{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T18:47:53Z","timestamp":1792694873912,"version":"4.5.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0013727","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000}}],"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anthrax is a recurrent zoonosis in Uganda, with 11 outbreaks reported in 2024. On September 17, 2024, the Ministry of Health received reports of two human deaths in Kanungu District, later confirmed as anthrax\u2014the district\u2019s first recorded outbreak. We investigated to determine its scope, risk factors, and recommend control measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We defined a suspected cutaneous anthrax case as an acute onset of skin lesions (papule, vesicle, or eschar) with \u22652 of itching, reddening, lymphadenopathy, fever, or malaise. Suspected gastrointestinal anthrax was onset of abdominal pain with \u22652 of vomiting, diarrhea, fever, or loss of appetite in a Kanungu resident from June\u2013November 2024. Confirmation required Polymerase Chain Reaction (PCR) detection of\n                      <jats:italic>Bacillus anthracis<\/jats:italic>\n                      . In a 1:2 unmatched case-control study, we enrolled all cases and controls from neighboring asymptomatic households in the two most affected sub-counties. Logistic regression was used to identify risk factors for infection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 90 cases (86 suspected and 4 confirmed); 80% had cutaneous, 11% gastrointestinal, and 9% both forms. Males were more affected (attack rate [AR]=48\/100,000) than females (AR\u2009=\u200915\/100,000); case fatality rate was 6.7% (6\/90). Overall, 10\/27 sub-counties were affected, with Bugongi (AR\u2009=\u2009257\/100,000) being the most affected. Consuming meat from suddenly dead livestock (adjusted odds ratio [aOR]=5.5, 95% CI: 2.7\u201311), handling carcasses (aOR=8.2, 95% CI: 3.8\u201318), having a low education level (aOR=6.0, 95% CI: 2.6\u201314), and being male (aOR=2.3, 95%CI\u2009=\u20091.03-4.9) increased the odds of infection. Notably, 90% of the case-patients purchased the contaminated meat from a single dealer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The outbreak was linked to consuming and handling meat from livestock that died suddenly, underscoring gaps in veterinary inspection and carcass management. Strengthening inspections, enforcing carcass disposal, and targeted community education are essential for prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0013727","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T17:54:41Z","timestamp":1783706081000},"page":"e0013727","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Anthrax outbreak associated with the consumption and handling of carcasses of livestock that suddenly died, Kanungu District, Uganda, June\u2013November 2024"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5986-2211","authenticated-orcid":true,"given":"Charity","family":"Mutesi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Migisha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannington","family":"Katumba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bridget","family":"Ainembabazi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen Nelly","family":"Naiga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Kellermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birungi","family":"Mutahunga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Ouma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aloysius","family":"Tumwesigye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Ilimaso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian","family":"Bulage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex Riolexus","family":"Ario","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"pntd.0013727.ref001","doi-asserted-by":"crossref","unstructured":"Migisha R, Mbatidde I, Agaba DC, Turyakira E, Tumwine G, Byaruhanga A. Risk factors for human anthrax outbreak in Kiruhura District, southwestern Uganda: a population-based case control study. 2021.","DOI":"10.11604\/pamj-oh.2021.5.13.29385"},{"issue":"12","key":"pntd.0013727.ref002","doi-asserted-by":"crossref","first-page":"2799","DOI":"10.3201\/eid2612.191373","article-title":"Outbreak of anthrax associated with handling and eating meat from a cow, Uganda, 2018","volume":"26","author":"E Kisaakye","year":"2020","journal-title":"Emerg Infect Dis"},{"key":"pntd.0013727.ref003","unstructured":"Bhattacharya D, Barla D, Pati S. How can anthrax outbreaks be prevented in Odisha. 2019."},{"issue":"2","key":"pntd.0013727.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0008026","article-title":"Outbreak of gastrointestinal anthrax following eating beef of suspicious origin: Isingiro District, Uganda, 2017","volume":"14","author":"M Nakanwagi","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0013727.ref005","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s42522-021-00040-z","article-title":"Cutaneous anthrax outbreak associated with handling dead animals, Rhino Camp sub-county: Arua District, Uganda, January\u2013May 2018","volume":"3","author":"V Ntono","year":"2021","journal-title":"One Health Outlook"},{"issue":"9","key":"pntd.0013727.ref006","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.3201\/eid2009.140181","article-title":"Investigation and control of anthrax outbreak at the human-animal interface, Bhutan, 2010","volume":"20","author":"NK Thapa","year":"2014","journal-title":"Emerg Infect Dis"},{"issue":"2","key":"pntd.0013727.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.9734\/IJTDH\/2016\/22359","article-title":"Anthrax outbreak investigation among humans and animals in Northern Ghana: case report","volume":"12","author":"J Awoonor-Williams","year":"2016","journal-title":"Int J Trop Dis Health"},{"issue":"16","key":"pntd.0013727.ref008","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1056\/NEJM200010193431615","article-title":"Anthrax: the investigation of a deadly outbreak","volume":"343","author":"J Guillemin","year":"2000","journal-title":"N Engl J Med"},{"issue":"2","key":"pntd.0013727.ref009","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1093\/infdis\/116.2.123","article-title":"Pathophysiology of anthrax","volume":"116","author":"F Klein","year":"1966","journal-title":"J Infect Dis"},{"issue":"2","key":"pntd.0013727.ref010","doi-asserted-by":"crossref","first-page":"433","DOI":"10.2353\/ajpath.2006.051330","article-title":"Sepsis and pathophysiology of anthrax in a nonhuman primate model","volume":"169","author":"DJ Stearns-Kurosawa","year":"2006","journal-title":"Am J Pathol"},{"issue":"1","key":"pntd.0013727.ref011","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1146\/annurev.cellbio.19.111301.140655","article-title":"Anthrax toxin","author":"RJ Collier","year":"2003","journal-title":"Annu Rev Cell Dev Biol"},{"issue":"6","key":"pntd.0013727.ref012","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/S2221-1691(11)60109-3","article-title":"Anthrax: an update","volume":"1","author":"SM Kamal","year":"2011","journal-title":"Asian Pac J Trop Biomed"},{"issue":"6","key":"pntd.0013727.ref013","doi-asserted-by":"crossref","first-page":"690","DOI":"10.3390\/pathogens11060690","article-title":"What is anthrax?","volume":"11","author":"WA Bower","year":"2022","journal-title":"Pathogens"},{"issue":"3","key":"pntd.0013727.ref014","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.jiph.2010.07.004","article-title":"A review of cutaneous anthrax and its outcome","volume":"3","author":"M Doganay","year":"2010","journal-title":"J Infect Public Health"},{"issue":"20","key":"pntd.0013727.ref015","doi-asserted-by":"crossref","first-page":"2527","DOI":"10.1001\/archinte.163.20.2527","article-title":"Gastrointestinal anthrax: review of the literature","volume":"163","author":"ME Beatty","year":"2003","journal-title":"Arch Intern Med"},{"issue":"6","key":"pntd.0013727.ref016","doi-asserted-by":"crossref","first-page":"2291","DOI":"10.1073\/pnas.90.6.2291","article-title":"Pathology of inhalational anthrax in 42 cases from the Sverdlovsk outbreak of 1979","volume":"90","author":"FA Abramova","year":"1993","journal-title":"Proc Natl Acad Sci"},{"issue":"6","key":"pntd.0013727.ref017","doi-asserted-by":"crossref","first-page":"933","DOI":"10.3201\/eid0706.010604","article-title":"Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States","volume":"7","author":"JA Jernigan","year":"2001","journal-title":"Emerg Infect Dis"},{"issue":"12","key":"pntd.0013727.ref018","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1164\/rccm.201102-0209CI","article-title":"Anthrax infection","volume":"184","author":"DA Sweeney","year":"2011","journal-title":"Am J Respir Crit Care Med"},{"issue":"4","key":"pntd.0013727.ref019","doi-asserted-by":"crossref","first-page":"553","DOI":"10.17219\/acem\/68380","article-title":"Injectional anthrax in human: a new face of the old disease","volume":"27","author":"AA Zasada","year":"2018","journal-title":"Adv Clin Exp Med"},{"key":"pntd.0013727.ref020","first-page":"502","article-title":"Anthrax and its impact on public health","volume":"4","author":"MF Rahim","year":"2023","journal-title":"Zoonosis Unique Sci Publ"},{"issue":"15","key":"pntd.0013727.ref021","article-title":"Emergence of anthrax in Bududa District, Eastern Uganda, February-May 2022: implications for prevention and control","volume":"14","author":"Z Kabami","year":"2024","journal-title":"PAMJ-One Health"},{"issue":"8","key":"pntd.0013727.ref022","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0009645","article-title":"Cutaneous anthrax associated with handling carcasses of animals that died suddenly of unknown cause: Arua District, Uganda, January 2015-August 2017","volume":"15","author":"FL Aceng","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"issue":"5","key":"pntd.0013727.ref023","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0196799","article-title":"Multisectoral prioritization of zoonotic diseases in Uganda, 2017: a One Health perspective","volume":"13","author":"M Sekamatte","year":"2018","journal-title":"PLoS One"},{"issue":"1","key":"pntd.0013727.ref024","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s42522-025-00151-x","article-title":"Anthrax outbreak linked to consumption and handling of meat from unexpectedly deceased cattle, Kyotera district, Uganda, June-December 2023","volume":"7","author":"L Tumusiime","year":"2025","journal-title":"One Health Outlook"},{"key":"pntd.0013727.ref025","unstructured":"Nuwamanya Y, Kizza D, Kiyimba A, Ssemanda I, Waako S, Aanyu D. Anthrax outbreaks in western Uganda: the role of illegal meat dealers in spreading the infection. 2022."},{"key":"pntd.0013727.ref026","author":"Uganda Bureau of Statistics","year":"2024"},{"key":"pntd.0013727.ref027","unstructured":"Barasa B, Egeru A, Patrick PO, Fridah M. Dynamics of land use\/cover trends in Kanungu district, South-western Uganda. 2010."},{"issue":"12","key":"pntd.0013727.ref028","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0295915","article-title":"Untangling the effects of multiple exposures with a common reference group in an epidemiologic study: a practical revisit","volume":"18","author":"RE Fontaine","year":"2023","journal-title":"PLoS One"},{"key":"pntd.0013727.ref029","unstructured":"Bainomugisha K, Kisaakye E, Bulage L, Ario AR. Cutaneous and gastrointestinal anthrax out-break caused by handling meat from infected carcass, Makutano village, Kween district, Uganda, May 2018; 2018."},{"issue":"1","key":"pntd.0013727.ref030","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2023.e23481","article-title":"Animal, human, and environmental perspectives on anthrax in Bangladesh","volume":"10","author":"SS Islam","year":"2024","journal-title":"Heliyon"},{"key":"pntd.0013727.ref031","doi-asserted-by":"crossref","DOI":"10.15585\/mmwr.mm7223a6","article-title":"Notes from the field: rift Valley fever outbreak\u2014Mbarara district, western Uganda, January\u2013March 2023","volume":"72","author":"Z Kabami","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pntd.0013727.ref032","unstructured":"King P, Simbwa BN, Kawungezi PC, Morukileng J, Wanyana MW, Nicholas M. Gastrointestinal anthrax outbreak investigation, Ibanda District, southwestern Uganda, August 2022. 2022."},{"key":"pntd.0013727.ref033","unstructured":"Kibwika B, Namulondo E, Aanyu D, Nuwamanya Y, Rek J, Kiza D. Anthrax outbreak associated with handling and consuming meat from animals that died suddenly, Ibanda District, Uganda, May 2023. 2023."},{"issue":"9","key":"pntd.0013727.ref034","doi-asserted-by":"crossref","first-page":"180479","DOI":"10.1098\/rsos.180479","article-title":"Risk factors for human cutaneous anthrax outbreaks in the hotspot districts of Northern Tanzania: an unmatched case-control study","volume":"5","author":"ER Mwakapeje","year":"2018","journal-title":"R Soc Open Sci"},{"key":"pntd.0013727.ref035","article-title":"Are we ready for the next anthrax outbreak? Lessons from a simulation exercise in a rural-based district in Uganda","author":"AW Walekhwa","year":"2024","journal-title":"Epidemiol Infect"},{"key":"pntd.0013727.ref036","doi-asserted-by":"crossref","first-page":"1442937","DOI":"10.3389\/fpubh.2024.1442937","article-title":"Risk factors associated with cutaneous anthrax outbreaks in humans in Bangladesh","volume":"12","author":"S Chowdhury","year":"2024","journal-title":"Front Public Health"},{"issue":"10","key":"pntd.0013727.ref037","doi-asserted-by":"crossref","first-page":"2462","DOI":"10.3390\/microorganisms11102462","article-title":"One health assessment of Bacillus anthracis incidence and detection in anthrax-endemic areas of Pakistan","volume":"11","author":"N Sardar","year":"2023","journal-title":"Microorganisms"},{"issue":"1","key":"pntd.0013727.ref038","doi-asserted-by":"crossref","first-page":"167","DOI":"10.3390\/microorganisms12010167","article-title":"Human Exposure to naturally occurring Bacillus anthracis in the Kars region of eastern T\u00fcrkiye","volume":"12","author":"F Buyuk","year":"2024","journal-title":"Microorganisms"},{"issue":"1","key":"pntd.0013727.ref039","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s41182-022-00445-0","article-title":"Outbreak of cutaneous anthrax associated with handling meat of dead cows in southwestern Uganda, May 2018","volume":"50","author":"A Musewa","year":"2022","journal-title":"Trop Med Health"},{"issue":"1","key":"pntd.0013727.ref040","first-page":"1","article-title":"A review on trans-boundary animal diseases management","volume":"12","author":"JJ Edo","year":"2019","journal-title":"Vet Res"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0013727","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0013727","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T17:53:11Z","timestamp":1784137991000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0013727"}},"subtitle":[],"editor":[{"given":"Richard A.","family":"Bowen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":40,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0013727","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]}}}