In this report, VICTOR AYENI writes on how a recurrent wave of anthrax has led to illnesses and losses in West African countries and why the Federal Government need additional measures to prevent its outbreak in Nigeria
On June 12, while Nigeria commemorated Democracy Day, the Federal Government raised the alarm over the outbreak of a deadly disease known as anthrax, which dampened the mood of the celebration.
The presence of the bacterial disease was confirmed in northern Ghana, which borders Burkina Faso and Togo.
Amidst the anthrax anxiety, which swept across various states, the Permanent Secretary of the Ministry of Agriculture and Rural Development, Ernest Umakhihe, advised citizens to avoid the consumption of hides (ponmo), smoked meat, and bush meat to avoid possible spread.
In the public health advisory jointly signed by the Federal Ministry of Agriculture and Rural Development and the Nigeria Centre for Disease Control, Nigeria was said to be at high risk of importing the disease from Ghana, where it was confirmed both in humans and animals on June 1.
But for Ishola Azeez, a meat seller in Ibadan, Oyo State, the warning was no more than a needless hype that would eventually fizzle with the winds of other events.
Speaking with Sunday PUNCH, Azeez argued that from time to time there were reports of such zoonotic diseases which did not really affect people.
He said, “That is how they always shout about one meat or the other every year but nothing happens to consumers eventually. These diseases don’t really affect us; they just put unnecessary fear in people’s minds. Do you remember that some years ago, there was noise about killer ponmo, what came out of it?
“We are meat sellers and we take necessary steps. If the butcher sees that a cow has died of a disease, he would not want the meat to be sold publicly unless he is a wicked soul.
“We are humans like you; we also have our families and we know how to protect ourselves. So, forget it, there can’t be anthrax in Nigeria.”
However, for people who live in northern Ghana, anthrax has plunged livestock farmers and meat consumers into dire situations.
In a report by Citi Newsroom, the Deputy Ranking Member of the Health Committee in the Ghanaian Parliament, Mark Nawaane, revealed that three persons and at least 30 animals had been confirmed dead following the infection.
He said, “The anthrax outbreak was first noted in Binduri and has spread to Boku, Boku West, Pusiga, Talensi, Kwahu, and Mopani districts. As of June 7, 2023, three human deaths have been recorded and about 13 cases have tested positive for the anthrax bacteria.
“Also, a number of cattle, sheep, and goats exceeding 30 have died. Mr Speaker, there is a collaborative effort between the Ministry of Health, the Ministry of Food and Agriculture, and other stakeholders to contain the situation.”
A video clip viewed by our correspondent in June showed dozens of dead cattle, some having blood patches on their bodies, littering a large farm field in northern Ghana.
The caption on the video indicated that the herds of cattle were killed by anthrax and some people were alleged to have transported portions of their meat to neighbouring cities for sale.
To curb the outbreak, the Ghanaian government placed a ban on the movement of ruminants such as goats, sheep, pigs, cattle, and dogs from the eastern corridor of the Upper East region.
Nigerian govt’s efforts
While Ghana grappled with the sordid effect of the outbreak, the Federal Government attempted to shed more light on the disease.
In the statement signed by Umakhihe, he listed the symptoms of anthrax to include cough, fever, and muscle aches, which if not diagnosed and treated early could lead to pneumonia, severe lung problems, difficulty in breathing, shock, and death.
He also noted that being a severe bacterial disease that affects both humans and livestock such as cows, pigs, camels, sheep and goats, it responds to treatment with antibiotics and supportive therapy.
He said, “It is primarily a disease of animals but because of man’s closeness to animals, non-vaccinated animals with anthrax can easily transmit it to man through the inhalation of anthrax spores or consumption of contaminated/infected animal products such as hides and skin, meat or milk.
“So, in this present case, there is the need to intensify animal vaccinations along the border states of Sokoto, Kebbi, Niger, Kwara, Oyo, Ogun, and Lagos because of their proximity to Burkina Faso, Togo, and Ghana. Other states of Nigeria are equally advised to join in the exercise.
“However, infected animals cannot be vaccinated but animals at risk can be vaccinated. Infected dead animals should be buried deep into the soil along with the equipment used in the burial after applying chemicals that will kill the anthrax spores.”
He noted that annual vaccination with anthrax spore vaccines was available at the National Veterinary Research Institute Vom, Plateau State, adding that it was the cheapest and easiest means of prevention and control of the disease in animals.
“Meanwhile, the public is urged to remain calm and vigilant as the Federal Government has resuscitated a standing committee on the control of anthrax in the Ministry of Agriculture and Rural Development,” he added.
Sunday PUNCH gathered that although Nigeria is yet to record any suspected or confirmed case, the outbreak in Ghana poses a great public health risk to Nigeria due to the highly transmissible nature of the disease.
A veterinarian and Chief Executive Officer, El-Mond Veterinary Services, Abuja, Dr Monday Ojeamiren, in an interview with a national newspaper in June, faulted the country’s low level of preparation and awareness to prevent the outbreak.
“There are concerns with regards to the outbreak of anthrax because of the free movement of animals across borders without check, and it should be a serious concern, particularly among communities that border the country.
“I can tell you that it is just a small percentage of people that are aware of this disease. But beyond that, the greater majority of Nigerians are not aware.
“I am not aware of any jingle informing Nigerians that this disease is happening, and we have less number of people who can read. One can say that the level of preparedness is not too far from zero,” he stated.
In Nigeria, cow skin is the staple of the masses because of its relative cheapness. Bush meat is also popular in rural areas.
Our correspondent visited a number of markets in Ogun State to inquire if meat sellers were aware of the possible outbreak of the disease.
At the Mowe Market, a meat seller, Kehinde Mudashiru, told our correspondent that he had not heard about anthrax.
“No, I have not heard of it, and even if there is such a disease around, I don’t think it can affect our consumers if they properly cook the meat before eating it,” he said.
A trader, Morenikeji Bello, who sells cow hides (ponmo) at Ibafo, disclosed that there had been no decline in the sale of hides.
She said, “I am not aware of any of such issue. In fact, people are still purchasing ponmo as they have always done. We all want to survive and this is the business I do; no disease will spoil it for me. I wash these hides and ensure they are in good condition.”
Another ponmo seller, Faith Ibiene, told our correspondent that she had yet to hear of any report about why ponmo should be avoided.
“Who said it? These are just things people say when they don’t like certain foods. These are the foods our forefathers ate and they didn’t die early, so why will they kill us now?
“Unless someone puts bad chemicals in ponmo, if you cook it well, it won’t do you anything. Nobody has ever come to me to tell me why I should not sell this. We are still being patronised,” she argued.
The Federal Capital Territory Veterinary Services Director, Dr Regina Adulugba, during an interview with journalists, urged that relevant stakeholders should be properly sensitised.
“The possibility of it coming into Nigeria is very high, so we need to promptly alert stakeholders, livestock dealers, and butchers to take the right actions,” she added.
A devastating disease
In the 2014 anthrax outbreak, seven deaths were recorded worldwide. In 2016, there were one human and 2,300 animal deaths.
Anthrax has been described by experts as an economically devastating disease for the livestock industry because it kills many animals quickly.
Infected livestock are often found dead with no illness detected and the bacterial anthrax spores are known to survive indefinitely in contaminated soil.
These spores have the ability to survive in the environment for decades because of their ability to resist heat, cold and drying.
However, when conditions such as temperature and humidity become favourable, the spores germinate into colonies of bacteria which are often ingested by grazing cows.
Although there are no reports of person-to-person transmission of anthrax, people often get infected by handling contaminated animals or animal products, consuming undercooked meat of infected animals, and in some cases, an intentional release of spores.
According to the United States CDC, there are four types of anthrax: cutaneous, inhalation, gastrointestinal, and injection.
Cutaneous anthrax is the most common form of the infection and it is often considered to be the least dangerous.
“When anthrax spores get into the skin, usually through a cut or scrape, a person can develop cutaneous anthrax. This can happen when a person handles infected animals or contaminated animal products like wool, hides, or hair.
“Without treatment, up to 20 per cent of people with cutaneous anthrax die. However, with proper treatment, almost all patients with cutaneous anthrax survive,” says the CDC.
A medical consultant, Dr Michael Adebogun, during a phone interview with Sunday PUNCH, explained that the most deadly form of anthrax was inhalation.
He said, “This type of infection occurs when people breathe in anthrax spores and this could easily happen to those who work in abattoirs and tanneries. They could easily breathe in spores when working with infected animals or contaminated animal products.
“The infection usually spreads to the chest and causes breathing problems and without treatment, this type of anthrax is usually fatal although with early treatments, some patients can survive.”
He noted that gastrointestinal anthrax might be the form that many Nigerians could be exposed to if they consumed undercooked meat.
“This type of anthrax occurs when the bacterial spores are ingested in raw or undercooked meat from animals infected with anthrax. If you look around in some of our restaurants, you will find people consuming these types of undercooked meat under the guise of following a trend or recipe.
“If the animal the meat comes from contains anthrax spores, they can affect the gastrointestinal tract and cause a wide range of symptoms and if not treated on time, this could lead to death.”
The CDC describes injection anthrax as a recently identified type of disease discovered among heroin-injecting drug users in northern Europe.
“This type of infection has never been reported in the United States. Its symptoms might be similar to those of cutaneous anthrax, but there may be infection deep under the skin or in the muscle where the drug was injected.
“Injection anthrax can spread throughout the body faster and can be harder to recognise and treat,” the CDC added.
Recurrence in West Africa
It was gathered that anthrax has been a sad recurring epidemic in West Africa due to certain cultural practices which involve the consumption of raw or undercooked meat, among others.
In Ghana, for instance, the persons who died were said to have eaten the carcass of an anthrax-infected dead cow.
According to a press release published by Citi News, the Regional Director of Health Services, Dr Emmanuel Dzotse, disclosed that his team had begun contact tracing of 11 people who were believed to have eaten the carcasses of anthrax-infected cows.
Dzotse said, “On June 1, 2023, the Regional Health Directorate received notification of two suspected cases of anthrax with one death in Binduri District following the consumption of dead cattle.
“In all, four cattle died in the affected community. So far, 11 suspected cases have been identified, and contact tracing efforts are underway in the affected community.”
The health service director also warned members of the community to refrain from eating the carcasses of cattle without establishing the cause of death.
He added that cattle owners in all districts in the region should seek veterinary services for holistic control of the disease.
As of July 4, a month after the outbreak of the disease was announced, the country’s authorities reported that over one million livestock had been vaccinated in the Upper East region.
The Risk Communications Manager at the Ghana Veterinary Service, Dr Benjamin Sasu, said the situation had been brought under control.
“A total of 1,243,000 animals have been vaccinated in the Upper East region so far, so good. Looking at the data and the participation of the community, the various districts have now cooperated and we have had a good number of animal vaccinations ongoing.
“Currently, we are not seeing any signs (of Anthrax), and we hope it will keep up. So yes, we have been able to contain it that way.”
A global health task force, Training Programmes in Epidemiology and Public Health Intervention Network, reported that the South-West region of Burkina Faso had had recurring cases of anthrax in animals and humans.
In February 2021, two unexplained deaths were recorded in Kolko village in Dano Health District among persons that consumed cattle that died as a result of bleeding.
The task force identified four dead cattle and four suspected human cases with two deaths from Kolkol village, which had a history of consuming dead cattle meat.
In a research study conducted in Togo by Patassi et al, which was published in the Tropical Doctor Journal, localised groups of deaths occurred among villagers and their livestock due to anthrax in December 2009.
The National Disease Control Department undertook an investigation to describe the epidemiological, clinical, and bacteriological characteristics of this outbreak.
Their result revealed that 34 individuals showed clinical signs of anthrax with six deaths recorded at the beginning of the epidemic.
All patients were known to have consumed meat from cattle that died of unknown causes or were killed as a result of an unknown illness.
The researchers identified the increase of community awareness toward health promotion and vaccination of all farm animals as two factors that halted the spread of the disease.
Anthrax is not limited to West Africa. It has also been detected in the US and reported in Afghanistan, the Islamic Republic of Iran, Iraq, Morocco, Pakistan, and Sudan
In September 2022, the state of South Dakota in the US confirmed an outbreak of anthrax leading to the death of several cows.
According to the South Dakota State Veterinarian, Dr Beth Thompson, several cows in Meade Country died after they came into contact with a herd of unvaccinated cows.
The animal disease researcher confirmed the disease from samples submitted to the South Dakota State University laboratory and recommended vaccines that ranchers ought to use for their livestock prior to going out on pasture.
Similarly, in July 2022, the Colorado State Veterinarian Office also reported the first case of anthrax which was confirmed at the Colorado State University Veterinary Diagnostic Laboratory after seven cows had been killed in a herd.
Livestock producers in the northeast part of the state were warned to monitor their herds for unexplained deaths and work with their veterinarians to ensure proper laboratory testing.
According to a report by the World Health Organisation, the estimated incidence of human anthrax decreased from between 20,000 and 100,000 cases per year in 1958, to 2,000 per year during the 1980s.
“Additionally, Bacillus anthracis has always been high on the list of potential agents with respect to biological warfare and bioterrorism, having been used in that context on at least two occasions.
“Hospitalisation is required for all human cases of anthrax. Individuals potentially exposed to anthrax spores may be provided with prophylactic treatment.
“Anthrax vaccines for livestock and humans exist. Veterinary vaccines are used for the control of anthrax in livestock. Human vaccines are in limited supply and used primarily for the protection of selected individuals with possible occupational exposure to anthrax.
“Any animal that is sick, behaves strangely or has died suddenly should not be used for food or for making any product, as it may have succumbed to an infectious disease.
“Make sure to follow national rules on veterinary inspection prior to slaughter as these measures ensure food safety as well as the safety of persons involved in the slaughter. All parts of an animal that has died of anthrax should be safely disposed of,” the report stated.
Vaccination, improved safety standards needed
An environmental health and safety officer, Oluwaseun Ayoade, explained to Sunday PUNCH that if the vaccination programme was efficiently handled, the disease outbreak would be prevented.
“The major task is to ensure that all livestock animals are properly vaccinated against anthrax. These centres should be set up across the states of the country for accessibility to livestock owners. The FMARD, the Nigeria CDC, and the states’ health ministries must step up efforts to prevent this disease from infiltrating the country.
“This vaccination exercise should be accompanied by the inspection and testing of meat at abattoirs and of dairy products before they reach consumers.
“Unfortunately, many of these abattoirs are unhygienic and it is very important for states and local governments to clean up these facilities to protect citizens from anthrax and other diseases. These measures will prevent the influx of anthrax into the country,” he stated.
On his part, a Microbiology researcher at Bowling Green State University, in the US, Jeremiah Adesanya, told our correspondent that cattle rearers and people who consumed and hunted animals were mostly at risk of being infected.
“Bacillus anthracis produces toxins which can cause death in a brief period. Its long incubation time makes it difficult to detect and gives it ample chance to proliferate, leading to a progressed disease that may be difficult to treat.
“Anthrax can affect the intestine, causing vomiting and bloody diarrhoea. Its effects on the lungs when the spores are inhaled result in difficulty in breathing and skin lesions could result from infected cuts on the skin.
“Cattle rearers, herders and communities that consume and hunt animals are at the highest risk of infection. It is also possible for the pathogen to be spread through infected animals.
“Hence, proper protective equipment should be used to reduce the risk of exposure. Several antibiotics have been used in its treatment, including clindamycin and penicillin. However, proper diagnosis and timely treatment are required to reduce the disease burden.”
Adesanya, however, added that the sale of bush meat by the roadside should be discouraged as this might also contribute to the spread of anthrax.
“Antibiotic resistance is a major threat to public health, hence, proper administration of antibiotics and/or vaccine is required to treat the disease in humans and animals to reduce its spread.
“Consumption of wild animals popularly referred to as bush meat, especially those sold by the roadside should be discouraged, as that may be a potential source of disease in the human population. Meat and other packaged animal products should be cooked appropriately before consumption to kill the pathogen and reduce its load.
“Proper sanitation and constant disease surveillance should be maintained in all slaughterhouses to limit disease transmission,” he added.
On her part, a public health professional and optometrist, Dr Omojeme Adomi, told Sunday PUNCH that people should avoid physically touching meat while pricing them in markets.
She added that livestock owners should also ensure that their animals were vaccinated against diseases.
“Practical measures include reducing contact with uncooked meat products such as touching meat when pricing in the market.
“If you own livestock, make sure you vaccinate them for diseases and use protective gloves, masks, goggles, and boots when working with them. Refrain from taking unprocessed milk products such as nunu.
“Wash your meat thoroughly with running water and wash your hands properly after washing the meat. Cook your meat properly and fully. Report to a hospital when you notice signs of the infection.
“Anthrax can’t spread from person to person but from animal to person, so be careful where you eat and make sure they cook the meat properly. Don’t eat meat that isn’t well cooked,” Adomi said.