LETTERS

References several species of feral animals. Since were available on the safety and ef- 1. Straub TM, Honer zu Bentrup K, Orosz- 1990, there has been a program for rein- fi cacy of Carbosap vaccine (Istituto Coghlan P, Dohnalkova A, Mayer BK, troduction of red deer (Cervus elaphus) Zooprofi lattico Sperimentale of Pug- Batholomew RA, et al. In vitro cell culture into this park from Tuscany, Italy, and lia and Basilicata, Foggia, Italy) in assay for human noroviruses. Emerg Infect Carinthia, Austria. The animals are kept wild ruminants. Extensive vaccination Dis. 2007;13:396–403. Available from http://www.cdc.gov/eid/content/13/3/396. in quarantine in a corral by the veteri- limited the outbreaks in livestock and htm nary services of the park and given an red deer, which probably prevented 2. Rochelle PA, Marshall MM, Mead JR, electronic tag before their release. At further spread of infection from farm Johnson AM, Korich DG, Rosen JS, et the time of the anthrax outbreaks, the animals to free-ranging deer. al. Comparison of in vitro cell culture and mouse assay for measuring infectivity of red deer population of the park was 45, These anthrax outbreaks in south- Cryptosporidium parvum. Appl Environ of which 10 were living in the corral. ern Italy suggested that red deer are Microbiol. 2002;68:3809–17. These outbreaks killed 8 deer (4 free- highly susceptible to infection with B. ranging and 4 confi ned animals). anthracis and that the mortality rate in Address for correspondence: Timothy M. Each carcass was examined by these deer could be even higher than Straub, Pacifi c Northwest National Laboratory the veterinary offi cer, who collected that observed in domestic animals. Al- – Chemical and Biologic Sciences, PO Box 999, clinical samples that were examined though epidemiologic data are limited MS P7–50, Richland, WA 99352, USA; email: for B. anthracis by using standard pro- and need to be supported experimen- [email protected] cedures of the Istituto Zooprofi lattico tally by assessment of the 50% lethal Sperimentale of Puglia and Basilicata. dose of B. anthracis in red deer, the DNA from the suspected colonies was ecologic effect on deer populations in analyzed by PCR with primers specif- parks should not be underestimated. ic for B. anthracis (2) and subsequent Moreover, concerns for public health genotyping by using MLVA with 8 may arise in parks in disease-endemic VNTRs (3). All B. anthracis isolates areas, where susceptible wild animals Anthrax in Red belonged to cluster A1a, genotype could represent an amplifi cation fac- 1 (A. Fasanella, unpub. data). This tor for B. anthracis spores, which in- Deer (Cervus genotype was also identifi ed in sub- creases the probability of outbreaks elaphus), Italy sequent outbreaks that involved farm in domestic animals and in humans animals in the same area and resulted living near, working in, or visiting the To the Editor: Anthrax is hypo- in the deaths of 116 domestic animals, parks. This article stresses the need for endemic in Italy; a few outbreaks oc- including 81 cattle, 15 sheep, 9 goats, evaluating the safety and effi cacy of B. curred yearly involving unvaccinated and 11 horses. Red deer showed the anthracis vaccines in deer and for in- herbivores on pastures in central and highest mortality rate during these cluding wild ruminants in the anthrax southern regions and the major islands. outbreaks (Table). An ELISA (4) per- prophylaxis programs. Multiple-locus variable-number tan- formed with 27 serum samples ob- dem-repeat analysis (MLVA) with 8 tained from deer in the park detected This study was supported by Ricerca variable-number tandem repeats (VN- low levels of antibodies to B. anthra- Corrente 2004 of the Ministry of Heath of TRs) of Italian isolates of Bacillus an- cis in 22% of the examined animals. Italy. thracis has identifi ed 9 genotypes be- This seroprevalence is consistent with longing to cluster A1a (1). An isolate of levels found in unvaccinated livestock cluster A3 has been identifi ed recently reared in areas endemic for anthrax Antonio Fasanella,* in Sardinia, which suggests that such a (A. Fasanella, unpub. data). Lucia Palazzo,* strain could have been introduced into A vaccination program was then Antonio Petrella,* Italy from another country (1). instituted for farm animals, but the Vincenzo Quaranta,* A total of 37 anthrax outbreaks oc- deer population in the park was ex- Bruno Romanelli,* curred in a 41-day period from August cluded because no experimental data and Giuliano Garofolo* 28 to October 3, 2004, in a restricted Table. Mortality rates during anthrax outbreaks, Italy, 2004 area of Pollino National Park (Basili- Animal Population of area No. (%) dead animals cata region in southern Italy) and re- Cattle ≈7,000 81 (≈1.15) sulted in the deaths of 124 domestic or Sheep ≈20,000 15 (≈0.075) wild animals. Two suspected cases of Goats ≈13,000 9 (≈0.069) cutaneous anthrax in humans were re- Horses ≈600 11 (≈1.83) corded. Pollino National Park contains Red deer 45 8 (≈17.77)

1118 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 13, No. 7, July 2007 LETTERS

*Istituto Zooprofi lattico Sperimentale of Even more alarming were the outbreaks of angiostrongyliasis infect- Puglia and Basilicata, Foggia, Italy multiple outbreaks of a severe brain ing >100 patients (6,7). A 2006 out- disease (angiostrongyliasis) in Taiwan break in Beijing infected 131 persons References that were linked to P. canaliculata (8). Based on the biologic character- (3,4). Angiostrongyliasis is caused by istics of P. canaliculata, blocking its 1. Fasanella A, van Ert M, Altamura SA, Garofolo G, Buonavoglia C, Leori G, et Angiostrongylus cantonensis, a lung life cycle is one of the most effective al. Molecular diversity of Bacillus an- nematode of wild rodents, commonly methods to limit the outbreak of an- thracis isolates in Italy. J Clin Microbiol. known as the rat lungworm. In Main- giostrongyliasis. However, the current 2005;43:3398–401. land China, epidemiologic evidence widespread distribution of P. canalic- 2. Fasanella A, Losito S, Trotta T, Adone R, Massa S, Ciuchini F, et al. Detec- also indicates that P. canaliculata, ulata in China and the lack of a highly tion of anthrax vaccine virulence factors because of its high susceptibility to effective control method make the dis- by polymerase chain reaction. Vaccine. A. cantonensis, is becoming the most ease extremely diffi cult to eliminate 2001;19:4214–8. important natural intermediate host (9). More outbreaks associated with 3. Keim P, Price LB, Klevytska AM, Smith KL, Schupp JM, Okinaka R, et al. Mul- for this parasite (5). Previously, other ingestion of this snail will likely occur tiple-locus variable-number tandem re- terrestrial snails like Achatina fulicia, if food safety rules are not strictly en- peat analysis reveals genetic relationships and some species of slugs such as forced. Citizens must also be educated within Bacillus anthracis. J Bacteriol. Philomycus bilineatus were regarded to avoid eating raw, undercooked snail 2000;182:2928–36. 4. Fasanella A, Fabiano MP, Garofolo G, as the major intermediate hosts for A. meat or raw vegetables from regions Losito S. Preliminary studies on recom- cantonensis (6). Epidemiologic survey that may be contaminated with infec- binant protective antigen (rPA) vaccine results from 1997 to 1999 demonstrat- tive mucous trails deposited by these against anthrax for veterinary use. In: Ab- ed that 20.8%–69.4% of P. canalicu- snails (10). stracts of the International Veterinary Vac- cines and Diagnostic Conference. Oslo, lata were infected with A. cantonen- Norway; Jun 25–29, 2006. Oslo: Univer- sis in some regions of Guangdong, Acknowledgments sity of Oslo; 2006. p. 69. Zhejiang, and Fujian Provinces (5). We thank Anthony A. James for his Even in provinces where the snail is critical review of this manuscript. Address for correspondence: Antonio Fasanella, not found, a high incidence and preva- Istituto Zooprofi lattico Sperimentale of Puglia lence of infection occur because of its Authors’ laboratories are supported in and Basilicata, Anthrax Reference Institute of widespread distribution, high suscep- part by The National Science Foundation Italy, Via Manfredonia, 20, 71100 Foggia, Italy; tibility to A. cantonensis, and growing of China (nos. 30570245 and 30670275) to email: [email protected] popularity as a food. In 1997, 2002, Z.-R.L. and The Ministry of Science and and 2002, ingestion of raw or under- Technology of the People’s Republic of cooked P. canaliculata meat led to 3 China (2003BA712A03-07) to X.-G.C.

Invasive Freshwater Snail, China To the Editor: Pomacea canalic- ulata, an invasive freshwater snail na- tive to South America, was fi rst intro- duced as a food to Taiwan in1979 and then to Mainland China in 1981 (1). It adapted well to the environment, par- ticularly to the southern parts of the Mainland, spreading rapidly to more than 10 provinces (Figure) and caus- ing tremendous damage to agriculture and the ecosystem (1,2). Thousands of hectares of rice, vegetables, and Figure. Distribution of Pomacea canaliculata in China. The dark triangles indicate the other crops in these provinces were regions where angiostrongyliasis outbreaks were reported due to ingestion of raw or destroyed (2). undercooked P. canaliculata snails.

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