Recurrent Anthrax Outbreaks in Humans, Livestock, and Wildlife in the Same Locality, Kenya, 2014–2017

Abstract. Epidemiologic data indicate a global distribution of anthrax outbreaksassociated with certain ecosystems that promote survival and viability of Bacillus anthracisspores. Here, we characterized three anthrax outbreaksinvolving humans, livestock, and wildlifethat occurred in the same locality in Kenya between 2014 and 2017. Clinical and epidemiologic data on the outbreakswere collected using active case finding and review of human, livestock, and wildlifehealth records. Information on temporal and spatial distribution of prior outbreaksin the area was collected using participatory epidemiology. The 2014–2017 outbreaksin Nakuru West subcounty affected 15 of 71 people who had contact with infected cattle ( attack rate= 21.1%), including seven with gastrointestinal, six with cutaneous, and two with oropharyngeal forms of the disease. Two (13.3%) gastrointestinal human anthrax cases died. No human cases were associated with infected wildlife. Of the 54 cattle owned in 11 households affected, 20 died ( attack rate= 37%). The 2015 outbreakresulted in death of 10.5% of the affected herbivorous wildlifeat Lake Nakuru National Park, including 745 of 4,500 African buffaloes (species-specific mortality rate = 17%) and three of 18 endangered white rhinos (species-specific mortality rate = 16%). The species mortality rate ranged from 1% to 5% for the other affected wildlifespecies. Participatory epidemiology identified prior outbreaksbetween 1973 and 2011 in the same area. The frequency and severity of outbreaksin this area suggests that it is an anthrax hotspot ideal for investigating risk factors associated with long-term survival of anthrax spores and outbreakoccurrence.