10 June 2003
Dear Doctor,
Today, the Department of Health (DH) announced a fatal case of anthrax infection in a 2-year-old boy. He had sudden onset of fever and anorexia on 27 May. His condition deteriorated on May 30 with abdominal pain, irritability, vomiting and shortness of breath. He was immediately taken to a hospital where he was certified dead shortly afterwards. Based on the clinical features, postmortem examination and laboratory findings, the case was likely to have contracted the disease through the oral route. The pathogen was detected in the cerebrospinal fluid and blood by polymerase chain reaction and culture. Investigation has been carried out at the patient's home, the nursery and the hospital, and no other contacts have suffered from the illness.
Oropharygneal and intestinal anthrax may follow consumption of contaminated meat that has not been sufficiently cooked. The incubation period is usually within the range of 1 - 7 days. Meningitis may occur following bacteremia as a complication of the other clinical forms of anthrax infection, or very rarely, occur without a clinically apparent primary focus. The case-fatality rate for the oropharyngeal and intestinal forms may be as high as 50%, and the meningitis form is almost invariably fatal.
The public is advised to observe good personal, food and environmental hygiene. In particular, hands should be properly washed before food handling, and food should be thoroughly washed and cooked before consumption.
If you encounter a suspected case of anthrax, please report to the Department of Health immediately. An information sheet on anthrax is attached for your easy reference. You may also wish to browse a summary article "Human Anthrax in Hong Kong in the Past Two Decades" in the February 2002 issue of Public Health & Epidemiology Bulletin.
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