The need to promote public health in the field of illicit drug use

Outbreak of wound botulism in injecting drug users

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.