The risk of contracting anthrax from animal hide drums

Summary review of the literature

See also  Health Protection Report 7 November 2008.

Review of world literature to April 2010: 7 documented cases (plus one due to secondary contamination of environment)

1.  USA 1974 (MMWR 1974;23:142;147. MMWR 1974;23:149-50. MMWR 1974;23:224. MMWR 1977;26:31. MMWR 1981;30:338)
Cutaneous anthrax in a 22 year old female, acquired from goat skin bongo drums from Haiti. The drum skins still had hair attached. Surveys of goat hide products and artefacts from Haiti from 1971 to 1981 revealed positivity rates of between 26 and 55%.
2. Canada, 2001 (moderator comment in ProMED report 20060824.2391 24/08/06, Kimor L, Bates L, Stephens S. http://www.gov.mb.ca/agriculture/livestock/anhealth/pdf/jaa02s00c.pdf and British Columbia Centre for Disease Control, Laboratory Services Annual Report 2001 http://www.bccdc.org/)
Cutaneous anthrax was recorded in 2001 in a woman in British Columbia. Her diagnosis was clinical as her lesions were culture negative. However, Bacillus anthracis was isolated from a sample of imported African goat hide that had been used in a drum making class that she had attended, and was attributed to be the source of her infection.
3. USA New York, 2006 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5510a4.htm )
Inhalation anthrax in a 44 year old male following exposure to B. anthracis spore-containing aerosols produced by the mechanical scraping of a contaminated animal hide in a non-ventilated workspace.
4. UK Scotland, August 2006  (http://www.nhsborders.org.uk/uploads/18645/anthrax_report_131207.pdf)
Atypical inhalation anthrax in a 50 year old male, who made musical instruments, including African style drums using skins obtained from imported African goat hides and skins recovered from local road-kill badgers. Extensive microbiological investigations ruled out the initial hypothesis that the case had been exposed during his work at home with animal skins. The conclusion was that on the balance of probabilities he became infected as a result of using or handling one or more West African style drums contaminated with viable anthrax spores, at drumming classes or workshops. It is possible that the case was more susceptible to anthrax due to a previous medical condition (acute myeloid leukaemia in remission).
5. USA Connecticut, August 2007 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5723a3.htm )
Cutaneous anthrax involving a drum maker and one of his three children. The investigation revealed that the drum maker was exposed while working with a contaminated goat hide from Guinea and that his workplace and home were contaminated with B. anthracis. His child was most likely exposed from cross-contamination of the home. The father made traditional West African drums (djembe drums) by soaking animal hides in water, stretching them over the drum body, then scraping and sanding them. The affected child never participated in any drum making and had no known exposure to animal hides; he played indoors on carpeted floors and was prohibited from entering the shed.
6. UK London, October 2008 (http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19076) A fatal case of inhalation anthrax in a patient who made and played drums using imported animal hides. Investigations determined that one drum and some residual animal hides were contaminated with spores of B. anthracis         
7. USA New Hampshire, December 2009 (link to MMWR report). A rare case of gastrointestinal anthrax was reported in a woman who apparently inhaled anthrax spores from an animal hide drum used at a drumming event. Anthrax spores were later found on drums and environmental samples from the room used for the event.

Reports on incidents:

Report On The Management Of An Anthrax Incident In The Scottish Borders, December 2007. http://www.nhsborders.org.uk/uploads/18645/anthrax_report_131207.pdf
"This case is the first case of inhalation anthrax that was contracted after playing or handling drums…" "From the documented cases it appears that there is a risk, although very rare and difficult to quantify, from working with untreated hides and from handling or playing drums made from untreated hides. There have been 4 cases (3 in the USA and this case) in the last two years…" "Playing drums should also now be considered to be a potentially hazardous activity, particularly if drums with untreated skins are played by or next to people with predisposing health conditions or compromised immune systems" "The risk of exposure through drumming remains low"
New York City Department Health 2008. http://www.nyc.gov/html/doh/downloads/pdf/cd/anthrax_and_drummers.pdf
"Animal hides pose a low risk of cutaneous, inhalation and meningeal anthrax. Animal hides imported from other countries where anthrax is more common (for example, Africa) may be riskier to use than hides that came from animals in the U.S. Only one case of cutaneous anthrax has been documented in the United States in the past 50 years from playing a drum. The drum in question still had hair on it and was obtained from Haiti. There has never been a case of inhalation anthrax in the United States that resulted from playing drums. The practice of drumming has many cultural and personal benefits that can enhance your life and that may outweigh the low risk of anthrax."
MMWR 2008 (reporting on 2007 case) http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5723a3.htm
"To eliminate individual and environmental risks for anthrax in drum making, public health agencies have long advised that animal hides of unknown origin or from areas of epizootic anthrax should not be used. However, imported animal hides from West Africa, particularly goat hides, remain in demand because they are prized by drum makers for their acoustical quality. Because anthrax outbreaks in livestock frequently occur in West Africa, hides brought into the United States might contain B. anthracis spores. The Animal and Plant Health Inspection Service (APHIS) of the U.S. Department of Agriculture has the authority to regulate importation of all animal hides, mainly to prevent the introduction of foreign animal diseases of agricultural importance into the United States. However, APHIS does not mandate screening of imported hides for B. anthracis, and potentially contaminated hides might continue to be imported. In addition, importation can bypass legal channels."
Anthrax on African drums FAQ (August 2006) http://www.wwdrums.com/anthrax-on-african-drums-faq-a-17.html
USA Risk assessment 2006. CDC health update 24th March 2006 http://www.bt.cdc.gov/agent/anthrax/han022406.asp, CDC Q&As http://www.bt.cdc.gov/agent/anthrax/faq/pelt.asp, NYC Health Department http://home2.nyc.gov/html/doh/html/cd/cd-anthrax-hcp.shtml )
"The risk of acquiring anthrax from an animal hide drum is very low". Of 236 cases of anthrax reported to CDC from 1955 to 1999, only one case of cutaneous anthrax was associated with exposure to a goat hide bongo drum from Haiti (MMWR 1974). No cases of inhalation anthrax in the US have ever been associated with simply owning or playing animal hide drums. Animal hides pose a low risk of cutaneous anthrax, and an extremely low risk of inhalation anthrax. The risk of contracting B. anthracis for handling individual hides is believed to be very low; however, the industrial processing of hides or hair has historically been associated with increased risk of anthrax. Industrial processing involves the handling of large numbers of hides resulting in prolonged contact with contaminated materials, often in enclosed or poorly ventilated settings. The drum maker in NYC mechanically removed the hair from untanned hides using a razor in a small and poorly ventilated workspace, and without respiratory protection. This process can aerosolise spores present on the hides. Playing on African drums, owning drums, or attending African dance performances, and touching finished animal hides are not associated with inhalation anthrax. Once hides have been tanned and the drums are 'finished', there is no known risk of inhalation anthrax. There is a small risk of anthrax in people who manipulate (for example, scraping fur/hair off the hide with a razor) untanned animal hides that come from areas of the world where anthrax occurs in animals (some parts of Africa, Asia, the Americas, and Europe).

USA CDC 2010, MMWR Weekly July 23, 2010 / 59(28);872-877. "The risk for infection posed by handling animal-hide drums, or attending events where such drums are played, is difficult to quantify. Drumming circles are common activities, and given the extreme rarity of cases like the one reported here, the risk for infection must be considered to be very low."

Last reviewed: 6 August 2010