Background and Objective:
Bacillus anthracis, the etiologic agent of anthrax, primarily infects herbivores and is transmitted to humans through contact with infected animal products. Despite its clinical impact, there is currently no global estimate of its disease burden. We aimed to identify incidence and clinical data to contribute towards calculating a Disability-Adjusted Life Years estimate for anthrax.

Methods:
14,146 articles published between January 1990 and December 2021 were identified from eight databases relating to human anthrax. In addition, we also reviewed international surveillance databases. We derived appropriate disability weights for anthrax from the Global Burden of Disease study.

Results:
Sixteen studies from the review provided information on incidence, and 45 on clinical manifestations. Data were available for 30 countries in Europe, the Middle East, Sub-Saharan Africa, Asia and the Caribbean. Anthrax incidence varied widely between countries, ranging from 0.03 in Ghana to 1.4 in Georgia per 100,000 inhabitants. Based on the literature, we assumed that 95% of all cases are cutaneous and that the remaining 5% are gastrointestinal. For the disease model, we summarized the clinical manifestations into three main forms of cutaneous anthrax – mild (DW 0.074), moderate (DW 0.228), and severe (DW 0.597), and two health states for gastrointestinal anthrax – oropharyngeal (DW 0.223) and intestinal (DW 0.550). The duration was estimated following the same clinical manifestation, with a time frame between two for the less severe forms and eight weeks for the critical ones.

Conclusion:
Epidemiological and clinical data are essential for accurate assessments of the burden of disease. For anthrax, urgent efforts are needed to fill in the missing data in developing countries, specifically focusing on the duration of the post-acute phase and underreporting. Meanwhile, an integrated approach to disease surveillance involving human health and veterinary services would allow for a better understanding of disease dynamics.