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1 Zoonotic Disease Response: Anthrax Angel Holts Walden University Dr. McNeal July 30, 2023

2 Zoonotic Diseases Response: Anthrax Anthrax is one of the most devastating yet common zoonotic diseases caused by the Bacillus anthracis bacteria. The disease usually affects herbivorous animal hosts such as sheep, goats, and cattle but can be spread to humans through interaction with infected animals and animal products (Makurumidze et al., 2021). It includes coming into contact with the body fluid of an infected animal, such as blood, saliva, urine, feces, and mucus, through such acts as petting or touching the animals, scratches by the animals, and bites (Yadeta et al., 2020). Anthrax is a complex and unique zoonotic disease that can enter the body through the cutaneous, gastrointestinal, and inhalation routes. Cutaneous anthrax is the predominant form and commonly exhibits skin lesions. Inhalation anthrax, on the other hand, is the most lethal form, primarily exhibiting severe respiratory distress in individuals (Makurumidze et al., 2021). In the scenario described, the cattle initially died from an unknown disease. When the samples were collected, it was confirmed that they had ingested naturally occurring anthrax spores, which caused the deaths. One characteristic that makes anthrax so virulent is that it is fatal and fast-moving. These two characteristics are evident from the rapid progression and increased cattle mortality rate. In the case provided, many cattle died, and exposure to the human population is evident, with anthrax already affecting 20–30 individuals. Furthermore, the environmental persistence of anthrax spores is long, making it a significant public health concern. These spores can survive for a long time in water, soil, and contaminated animal products, an aspect that enhances their risk-posing attributes and future potential for outbreaks and exposure to both animals and humans (Makurumidze et al., 2021). With the exposure of 20–30 people already, public health concerns, especially the fear of the potential development of anthrax disease, should be a priority. Human infections can range

3 from mild to severe, and untimely intervention may threaten the patient's life. Also, outbreak instances require prompt public health intervention to curtail the further spread of the disease and thus protect human health. The most common interventions include disinfection of infected areas; quarantine of animals, animal products, and people; and disposal of any material or tool suspected to be infected with the bacteria. Animal and human vaccination against anthrax is also a viable option that can be pursued to prevent inter-species transmission (Carpenter et al., 2022). These interventions are important and necessary as they enable the containment of the disease within the affected area. In addition, prompt treatment and post-exposure prophylaxis are necessary for those exposed to anthrax to prevent the development of human disease and further complications (Makurumidze et al., 2021). Furthermore, public health professionals are expected to initiate outreach and educational programs to raise public awareness and curtail the further spread of the disease. Identifying the anthrax disease and confirming the same through lab analysis showcases the significance of proactive surveillance systems and early detection in preventing and controlling zoonotic diseases. Timely reporting, collaboration, and communication between public health professionals and veterinarians are essential to a coordinated response against an anthrax outbreak (Belay et al., 2017). All these efforts will hold the outbreak in check and ensure that few animals and people get infected. Anthrax, a zoonotic disease, can be transmitted from animals to humans. The transmission process from the initial environment to humans can be described using several steps (Yadeta et al., 2020). The animals (in this case, cattle) get exposed to naturally occurring anthrax spores in the environment through ingestion. This ingestion can occur through drinking water or grazing. The anthrax bacteria, once ingested, will multiply in the gastrointestinal tract of the

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4 cattle and, when mature, produce spores, which are present in their feces (Osman et al., 2018). The bacteria also colonize the cattle's body organs as their population continues to multiply. Thus, humans can be infected by contacting the infected cattle's fluids and products, such as hides, milk, meat, and blood. Also, the cattle can infect each other within the same herd or adjacent. In the case herein, the highest possibility is that the people infected with the disease came into direct contact with an infected animal (cattle) or products of infected animals. Infection can also occur if the infected animal's urine, feces, and other discharges contaminate the environment, thus exposing humans to anthrax-causing bacteria (Doganay & Demiraslan, 2015). Once infected, the bacteria enter the human body and continue to multiply. The anthrax spores, germinating, cause organ-specific anthrax, i.e., inhalational, cutaneous, or gastrointestinal anthrax. Many environmental health factors significantly impact the transmission of anthrax disease from animals to humans. First, spores that occur naturally in the environment and persist for long periods can contaminate the water, soil, and vegetation. Such contamination puts the people and animals that live nearby at a greater risk of contracting and transmitting anthrax (Alam et al., 2022). Furthermore, changes in land usage, such as urbanization and deforestation, significantly impact the environment and can increase people's contact with domestic animals and wildlife. Such changes in land use also disrupt the balance of the natural ecosystem, which predisposes people and areas to zoonotic diseases such as anthrax. Also, the increased popularity of global trade and travel allows individuals to spread zoonotic diseases such as anthrax across the globe (Durrheim et al., 2020). More importantly, people's poor hygiene and sanitation practices are a crucial indicator of diseases' capability to move from one individual to another or from an animal to a human.

5 Given the information in this case, several barriers and challenges can be expected when responding to the anthrax outbreak in cattle and the associated risks this poses to human health. First is the enormous difficulty in identifying and diagnosing the disease (Bloom & Cadarette, 2019). It usually takes time and several casualties to suspect anthrax infection in animals such as cattle. Anthrax can also be significantly challenging to diagnose initially, as several other animal illnesses present similar physical symptoms to anthrax (Sitali et al., 2018). The difficulty in identifying and diagnosing anthrax is a cause of delayed treatment of the disease and a subsequent increase in animal-human transmission. Owing to the fear of infection, the diagnosis of anthrax requires using more advanced laboratories to safeguard the technicians and members of the public (Bloom & Cadarette, 2019). Thus, the diagnosis will likely take time, which also affords more time for animal-human transmissions and further health deterioration for those already infected. Other challenges and barriers likely to be faced are highlighted below. There is a problem with the limited resources available for disease surveillance and response. Issues with limited resources are evident in this case and are more common in developing countries. Poor infrastructure and sanitation are another resource issue that increases the risk of exposure to anthrax and other disease-causing microorganisms (Chatterjee et al., 2017). This aspect is especially a considerable problem in remote and rural areas where roads and other forms of infrastructure may be deteriorating. Unfortunately, most cattle farmers usually live in these rural and remote areas. Resource issues can also manifest in terms of limited access to healthcare. This aspect includes an impassable transport network, the distance to the hospital, and the equipment of the hospital to handle anthrax.

6 Another barrier and challenges faced when trying to intervene against anthrax disease is resistance to public health interventions. Like in many instances when the government needs to contain the spread of a super-fast infectious disease, anthrax can be contained through vaccination and quarantine measures. However, many individuals resist being restricted to their localities and can thus be challenging to maintain (Sitali et al., 2018). In instances where people embark on international travel and trade, the spread of the disease into different continents and jurisdictions makes it difficult to follow up and contain outbreaks before the disease spreads far and wide. The core public health roles and responsibilities for prevention and response against anthrax outbreaks include surveillance and monitoring, diagnosis and reporting, risk assessment and communication, outbreak investigation and response, and collaboration and coordination (Vieira et al., 2017). Surveillance at all levels of government is vital to preventing and curtailing outbreaks. Laboratory tests are necessary to confirm the bacteria, and reporting the same to responsible authorities will help the investigation and response. On risk assessment and communication, healthcare providers, the public, and other stakeholders need information on prevention and, generally, creating awareness. In the investigation and response part, all public health agencies need to coordinate to identify the source of the infection, trace all relevant contacts, and put in place control measures. Through joint investigations, the local, state, and federal public health agencies should coordinate to share resources, information, and expertise to prevent spreading (Sidwa et al., 2020). Federal public agencies such as the CDC will be critical in providing guidance and technical assistance. Several resources and partnerships will be needed to respond to the anthrax outbreak. Lab testing agencies from various public agencies need to be involved to provide the test results on

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7 time. Also, health providers and veterinarians are vital in identifying and treating human and animal anthrax cases respectively (Sahoo et al., 2020). Public health agencies must collaborate with local providers and veterinarians to clarify what signs and symptoms to look out for and how to report cases. In this case, the community organization is another critical partner in the response. Public health agencies should partner with community organizations to create awareness and educate locals on prevention measures. Finally, national and international organizations such as WHO and CDC are best suited to provide guidance and technical assistance in responding to the anthrax outbreak (Sidwa et al., 2020). Public health agencies must partner with these groups to access the latest information and best practices. Many specific public health and community protection procedures are highly effective in the case highlighted herein. The first is the vaccination of animals and humans. The CDC (2016) recommends that technicians and professionals who directly handle infected animals and samples get vaccinated to reduce the risk of infection. Disease surveillance should be done to monitor the disease's spread in animals and humans. This aspect involves data collection and analysis, identifying trends, and detecting new outbreaks. Also, implementing early detection and diagnosis in animals and humans will ensure recovery and curb the spread of the disease. Another procedure, in this case, is quarantining the infected area to prevent further spread to other animals and humans. Animals and individuals infected are isolated, and their movements are restricted until they recover or get the disease under control. Next is the disinfection of areas that are contaminated by anthrax spores. It helps to kill anthrax spores so that the disease may not develop again. Further public health procedures must be implemented to protect the community and control the spread of anthrax. First, there is disease investigation and control to identify the

8 source and track the spread. Control can be done through quarantine, disinfecting contaminated areas, and surveillance (Croicu 2019). Exposure treatment comprises providing prophylactic treatment and vaccines to those exposed to curtail disease development (Savransky et al., 2020). Treatments should also be started for those infected to limit disease severity. Also, the dead animals from anthrax should be disposed of properly to prevent continued transmission and contamination. Disseminating public information should be planned and implemented accurately and timely (Croicu, 2019). This information should include risks, prevention measures, awareness, and signs and symptoms. In conclusion, the public health sector has a massive role in preventing and responding to zoonotic diseases like anthrax. This fast-spreading disease can be fatal if the intervention is not taken early. Public health agencies should work to minimize or eradicate barriers to effective responses against anthrax disease. It requires collaboration between many stakeholders, such as veterinarians, community organizations, all levels of government, and international organizations. I recommend including members of the public as stakeholders because, without their contribution, the efforts made will bear little fruit.

9 References Alam, M. E., Kamal, M. M., Rahman, M., Kabir, A., Islam, M. S., & Hassan, J. (2022). Review of anthrax: A disease of farm animals. Journal of Advanced Veterinary and Animal Research , 9 (2), 323. Belay, E. D., Kile, J. C., Hall, A. J., Barton-Behravesh, C., Parsons, M. B., Salyer, S., & Walke, H. (2017). Zoonotic disease programs for enhancing global health security. Emerging infectious diseases , 23 (Suppl 1), S65. Bloom, D. E., & Cadarette, D. (2019). Infectious disease threats in the twenty-first century: strengthening the global response. Frontiers in immunology , 10 , 549. Carpenter, A., Waltenburg, M. A., Hall, A., Kile, J., Killerby, M., Knust, B., ... & Vaccine Preventable Zoonotic Disease Working Group. (2022). Vaccine preventable zoonotic diseases: challenges and opportunities for public health progress. Vaccines , 10 (7), 993. CDC, (2016). Anthrax Vaccination: What Everyone Should Know. Retrieved from: https://www.cdc.gov/vaccines/vpd/anthrax/public/index.html Chatterjee, P., Bhaumik, S., Chauhan, A. S., & Kakkar, M. (2017). Protocol for developing a database of zoonotic disease research in India (DoZooRI). BMJ open , 7 (12), e017825. Croicu, A. M. (2019). An optimal control model to reduce and eradicate anthrax disease in herbivorous animals. Bulletin of mathematical biology , 81 (1), 235-255. Doganay, M., & Demiraslan, H. (2015). Human anthrax as a re-emerging disease. Recent Patents on Anti-Infective Drug Discovery , 10 (1), 10-29. Durrheim, D. N., Gostin, L. O., & Moodley, K. (2020). When does a major outbreak become a Public Health Emergency of International Concern?. The Lancet Infectious Diseases , 20 (8), 887-889.

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10 Makurumidze, R., Gombe, N. T., Magure, T., & Tshimanga, M. (2021). Investigation of an anthrax outbreak in Makoni District, Zimbabwe. BMC public health , 21 , 1-10. Osman, S., Makinde, O. D., & Theuri, D. M. (2018). Mathematical modelling of transmission dynamics of anthrax in human and animal population. Mathematical Theory and Modelling , 8 . Sahoo, K. C., Negi, S., Barla, D., Badaik, G., Sahoo, S., Bal, M., ... & Bhattacharya, D. (2020). The landscape of anthrax prevention and control: stakeholders' perceptive in Odisha, India. International Journal of Environmental Research and Public Health , 17 (9), 3094. Savransky, V., Ionin, B., & Reece, J. (2020). Current status and trends in prophylaxis and management of anthrax disease. Pathogens , 9 (5), 370. Sidwa, T., Salzer, J. S., Traxler, R., Swaney, E., Sims, M. L., Bradshaw, P., ... & Hendricks, K. (2020). Control and prevention of anthrax, Texas, USA, 2019. Emerging infectious diseases , 26 (12), 2815. Sitali, D. C., Twambo, M. C., Chisoni, M., Bwalya, M. J., & Munyeme, M. (2018). Lay perceptions, beliefs and practices linked to the persistence of anthrax outbreaks in cattle in the Western Province of Zambia. Onderstepoort Journal of Veterinary Research , 85 (1), 1-8. Vieira, A. R., Salzer, J. S., Traxler, R. M., Hendricks, K. A., Kadzik, M. E., Marston, C. K., ... & Walke, H. T. (2017). Enhancing surveillance and diagnostics in anthrax-endemic countries. Emerging infectious diseases , 23 (Suppl 1), S147. Yadeta, W., Giro, A., Amajo, M., & Jilo, K. (2020). Recent understanding of the epidemiology of animal and human anthrax in Ethiopia with emphasis on diagnosis, control and prevention interventions-review. World J Med Sci , 17 (1), 1-9.