Anthrax in Albania: A Comprehensive Analysis of Epidemiology, Laboratory Diagnosis, and National Control Strategies in Animals.

Anthrax is one of the most significant zoonotic diseases in Albania due to its endemic presence in livestock, the potential for occupational exposure, and human cases. Although the implementation of risk-based livestock immunization, animal movement restrictions, and appropriate carcass disposal, the efficacy of targeted management remains limited in certain outbreaks due to insufficient enforcement of these measures. Their efficacy is specifically diminished by insufficient disinfection, the absence of grazing bans in contaminated pastures, and the absence of designated burial sites for the safe disposal of dead animals. District-level data on animal anthrax control programs were collected and analyzed for the period 2021-2025. In addition, a retrospective analysis of national datasets covering the same period was conducted using data from the national surveillance system, alongside a review of the relevant scientific and grey literature and aggregated program and routine surveillance data. Analysis showed that anthrax affected 149 animals in 97 farms, and the average number of animals per infected farm declined from 1.70 to 1.08, indicating a slight reduction within-farm outbreak. Hotspots for human anthrax were aligned with the animal cases and persisted particularly in the southern districts. The peak of outbreaks was in 2023, primarily driven by cattle (n = 32) and sheep (n = 24). Equine cases appeared only in 2024, with small clusters of 3 cases in both 2024 and 2025. Caprine cases remained consistently low throughout the period. Nevertheless, the number of outbreaks and within-herd cases are decreasing due to more rapid identification and response. Targeted surveillance on animal outbreaks provides critical insights into disease spread and links among affected farms in Albania. Therefore, One Health genomic surveillance and antibiotic susceptibility testing of Bacillus anthracis isolates are essential for understanding its epidemiology, transmission routes, and for tracing the sources of infection across humans, animals, and the environment.