TY - JOUR AU - Price, Erin AU - Seymour, Meagan AU - Sarovich, Derek AU - Latham, Jennie AU - Wolken, Spenser AU - Mason, Joanne AU - Vincent, Gemma AU - Drees, Kevin AU - Beckstrom-Sternberg, Stephen AU - Phillippy, Adam AU - Koren, Sergey AU - Okinaka, Richard AU - Chung, Wai-Kwan AU - Schupp, James AU - Wagner, David AU - Vipond, Richard AU - Foster, Jeffrey AU - Bergman, Nicholas AU - Burans, James AU - Pearson, Talima AU - Brooks, Tim AU - Keim, Paul T1 - Molecular Epidemiologic Investigation of an Anthrax Outbreak among Heroin Users, Europe T2 - Emerging Infectious Disease journal PY - 2012 VL - 18 IS - 8 SP - 1307 SN - 1080-6059 AB - 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. KW - Anthrax KW - heroin KW - canSNP KW - epidemic KW - outbreak KW - Scotland KW - Bacillus anthracis KW - epidemiology KW - Trans-Eurasian KW - phylogenetic KW - bacteria DO - 10.3201/eid1808.111343 UR - https://wwwnc.cdc.gov/eid/article/18/8/11-1343_article ER - End of Reference