Molecular epidemiologic investigation of an anthrax outbreak among heroin users, Europe - PubMed (original) (raw)

. 2012 Aug;18(8):1307-13.

doi: 10.3201/eid1808.111343.

Meagan L Seymour, Derek S Sarovich, Jennie Latham, Spenser R Wolken, Joanne Mason, Gemma Vincent, Kevin P Drees, Stephen M Beckstrom-Sternberg, Adam M Phillippy, Sergey Koren, Richard T Okinaka, Wai-Kwan Chung, James M Schupp, David M Wagner, Richard Vipond, Jeffrey T Foster, Nicholas H Bergman, James Burans, Talima Pearson, Tim Brooks, Paul Keim

Affiliations

Molecular epidemiologic investigation of an anthrax outbreak among heroin users, Europe

Erin P Price et al. Emerg Infect Dis. 2012 Aug.

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.

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Figures

Figure

Figure

Phylogenetic location of the heroin Ba4599 genome on the global Bacillus anthracis phylogenetic tree (1). Ba4599 was isolated from a heroin user who died of anthrax at the beginning of the 2009–2010 European anthrax outbreak. Canonical single nucleotide polymorphism (SNP) typing situated Ba4599 within the A.Br.008/011 clade of the Trans-Eurasian group (arrows). Closer examination of the boxed area (inset) revealed that Ba4599 was closely related to 2 isolates from Turkey, A0149 and A0264. Solid black circles indicate the approximate position of collapsed branches (n = 3) and are labeled with the corresponding number of strains that fall within the node. Branch termini are occupied by whole genome sequenced strains (black stars). SNPs are numbered on a given branch; vertical bars along the A.Br.008/011 branches denote the phylogenetic placement of SNP assays used in our analysis of B. anthracis from heroin users in Europe. Consistency index = 0.923.

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