to September 2018, camera traps at 11 carcass sites were triggered 1996 times by avian scavengers. While the majority were facultative avian scavengers such as corvids and eagles, our results suggest that facultative scavengers cannot replace vultures as a surveillance tool in this ecosystem due to their absence during the anthrax risk period (June to August), reduced search efficiency, or low flight patterns. We found that the conditions in Montana likely parallel systems elsewhere in the continental United States. Using ecological niche models of B. anthracis distribution overlaid with relative abundance maps of turkey vultures, we found that much of North Dakota, South Dakota, Minnesota, Wyoming, Nebraska, and Iowa have areas of anthrax risk, but low or absent turkey vulture populations. Without vultures in these areas, surveillance capacity is reduced, and it becomes more difficult to identify anthrax cases, meaning fewer carcasses are decontaminated, and consequently, outbreaks could become more frequent or severe.

Environmentally mediated indirect pathogen transmission is linked to host movement and foraging in areas where pathogens are maintained in the environment. In the case of anthrax, spores of the causative bacterium Bacillus anthracis are released into the environment following host death and create locally infectious zones (LIZs) around carcass sites; by grazing at LIZs, herbivores are potentially exposed to spores. Here, we used camera traps to assess how ungulate species use carcass sites in southwestern Montana and evaluated how these behaviours may promote indirect anthrax transmission, thus providing, to our knowledge, the first detailed documentation and study of the fine-scale mechanisms underlying foraging-based disease transmission in this ecosystem. We found that carcasses at LIZs significantly increased aboveground biomass of vegetation and concentrations of sodium and phosphorus, potentially making these sites more appealing to grazers. Host behavioural responses to LIZs varied depending on species, sex, season and carcass age; but, overall, our results demonstrated that carcasses or carcass sites serve as an attractant to herbivores in this system. Attraction to LIZs probably represents an increased risk of exposure to B. anthracis and, consequently, increased anthrax transmission rates. Accordingly, continued anthrax surveillance and control strategies are critical in this system.

Anthrax is a zoonosis caused by the spore-forming bacterium Bacillus anthracis, with potential for high fatality rate, especially in herbivores. Upon host death, spores can enter the soil surrounding the carcass and be ingested by other animals feeding in the same location. Accordingly, surveillance to quickly identify and decontaminate anthrax carcasses is crucial to outbreak prevention. In endemic anthrax areas such as Texas and Africa, vultures are used as a surveillance tool for identifying presence and location of dead animals. However, many anthrax outbreaks in the United States have occurred in areas outside the ranges of both black and turkey vultures. Here, we used a longitudinal camera trap survey at carcass sites in southwestern Montana to investigate the utility of facultative avian scavengers on disease and carcass surveillance in a reemerging anthrax risk zone. From August 2016 to September 2018, camera traps at 11 carcass sites were triggered 1996 times by avian scavengers. While the majority were facultative avian scavengers such as corvids and eagles, our results suggest that facultative scavengers cannot replace vultures as a surveillance tool in this ecosystem due to their absence during the anthrax risk period (June to August), reduced search efficiency, or low flight patterns. We found that the conditions in Montana likely parallel systems elsewhere in the continental United States. Using ecological niche models of B. anthracis distribution overlaid with relative abundance maps of turkey vultures, we found that much of North Dakota, South Dakota, Minnesota, Wyoming, Nebraska, and Iowa have areas of anthrax risk, but low or absent turkey vulture populations. Without vultures in these areas, surveillance capacity is reduced, and it becomes more difficult to identify anthrax cases, meaning fewer carcasses are decontaminated, and consequently, outbreaks could become more frequent or severe. [ABSTRACT FROM AUTHOR]