Date of Award

Spring 5-12-2012

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Sheryl Strasser

Second Advisor

Sheryl Strasser


Objective: To describe the worldwide experience of Bacillus anthracis infection reported in pregnant and postpartum women.

Data Sources: Studies were identified through MEDLINE, WEB OF SCIENCE, EMBASE, and GLOBAL HEALTH databases from inception until April 2012. The keywords [(“anthrax” or “anthracis”) and (“pregna*” or “matern*” or “post partum” or “postpartum” or “puerperal” or “lact*” or “breastfed*” or “fetal” or “fetus” or “neonate” or “newborn” or “abort*” or “uterus”)] were used. In addition, all references from selected articles were reviewed, hand searches were conducted and relevant authors were contacted.

Methods of Study Selection: The inclusion criteria were: 1) published articles referring to women diagnosed with an anthrax infection during pregnancy or within six months postpartum, 2) any article type reporting patient-specific data, 3) articles in any language, and 4) non-duplicate cases. Non-English articles were professionally translated. Duplicate reports, unpublished reports and review articles depicting previously identified cases were excluded.

Tabulation, Integration and Results: Two authors independently reviewed articles for inclusion. The primary search of the 4 databases yielded 800 articles and the secondary cross-reference search revealed 146 articles. Seven articles from these searches met inclusion criteria. By contacting the lead author of the largest systematic review of inhalation anthrax to date, 6 additional articles, published before the databases’ inception, were identified that met inclusion criteria. In total, 19 cases of anthrax infection were found, 16 in pregnant women and 3 in postpartum women.

Conclusions: Based on these case reports, anthrax infection in pregnant and postpartum women is associated with high rates of maternal and fetal death. Evidence of possible maternal-fetal transmission of B. anthracis was identified in early case reports. Transmission of B. anthracis through breast milk has not been reported. This review provides important insight to guide anthrax treatment and prophylaxis recommendations for pregnant and postpartum women.