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Summary:

As of 21 September 2012, a total of 11 cases of anthrax including 4 deaths among injecting heroin users have been reported to WHO by Germany (4 cases, 2 fatal), Denmark (2 cases), France (1 case) and United Kingdom (4 cases, 2 fatal). The last case was notified by Germany on 14 September 2012.
Of the six isolates (Germany: 3, Denmark: 2 and United Kingdom: 1) tested so far, all were indistinguishable from the B. anthracis strain that circulated during the 2009/2010 outbreak in Germany and the United Kingdom.

Event update:

The United Kingdom reported to WHO four cases of anthrax including two deaths among injecting heroin users to date. The latest (fatal) case was reported on 10 September 2012. All four cases were laboratory confirmed by PCR. Advanced molecular techniques have shown that the strain from the first case in Blackpool was indistinguishable from those in the 2009/2010 outbreak. Molecular typing was not possible on the Scottish case, but will be attempted for the most recently confirmed patients.

On 10 July 2012, France reported to WHO one laboratory confirmed case of anthrax. The result of molecular typing is pending.

Two cases of anthrax including one death were reported by Denmark. The first case was reported on 8 July 2012 and the last case was reported on 26 July 2012. Molecular typing of the isolates from the two cases reported revealed that they are almost identical to those found in the 2009/10 cases in Germany and the United Kingdom.

A total of four cases of anthrax among injecting heroin users including two deaths were reported in Germany. The latest case was reported on 14 September 2012; the case is PCR confirmed and molecular typing is pending. The initial three laboratory confirmed cases were infected with almost indistinguishable B. anthracis strains when compared to the strain that circulated during the 2009/2010 outbreak in Germany and the United Kingdom. Minor variation in genotyping does not exclude similar sources of contamination.

WHO requests:
1. Public health authorities, medical personnel and others providing services to drug users in Europe should be made aware in order to recognize and report potential cases and support efforts to identify and track contaminated products.
2. Cases should be reported to WHO through their respective IHR Regional Contact Points.
3. Representative B. anthracis isolates from confirmed cases or clusters should be genotyped to establish links between cases, contaminated product, and possible environmental sources.
4. If you require information or assistance on laboratory genotyping testing or potential reference laboratories, please contact your WHO IHR Regional Contact Point.
 
Information about anthrax infections among heroin users provided by:

Statens Serum Institut (only in Danish)
http://www.ssi.dk/Aktuelt/Nyheder/2012/2012_07_anthrax.aspx

Health Protection Agency http://www.hpa.org.uk/NewsCentre/NationalPressReleases/2012PressReleases/120817ConfirmedcaseofAnthraxininjectingdruguser/

Robert Koch Institute (only in German)
www.rki.de/DE/Content/InfAZ/A/Anthrax/aktuell.html

European Centre for Disease Prevention and Control  - Joint ECDC and EMCDDA Rapid Risk Assessment http://www.ecdc.europa.eu/en/publications/Publications/Forms/ECDC_DispForm.aspx?ID=929

International Network of People Who Use Drugs
http://www.inpud.net/index.php/statements-and-position-papers/24-inpud-anthrax-alert.html

WHO resources:

Anthrax in humans and animals. Fourth edition. http://www.who.int/csr/resources/publications/anthrax_webs.pdfhttp://www.who.int/csr/resources/publications/anthrax_webs.pdf

Manual for Laboratory Diagnosis of Anthrax, WHO/SEARO, 2003,
http://www.searo.who.int/LinkFiles/Reports_anthrax.pdf

Guidelines for the Surveillance and Control of Anthrax in Human and Animals. 3rd edition, WHO, 1998, http://www.who.int/csr/resources/publications/anthrax/WHO_EMC_ZDI_98_6/en/