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

Risk assessment

This is an update to the joint rapid risk assessment published on 6 July 2012 by ECDC and EMCDDA on anthrax cases among injecting drug users in Germany. This is in response to further cases in France and Denmark. It contains information updated up to the 13 July 2012.

Executive summary

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.