Epidemiology and Infection

Original Papers

Outbreaks

Outbreak of wound botulism in injecting drug users

M. SCHROETERa1, K. ALPERSa2 c1, U. VAN TREECKa1, C. FRANKa2, N. ROSENKOETTERa1 and R. SCHAUMANNa3

a1 Institute for Public Health, North Rhine-Westphalia, Bielefeld and Münster, Germany

a2 Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany

a3 Institute for Medical Microbiology and Epidemiology of Infectious Diseases, National Reference Laboratory for Anaerobes, University of Leipzig, Leipzig, Germany

SUMMARY

Between October and December 2005, 16 cases of wound botulism were notified to the health authorities of North Rhine-Westphalia, Germany. All patients were injecting drug users (IDU) and the epidemiological investigations suggested contaminated injection drugs as the most probable source of infection. Clostridium botulinum was cultivated from clinical samples of six patients and molecular typing revealed that the different isolates were clonally identical. Two samples of heroin, one of them provided by a patient, were examined but C. botulinum could not be isolated. This outbreak demonstrates that IDU are at risk for acquiring wound botulism by injecting contaminated drugs. A greater awareness of this disease is needed by physicians and a close cooperation between public health authorities, street workers, operators of sheltered injecting facilities, and medical centres focusing on IDU is essential to prevent and manage outbreaks in IDU in a timely manner.

(Accepted March 06 2009)

(Online publication April 07 2009)

Correspondence:

c1 Author for correspondence: Dr K. Alpers, Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, D-13353 Berlin. (Email: AlpersK@rki.de)

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