Following reports of two cases of anthrax among injecting drug users in Regensburg (Bavaria, Germany), ECDC and EMCDDA jointly prepared a rapid risk assessment.

They conclude that it is probable that both cases are linked through exposure to heroin contaminated by Bacillus anthracis. The geographical distribution of the contaminated heroin is unknown at this time, but it is possible that the batch 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 Germany and other countries is presumably still present and therefore it is likely that additional cases among injecting drug users will be identified in the near future.

As anthrax has rarely been associated with severe infection among drug users, clinicians may not consider anthrax in the differential diagnosis of severe infections in this population and this consequently may result in undiagnosed cases. Clinical awareness in healthcare settings of the risk of injection-related infection with rare pathogens among the IDU population is therefore crucial.

Updated on 25 June 2012, 12:00: Both cases of anthrax reported in Bavaria presented with the same strain type as the 2009/2010 outbreak of Bacillus anthracis in Scotland, also associated with heroin injection.

Read full Joint rapid risk assessment: Anthrax cases among injecting drug users, Germany

Read more on ECDC website:
Anthrax health topic page

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) website

Robert Koch Institute (RKI) press release (in German)