Supplementary Material for: An Aggregate of Four Anthrax Cases during the Dry Summer of 2011 in Epirus, Greece

<b><i>Background:</i></b> Human anthrax is currently a sporadic disease in Europe, without significant regional clustering. <b><i>Objective:</i></b> To report an unexpected aggregate of anthrax cases and correlate local climatic factors with yearly anthrax admissions. <b><i>Methods:</i></b> Clinical description of a geographical-temporal anthrax aggregate, correlation of disease admissions with local weather data in the period 2001-2014 and literature reports of anthrax clusters from Europe in the last 20 years. <b><i>Results:</i></b> We identified 5 cases, all cutaneous: an unexpected aggregate of 4 cases in mid-summer 2011 (including a probable human-to-human transmission) and a sporadic case in August 2005, all in relatively dry periods (p &lt; 0.05). Remarkably, 3/6 reports of human anthrax aggregates from Europe were observed in Balkan Peninsula countries in the year 2011. <b><i>Conclusion:</i></b> In the light of the predicted climatic change, unexpected anthrax aggregates during dry periods in southern Europe underscore the risk of future anthrax re-emergence on this continent.

<b><i>背景：</i></b> 目前，人类炭疽在欧洲呈散发性发病，未出现显著的区域聚集性病例。
<b><i>目的：</i></b> 报告一起意外出现的炭疽聚集性病例，并探讨当地气候因素与年度炭疽入院病例数的相关性。
<b><i>方法：</i></b> 对一起时空分布的炭疽聚集性病例开展临床特征描述，分析2001至2014年当地气象数据与炭疽入院病例数的相关性，并梳理近20年欧洲炭疽聚集性病例的文献报道。
<b><i>结果：</i></b> 本研究共纳入5例皮肤炭疽病例：2011年仲夏出现4例聚集性病例（其中1例疑似存在人际传播），2005年8月出现1例散发病例，所有病例均发生在相对干燥的时段（p < 0.05）。值得注意的是，欧洲上报的6起人类炭疽聚集性病例中，有3起发生于2011年的巴尔干半岛国家。
<b><i>结论：</i></b> 鉴于气候变化的预测趋势，南欧干燥时段内意外出现的炭疽聚集性病例，凸显了该大陆未来炭疽疫情重现的风险。