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. 2023 Jan 23;108(3):492-502.
doi: 10.4269/ajtmh.22-0384. Print 2023 Mar 1.

Informing One Health Anthrax Surveillance and Vaccination Strategy from Spatial Analysis of Anthrax in Humans and Livestock in Ha Giang Province, Vietnam (1999-2020)

Tan Luong  1   2   3 , Tat Thang Nguyen  4 , Van Binh Trinh  5 , Morgan A Walker  1   3 , Thi Thu Ha Hoang  2 , Quang Thai Pham  2   6 , Thi Mai Hung Tran  2 , Van Khang Pham  2 , Van Long Nguyen  7 , Thanh Long Pham  7 , Jason K Blackburn  1   3
Affiliations

Informing One Health Anthrax Surveillance and Vaccination Strategy from Spatial Analysis of Anthrax in Humans and Livestock in Ha Giang Province, Vietnam (1999-2020)

Tan Luong et al. Am J Trop Med Hyg. .

Abstract

Anthrax, caused by Bacillus anthracis, has a nearly global distribution but is understudied in Southeast Asia, including Vietnam. Here, we used historical data from 1999 to 2020 in Ha Giang, a province in northern Vietnam. The objectives were to describe the spatiotemporal patterns and epidemiology of human and livestock anthrax in the province and compare livestock vaccine coverage with human and livestock anthrax incidence. Annual incidence rates (per 10,000) for humans, buffalo/cattle, and goats were used to explore anthrax patterns and for comparison with livestock annual vaccine variations. A data subset describes anthrax epidemiology in humans by gender, age, source of infection, type of anthrax, admission site, and season. Zonal statistics and SaTScan were used to identify spatial and space-time clusters of human anthrax. SaTScan revealed space-time clusters in 1999, 2004, and 2007-2008 in the province, including in the northeastern, eastern, and western areas. Most human anthrax was reported between July and October. Most patients were male, aged 15-59 years, who had handled sick animals and/or consumed contaminated meat. High case-fatality rates were reported with gastrointestinal or respiratory cases. Our data suggest that vaccination in buffalo and cattle reduces the disease burden in humans and vaccinated animals but does not reduce the incidence in unvaccinated animals (goats). This study identified spatial areas of high risk for anthrax and can inform One Health surveillance and livestock vaccination planning in contextual settings similar to Ha Giang province.

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Figures

Figure 1.
Figure 1.
Ha Giang province is located in the north of Vietnam and shares a border with southern China (produced in ArcGIS Pro using shapefiles from www.gadm.org).
Figure 2.
Figure 2.
Distribution of livestock by number of livestock heads and species, Ha Giang province, Vietnam. (A) 2010. (B) 2015. (C) 2020.
Figure 3.
Figure 3.
Annual patterns of anthrax by number of cases at the district level and the incidence per 10,000 at the provincial level for humans in Ha Giang province, Vietnam, 1999–2020.
Figure 4.
Figure 4.
Spatial overlaps of anthrax in humans and livestock, Ha Giang province, Vietnam, 1999–2020.
Figure 5.
Figure 5.
Temporal pattern of human anthrax by types of infection and case-fatality rate, Ha Giang province, Vietnam, 1999–2020.
Figure 6.
Figure 6.
Monthly distribution of human anthrax, Ha Giang province, Vietnam (2004–2020) (N = 139).
Figure 7.
Figure 7.
(A) Spatial-only clusters (25%; results at 15% and 50% were similar to those at 25%). (B–D) Space-time clusters (B, 15%; C, 25%; D, 50%) of human anthrax identified by SaTScan Statistics (Poisson model, 999 permutations, 15%, 25%, 50% of population at risk). The RR indicates the risk of having human anthrax reported for the commune inside of the clusters compared with outside of the clusters.
Figure 8.
Figure 8.
Vaccine coverage in buffalo and cattle and the incidence (per 10,000) of anthrax in humans and livestock, Ha Giang province, Vietnam, 1999–2020.
See this image and copyright information in PMC

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