Anthrax is an acute infectious zoonotic disease caused by the spore-forming, aerobic, gram-positive, non-motile bacterium Bacillus anthracis.1,2 Among the three clinical forms of anthrax in humans, more than 95% of naturally occurring infections are cutaneous anthrax.3 Gastrointestinal anthrax is usually caused by consumption of insufficiently cooked contaminated meat and it is relatively uncommon.4,5 Inhalation anthrax is rare in naturally occurring infections and it is associated with processing and handling of hides and wool in enclosed factory spaces, where aerosolized anthrax spores may be inhaled.5 Cutaneous anthrax occurs worldwide, with an estimated 20,000–100,000 human cases occurring annually,5,6 generally in low-income countries, where livestock are not routinely vaccinated. No cutaneous anthrax outbreaks have been reported from Bangladesh since 1986,7,8 but anthrax infection among livestock in Bangladesh was reported routinely,9 and cutaneous anthrax outbreaks have been reported from neighboring states in India in recent years.10,11
During August 2009–October 2010, we investigated 14 reported outbreaks of cutaneous anthrax in Bangladesh (Figure 1). A collaborative team of epidemiologists, physicians, veterinarians, and anthropologists from the Institute of Epidemiology, Disease Control and Research (IEDCR), the Department of Livestock Services of the Government of Bangladesh, and International Centre for Diarrheal Disease Research, Bangladesh conducted the outbreak investigations. The objectives of these outbreak investigations were to identify the etiology, modes of transmission, the social, behavioral, and cultural factors that contributed to these outbreaks, along with suggesting control and prevention measures.