摘要：The recent anthrax outbreak among injecting drug users (IDUs) in Europe has highlighted an ongoing problem with severe illness resulting from spore-forming bacteria in IDUs. We collated the numbers of cases of 4 bacterial illnesses (botulism, tetanus, Clostridium novyi , and anthrax) in European IDUs for 2000 to 2009 and calculated population rates. Six countries reported 367 cases; rates varied from 0.03 to 7.54 per million people. Most cases (92%) were reported from 3 neighboring countries: Ireland, Norway, and the United Kingdom. This geographic variation needs investigation. The emergence of anthrax among injecting drug users (IDUs), mostly of heroin, in Scotland in 2009 1 constituted the second major cluster of severe bacterial illness among IDUs in the country in a decade. In 2000 and 2001, an outbreak of Clostridium novyi affected IDUs across Great Britain and Ireland, 2,3 with the majority of cases observed in Scotland. Since then, there have been ongoing reports of illness and death among IDUs taking heroin in the United Kingdom. These cases have been associated with a range of spore-forming bacteria, with wound botulism and tetanus cases continuing to occur since being first reported in the early 2000s. 4–6 Contaminated heroin, mainly supplied to the United Kingdom and other European countries via trafficking routes emanating from Afghanistan, 7,8 is considered to be the likely source of infection in most, if not all, instances. However, the basic geographic epidemiology of these infections among IDUs in Europe has not been described. To ascertain whether what is being observed in the United Kingdom is unique or is similar to what is occurring elsewhere in Europe, we explored differences in rates of severe infections among IDUs caused by 4 spore-forming bacteria that have been associated with contaminated heroin. Such analysis might provide insights into where, for example, contamination of heroin is occurring.
