The Role of Sediment Ingestion in Exposing Bottom-Feeding Fish to Chemical Elements.

Digesta were collected from the intestines of seven species of bottom-feeding fish to better understand the role of incidental ingestion of sediment in exposing fish to inorganic contaminants. A composite sediment tracer variable, based on concentrations of Co, Cr, Ni, Ti, V, and Y in digesta and in sediment, was calculated to estimate sediment content of digesta. Concentration factors (mg/kg in digesta divided by mg/kg in sediment) of eight elements of interest were linearly regressed on this tracer variable. The relative importance of sediment ingestion to oral exposure was quantified. Zinc, Cd, and Cu were ingested mainly from sediment-free food. Arsenic, Cr, Ni, Al, and Pb, in contrast, were ingested mainly from sediment. As an example, 93% of the Ni in digesta from a brown bullhead (Ameiurus nebulosus) was from sediment and only 7% from food. Regressions of Al and Pb in digesta of suckers (Catostomidae) suggested an additional oral source, possibly from oxides coating biotic or abiotic surfaces. Overall, concentrations of 12 of 21 elements studied were positively correlated with sediment content (p < 0.005). Including sediment ingestion as a pathway for bottom-feeding fish is essential for accurately estimating exposures in toxicological studies. Environ Toxicol Chem 2024;43:1036-1046. Published 2024. This article is a U.S. Government work and is in the public domain in the USA.

Revisiting the Avian Eco-SSL for Lead: Recommendations for Revision.

The avian ecological soil screening level (Eco-SSL) for Pb (11 mg/kg) is within soil background concentrations for >90% of the United States. Consequently, its utility as a soil screening level is limited. Site-specific ecological risk-based remedial goals for Pb are frequently many times greater. Toxicity reference values (TRVs) play a major role in defining Eco-SSLs. The Pb Eco-SSL TRV is driven by reduced egg production in Japanese quail (Coturnix japonica), which displays effects at doses both substantially lower and greater than other tested species. High variability in egg production in Japanese quail has also been observed for other contaminants. Japanese quail egg production may therefore be too variable and unreliable an effect endpoint upon which to base regulatory screening criteria. Toxicity data supporting the Eco-SSL were reevaluated and only studies reporting both no and lowest observed adverse effect levels (NOAELs and LOAELs) for reproduction, growth, or survival were considered. Dose-response data were extracted from 10 studies both as concentrations and doses. Dose-response relationships were developed using the US Environmental Protection Agency (USEPA) Benchmark Dose Software for dietary concentrations and doses for egg production in Japanese quail and chickens. Effect levels (of 10%, 20%, and 50%) were extracted from the dose-response analyses. Species sensitivity distributions and dose-response data indicated reproduction was most sensitive to Pb and survival was least sensitive, with growth intermediate. Limited data for ringed turtle doves (Streptopelia risoria) and American kestrels (Falco sparverius) suggest lower sensitivity than chickens to Pb. The ED10 and ED20 thresholds for chickens were 4.4 and 9.8 mg·kg-1 ·d-1 , respectively. Avian Pb Eco-SSLs were recalculated based on the chicken ED10 and ED20, with and without a bioavailability adjustment. Revised avian Pb Eco-SSLs for the most highly exposed species (American woodcock), based on the ED10 and assuming 100% and 50% bioavailability, were 36.3 mg/kg and 43.7 mg/kg, respectively. Integr Environ Assess Manag 2019;15:739-749. © 2019 SETAC.

Biomarker responses of Peromyscus leucopus exposed to lead and cadmium in the Southeast Missouri Lead Mining District.

Biomarker responses and histopathological lesions have been documented in laboratory mammals exposed to elevated concentrations of lead and cadmium. The exposure of white-footed mice (Peromyscus leucopus) to these metals and the potential associated toxic effects were examined at three contaminated sites in the Southeast Missouri Lead Mining District and at a reference site in MO, USA. Mice from the contaminated sites showed evidence of oxidative stress and reduced activity of red blood cell δ-aminolevulinic acid dehydratase (ALAD). Histological examinations of the liver and kidney, cytologic examination of blood smears, and biomarkers of lipid peroxidation and DNA damage failed to show indications of toxic effects from lead. The biomagnification factor of cadmium (hepatic concentration/soil concentration) at a site with a strongly acid soil was 44 times the average of the biomagnification factors at two sites with slightly alkaline soils. The elevated concentrations of cadmium in the mice did not cause observable toxicity, but were associated with about a 50% decrease in expected tissue lead concentrations and greater ALAD activity compared to the activity at the reference site. Lead was associated with a decrease in concentrations of hepatic glutathione and thiols, whereas cadmium was associated with an increase. In addition, to support risk assessment efforts, we developed linear regression models relating both tissue lead dosages (based on a previously published a laboratory study) and tissue lead concentrations in Peromyscus to soil lead concentrations.

Anomalous bioaccumulation of lead in the earthworm Eisenoides lonnbergi (Michaelsen).

Lead concentrations in soil organisms are usually well below those in the associated soil and tend to decrease with each higher trophic level in a food chain. Earthworms of the species Eisenoides lonnbergi provide an exception to this observation, accumulating very high concentrations of lead from acidic soils. Earthworms belonging to this species were collected from strongly to extremely acidic soils at 16 sites on a wildlife refuge in Maryland, USA. A lead concentration as high as 766 mg/kg, dry weight, was detected in depurated E. lonnbergi collected from soil containing only 17 mg/kg of lead. Concentration factors (ratio of lead concentration in earthworms to lead concentration in soil, dry wt) were highly variable at the sites, from 1.0 to 83. As suggested previously, lead absorption by earthworms is enhanced in low-calcium soils. The anomalously high concentrations of lead found in E. lonnbergi are more closely correlated with the uptake of calcium from acidic soils than with bioaccessibility of soil lead. Environ Toxicol Chem 2018;37:914-919. Published 2017 Wiley Periodicals Inc. on behalf of SETAC. This article is a US government work and, as such, is in the public domain in the United States of America.

Use of the mice passive protection test to evaluate the humoral response in goats vaccinated with Sterne 34F2 live spore vaccine.

The Sterne live spore vaccine (34F2) is the most widely used veterinary vaccine against anthrax in animals. Antibody responses to several antigens of Bacillus anthracis have been described with a large focus on those against protective antigen (PA). The focus of this study was to evaluate the protective humoral immune response induced by the live spore anthrax vaccine in goats. Boer goats vaccinated twice (week 0 and week 12) with the Sterne live spore vaccine and naive goats were used to monitor the anti-PA and toxin neutralizing antibodies at week 4 and week 17 (after the second vaccine dose) post vaccination. A/J mice were passively immunized with different dilutions of sera from immune and naive goats and then challenged with spores of B. anthracis strain 34F2 to determine the protective capacity of the goat sera. The goat anti-PA ELISA titres indicated significant sero-conversion at week 17 after the second doses of vaccine (p = 0.009). Mice receiving undiluted sera from goats given two doses of vaccine (twice immunized) showed the highest protection (86%) with only 20% of mice receiving 1:1000 diluted sera surviving lethal challenge. The in vitro toxin neutralization assay (TNA) titres correlated to protection of passively immunized A/J mice against lethal infection with the vaccine strain Sterne 34F2 spores using immune goat sera up to a 1:10 dilution (rs ≥ 0.522, p = 0.046). This study suggests that the passive mouse protection model could be potentially used to evaluate the protective immune response in livestock animals vaccinated with the current live vaccine and new vaccines.

Rationale for two influenza B lineages in seasonal vaccines: A meta-regression study on immunogenicity and controlled field trials.

B lineage mismatch prompted introduction of quadri-valent influenza vaccines (QIV) with two influenza B viruses representing distinct antigenic lineages. To explore the impact on antibody induction and vaccine effectiveness predicted from antibody (VEab), we performed a systematic literature search on immunogenicity studies conducted to assess antibody superiority of QIV over trivalent influenza vaccine (TIV). Thirteen relevant articles described 31 trials from 2007 and 2013. Log-transformed GMT trial estimates and their variances were converted to clinical protection rates predicted from antibody (PRab). VEab estimates were calculated from pre- and post-vaccination PRab. Without specific pre-vaccination immunity, average VEab was 69% for match, and -4% for lineage mismatch. With increasing pre-vaccination seropositivity, mismatch impact declined to 2%. We also performed an umbrella literature search for randomised controlled trials and test-negative case-control trials with TIV, and estimated vaccine effectiveness against laboratory-confirmed influenza B (VEf). Sixty-eight eligible clinical articles described 110 season-trials from 1965 to 2012, covering seasons with B lineage match (n=52), lineage drift (n=15) and lineage mismatch (n=43). With no pre-vaccination antibody levels determined, we used chance of previous exposure to influenza B (Ppe) as pre-seasonal immunity measure. When Ppe was 0%, average VEf for matched seasons was 67%, and for mismatched seasons 35%, indicating a moderate, yet significant mismatch impact on VEf. With increasing Ppe, mismatch impact declined to 3%. Thus serological and field trials indicate that B lineage mismatch impact is negatively related to pre-seasonal immunity and that the gain of QIV over TIV most benefits infants and children not yet exposed to influenza B.

An evaluation of inorganic toxicity reference values for use in assessing hazards to American robins (Turdus migratorius).

When performing screening-level and baseline risk assessments, assessors usually compare estimated exposures of wildlife receptor species with toxicity reference values (TRVs). We modeled the exposure of American robins (Turdus migratorius) to 10 elements (As, Cd, Cr, Cu, Hg, Mn, Pb, Se, Zn, and V) in spring and early summer, a time when earthworms are the preferred prey. We calculated soil benchmarks associated with possible toxic effects to these robins from 6 sets of published TRVs. Several of the resulting soil screening-level benchmarks were inconsistent with each other and less than soil background concentrations. Accordingly, we examined the derivations of the TRVs as a possible source of error. In the case of V, a particularly toxic chemical compound (ammonium vanadate) containing V, not normally present in soil, had been used to estimate a TRV. In the cases of Zn and Cu, use of uncertainty values of 10 in estimating TRVs led to implausibly low soil screening values. In the case of Pb, a TRV was calculated from studies demonstrating reductions in egg production in Japanese quail (Coturnix coturnix japonica) exposed to Pb concentrations well below than those causing toxic effects in other species of birds. The results on quail, which were replicated in additional trials, are probably not applicable to other, unrelated species, although we acknowledge that only a small fraction of all species of birds has been tested. These examples underscore the importance of understanding the derivation and relevance of TRVs before selecting them for use in screening or in ecological risk assessment. Integr Environ Assess Manag 2017;13:352-359. © 2016 SETAC.

Bioaccessibility tests accurately estimate bioavailability of lead to quail.

Hazards of soil-borne lead (Pb) to wild birds may be more accurately quantified if the bioavailability of that Pb is known. To better understand the bioavailability of Pb to birds, the authors measured blood Pb concentrations in Japanese quail (Coturnix japonica) fed diets containing Pb-contaminated soils. Relative bioavailabilities were expressed by comparison with blood Pb concentrations in quail fed a Pb acetate reference diet. Diets containing soil from 5 Pb-contaminated Superfund sites had relative bioavailabilities from 33% to 63%, with a mean of approximately 50%. Treatment of 2 of the soils with phosphorus (P) significantly reduced the bioavailability of Pb. Bioaccessibility of Pb in the test soils was then measured in 6 in vitro tests and regressed on bioavailability: the relative bioavailability leaching procedure at pH 1.5, the same test conducted at pH 2.5, the Ohio State University in vitro gastrointestinal method, the urban soil bioaccessible lead test, the modified physiologically based extraction test, and the waterfowl physiologically based extraction test. All regressions had positive slopes. Based on criteria of slope and coefficient of determination, the relative bioavailability leaching procedure at pH 2.5 and Ohio State University in vitro gastrointestinal tests performed very well. Speciation by X-ray absorption spectroscopy demonstrated that, on average, most of the Pb in the sampled soils was sorbed to minerals (30%), bound to organic matter (24%), or present as Pb sulfate (18%). Additional Pb was associated with P (chloropyromorphite, hydroxypyromorphite, and tertiary Pb phosphate) and with Pb carbonates, leadhillite (a lead sulfate carbonate hydroxide), and Pb sulfide. The formation of chloropyromorphite reduced the bioavailability of Pb, and the amendment of Pb-contaminated soils with P may be a thermodynamically favored means to sequester Pb. Environ Toxicol Chem 2016;35:2311-2319. Published 2016 Wiley Periodicals Inc. on behalf of SETAC. This article is a US Government work and, as such, is in the public domain in the United States of America.

Organic amendments for risk mitigation of organochlorine pesticide residues in old orchard soils.

Performance of compost and biochar amendments for in situ risk mitigation of aged DDT, DDE and dieldrin residues in an old orchard soil was examined. The change in bioavailability of pesticide residues to Lumbricus terrestris L. relative to the unamended control soil was assessed using 4-L soil microcosms with and without plant cover in a 48-day experiment. The use of aged dairy manure compost and biosolids compost was found to be effective, especially in the planted treatments, at lowering the bioavailability factor (BAF) by 18-39%; however, BAF results for DDT in the unplanted soil treatments were unaffected or increased. The pine chip biochar utilized in this experiment was ineffective at lower the BAF of pesticides in the soil. The US EPA Soil Screening Level approach was used with our measured values. Addition of 10% of the aged dairy manure compost reduced the average hazard quotient values to below 1.0 for DDT + DDE and dieldrin. Results indicate this sustainable approach is appropriate to minimize risks to wildlife in areas of marginal organochlorine pesticide contamination. Application of this remediation approach has potential for use internationally in areas where historical pesticide contamination of soils remains a threat to wildlife populations.

[Treat to participation : Position paper of the German Society for Rheumatology on sustained improvement of functional health of patients with rheumatic and musculoskeletal diseases]. / Treat to Participation : DGRh-Positionspapier zur nachhaltigen Verbesserung des funktionalen Gesundheitszustandes von Rheumakranken.

From the perspective of patients with rheumatic diseases, the reduction of inflammatory disease activity alone is not a sufficient treatment goal. In addition the functional health and participation also have to be improved. Starting with the first symptoms the empowerment for the self-management of the disease is important for the patients; therefore, the established treat to target-strategy has to be expanded by the functional dimension to treat to participation. The position paper of the German Society for Rheumatology (GSR) summarizes the relevant fields of the multiprofessional action that is frequently necessary. This includes the acquirement of function-related competencies during training, further education and advanced training as well as implementation in the everyday practice of patient care. Furthermore, the GSR acknowledges the need for research related to functional and sociomedical consequences of rheumatic diseases and to individual and combined function-related programs in outpatient and inpatient care in rheumatology.

Antibody landscapes after influenza virus infection or vaccination.

We introduce the antibody landscape, a method for the quantitative analysis of antibody-mediated immunity to antigenically variable pathogens, achieved by accounting for antigenic variation among pathogen strains. We generated antibody landscapes to study immune profiles covering 43 years of influenza A/H3N2 virus evolution for 69 individuals monitored for infection over 6 years and for 225 individuals pre- and postvaccination. Upon infection and vaccination, titers increased broadly, including previously encountered viruses far beyond the extent of cross-reactivity observed after a primary infection. We explored implications for vaccination and found that the use of an antigenically advanced virus had the dual benefit of inducing antibodies against both advanced and previous antigenic clusters. These results indicate that preemptive vaccine updates may improve influenza vaccine efficacy in previously exposed individuals.

[Trends in rehabilitation of patients with rheumatic diseases in Germany]. / Leistungstrends der rehabilitativen rheumatologischen Versorgung in Deutschland.

Recent Deutsche Gesellschaft für Rheumatologie (DGRh, German Society of Rheumatology) guidelines emphasized the significance of coordinated multidisciplinary care and rehabilitation of patients with inflammatory rheumatic diseases. Nationwide data from the German pension insurance funds showed that inpatient rehabilitation due to rheumatoid arthritis (RA) varied by a factor of 2.6 between the different German states. From 2000 to 2012 rehabilitation measures were reduced by one third, most significantly in men with ankylosing spondylitis (AS). Rehabilitation measures because of RA or AS were provided up to 14 times more frequently by the German statutory pension insurance scheme compared with a large compulsory health insurance which is responsible for rehabilitation measures after retirement. In rehabilitation centers with high numbers of patients with inflammatory rheumatic diseases, higher structural and process quality were demonstrated. In 2011 a total of 40 % of RA patients in the national database of the collaborative arthritis centers showed medium or severe functional limitations. Among these disabled RA patients inpatient rehabilitation was reduced by about 50 % between 1995 and 2011. Out of all RA patients from outpatient rheumatology care with severe functional limitations 38 % had no functional restoration therapy within the previous 12 months with a high variation between rheumatologists. Experiences from other European countries may inspire German rheumatologists and other involved health professionals to initiate a wider range of rehabilitative interventions in the future.

Utilizing thin-film solid-phase extraction to assess the effect of organic carbon amendments on the bioavailability of DDT and dieldrin to earthworms.

Improved approaches are needed to assess bioavailability of hydrophobic organic compounds in contaminated soils. Performance of thin-film solid-phase extraction (TF-SPE) using vials coated with ethylene vinyl acetate was compared to earthworm bioassay (Lumbricus terrestris). A DDT and dieldrin contaminated soil was amended with four organic carbon materials to assess the change in bioavailability. Addition of organic carbon significantly lowered bioavailability for all compounds except for 4,4'-DDT. Equilibrium concentrations of compounds in the polymer were correlated with uptake by earthworms after 48d exposure (R(2) = 0.97; p < 0.001), indicating TF-SPE provided an accurate uptake simulation. Bioavailability of residues in soil was compared with a spiked soil aged for 90d in laboratory. Dieldrin and DDX were respectively 18% and 11% less bioavailable in contaminated soil relative to spiked soil despite >40yr of aging. Results show that TF-SPE can be useful in examining potential risks associated with contaminated soils and to test effectiveness of remediation efforts.

Soil criteria to protect terrestrial wildlife and open-range livestock from metal toxicity at mining sites.

Thousands of hard rock mines exist in the western USA and in other parts of the world as a result of historic and current gold, silver, lead, and mercury mining. Many of these sites in the USA are on public lands. Typical mine waste associated with these sites are tailings and waste rock dumps that may be used by wildlife and open-range livestock. This report provides wildlife screening criteria levels for metals in soil and mine waste to evaluate risk and to determine the need for site-specific risk assessment, remediation, or a change in management practices. The screening levels are calculated from toxicity reference values based on maximum tolerable levels of metals in feed, on soil and plant ingestion rates, and on soil to plant uptake factors for a variety of receptors. The metals chosen for this report are common toxic metals found at mining sites: arsenic, cadmium, copper, lead, mercury, and zinc. The resulting soil screening values are well above those developed by the US Environmental Protection Agency. The difference in values was mainly a result of using toxicity reference values that were more specific to the receptors addressed rather than the most sensitive receptor.

Toxicity of Pb-contaminated soil to Japanese quail (Coturnix japonica) and the use of the blood-dietary Pb slope in risk assessment.

This study relates tissue concentrations and toxic effects of Pb in Japanese quail (Coturnix japonica) to the dietary exposure of soil-borne Pb associated with mining and smelting. From 0% to 12% contaminated soil, by weight, was added to 5 experimental diets (0.12 to 382 mg Pb/kg, dry wt) and fed to the quail for 6 weeks. Benchmark doses associated with a 50% reduction in delta-aminolevulinic acid dehydratase activity were 0.62 mg Pb/kg in the blood, dry wt, and 27 mg Pb/kg in the diet. Benchmark doses associated with a 20% increase in the concentration of erythrocyte protoporphyrin were 2.7 mg Pb/kg in the blood and 152 mg Pb/kg in the diet. The quail showed no other signs of toxicity (histopathological lesions, alterations in plasma-testosterone concentration, and body and organ weights). The relation of the blood Pb concentration to the soil Pb concentration was linear, with a slope of 0.013 mg Pb/kg of blood (dry wt) divided by mg Pb/kg of diet. We suggest that this slope is potentially useful in ecological risk assessments on birds in the same way that the intake slope factor is an important parameter in risk assessments of children exposed to Pb. The slope may also be used in a tissue-residue approach as an additional line of evidence in ecological risk assessment, supplementary to an estimate of hazard based on dietary toxicity reference values.

Co-infection of an animal with more than one genotype can occur in anthrax.

UNLABELLED: During the routine fingerprinting of outbreak strains of Bacillus anthracis of European and African origin by means of a 31-marker multi-locus variable number of tandem repeats analysis (MLVA), four cultures, two from the Etosha National Park (ENP), Namibia, and two from an outbreak in the Pyrenees in 1997, were found to harbour different genotypes (GTs). To investigate this further, isolates from 10 samples of blood-soaked soil from beneath anthrax carcasses and 18 clinical swabs taken from carcasses in the ENP were examined by a 31-marker MLVA. While only a single GT was found in any one of the 10 soil samples, four of the 18 swabs (22%) yielded different GTs. Two GTs were isolated from each of a zebra and a springbok and three GTs from each of a second zebra and an elephant. These animals had died in a region of the ENP where deaths caused by anthrax regularly occur every year. The results confirm the indications noted previously that co-infection with more than one GT is probably not especially uncommon. The results show that, for the purpose of analysing genotypes involved in an outbreak, it is important to examine more than a single colony from a clinical sample. SIGNIFICANCE AND IMPACT OF THE STUDY: Multi-locus variable number of tandem repeats analysis (MLVA)-based fingerprinting techniques have been used in many studies worldwide to characterize the occurrence of different genotypes of Bacillus anthracis in outbreaks of wildlife or livestock and to draw conclusions about the source, the possible routes of spread and the temporal and spatial distribution of outbreak strains. Simultaneous isolation of different genotypes from the same host revealed in our study by MLVA highlights the importance of examining more than a single colony from a clinical sample. This conclusion is not specific for MLVA but holds true for every high-resolution method, including full-genome sequencing.

Toxic exposure of songbirds to lead in the Southeast Missouri Lead Mining District.

Mining and smelting in the Southeast Missouri Lead Mining District has caused widespread contamination of soils with lead (Pb) and other metals. Soils from three study sites sampled in the district contained from approximately 1,000-3,200 mg Pb/kg. Analyses of earthworms [33-4,600 mg Pb/kg dry weight (dw)] collected in the district showed likely high Pb exposure of songbirds preying on soil organisms. Mean tissue Pb concentrations in songbirds collected from the contaminated sites were greater (p < 0.05) than those in songbirds from reference sites by factors of 8 in blood, 13 in liver, and 23 in kidney. Ranges of Pb concentrations in livers (mg Pb/kg dw) were as follows: northern cardinal (Cardinalis cardinalis) = 0.11-3.0 (reference) and 1.3-30 (contaminated) and American robin (Turdus migratorius) = 0.43-8.5 (reference) and 7.6-72 (contaminated). Of 34 adult and juvenile songbirds collected from contaminated sites, 11 (32%) had hepatic Pb concentrations that were consistent with adverse physiological effects, 3 (9%) with systemic toxic effects, and 4 (12%) with life-threatening toxic effects. Acid-fast renal intranuclear inclusion bodies, which are indicative of Pb poisoning, were detected in kidneys of two robins that had the greatest renal Pb concentrations (952 and 1,030 mg/kg dw). Mean activity of the enzyme delta-aminolevulinic acid dehydratase (ALAD) in red blood cells, a well-established bioindicator of Pb poisoning in birds, was decreased by 58-82% in songbirds from the mining sites. We conclude that habitats within the mining district with soil Pb concentrations of ≥1,000 mg Pb/kg are contaminated to the extent that they are exposing ground-feeding songbirds to toxic concentrations of Pb.

Phytotoxicity of zinc and manganese to seedlings grown in soil contaminated by zinc smelting.

Historic emissions from two zinc smelters have injured the forest on Blue Mountain near Palmerton, Pennsylvania, USA. Seedlings of soybeans and five tree species were grown in a greenhouse in a series of mixtures of smelter-contaminated and reference soils and then phytotoxic thresholds were calculated. As little as 10% Palmerton soil mixed with reference soil killed or greatly stunted seedlings of most species. Zinc was the principal cause of the phytotoxicity to the tree seedlings, although Mn and Cd may also have been phytotoxic in the most contaminated soil mixtures. Calcium deficiency seemed to play a role in the observed phytotoxicity. Exposed soybeans showed symptoms of Mn toxicity. A test of the effect of liming on remediation of the Zn and Mn phytotoxicity caused a striking decrease in Sr-nitrate extractable metals in soils and demonstrated that liming was critical to remediation and restoration.

Anthrax among heroin users in Europe possibly caused by same Bacillus anthracis strain since 2000.

Injection anthrax was described first in 2000 in a heroin-injecting drug user in Norway. New anthrax cases among heroin consumers were detected in the United Kingdom (52 cases) and Germany (3 cases) in 2009-10. In June 2012, a fatal case occurred in Regensburg, Bavaria. As of December 2012, 13 cases had been reported in this new outbreak from Germany, Denmark, France and the United Kingdom. We analysed isolates from 2009-10 and 2012 as well as from the first injection anthrax case in Norway in 2000 by comparative molecular typing using a high resolution 31 marker multilocus variable-number tandem repeat analysis (MLVA) and a broad single nucleotide polymorphism (SNP) analysis. Our results show that all cases may be traced back to the same outbreak strain. They also indicate the probability of a single source contaminating heroin and that the outbreak could have lasted for at least a decade. However, an additional serological pilot study in two German regions conducted in 2011 failed to discover additional anthrax cases among 288 heroin users.