Unvaccinated Workers and Anthrax, Belgium | CDC EID

EID Journal Home > Volume 15, Number 10–October 2009

Volume 15, Number 10–October 2009
Dispatch
Immunologic Response of Unvaccinated Workers Exposed to Anthrax, Belgium
Pierre Wattiau, Marc Govaerts, Dimitrios Frangoulidis, David Fretin, Esther Kissling, Mieke Van Hessche, Bernard China, Martine Poncin, Yvo Pirenne, and Germaine Hanquet
Author affiliations: Veterinary and Agro-chemical Research Centre, Brussels, Belgium (P. Wattiau, M. Govaerts, D. Fretin, M. Van Hessche); Bundeswehr Institute of Microbiology, Munich, Germany (D. Frangoulidis); Institute of Public Health, Brussels, Belgium (E. Kissling, B. China, G. Hanquet); Occupational Medicine PROVIKMO, Verviers, Belgium (M. Poncin); Medical Inspection, Angleur, Belgium (Y. Pirenne); and European Centre for Disease Control and Prevention, Stockholm, Sweden (E. Kissling)

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Abstract
To determine immunologic reactivity to Bacillus anthrax antigens, we conducted serologic testing of workers in a factory that performed scouring of wool and goat hair. Of 66 workers, ≈10% had circulating antibodies or T lymphocytes that reacted with anthrax protective antigen. Individual immunity varied from undetectable to high.

Industrial anthrax, also known as woolsorter's disease, was a serious threat in the 19th and early 20th centuries when the wool industry was flourishing. The causal agent, Bacillus anthracis, was brought into factories in sporulated form with the organic matter that was contaminating the animal fibers. The pathogen provoked the characteristic necrotic lesions on the skin of the wool workers (cutaneous anthrax), but it could also cause a respiratory disease through airborne transmission (inhalational anthrax). In 1950, 90% of those with the latter form died, although the proportion of deaths could be lowered to 50% with the aggressive therapy that was later used to treat the victims of the deliberate release of anthrax in the United States in 2001 (1,2).

Today, industrial processing of wool and goat hair has almost disappeared from Western industrialized countries. Cases of human anthrax have become rare in Europe (3,4), but they can sometimes result from contact with imported contaminated material (6,6). Apart from the 2001 attacks (7), the most recent human anthrax epidemic in the United States was reported in 1957 in a large goat hair–processing mill in Manchester, New Hampshire (1). In a recent study, we investigated the microbiologic flora of a Belgian factory (in operation since 1880) that processes and scours wool and goat hair from all over the world. Living anthrax spores were demonstrated in goat hair fibers, air dust, and unprocessed wastewater produced from goat hair scouring (8). No clinical case of anthrax was recorded among the employees of this company except for a possible cutaneous lesion, reported by a worker in 2002, the cause of which remained unconfirmed. In the current study, we investigated the immunity of the factory workers. Since none of these workers had been vaccinated against anthrax, we assumed that immunologic reactivity to anthrax antigens, if any, would very likely demonstrate exposure to B. anthracis.

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