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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    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.",
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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",
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    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

    TY - JOUR

    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

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    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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