Joint Ecdc and Emcdda Rapid Risk Assessment

As of 4 July 2012, three cases of anthrax among injecting drug users (IDUs) have been reported from Germany; two from Regensburg, Bavaria and one from Berlin. All three cases had onset of symptoms in June 2012 and one case has died. The first two cases are likely linked through exposure to heroin contaminated by a most likely identical Bacillus anthracis strain (based on molecular typing results). The link of 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 it 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 not excluded that additional cases among IDUs will be identified in the near future. JOINT ECDC AND EMCDDA RAPID RISK ASSESSMENT