Anthrax infection in injecting drug uses: risk assessment update

As of 10 July 2012, two new cases of anthrax have been reported among injecting drug users (IDUs) in Denmark and France in addition to three cases in Germany. Reported dates of onset in all five cases range between early June 2012 and 11 July 2012. The patient in Denmark died on 8 July. ECDC and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have updated their risk assessment according to this new information.

The first two cases from Germany are likely linked through exposure to heroin contaminated by a most likely identical Bacillus anthracis strain. The third German case cannot be confirmed although there is also some laboratory evidence that the strain could be identical with the outbreak strain. The link of the remaining two cases, though probable, needs to be confirmed through molecular typing.

The risk of exposure for heroin users in Europe is presumably still present and therefore it is not excluded that additional cases among IDUs will be identified in the near future. As anthrax cannot normally be transmitted from person to person, the risk to the general population is negligible. In healthcare settings where anthrax infected patients are cared for, standard infection control guidelines would be advisable.

Public health authorities in Europe could consider providing information for healthcare and drug treatment workers describing the symptoms of anthrax infection to ensure early treatment, and the provision of appropriately-dosed opiate substitution treatment to prevent further anthrax cases.

Read the full Risk assessment: Anthrax cases among injecting drug users Germany, June-July 2012 – Update, 13 July 2012

Read more:
Previous ECDC-EMCDDA risk assessment update, 6 July 2012
Additional guidance including documents on case detection, clinical management and post mortem examinations - Health Protection Scotland, UK
Robert Kock Institut, Germany
ECDC anthrax factsheet for the general public

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