Rapid Risk Assessment: Wound botulism among people who inject heroin in Norway

Risk assessment

​At the request of the European Commission, ECDC performed a risk assessment after six cases of wound botulism were reported in Norway among people who had injected heroin. As this is an ongoing problem, some relevant measures are proposed for consideration by other EU/EEA Member States.

Executive summary

​As of 28 October 2013, six cases of wound botulism have been reported in Norway among people who had injected heroin. Two cases have been confirmed through mice inoculation and four are suspected cases with laboratory results pending.  All cases reported heroin use and most reported intramuscular injection of heroin. They all reside in the Oslo area or in neighbouring municipalities.

The source of infection is thought to be a batch of contaminated heroin. The geographical distribution of the potentially contaminated heroin is unknown at this time, as is the distribution stage at which the heroin may have been contaminated.

The potential risk for the EU/EEA will depend on the stage of contamination. If heroin contamination occurred early in the stage of distribution, it cannot be excluded that additional wound botulism-infected heroin injectors will be identified in the EU/EEA. No person-to-person transmission has ever been reported.

Guidance on drug treatment and prevention and control of infections among people who inject drugs has recently been issued by ECDC and the EMCDDA. The two agencies will continue to monitor the evolution of this situation in terms of the epidemiological information available.