An unholy disease in the Holy Land: the history of anthrax between the Jordan River and the Mediterranean Sea (1909-2012).

The history of recorded cases of anthrax in human beings and animals from 1909 to 2012 in the area between the Jordan River and the Mediterranean Sea is reviewed. The disease was endemic until the middle of the 20th century, but the incidence decreased thereafter, with only sporadic cases from the 1980s onwards. Human cases have not been diagnosed in the region since 1984 and the number of episodes of animal disease has reduced to less than one per year. This decline is mostly due to the disruption of the infective cycle by improved veterinary control, including vaccination, treatment and outbreak management. A policy of reactive vaccination for 10 years of affected herds and herds grazing in their proximity has been applied. No new outbreaks have been observed in such herds after the cessation of vaccination, despite continued grazing on the same sites, so it is assumed that spore survival in such areas is shorter than 10 years. This is independent of the soil composition, which is calcareous throughout most of the relevant area. However, reemergence of anthrax, even after decades, has occurred following disturbance and heavy rainfall.