. 2012 Jan;102(1):122–125. doi: 10.2105/AJPH.2011.300314

TABLE 1—

Reports of Clinically or Microbiologically Confirmed Cases of Spore-Forming Bacterial Infection Among Injecting Drug Users: European Union, Croatia, and Norway, 2000–2009

Country	Population in 2005	Estimated IDUs				Bacterial Infections							Summary of Responses to Request for Further Information on IDU Cases	References
Country	Population in 2005	Range	Central Estimate, No.	Year	Method	Botulism, No.	Tetanus, No.	Clostridium noyvi, No.	Anthrax, No.	Total No.	Rate/ Million People	Rate/ 1000 IDUs		References
Austria	8 206 524	12 000–23 000	NA	2000	MM					0	0	0	No cases reported^a
Belgium	10 445 852	23 200–28 400	NA	1997	HM					0	0	0	No cases reported^b
Bulgaria	7 761 049												No data on injecting status
Croatia	4 443 901	2521–4167	3145	2009	MM					0	0	0	No cases reported
Cyprus	749 175	379–646	481	2009	OT					0	0	0	No cases reported
Czech Republic	10 220 577	34 200–36 400	35 300	2009	TM					0	0	0	No cases reported
Denmark	5 411 405	10 066–16 821	12 754	2006	CR					0	0	0	No cases reported
Estonia	1 347 510	8132–34 443	13 886	2004	CR					0	0	0	No cases reported
Finland	5 236 611	12 200–19 700	15 650	2002	OT					0	0	0	No cases reported
France	62 637 596	NA	122 000	1999	HM					0	0	0	No cases reported
Germany	82 500 849	78 000–110 500	NA	2005	MM	21			1	22	0.27	0.20–0.28	Botulism: 4 more cases	12–17
Greece	11 082 751	8999–12 713	10 658	2009	CR	1	2			3	0.27	0.24–0.33	Botulism: 1 case; tetanus: 2 cases^c
Hungary	10 097 549	NA	5699	2008–2009	OT					0	0	0	No cases reported^d
Ireland	4 109 173	4694–7884	NA	1996	MM	9		22		31	7.54	3.9–6.6	No additional cases	18–20
Italy	58 462 375	NA	326 000	1996	HM	2				2	0.03	0.0061	Botulism: 2 cases
Latvia	2 306 434									0	0		No cases reported
Lithuania	3 425 324									0	0		No cases reported^e
Luxembourg	461 230	1253–1919	1485	2007	OT								Unable to provide data
Malta	402 668									0	0		No cases reported
The Netherlands	16 305 526	2336–2444	2390	2008	TM	1	1			2	0.12	0.82–0.86	No additional cases	21,22
Norway	4 606 363	8 810–12 480	10 238	2008	MM	5		1	1	7	1.52	0.56–0.79	Botulism: 4 more cases	23
Poland	38 173 835									0	0		No cases reported^f
Portugal	10 529 255	13 183–16 285	NA	2005	TM					0	0	0	No cases reported
Romania	21 658 528									0	0		No cases reported
Slovakia	5 384 822	13 732–34 343	18 841	2006	TM					0	0	0	No cases reported
Slovenia	1 997 590	NA	7320	2001	OT					0	0	0	No cases reported
Spain	43 038 035	NA	83 972^g	1998	MM					0	0	0	No cases reported
Sweden	9 011 392									0	0		No cases reported
United Kingdom	60 059 900	143 298–156 017	147 900	2006–2007	OT	160	34	93	13	300	5.00	1.9–2.1	Not applicable
Total^h	491 851 520					199	37	116	15	367	0.75
Total^h (excluding UK)	431 791 620					39	3	23	2	67	0.16

Note. CR = capture recapture; EMCDDA = European Monitoring Centre for Drugs and Drug Addiction; HM = HIV multiplier; IDU = injecting drug user; MM = mortality multiplier; NA = not available; OT = other or multiple methods; TM = treatment multiplier.

Source. Estimates of numbers of IDUs are from the EMCDDA.²⁴

^{^a}

No cases reported through the Austrian early warning system.

^{^b}

Data from 2006–2009.

^{^c}

Data from 2003–2009, drug user or IDU. Data on drug use not systematically collected.

^{^d}

Data from 2004–2009 for tetanus, and from 2006–2009 for botulism.

^{^e}

No information on these infections occurring among injecting drug users.

^{^f}

Drug use not routinely collected; however, in all known cases, other routes were implicated.

^{^g}

Opiate injectors only.

^{^h}

Excluding Bulgaria and Luxembourg.