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Antimicrobial resistance (AMR) among Escherichia coli from food animals is a rising problem, and heavy antimicrobial use in poultry is a contributing factor. In Zambia, studies linking poultry-associated AMR and antibiotic use (AMU) are rare. This study aimed to investigate commercial and medium-/small-scale poultry farmers' usage of antimicrobials based on a questionnaire survey in ten districts of Zambia. In addition, the study characterized extended-spectrum β-lactamase (ESBL)-producing E. coli isolates obtained from poultry in the same districts. Data regarding knowledge and usage of antimicrobials were collected from commercial and medium-/small-scale poultry farmers using a pre-tested structured questionnaire. At the same time, cloacal samples were collected and analyzed. One hundred and fifty E. coli isolates were tested for antimicrobial susceptibility using eight antibiotic classes. The isolates were further screened for ESBL production by streaking them on cefotaxime (CTX)-supplemented MacConkey agar, then subjecting them to sequencing on a NextSeq. The questionnaire survey showed that more medium-/small-scale than commercial poultry farmers used antimicrobials (OR = 7.70, 95% CI = 2.88–20.61) but less prescriptions (OR = 0.02, 95% CI = 0.00–0.08). Susceptibility testing revealed that resistance was highest to ampicillin (128/148, 86.5%) and tetracycline (101/136, 74.3%) and that the prevalence of multidrug resistance (MDR) (28/30, 93.3%) was high. Whole-genome sequencing (WGS) of eight (8/30, 26.7%) isolates with CTX Minimum Inhibitory Concentration (MIC) ≥ 4 µg/mL revealed the presence of ESBL-encoding genes blaCTX-M-14, blaCTX-M-55, and blaTEM. WGS also detected other AMR genes for quinolones, aminoglycosides, phenicols, tetracycline, macrolides, and folate-pathway antagonists. Altogether, the questionnaire survey results showed a higher proportion of AMU and lower prescription usage among medium-/small-scale farmers. In addition, our results emphasize the circulation of ESBL-producing E. coli strains with associated MDR. It is critical to educate farmers about AMR risks and to encourage responsible usage of antimicrobials. Furthermore, there is a need to strengthen regulations limiting access to antimicrobials. Finally, there is a need to establish a one health system to guide public health response. [ABSTRACT FROM AUTHOR]

Escherichia coli (E. coli), a major foodborne disease-causing pathogen found in raw cow milk, has even far more reaching public health ramifications as it encodes for antimicrobial resistance (AMR). This study aimed to identify multidrug-resistant (MDR) E. coli from raw cow's milk and evaluate their antimicrobial-resistant profiles. In total, 418 pooled raw cow milk samples were collected from milk collection centers and analysed using standard culture methods to isolate E. coli. Antimicrobial Susceptibility Testing (AST) was conducted using the Kirby Bauer disk diffusion method and PCR was used to identify cefotaxime (CTX) resistant genes. Overall isolation of E. coli was 51.2% (214/418) with MDR observed in 21% (45/214) of isolates across different antibiotic combinations. Resistance was observed towards ampicillin (107/214, 50%), tetracycline (86/214, 40.1%), trimethoprim/sulfamethoxazole (61/214, 28.5%), and amoxicillin/clavulanic acid (CTX) (50/214, 23.4%). Notably, 15% (32/214) resistance to CTX was observed, while 12.6% (27/214) exhibited resistance to imipenem. The blaCTX-M and blaTEM genes were detected in CTX-resistant isolates. The findings of MDR E. coli that harbour blaCTX-M and blaTEM genes in raw cow's milk indicate serious public health risks for consumers. [ABSTRACT FROM AUTHOR]

The emergence of pre-extensively drug-resistant tuberculosis (pre-XDR-TB) is a threat to TB control programs in developing countries such as Zambia. Studies in Zambia have applied molecular techniques to understand drug-resistance-associated mutations, circulating lineages and transmission patterns of multi-drug-resistant (MDR) Mycobacterium tuberculosis. However, none has reported genotypes and mutations associated with pre-XDR TB. This study characterized 63 drug-resistant M. tuberculosis strains from the University Teaching Hospital between 2018 and 2019 using targeted gene sequencing and conveniently selected 50 strains for whole genome sequencing. Sixty strains had resistance mutations associated to MDR, one polyresistant, and two rifampicin resistant. Among MDR strains, seven percent (4/60) had mutations associated with pre-XDR-TB. While four, one and nine strains had mutations associated with ethionamide, para-amino-salicylic acid and streptomycin resistances, respectively. All 50 strains belonged to lineage 4 with the predominant sub-lineage 4.3.4.2.1 (38%). Three of four pre-XDR strains belonged to sub-lineage 4.3.4.2.1. Sub-lineage 4.3.4.2.1 strains were less clustered when compared to sub-lineages L4.9.1 and L4.3.4.1 based on single nucleotide polymorphism differences. The finding that resistances to second-line drugs have emerged among MDR-TB is a threat to TB control. Hence, the study recommends a strengthened routine drug susceptibility testing for second-line TB drugs to stop the progression of pre-XDR to XDR-TB and improve patient treatment outcomes. [ABSTRACT FROM AUTHOR]

Fish have been identified as suitable vehicles for transmitting Listeria species to humans. Therefore, the thrust of this study was to determine possible Listeria species likely to circulate in freshly caught Nile tilapia (Oreochromis niloticus) in a large freshwater body. Accordingly, 150 Nile tilapia were sampled on landing. Of this number, half (n=75) were wild caught, while the other half (n=75) were from cage culture farms. All the sampled tilapia fish were independently caught from the same lake. Skin surfaces and gills were the only points sampled to restrict sites swabbed to those in contact with the environment. Swabs were processed using standard bacteriological culturing and identification tests. Only 2% (3/150) of the samples on culture and biochemical tests were presumptively Listeria. However, on Polymerase Chain Reaction (PCR), none yielded any noticeable results. None-detection of Listeria species on PCR may, in part, indicate the absence or undetectable levels in freshwater bodies. The detection of presumptive Listeria species phenotypically indicates possible contaminants other than Listeria. Our study has inherent limitations since it restricted itself to identifying contamination based on the fish's growth environment. We recommend determining the pathogen by incorporating enteric organs or whole fish analysis to increase isolation rates based on the current results. [ABSTRACT FROM AUTHOR]

Influenza A viruses (IAVs) cause highly contagious respiratory diseases in humans and animals. In 2009, a swine‐origin pandemic H1N1 IAV, designated A(H1N1)pdm09 virus, spread worldwide, and has since frequently been introduced into pig populations. Since novel reassortant IAVs with pandemic potential may emerge in pigs, surveillance for IAV in pigs is therefore necessary not only for the pig industry but also for public health. However, epidemiological information on IAV infection of pigs in Africa remains sparse. In this study, we collected 246 serum and 605 nasal swab samples from pigs in Zambia during the years 2011–2018. Serological analyses revealed that 49% and 32% of the sera collected in 2011 were positive for hemagglutination‐inhibition (HI) and neutralizing antibodies against A(H1N1)pdm09 virus, respectively, whereas less than 5.3% of sera collected during the following period (2012–2018) were positive in both serological tests. The positive rate and the neutralization titres to A(H1N1)pdm09 virus were higher than those to classical swine H1N1 and H1N2 IAVs. On the other hand, the positive rate for swine H3N2 IAV was very low in the pig population in Zambia in 2011–2018 (5.3% and 0% in HI and neutralization tests, respectively). From nasal swab samples, we isolated one H3N2 and eight H1N1 IAV strains with an isolation rate of 1.5%. Phylogenetic analyses of all eight gene segments revealed that the isolated IAVs were closely related to human IAV strains belonging to A(H1N1)pdm09 and seasonal H3N2 lineages. Our findings indicate that reverse zoonotic transmission from humans to pigs occurred during the study period in Zambia and highlight the need for continued surveillance to monitor the status of IAVs circulating in swine populations in Africa. [ABSTRACT FROM AUTHOR]

Mycobacterium bovis (M. bovis) causes tuberculosis in mammals and is a major public health threat worldwide. While M. bovis has been reported in humans, domestic and wild ruminants at the human-wildlife-livestock interface area in Zambia, there is paucity of information on the role of primates as reservoir hosts. We screened seven wild chacma baboons (Papio ursinus) for tuberculosis at the human-wildlife interface area in Lochinvar National Park in the Kafue Flats, Zambia. Following necropsy, lung tissue and associated lymph nodes with tuberculous-like lesions collected from four adult male baboons were prepared for Mycobacterium culture. The isolates were initially typed using the Mycobacterium tuberculosis complex-discrimination multiplex PCR assay and further characterized by spoligotyping and 26-loci MIRU-VNTR. Mycobacteria were isolated from all four animals and identified as M. bovis by PCR. On Spoligotyping, all isolates belonged to SB 0120 spoligotype, which is similar to what was previously reported in humans, cattle and Kafue lechwe antelopes in Kafue Flats ecosystem. Furthermore, on MIRU-VNTR typing, the baboon isolates clustered with cattle and Kafue lechwe isolates from the same catchment area. This finding intimates probable cross-species transmission of M. bovis in the Kafue Flats ecosystem. Due to the close interaction of baboons and humans at interface areas in Zambia, our results have potential implications for public health. Equally, this finding raises concerns for conservation. [ABSTRACT FROM AUTHOR]

In Zambia, anthrax has emerged as a serious disease decimating humans, livestock and wildlife with devastating effects on eco‐tourism resulting in the destabilization of major pristine wildlife sanctuaries. Consequently, the thrust of this study was to establish the spatial distribution of anthrax and determine ecological drivers of its recurrence, maintenance and epidemiological linkage to anthropogenic activities. Environmental and biological samples were collected within the livestock production and conservation areas (n = 80). Each sample was serially tested for Bacillus anthracis positivity through blood agar culture and Gram stain technique, and then confirmation by multiplex polymerase chain reaction (MPCR). Questionnaires (n = 113) were conducted at independently distinct villages in terms of space and time. Most respondents showed that animals that died from anthrax were not properly disposed off. More likely than not, poverty being the main driver for anthrax carcass dressing and meat distribution contributed to environmental contamination with anthrax spores in areas where the animals subsequently died resulting in further environmental contamination, which is the major source of primary infection for livestock and wildlife. From the samples, 15 pure isolates of anthrax were obtained which were spatially distributed across four districts. Twelve, biologically plausible variables were found to be highly significant on multivariable logistic regression analysis model for questionnaires which included herd size (odds = 10.46; P = 0.005; CI 8.8–16), carcass disposal method (odds = 6.9; P = 0.001; CI = 3.4–9.8), access to veterinary services (odds = 10.87; P = 0.004; CI = 4.8–15.9) and management system (odds = 2.57; P = 0.001; CI = 1.3–7.5). In summary, the majority (78.7%) of anthrax outbreaks were observed in areas with low veterinary services (χ2 = 8.6162, P = 0.013) within the newly created districts of Nalolo, Mwandi and Luampa. [ABSTRACT FROM AUTHOR]

Background: The non-tuberculous mycobacteria include those mycobacterium species that are not members of the Mycobacterium tuberculosis complex, the causative agent of pulmonary tuberculosis and Mycobacterium leprae. In Zambia, Non-tuberculous Mycobacteria are gaining recognition as pathogens of public health significance. However, there is scanty information on the isolation and speciation of these organisms for better patient management, consequently reducing the burden of these infections. Given the above information, the thrust of this study was to isolate and characterize NTM from humans and water in Namwala district of Zambia.Method: This was a cross-sectional study were 153 individuals with suspected TB were sampled from four health facilities in Namwala district, sputum samples were also collected. Additionally, 149 water samples were collected from different water drinking sources such as Tap water, Borehole water, rivers, wells and streams. Standard TB culture methods were employed to isolate Non-tuberculous Mycobacteria and later 16S-23S internal transcribed spacer region Sequencing was employed to characterize NTM.Results: Seven (7, 4.6%) NTM species were identified from humans with M. arupense (3, 42.9%) being the most common organism, while twenty three (23, 15.4%) NTM were identified from water with the common species being Mycobacterium gordonae (5, 21.7%). Mycobacterium avium and Mycobacterium fortuitum were both identified from human and water samples.Conclusion: This study has shown the isolation of NTM species from humans and water. The isolation of NTM from drinking water sources could signify a public health risk to humans. [ABSTRACT FROM AUTHOR]

The article reports on a symposium in which Human African Trypanosomiasis (HAT) was discussed. It states that this neglected tropical disease is caused by Trypanosoma brucei rhodesiense or Trypanosoma brucei gambiense. It also states that the bite of an infected tsetse fly called Glossina species causes its transmission.

Background: The genus Mycobacterium contains more than 100 species, most of which are classified as non-tuberculous mycobacteria (NTM). In Zambia, the NTM are slowly becoming recognized as pathogens of major public health significance with the advent of Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS). This study aimed at reporting the isolated NTM and ascertains their zoonotic potential and diagnostic significance in Zambia. Method: A total of 100 sputum samples were collected from three health facilities from suspected pulmonary tuberculosis human patients. In addition, 67 lymph node tissue samples from cattle and 14 from Kafue lechwe (Kobus leche kafuensis) showing tuberculosis-like lesions were collected. The samples were appropriately decontaminated and cultured on Middlebrook 7H10 and Stone brink. The isolates were then identified accordingly using the 16S ribosomal RNA analysis method. Results: A total of 8 NTM were isolated from human sputum, 12 from cattle and 1 from the Kafue lechwe. The identified NTM included M. intracellulae, M. abscess, M. chimaera, M. bolleti, M. fortuitum and M. stomatopae sp. Nov. Conclusion: The isolation of NTM from humans and animals at the interface in Namwala district has highlighted the clinical significance and diagnostic challenge. The epidemiological investigation of NTM in the study area is therefore recommended. This should include sampling from environmental sources such as water and soil. [ABSTRACT FROM AUTHOR]

Babesia spp. were detected from 4 asymptomatic pukus captured on a game ranch in central Zambia in October 2008. Blood smears were examined in 4 species of aymptomatic free-ranging antelopes, namely the puku (Kobus vordanii), reedbuck (Redunca arundinum), bushbuck (Tragelaphus sylvaticus), and kudu (Tragelaphus strepsiceros), and showed the presence of Babesia parasites only in the puku. In the puku, the prevalence of babesiosis was estimated at 33.3% (n=12), while the overall prevalence in all examined animals was 8.5% (n=47). The parasites showed morphological characteristics of paired ring-like stages with the length varying between 1.61 µm and 3.02 µm (mean=2.12 µm, n= 27; SD=0.76 µm). Both the infected and non-infected pukus showed good body condition scores (BCS), while the dominant tick species detected from all animals were Rhipicephalus appendiculatus, Rhipicephalus spp., and Boophilus spp. To our knowledge this is the first report of Babesia spp. infection in pukus in Zambia. These findings suggest that wildlife could play an important role in the epidemiology of babesiosis in Zambia. [ABSTRACT FROM AUTHOR]

A case of toxaemia secondary to pyloric foreign body obstruction in two four-month-old African lion cubs were presented in this article. The lion cubs were presented to the school of veterinary medicine with a complaint of weight loss and stunted growth despite having a normal appetite and seizures. Definitive diagnosis was made based on gross pathology after attempting various symptomatic treatments. This article therefore is meant to discourage the use of blankets as bedding in holding enclosures for warmth and comfort post-weaning in captive lion cubs and indeed wild cats in general as they tend to eat bedding that has been soiled with food. [ABSTRACT FROM AUTHOR]

A cross-sectional study was used to identify and assess prevalence and phenotypic antimicrobial resistance (AMR) profiles of Escherichia coli and other enterobacteria isolated from healthy wildlife and livestock cohabiting at a 10,000 acres game ranch near Lusaka, Zambia. Purposive sampling was used to select wildlife and livestock based on similarities in behavior, grazing habits and close interactions with humans. Isolates (n = 66) from fecal samples collected between April and August 2018 (n = 84) were examined following modified protocols for bacteria isolation, biochemical identification, molecular detection, phylogenetic analysis, and antimicrobial susceptibility testing by disc diffusion method. Data were analyzed using R software, Genetyx ver.12 and Mega 6. Using Applied Profile Index 20E kit for biochemical identification, polymerase chain reaction assay and sequencing, sixty-six isolates were identified to species level, of which Escherichia coli (72.7%, 48/66), E. fergusonii (1.5%, 1/66), Shigella sonnei (22.7%, 14/66), Sh. flexinerri (1.5%, 1/66) and Enterobacteriaceae bacterium (1.5%, 1/66), and their relationships were illustrated in a phylogenetic tree. Phenotypic antimicrobial resistance or intermediate sensitivity expression to at least one antimicrobial agent was detected in 89.6% of the E. coli, and 73.3% of the Shigella isolates. The E. coli isolates exhibited the highest resistance rates to ampicillin (27%), ceftazidime (14.3%), cefotaxime (9.5%), and kanamycin (9.5%). Multidrug resistance (MDR) was detected in 18.8% of E. coli isolates while only 13.3% Shigella isolates showed MDR. The MDR was detected among isolates from impala and ostrich (wild animals in which no antimicrobial treatment was used), and in isolates from cattle, pigs, and goats (domesticated animals). This study indicates the possible transmission of drug-resistant microorganisms between animals cohabiting at the wildlife–livestock interface. It emphasizes the need for further investigation of the role of wildlife in the development and transmission of AMR, which is an issue of global concern. [ABSTRACT FROM AUTHOR]

Trypomastogotes of Trypanosoma brucei were detected from 4 asymptomatic kudus (Tragelaphus strepsiceros) on a game ranch located approximately 45 km north east of Lusaka, Zambia. Blood smears examined from 14 wildlife species comprising of the impala (Aepyceros melampus), Kafue lechwe (kobus leche kafuensis), sable antelope (Hippotragus niger), tsessebe (Damaliscus lunatus), warthog (Phacochoerus aethiopicus), puku (Kobus vardoni), zebra (Equus burchelli), waterbuck (Kobus ellipsiprymnus), bushbuck (Tragelaphus scriptus), reedbuck (Redunca arundinum), wilderbeest (Connochaetes taurinus), hartebeest (Alcephelus lichtensteini), African buffalo (Syncerus caffer), and kudu (Tragelaphus strepsiceros) showed that only the kudu had T. brucei. Although game ranching has emerged to be a successful ex-situ conservation strategy aimed at saving the declining wildlife population in the National Parks, our findings suggest that it has the potential of aiding the re-distribution of animal diseases. Hence, there is a need for augmenting wildlife conservation with disease control strategies aimed at reducing the risk of disease transmission between wildlife and domestic animals. [ABSTRACT FROM AUTHOR]

Bluetongue (BT) is an arthropod-borne viral disease of ruminants with serious trade and socio-economic implications. Although the disease has been reported in a number of countries in sub-Saharan Africa, there is currently no information on circulating serotypes and disease distribution in Zambia. Following surveillance for BT in domestic and wild ruminants in Zambia, BT virus (BTV) nucleic acid and antibodies were detected in eight of the 10 provinces of the country. About 40% (87/215) of pooled blood samples from cattle and goats were positive for BTV nucleic acid, while one hartebeest pool (1/43) was positive among wildlife samples. Sequence analysis of segment 2 revealed presence of serotypes 3, 5, 7, 12 and 15, with five nucleotypes (B, E, F, G and J) being identified. Segment 10 phylogeny showed Zambian BTV sequences clustering with Western topotype strains from South Africa, intimating likely transboundary spread of BTV in Southern Africa. Interestingly, two Zambian viruses and one isolate from Israel formed a novel clade, which we designated as Western topotype 4. The high seroprevalence (96.2%) in cattle from Lusaka and Central provinces and co-circulation of multiple serotypes showed that BT is widespread, underscoring the need for prevention and control strategies. [ABSTRACT FROM AUTHOR]

Background and Aim: Inappropriate use of antimicrobials exacerbates antimicrobial resistance (AMR) in the poultry sector. Information on factors driving AMR in the layer poultry sector is scarce in Zambia. This study examined the drivers of AMR in the layer poultry sector in the Lusaka and Copperbelt Provinces of Zambia. Materials and Methods: This cross-sectional study employed a structured questionnaire in 77 layer poultry farms in the provinces of Lusaka and Copperbelt, Zambia, from September 2020 to April 2021. Data analysis was conducted using Stata version 16.1. Antimicrobial resistance was defined as the presence of multidrug resistance (MDR) isolates. Multivariable regression analysis was used to identify drivers of AMR. Results: In total, 365 samples were collected, from which 339 (92.9%) Escherichia coli and 308 (84.4%) Enterococcus spp. were isolated. Multidrug resistance was identified in 39% of the E. coli and 86% of the Enterococcus spp. The overall prevalence of AMR in layer poultry farms was 51.7% (95% confidence interval [CI]: 40.3%-63.5%). Large-scale farmers (Adjusted odds ratio [AOR] = 0.20, 95% CI: 0.04%-0.99%) than small-scale and farmers who were aware of AMR than those who were unaware (AOR = 0.26, 95% CI: 0.08%-0.86%) were less likely to experience AMR problems. Conclusion: This study found a high prevalence of AMR in layer poultry farming linked to the type of farm management practices and lack of AMR awareness. Evidence of high MDR in our study is of public health concern and requires urgent attention. Educational interventions must increase AMR awareness, especially among small- and medium-scale poultry farmers. [ABSTRACT FROM AUTHOR]

Objective To determine the impact of seasonal variations on health indices of free-ranging asymptomatic guinea fowls ( Numida meleagris ) in Zambia. Methods A time series analysis was carried out on a prospective cohort study over a 12 month period between March 2010 and February 2011 by examining a total 147 guinea fowls for haematological and morphometric data of selected organs. Results There was a strong correlation in erythrocytic indices between packed cell volume and red blood cell counts (=0.824, P <0.001) as well as between packed cell volume and hemoglobulin (Hb) counts ( r =0.648, P <0.001). Seasonal differences showed that erythrocytic indices were higher in the males than the females and that the difference was significantly higher ( P <0.001) during the rainy season, which coincided with the breeding period when females were laying eggs. Increase in total plasma protein was positively correlated with overall body weight. Generally, females had higher body weights and total plasma protein levels than the males in the rain season. Of the 147 birds examined, 51% (n=147) had the bursa of Fabricius. For birds that had the bursa of Fabricius, the weights of bursae were higher ( P <0.05) in the cold-dry season than the other seasons and no sex differences were observed. Spleen morphometric data did not show any seasonal nor sex differences. Conclusions Overall, data presented herein demonstrate that seasonal variations have a significant influence on health indices of free-ranging guinea fowls and that these factors could influence the susceptibility of this species of birds to disease infections at different times of the year. [ABSTRACT FROM AUTHOR]

Based on the Codex Alimentarious framework, this study quantitatively assessed the risk of developing salmonellosis through consumption of beef in Lusaka Province of Zambia. Data used to achieve this objective were obtained from reviews of scientific literature, Government reports, and survey results from a questionnaire that was administered to consumers to address information gaps from secondary data. The Swift Quantitative Microbiological Risk Assessment (sQMRA) model was used to analyse the data. The study was driven by a lack of empircally-based risk estimation despite a number of reported cases of salmonellosis in humans. A typology of consumers including all age groups was developed based on their beef consumption habits, distinguishing between those with low home consumption, those with medium levels of home consumption, and those with high levels through restaurant consumption. This study shows that the risk of developing salmonellosis in this population, from consuming beef, was generally low. At ID50 of 9.61 × 10 3 cfu/g and a retail contamination concentration of 12 cfu/g, the risk of developing salmonellosis through the consumption of beef prepared by consumers with low and medium levels of beef consumption was estimated at 0.06% and 0.08%, respectively, while the risk associated with restaurant consumption was estimated at 0.16% per year. The study concludes that the risk of developing salmonellosis among residents in Lusaka province, as a result of beef consumption, was generally low, mainly due to the methods used for food preparation. Further work is required to broaden the scope of the study and also undertake microbiological evaluation of ready-to-eat beef from both the household and restaurant risk exposure pathways. [ABSTRACT FROM AUTHOR]

Abstract: An anthrax outbreak occurred in November 2010 in five villages of Sesheke district in Western Zambia. Control measures and data collection was carried out immediately the outbreak was reported. The prevalence of the disease in cattle was estimated at 7.4% (45/609) while the average herd size of infected cattle in affected villages was estimated at 121.8 (95% CI 48.8–194.8). Individual mortality per herd varied between 1.70% (3/179) and 20.25% (6/79). The relative risk of infection of cattle in the five affected villages varied between 0.18 (95% CI 0.4–5.7) and 3.7 (95% CI 1.99–6.68). In humans, the disease only affected three people and was characterized by cutaneous carbuncles. The ratio of infected persons per number of infected carcasses varied between 1:37 and 1:49 in affected villages while the overall ratio of people at risk to the number of carcasses was 42:1 indicating that despite availability of a large number of carcasses, human contact with infected carcasses was low. The findings of this study underline the importance of timely disease control measures in reducing the risk of human infections to anthrax in the face of an outbreak. [Copyright &y& Elsevier]