On 29 December 2014, the Norwegian Institute of Public Health (NIPH or Folkehelseinstituttet) was notified of a case of wound botulism in a heroin-injecting drug user living in Oslo. Since then an additional five Norwegian cases have been identified in intravenous drug users (IVDU), bringing the total number of cases of botulism in IVDUs to six; four of these cases are laboratory confirmed.

Concurrently, on January 6th 2015, Health Protection Scotland reported two linked cases of wound botulism in IVDUs, both from the greater Glasgow and Clyde area. Since then, an additional five cases of wound botulism in ICDUs have been identified in Scotland. Four of the Scottish cases are currently hospitalised.

Cases occurring in two EU Member States during a short time interval, strongly suggest the possibility of a batch of heroin contaminated with spores of the Clostridium botulinum. Alternatively, contamination may have occurred during the “cutting” process – cutting agents being additives used to bulk up the heroin prior to sale. Given the complex international distribution chain of heroin, the possibility exists that IVDUs in other EU countries (including Ireland) are at risk of exposure and disease.....