title: Molecular epidemiologic investigation of an anthrax outbreak among heroin users, Europe.
abstract: In December 2009, two unusual cases of anthrax were diagnosed in heroin users in Scotland. A subsequent anthrax outbreak in heroin users emerged throughout Scotland and expanded into England and Germany, sparking concern of nefarious introduction of anthrax spores into the heroin supply. To better understand the outbreak origin, we used established genetic signatures that provided insights about strain origin. Next, we sequenced the whole genome of a representative Bacillus anthracis strain from a heroin user (Ba4599), developed Ba4599-specific single-nucleotide polymorphism assays, and genotyped all available material from other heroin users with anthrax. Of 34 case-patients with B. anthracis-positive PCR results, all shared the Ba4599 single-nucleotide polymorphism genotype. Phylogeographic analysis demonstrated that Ba4599 was closely related to strains from Turkey and not to previously identified isolates from Scotland or Afghanistan, the presumed origin of the heroin. Our results suggest accidental contamination along the drug trafficking route through a cutting agent or animal hides used to smuggle heroin into Europe.
authors: Northern Arizona University, Flagstaff, Arizona, USA.
authors: Erin P
authors: EP
authors: Price
authors: Meagan L
authors: ML
authors: Seymour
authors: Derek S
authors: DS
authors: Sarovich
authors: Jennie
authors: J
authors: Latham
authors: Spenser R
authors: SR
authors: Wolken
authors: Joanne
authors: J
authors: Mason
authors: Gemma
authors: G
authors: Vincent
authors: Kevin P
authors: KP
authors: Drees
authors: Stephen M
authors: SM
authors: Beckstrom-Sternberg
authors: Adam M
authors: AM
authors: Phillippy
authors: Sergey
authors: S
authors: Koren
authors: Richard T
authors: RT
authors: Okinaka
authors: Wai-Kwan
authors: WK
authors: Chung
authors: James M
authors: JM
authors: Schupp
authors: David M
authors: DM
authors: Wagner
authors: Richard
authors: R
authors: Vipond
authors: Jeffrey T
authors: JT
authors: Foster
authors: Nicholas H
authors: NH
authors: Bergman
authors: James
authors: J
authors: Burans
authors: Talima
authors: T
authors: Pearson
authors: Tim
authors: T
authors: Brooks
authors: Paul
authors: P
authors: Keim
mesh_terms: D000881:Anthrax / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D001408:Bacillus anthracis / Q000235:genetics* / Q000302:isolation & purification; D015373:Bacterial Typing Techniques; D004269:DNA, Bacterial / Q000032:analysis / Q000235:genetics; D004196:Disease Outbreaks; D005060:Europe / Q000453:epidemiology; D005260:Female; D016680:Genome, Bacterial; D005838:Genotype; D003932:Heroin; D006801:Humans; D008297:Male; D017720:Molecular Epidemiology; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D020641:Polymorphism, Single Nucleotide; D017422:Sequence Analysis, DNA; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology
chemical_list: D004269:DNA, Bacterial; D003932:Heroin