| Abstract |
As of 10 July 2012, five cases of anthrax have been reported among injecting drug users (IDUs) from Germany (n=3), Denmark (n=1) and France (n=1). Reported dates of onset in all five cases range between early June 2012 and 11 July 2012. One German case and the case from Denmark have died. The first two cases from Germany are likely linked through exposure to heroin contaminated by a most likely identical Bacillus anthracis strain (based on molecular typing results). For the third German case there is also some laboratory evidence that the strain could be identical with the outbreak strain, but due to the limited amount of DNA, further typing is not possible. The link of the remaining two cases, though probable, needs to be confirmed through molecular typing. The geographical distribution of the potentially contaminated heroin is unknown at this time, but it is possible it has the same source as the contaminated heroin incriminated in the 2009/2010 outbreak in Scotland (with cases also reported from Germany and England). The risk of exposure for heroin users in European Union (EU) countries is presumably still present and therefore it is not excluded that additional cases among IDUs will be identified in the near future. Information could be disseminated to health care workers, drug treatment and harm reduction centres describing the symptoms of anthrax infection to ensure early treatment, and urging the provision of appropriately-dosed opiate substitution treatment to prevent further anthrax cases. |
