Rapid risk assessment: Anthrax cases among injecting drug users - Germany, June-July 2012 - Update, 6 July 2012

Risk assessment

This is an update to the joint rapid risk assessment published on 22 June 2012 by ECDC and EMCDDA on anthrax cases among injecting drug users in Germany. This is in response to a third case in Berlin. It contains information updated up to the 6 July 2012.

Executive summary

In June, ECDC and EMCDDA jointly assessed the risk associated with two cases of anthrax among injecting drug users (IDU) in Regensburg (Bavaria, Germany).
Another case of anthrax in a injecting drug user has been reported from Berlin. The first two cases, one of which was fatal, are likely linked through exposure to heroin contaminated by a most likely identical Bacillus anthracisstrain. The link with the third case, though probable, needs to be confirmed.
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 still present and therefore additional cases among IDUs may occur in the 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.
ECDC and EMCDDA will continue to monitor the evolution of this situation in terms of the epidemiological information available.