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Anthrax - Multistate - Outbreak among people who inject drugs (ECDC/CDTR, March 11 2013)
[Source: European Centre for Disease Prevention and Control (ECDC), full PDF document: (LINK). Edited.]
COMMUNICABLE DISEASE THREATS REPORT
Week 10, 3-9 March 2013
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Anthrax - Multistate - Outbreak among people who inject drugs
Opening date: 18 December 2009 Latest update: 8 March 2013
Epidemiological summary
In June 2012, Germany reported two cases of anthrax among IDUs in Regensburg. One of these cases died. The strain from these cases is reported to be almost identical to the strain from the 2009-2010 outbreak that mostly affected Scotland. A third confirmed case, a cutaneous anthrax affecting a IDUs, was reported in July in Berlin. Initial molecular typing of B. anthracis DNA from this patient suggests that it could be genetically similar to the first two cases in the Regensburg region. A fourth case was reported from Berlin by the RKI on 14 September 2012 in a person who injected heroin.
In July 2012, Denmark reported two confirmed cases (one fatal) and one possible case of cutaneous anthrax in IDUs in Copenhagen. The strains isolated from both of the confirmed cases were identical to the 2009 and 2010 outbreak strain.
France informed ECDC of a case of anthrax in an IDU in June 2012. The strain will be genotyped and compared with those isolated from German patients. Investigations revealed that the heroin used by this case was purchased in France in the Rh?ne-Alpes region and the patient had no recent history of travel.
In July 2012, UK reported a first case in Lanarkshire, Scotland. A second fatal case was reported in Blackpool, England on 17 August and a third case in Wales on 6 September 2012. On 10 September 2012, UK reported an additional fatal case in Blackpool, England. On 1 November 2012, UK authorities notified the fifth human anthrax case (PCR confirmed) in a IDU in Oxford, England. This case had injected heroin on 24 October and developed symptoms on 25 October. On 19 December 2012, UK authorities reported that a sixth person who injected heroin and had been diagnosed with anthrax infection had died in Medway, England.
On 8 March 2013, the Health Protection Agency was notified of a confirmed fatal case of human anthrax in Suffolk, England. This case was an adult female who injected heroin. She was admitted to hospital on 27 February 2013 and died on 2 March 2013.
The genetic typing for this case is on-going.
Since June 2012, 14 confirmed anthrax cases have been reported among IDUs in the EU.
(?)
ECDC assessment
This additional case is not unexpected and does not change the conclusions of the rapid risk assessment published by ECDC and EMCDDA on 16 July 2012. The reporting on cases of anthrax in IDUs in several countries over a long period of time suggests that contaminated heroin is still circulating in Europe. People who inject heroin in Europe are still at risk of exposure to anthrax.
Actions
ECDC and EMCDDA updated their joint rapid risk assessment (RRA) on 13 July 2012. The two organisations are working together to produce a joint guidance document on the prevention of anthrax among IDUs.
(?)
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COMMUNICABLE DISEASE THREATS REPORT
Week 10, 3-9 March 2013
(?)
Anthrax - Multistate - Outbreak among people who inject drugs
Opening date: 18 December 2009 Latest update: 8 March 2013
Epidemiological summary
In June 2012, Germany reported two cases of anthrax among IDUs in Regensburg. One of these cases died. The strain from these cases is reported to be almost identical to the strain from the 2009-2010 outbreak that mostly affected Scotland. A third confirmed case, a cutaneous anthrax affecting a IDUs, was reported in July in Berlin. Initial molecular typing of B. anthracis DNA from this patient suggests that it could be genetically similar to the first two cases in the Regensburg region. A fourth case was reported from Berlin by the RKI on 14 September 2012 in a person who injected heroin.
In July 2012, Denmark reported two confirmed cases (one fatal) and one possible case of cutaneous anthrax in IDUs in Copenhagen. The strains isolated from both of the confirmed cases were identical to the 2009 and 2010 outbreak strain.
France informed ECDC of a case of anthrax in an IDU in June 2012. The strain will be genotyped and compared with those isolated from German patients. Investigations revealed that the heroin used by this case was purchased in France in the Rh?ne-Alpes region and the patient had no recent history of travel.
In July 2012, UK reported a first case in Lanarkshire, Scotland. A second fatal case was reported in Blackpool, England on 17 August and a third case in Wales on 6 September 2012. On 10 September 2012, UK reported an additional fatal case in Blackpool, England. On 1 November 2012, UK authorities notified the fifth human anthrax case (PCR confirmed) in a IDU in Oxford, England. This case had injected heroin on 24 October and developed symptoms on 25 October. On 19 December 2012, UK authorities reported that a sixth person who injected heroin and had been diagnosed with anthrax infection had died in Medway, England.
On 8 March 2013, the Health Protection Agency was notified of a confirmed fatal case of human anthrax in Suffolk, England. This case was an adult female who injected heroin. She was admitted to hospital on 27 February 2013 and died on 2 March 2013.
The genetic typing for this case is on-going.
Since June 2012, 14 confirmed anthrax cases have been reported among IDUs in the EU.
(?)
ECDC assessment
This additional case is not unexpected and does not change the conclusions of the rapid risk assessment published by ECDC and EMCDDA on 16 July 2012. The reporting on cases of anthrax in IDUs in several countries over a long period of time suggests that contaminated heroin is still circulating in Europe. People who inject heroin in Europe are still at risk of exposure to anthrax.
Actions
ECDC and EMCDDA updated their joint rapid risk assessment (RRA) on 13 July 2012. The two organisations are working together to produce a joint guidance document on the prevention of anthrax among IDUs.
(?)
-
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