{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T14:40:33Z","timestamp":1792507233314,"version":"4.5.0"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anthrax is a zoonotic disease that remains endemic in Uganda, particularly in cattle-keeping areas. On December 28, 2023, the first suspected human case of anthrax was detected in Amudat District. We investigated to determine the outbreak\u2019s magnitude, identify risk factors, and recommend prevention and control measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We defined a suspected cutaneous anthrax case as acute onset of \u22652 of the following: skin lesions (papule, vesicle, or eschar) on exposed areas such as the hands, forearms, shoulders, back, thighs or face, localized itching, redness, swelling, or regional lymphadenopathy, in Amudat residents from December 2023\u2013June 2024.<\/jats:p>\n                    <jats:p>\n                      A confirmed case was a suspected case with PCR-positive test for\n                      <jats:italic>Bacillus anthracis<\/jats:italic>\n                      . In unmatched case-control study (1:3 ratio), we compared exposures among 40 cases and 120 controls. We identified cases through house-to-house search, medical record reviews, and snowballing among case-persons. Human and animal samples were collected and tested, alongside an environmental assessment. We used multivariable logistic regression to identify associated risk factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 102 cutaneous anthrax cases, including 7 confirmed cases; none died. The outbreak lasted 7 months, peaking in March 2024, with an overall attack rate of 169\/100,000 (males: 196\/100,000; females: 138\/100,000). Use of cattle hides as bedding (OR=12; 95% CI:2.7\u201352) and butchering cattle carcasses (OR=6; 95% CI:1.8\u201319) were significantly associated with anthrax. The highest infection risk was observed among individuals with multiple exposures: butchered only (OR = 6.9, 95% CI:2.6\u201318), butchered and carried cattle parts (OR = 11, 95% CI:1.2\u201396), butchered and skinned (OR = 14, 95% CI:3.5\u201356), and butchered, carried, and skinned (OR = 17, 95% CI:1.6\u2013219). No livestock had been vaccinated prior to the outbreak.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The outbreak was associated to use of cattle hides as bedding and the butchering of cattle carcasses. We recommended community education, livestock vaccination, and safe carcass handling to prevent future outbreaks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0336769","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T18:27:25Z","timestamp":1763404045000},"page":"e0336769","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cutaneous anthrax outbreak associated with use of cattle hides and handling carcasses, Amudat District, Uganda, 2023\u20132024"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8158-9529","authenticated-orcid":true,"given":"Patrick","family":"Kwizera","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":"Esther","family":"Nabatta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9782-7826","authenticated-orcid":true,"given":"Samuel","family":"Gidudu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0400-8635","authenticated-orcid":true,"given":"Benon","family":"Kwesiga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Job","family":"Morukileng","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":[[2025,11,17]]},"reference":[{"issue":"2","key":"pone.0336769.ref001","doi-asserted-by":"crossref","first-page":"323","DOI":"10.5455\/javar.2022.i599","article-title":"Review of anthrax: A disease of farm animals","volume":"9","author":"ME Alam","year":"2022","journal-title":"J Adv Vet Anim Res"},{"issue":"2","key":"pone.0336769.ref002","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0192031","article-title":"Rates and risk factors for human cutaneous anthrax in the country of Georgia: National surveillance data, 2008-2015","volume":"13","author":"A Kasradze","year":"2018","journal-title":"PLoS One"},{"key":"pone.0336769.ref003","first-page":"104418","article-title":"Anthrax outbreak amidst the COVID-19 pandemic in Africa: Challenges and possible solutions","volume":"81","author":"R Badri","year":"2022","journal-title":"Ann Med Surg (Lond)"},{"key":"pone.0336769.ref004","author":"CDC","year":"2025"},{"key":"pone.0336769.ref005"},{"key":"pone.0336769.ref006","doi-asserted-by":"crossref","first-page":"100024","DOI":"10.1016\/j.dcit.2024.100024","article-title":"A review of epidemiological characteristics, risk factors, and prevention strategies of human anthrax in China","volume":"2","author":"W Xin","year":"2024","journal-title":"Decoding Infection and Transmission"},{"issue":"4","key":"pone.0336769.ref007","doi-asserted-by":"crossref","DOI":"10.17219\/acem\/68380","article-title":"Injectional anthrax in human: A new face of the old disease","volume":"27","author":"A Zasada","year":"2018","journal-title":"Adv Clin Exp Med"},{"key":"pone.0336769.ref008","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1186\/s12889-019-6787-0","article-title":"A cutaneous Anthrax outbreak in Koraput District of Odisha-India 2015","volume":"19","author":"P Nayak","year":"2019","journal-title":"BMC Public Health"},{"issue":"5","key":"pone.0336769.ref009","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":"pone.0336769.ref010","article-title":"Anthrax outbreaks in western Uganda: The role of illegal meat dealers in spreading the infection","volume":"9","author":"Y Nuwamanya","year":"2024","journal-title":"Journal of Infectious Diseases"},{"key":"pone.0336769.ref011","doi-asserted-by":"crossref","unstructured":"Migisha R, Mbatidde I, Agaba DC, Turyakira E, Tumwine G, Byaruhanga A. 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