|
|
Letter
Age as a Risk Factor for Cutaneous
Human Anthrax: Evidence from Haiti, 1973–1974
Suggested citation for this article: Kaufmann AF, Dannenberg
AL. Age as a risk factor for cutaneous human anthrax: evidence from
Haiti, 1973-1974. Emerg Infect Dis [serial online] 2002 Aug [date
cited]; 8. Available from: URL: http://www.cdc.gov/ncidod/EID/vol8no8/02-0207.htm
To the Editor: Few cases of anthrax have been reported in children,
in part because most exposures to Bacillus anthracis occur in workplace
settings. Questions about the susceptibility of children to B. anthracis
infection were raised when cutaneous anthrax developed in a 7-month-old
child in New York City in 2001 after he was taken to visit his mother’s
workplace (1). No cases of anthrax were reported in persons
<24 years of age in the 1979 inhalational anthrax outbreak in the Soviet
city of Sverdlovsk, despite a presumed general population exposure (2).
Such reports have led some investigators to postulate that young persons
may be less susceptible to anthrax than older persons.
In 1974, the Center for Disease Control reviewed records on the occurrence
of human anthrax in District Sanitaire des Cayes, Haiti, as part of an
investigation of cutaneous anthrax in a Florida woman exposed to spore-contaminated
goatskin drums she purchased in Haiti (3). In 1973, a
total of 387 cases (7.6 per 10,000 population) were clinically diagnosed
in District Sanitaire des Cayes; another 59 cases occurred in the first
4 months of 1974. All cases were the cutaneous form; gastrointestinal
and inhalational anthrax are rarely, if ever, diagnosed in Haiti. The
source of infection in these 446 patients could not be determined. Although
cases of animal anthrax were rarely reported in Haiti because of a weak
surveillance system, 96 (26%) of 368 Haitian goatskin handicraft items
were found to be contaminated with B. anthracis during the 1974
investigation, suggesting that animal infections were not uncommon (4).
Therefore, the source of the infection may have been meat and other products
of value salvaged by local residents from anthrax-infected animals.
Age was reported for 366 of the 446 patients in District Sanitaire des
Cayes (Table). The distribution of anthrax cases
by age group was generally similar to that of the general population,
except the proportion of cases in the 15- to 44-year age group was lower
than the proportion of persons in that age group in the general population
(p<0.03; chi square). In 124 patients for whom information was available,
the cutaneous lesion was located on the head or neck (60 patients [48%]),
the arm (31 [25%]), the trunk (23 [19%]), and the leg (12 [10%]); this
anatomic distribution, reflecting the primary skin contact point of the
organism, was similar in all age groups. However, determining whether
the various age groups had differences in skin contact exposure leading
to infection is difficult. The affected rural population lived in extreme
poverty, typically in small huts with dirt floors and no safe water supply
or latrine. Malnutrition was epidemic, and nothing edible was discarded.
The crowded living conditions limited opportunities to maintain basic
personal hygiene and made it likely that exposure to B. anthracis–contaminated
materials was similar across all age groups. These previously unpublished
age-specific anthrax attack rates from Haiti suggest that adults and children
have similar susceptibility to cutaneous anthrax.
Arnold F. Kaufmann and Andrew L. Dannenberg
Centers for Disease Control and Prevention
Atlanta, Georgia, USA
References
- Centers for Disease Control and Prevention. Update:
investigation of anthrax associated with intentional exposure and interim
public health guidelines, October 2001. MMWR Morb Mortal Wkly Rep
2001;50:889–93.
- Meselson M, Guillemin J, Hugh-Jones M, Langmuir A, Popova I, Shelokov
A, et al. The
Sverdlovsk anthrax outbreak of 1979. Science 1994;266:1202–8.
- Center for Disease Control. Cutaneous anthrax acquired from imported
Haitian drums—Florida. MMWR Morb Mortal Wkly Rep 1974;23:142,147.
- Center for Disease Control. Follow-up on cutaneous anthrax acquired
from imported Haitian drums—Florida. MMWR Morb Mortal Wkly Rep 1974;23:224.
| Table.
Reported ages of persons with cutaneous anthrax, District Sanitaire
des Cayes, Haiti, 1973–74 |
|
|
Age group (yrs)
|
Anthrax patients
(%)
|
General population
(%)
|
Cases/10,000 persons
|
|
|
<1
|
15 (4.1)
|
16,361 (3.2)
|
9.2
|
|
1–4
|
49 (13.4)
|
59,291 (11.6)
|
8.3
|
|
5–14
|
96 (26.2)
|
120,532 (23.5)
|
8.0
|
|
15–44
|
135 (36.9)
|
235,164 (45.8)
|
5.7
|
|
45–64
|
58 (15.8)
|
64,882 (12.7)
|
8.9
|
|
>65
|
13 (3.6)
|
16,669 (3.2)
|
7.8
|
|
All ages
|
366
|
512,899
|
7.1
|
|
|
|
|
