Human Anthrax in Thailand: Pathogenesis, Transmission, Treatment  and Prevention

Kawisara Yooyongwatana; Wuttikorn Watcharapimonpan; Phanukit Kunhachan; Nitis Smanthong

Authors

Kawisara Yooyongwatana Triam Udom Suksa School, Thailand
Wuttikorn Watcharapimonpan Triam Udom Suksa School, Thailand
Phanukit Kunhachan National Institute of Health, Department of Medical Sciences
Nitis Smanthong Faculty of Medicine, Praboromarajchanok Institute https://orcid.org/0000-0002-6378-969X

Keywords:

Anthrax, Bacillus anthracis, Thailand, Outbreak

Abstract

Anthrax is an acute infectious disease caused by Bacillus anthracis. Although Post-Exposure Prophylaxis (PEP) with antibiotics and vaccination are highly effective at suppressing the spread of the disease, continuous surveillance remains imperative. Due to the persistence and environmental resilience of anthrax spores, which can remain viable in environmental substrates and animal reservoirs for prolonged periods, there is an ongoing risk of recurrent outbreaks. Despite this, academic literature regarding human anthrax in Thailand remains limited. This review article aims to synthesizes reports and summarizes literature of human anthrax outbreaks within Thailand, providing a comprehensive knowledge review. Data were retrieved from PubMed and ThaiJO databases using keywords such as "Anthrax", "Thailand", "Epidemiology", "Diagnosis", "Treatment", and "Therapy". The findings indicate that outbreaks in Thailand occur predominantly in the Northern and Northeastern regions, particularly along the borders of neighboring countries like Laos and Myanmar. While the reliance on antibiotic treatment has enabled public health agencies to limit disease transmission, a deeper understanding of the disease and its epidemiological patterns is vital for a crucial development of effective control and prevention strategies, including treatment and targeted vaccines-specifically tailored to B. anthracis within the Thai context.

References

Ashique, S., Biswas, A., Mohanto, S., Srivastava, S., Hussain, M. S., Ahmed, M. G., & Subramaniyan, V. (2024). Anthrax: A narrative review. New Microbes and New Infections, 62, 101501. https://doi.org/10.1016/j.nmni.2024.101501

Bower, W. A., Hendricks, K. A., Vieira, A. R., Traxler, R. M., Weiner, Z., Lynfield, R., & Hoffmaster, A. (2022). What is anthrax? Pathogens, 11(6), 690. https://doi.org/10.3390/pathogens11060690

Couse, Z., Cui, X., Li, Y., Moayeri, M., Leppla, S., & Eichacker, P. Q. (2021). A review of the efficacy of FDA-approved B. anthracis anti-toxin agents when combined with antibiotic or hemodynamic support in infection-or toxin-challenged preclinical models. Toxins, 13(1), 53. https://doi.org/10.3390/toxins13010053

Dhliwayo, T.H., Chonzi, P., Madembo, C., Juru, T. P., Chadambuka, A., Gombe, N. T., Chikerema, S., Shambira, G., Umeokonkwo, C. D., & Tshimanga, M. (2022). Anthrax outbreak investigation in Tengwe, Mashonaland West Province, Zimbabwe, 2022. PLoS One, 17(12), e0278537. https://doi.org/10.1371/journal.pone.0278537

Division of Epidemiology. (2025). Cutaneous anthrax-Phayao Province. Epidemiological Surveillance Report, 14(33), 406. https://he05.tci-thaijo.org/index.php/WESR/article/view/5723 (in Thai)

Doganay, M., Dinc, G., Kutmanova, A., & Baillie, L. (2023). Human anthrax: Update of the diagnosis and treatment. Diagnostics, 13(6), 1056. https://doi.org/10.3390/diagnostics13061056

Epidemiologist, Kanchanaburi Public Health Office. (1985). Anthrax-Kanchanaburi. Weekly Epidemiological Surveillance Report, 16(17), 209. https://he05.tci-thaijo.org/index.php/WESR/article/view/5865 (in Thai)

Epidemiologist, Ratchaburi Provincial Public Health Office, & Bureau of Epidemiology, Ratchaburi. (2025). Anthrax-Ratchaburi. Weekly Epidemiological Surveillance Report, 16(47), 574. https://he05.tci-thaijo.org/index.php/WESR/article/view/5954 (in Thai)

Hanczaruk, M., Reischl, U., Holzmann, T., Frangoulidis, D., Wagner, D. M., Keim, P. S., Antwerpen, M. H., Meyer, H., & Grass, G. (2014). Injectional anthrax in heroin users, Europe, 2000-2012. Emerging Infectious Diseases, 20(2), 322-323. https://doi.org/10.3201/eid2002.120921

Hossain, M. B., Dee, M., Springer, C., & Butler, R. (2026). Risk factors for human anthrax infection on a global scale: Understanding and quantifying outbreak-related exposure behaviors within socio-demographic and cultural contexts. Zoonotic Diseases, 6(1), 6. https://doi.org/10.3390/zoonoticdis6010006

Kolton, C. B., Marston, C. K., Stoddard, R. A., Cossaboom, C., Salzer, J. S., Kozel, T. R., Gates-Hollingsworth, M. A., Cleveland, C. A., Thompson, A. T., & Dalton, M. F. (2019). Detection of Bacillus anthracis in animal tissues using InBios active anthrax detect rapid test lateral flow immunoassay. Letters in Applied Microbiology, 68(6), 480-484. https://doi.org/10.1111/lam.13134

Kunanusont, C., Limpakarnjanarat, K., & Foy, H. M. (1990). Outbreak of anthrax in Thailand. Annals of Tropical Medicine & Parasitology, 84(5), 507-512. https://doi.org/10.1080/00034983.1990.11812502

Maxson, T., Kongphet-Tran, T., Mongkolrattanothai, T., Travis, T., Hendricks, K., Parker, C., McLaughlin, H. P., Bugrysheva, J., Ambrosio, F., & Michel, P. (2022). Systematic review of in vitro antimicrobial susceptibility testing for Bacillus anthracis, 1947-2019. Clinical Infectious Diseases, 75(Suppl 3), S373-S378. https://doi.org/10.1093/cid/ciac520

Nagachinda, B. (1990). Out-Breaks of anthrax in Kanchanaburi (1984-1989). Region 7 Medical Journal, 9(3), 161-166. https://he02.tci-thaijo.org/index.php/reg45/article/view/142339 (in Thai)

Ochai, S. O., Hassim, A., Dekker, E. H., Magome, T., Lekota, K. E., Makgabo, S. M., de Klerk-Loris, L.-M., van Schalkwyk, L. O., Kamath, P. L., & Turner, W. C. (2024). Comparing microbiological and molecular diagnostic tools for the surveillance of anthrax. PLOS Neglected Tropical Diseases, 18(11), e0012122. https://doi.org/10.1371/journal.pntd.0012122

Pillai, S. P., Prentice, K. W., Ramage, J. G., DePalma, L., Sarwar, J., Parameswaran, N., Bell, M., Plummer, A., Santos, A., Singh, A., Pillai, C. A., Thirunavvukarasu, N., Manickam, G., Avila, J. R., Sharma, S. K., Hoffmaster, A., Anderson, K., Morse, S. A., Venkateswaran, K. V., & Hodge, D. R. (2019). Rapid presumptive identification of Bacillus anthracis isolates using the Tetracore RedLine AlertTM test. Health Security, 17(4), 334-343. https://doi.org/10.1089/hs.2019.0038

Pilo, P., & Frey, J. (2011). Bacillus anthracis: Molecular taxonomy, population genetics, phylogeny and patho-evolution. Infection, Genetics and Evolution, 11(6), 1218-1224. https://doi.org/10.1016/j.meegid.2011.05.013

Sangwan, N., Gangwal, A., Jain, P., Langtso, C., Srivastava, S., Dhawan, U., Baweja, R., & Singh, Y. (2025). Anthrax: transmission, pathogenesis, prevention and treatment. Toxins, 17(2), 56. https://doi.org/10.3390/toxins17020056

Schwarz, N. G., Loderstaedt, U., Hahn, A., Hinz, R., Zautner, A. E., Eibach, D., Fischer, M., Hagen, R. M., & Frickmann, H. (2017). Microbiological laboratory diagnostics of neglected zoonotic diseases (NZDs). Acta Tropica, 165, 40-65. https://doi.org/10.1016/j.actatropica.2015.09.003

Sidwa, T., Salzer, J. S., Traxler, R., Swaney, E., Sims, M. L., Bradshaw, P., O’Sullivan, B. J., Parker, K., Waldrup, K. A., & Bower, W. A. (2020). Control and prevention of anthrax, Texas, USA, 2019. Emerging Infectious Diseases, 26(12), 2815-2824. https://doi.org/10.3201/eid2612.200470

Sirisanthana, T., & Brown, A. E. (2002). Anthrax of the gastrointestinal tract. Emerging Infectious Diseases, 8(7), 649-651. https://doi.org/10.3201/eid0807.020062

Slay, R. M., Hatch, G. J., & Hewitt, J. A. (2022). Evaluation of amoxicillin and amoxicillin-clavulanate (augmentin) for antimicrobial postexposure prophylaxis following Bacillus anthracis inhalational exposure in cynomolgus macaques. Clinical Infectious Diseases, 75(Suppl 3), S402-S410. https://doi.org/10.1093/cid/ciac572

Subedi, D., Pantha, S., Jyoti, S., Gautam, B., Kaphle, K., Yadav, R. K., Ghimire, S., & Dhakal, S. (2024). Anthrax in humans, animals, and the environment and the one health strategies for anthrax control. Pathogens, 13(9), 773. https://doi.org/10.3390/pathogens13090773

Taft, S. C., Nichols, T. L., Hines, S. A., Barnewall, R. E., Stark, G. V., & Comer, J. E. (2020). Physiological responses to multiple low-doses of Bacillus anthracis spores in the rabbit model of inhalation Anthrax. Pathogens, 9(11), 877. https://doi.org/10.3390/pathogens9110877

Tangsathapornpong, A. (n.d.). Anthrax vaccine. In K. Thiparat et al. (Eds.), Textbook of the Pediatric Infectious Diseases Society of Thailand: Vaccine (pp. 377-382). Pediatric Infectious Disease Society of Thailand. https://www.pidst.or.th/A370.html (in Thai)

Thompson, J. M., Cook, R., Person, M. K., Negrón, M. E., Traxler, R. M., Bower, W. A., & Hendricks, K. (2022). Risk factors for death or meningitis in adults hospitalized for cutaneous anthrax, 1950-2018: A systematic review. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 75(Suppl 3), S459–S467. https://doi.org/10.1093/cid/ciac533

Tumusiime, L., Kizza, D., Kiyimba, A., Nabatta, E., Waako, S., Byaruhanga, A., Kwesiga, B., Migisha, R., Bulage, L., & Ario, A. R. (2025). Anthrax outbreak linked to consumption and handling of meat from unexpectedly deceased cattle, Kyotera district, Uganda, June-December 2023. One Health Outlook, 7(1), 29. https://doi.org/10.1186/s42522-025-00151-x

Wassie, B. A., Fantaw, S., Mekonene, Y., Teshale, A. M., Yitagesu, Y., Tsige, E., Getahun, D., Tasew, G., Abichu, G., & Moges, B. (2022). First PCR confirmed anthrax outbreaks in Ethiopia-Amhara region, Ethiopia 2018-2019. PLOS Neglected Tropical Diseases 16(2), e0010181. https://doi.org/10.1371/journal.pntd.0010181

WATCH Team, Department of Disease Control. (2025a). Outbreak verification summary, week 18, 2025 (April 28-May 4, 2024). Weekly Epidemiological Surveillance Report, 56(5), e5907. https://doi.org/10.59096/wesr.v56i5.5907 (in Thai)

WATCH Team, Department of Disease Control. (2025b). Outbreak verification summary, week 19, 2025. Weekly Epidemiological Surveillance Report, 56(5), e5957. https://he05.tci-thaijo.org/index.php/WESR/article/view/5957 (in Thai)

World Health Organization. (2025a, May 29). Anthrax-Thailand [Online]. Disease outbreak news. https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON573

World Health Organization. (2025b). Anthrax: Implementation guidance for clinicians (Vol. 2025). World Health Organization. https://doi.org/10.2471/B09539

Zasada, A. A. (2020). Detection and identification of Bacillus anthracis: From conventional to molecular microbiology methods. Microorganisms, 8(1), 125. https://doi.org/10.3390/microorganisms8010125