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

Erin Price, Meagan Seymour, Derek Sarovich, j latham, Spenser Wolken, J Mason, Gemma Vincent, k drees, Stephen Beckstrom-Sternberg, A Phillippy, S Koren, R Okinaka, Wai-Kwan Chung, James Schupp, David M Wagner, r vipond, T Foster, Nicholas H Bergman, j Burans, Talima Pearson & 2 others t Brookes, Paul S Keim

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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.
Original languageEnglish
JournalEmerging Infectious Diseases
Volume18
Issue number8
DOIs
Publication statusPublished - Aug 2012

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Anthrax
Heroin
Disease Outbreaks
Scotland
Bacillus anthracis
Single Nucleotide Polymorphism
Drug Trafficking
Afghanistan
Turkey
Spores
England
Germany
Genotype
Genome
Polymerase Chain Reaction

Cite this

Price, E., Seymour, M., Sarovich, D., latham, J., Wolken, S., Mason, J., ... Keim, P. S. (2012). Molecular epidemiologic investigation of an anthrax outbreak among heroin users, Europe. Emerging Infectious Diseases, 18(8). https://doi.org/10.3201/eid1808.111343
Price, Erin ; Seymour, Meagan ; Sarovich, Derek ; latham, j ; Wolken, Spenser ; Mason, J ; Vincent, Gemma ; drees, k ; Beckstrom-Sternberg, Stephen ; Phillippy, A ; Koren, S ; Okinaka, R ; Chung, Wai-Kwan ; Schupp, James ; Wagner, David M ; vipond, r ; Foster, T ; Bergman, Nicholas H ; Burans, j ; Pearson, Talima ; Brookes, t ; Keim, Paul S. / Molecular epidemiologic investigation of an anthrax outbreak among heroin users, Europe. In: Emerging Infectious Diseases. 2012 ; Vol. 18, No. 8.
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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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author = "Erin Price and Meagan Seymour and Derek Sarovich and j latham and Spenser Wolken and J Mason and Gemma Vincent and k drees and Stephen Beckstrom-Sternberg and A Phillippy and S Koren and R Okinaka and Wai-Kwan Chung and James Schupp and Wagner, {David M} and r vipond and T Foster and Bergman, {Nicholas H} and j Burans and Talima Pearson and t Brookes and Keim, {Paul S}",
year = "2012",
month = "8",
doi = "10.3201/eid1808.111343",
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Price, E, Seymour, M, Sarovich, D, latham, J, Wolken, S, Mason, J, Vincent, G, drees, K, Beckstrom-Sternberg, S, Phillippy, A, Koren, S, Okinaka, R, Chung, W-K, Schupp, J, Wagner, DM, vipond, R, Foster, T, Bergman, NH, Burans, J, Pearson, T, Brookes, T & Keim, PS 2012, 'Molecular epidemiologic investigation of an anthrax outbreak among heroin users, Europe', Emerging Infectious Diseases, vol. 18, no. 8. https://doi.org/10.3201/eid1808.111343

Molecular epidemiologic investigation of an anthrax outbreak among heroin users, Europe. / Price, Erin; Seymour, Meagan; Sarovich, Derek; latham, j; Wolken, Spenser; Mason, J; Vincent, Gemma; drees, k; Beckstrom-Sternberg, Stephen; Phillippy, A; Koren, S; Okinaka, R; Chung, Wai-Kwan; Schupp, James; Wagner, David M; vipond, r; Foster, T; Bergman, Nicholas H; Burans, j; Pearson, Talima; Brookes, t; Keim, Paul S.

In: Emerging Infectious Diseases, Vol. 18, No. 8, 08.2012.

Research output: Contribution to journal › Article › Research › peer-review

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T1 - Molecular epidemiologic investigation of an anthrax outbreak among heroin users, Europe

AU - Price, Erin

AU - Seymour, Meagan

AU - Sarovich, Derek

AU - latham, j

AU - Wolken, Spenser

AU - Mason, J

AU - Vincent, Gemma

AU - drees, k

AU - Beckstrom-Sternberg, Stephen

AU - Phillippy, A

AU - Koren, S

AU - Okinaka, R

AU - Chung, Wai-Kwan

AU - Schupp, James

AU - Wagner, David M

AU - vipond, r

AU - Foster, T

AU - Bergman, Nicholas H

AU - Burans, j

AU - Pearson, Talima

AU - Brookes, t

AU - Keim, Paul S

PY - 2012/8

Y1 - 2012/8

N2 - 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.

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 - diamorphine

KW - anthrax

KW - article

KW - Bacillus anthracis

KW - clinical article

KW - controlled study

KW - drug use

KW - epidemic

KW - Europe

KW - gene sequence

KW - genetic distance

KW - genotype

KW - geographic origin

KW - human

KW - nonhuman

KW - nucleotide sequence

KW - phylogenetic tree

KW - phylogeography

KW - real time polymerase chain reaction

KW - single nucleotide polymorphism

KW - Anthrax

KW - Bacterial Typing Techniques

KW - Disease Outbreaks

KW - DNA, Bacterial

KW - Female

KW - Genome, Bacterial

KW - Genotype

KW - Heroin

KW - Humans

KW - Male

KW - Molecular Epidemiology

KW - Phylogeny

KW - Polymerase Chain Reaction

KW - Polymorphism, Single Nucleotide

KW - Sequence Analysis, DNA

KW - Substance Abuse, Intravenous

U2 - 10.3201/eid1808.111343

DO - 10.3201/eid1808.111343

M3 - Article

VL - 18

JO - Emerging Infectious Diseases

JF - Emerging Infectious Diseases

SN - 1080-6040

IS - 8

ER -

Price E, Seymour M, Sarovich D, latham J, Wolken S, Mason J et al. Molecular epidemiologic investigation of an anthrax outbreak among heroin users, Europe. Emerging Infectious Diseases. 2012 Aug;18(8). https://doi.org/10.3201/eid1808.111343

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