Anthrax outbreak in South Sudan

Officials in South Sudan, in East Africa, report since the beginning of the year, 162 human anthrax cases have been reported from two states: Western Bar El Ghazal (87 cases) and Warrap (75 cases). Among these 162 cases, three have resulted in deaths, with a case fatality rate (CFR) of 1.9%.

All 162 cases presented with fever, itching, swelling, and skin ulcers, and all had a history of consuming dead meat.

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Two-thirds of the cases have been in males and nearly half the cases are reported in people ages 15 to 57.

In 2024, a total of 36,861 animals have contracted the disease, of which 36,694 have died, representing a case fatality rate of 99.6% in animals. A total of 1,741 animals have been vaccinated across three Boma (Majok-Yienhliet, Malual-lukluk and Waar-Alel/Kuajok).

According to the World Health Organization, Warrap and Western Bahr el Ghazal (WBeG) States are responding to an anthrax outbreak, especially among vulnerable IDP populations. Critical gaps and challenges identified in surveillance, laboratory capacity, case management, community engagement, and Water, Sanitation, and Hygiene must be addressed to curb the spread and prevent loss of life. Overall, a comprehensive one health approach is necessary to mitigate the impact of the outbreak in South Sudan.

Anthrax is a serious infectious disease caused by a bacteria called Bacillus anthracis. Many different types of animals, as well as people, can get the disease.

In animals, signs of the illness usually appear 3 to 7 days after the spores are swallowed or inhaled. Once signs begin in animals, they usually die within two days. Infected animals may stagger, have difficulty breathing, tremble, and finally collapse and die within a few hours. Sometimes animals may have a fever and a period of excitement followed by staggering, depression, unconsciousness (lacking awareness), difficulty breathing, seizures, and death. Dark blood may ooze from the mouth, nose, and anus.

Handling or eating a dead or sick animal infected with anthrax can transmit anthrax to humans and other animals. Anthrax is not spread by sneezing or coughing. Person-to-person spread of the disease is unlikely.

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In humans, symptoms of disease vary depending on how the disease was contracted, but usually occur within 7 days after exposure. The three forms of human anthrax are inhalation anthrax (caused when the spores are inhaled into the lungs), cutaneous anthrax (caused when broken skin comes into contact with infected animals or hides), and intestinal anthrax (caused when undercooked meat from an infected animal is eaten). 
 
Initial symptoms of inhalation anthrax infection may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock. Inhalation anthrax is usually fatal, unless the patient is treated before any symptoms occur. 
 
The intestinal disease form of anthrax may follow the consumption of contaminated food and is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, and fever are followed by abdominal pain, vomiting of blood, and severe diarrhea. Like inhalation anthrax, the intestinal form is usually fatal. 

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The cutaneous form of the disease begins with itching at the site of the exposure, followed by the formation of a round, pimple-like sore. This sore will then form a blister which, after 2-6 days will become a hard, black scab (similar to the scab left after a deep burn). Untreated, between 5 and 20% of patients will die. However, with adequate antibiotic treatment very few deaths occur.