Drug Related Deaths: Infections & Bloodborne Viruses
On 14 March 2013, NHS Greater Glasgow and Clyde Public Health Protection Unit (PHPU) confirmed the death of a injecting drug user who had tested positive for Anthrax.
Public health consultant Dr Syed Ahmed described it as an isolated case in Glasgow and said there have been other sporadic cases in the UK and Europe in recent months.
He said: "We are working with other services and colleagues to be on the lookout for any other possible cases especially amongst other injecting drug users.
"It is possible that contaminated heroin or a contaminated cutting agent mixed with the heroin may be responsible for the death. The PHPU is working with Strathclyde Police to identify a possible source." Read more….
Health Protection Scotland has a website information page on Anthrax and People Who Inject Drugs (PWID) see here....
On 8 March 2013, the Health Protection Agency (HPA) confirmed the death of an injecting heroin user in Suffolk from anthrax.
There is an ongoing outbreak of anthrax among people who inject drugs in a number of countries in Europe with a number of cases now identified since early June 2012.
For more information on the Suffolk case see here....
ANTHRAX AMONG HEROIN USERS IN EUROPE POSSIBLY CAUSED BY SAME BACILLUS ANTHRACIS STRAIN SINCE 2000: Eurosurveillance information.
A case of anthrax was identified in an injecting drug user in Lanarkshire on 24th July 2012.
For more information see here....
On 17 August 2012, the Health Protection Agency announced that an injecting drug user in England (Blackpool) had died from a confirmed case of anthrax read more....
A second Anthrax death involving a drug user in England - again in Blackpool - was confirmed by the Health Protection Agency on 10 September 2012 read more...
On 2 November 2012, the Health Protection Agency (HPA) announced that a person who injected heroin had been diagnosed with anthrax infection in Oxford. The patient was recovering read more....
In November 2012 INPUD (International Network of People who Use Drugs) updated its guidance regarding the recent anthrax outbreaks among heroin users in Europe, following the recent case of a heroin user in Oxford, UK being hospitalised, subsequent to injecting heroin contaminated with anthrax.
Read more here.... Warning - contains graphic medical images
On 19 December 2012 the Health Protection Agency confirmed a heroin injector diagnosed with anthrax infection in Medway, Kent had died.
Scottish Drugs Forum in association with Health Protection Scotland, has produced a refreshed guide for frontline workers: Anthrax and Heroin Users: What Workers Need to Know (PDF 472kb).
Anthrax Alert information for drug users - Poster (PDF738kb)
Anthrax Alert information for drug users - Leaflet (PDF977kb)
Other Useful information
Report of the Anthrax Outbreak Control Team (2009/10) Outbreak in Scotland.
European Risk Assessment: anthrax cases in injecting drug users in Germany, Denmark and France (2012) - 13 July 2012 update.
The deadly outbreak of anthrax among injecting drug users in 2009-2010 has highlighted the continuing risks of exposure to very serious infection from a variety of organisms as a result of injecting and sometimes smoking or snorting drugs.
The outbreak resulted in Scottish Drugs Forum being involved, for the first time in our history, in the national response to a major public health emergency.
Public health experts drew on Scottish Drugs Forum’s expertise and networks to help tackle the outbreak, which killed 13 people and made 34 seriously ill across eight Scottish health board areas over an eight month period.
The outbreak is thought to be due to a single novel strain of anthrax not previously seen in the UK or elsewhere – and related to anthrax strains previously identified in goats in Turkey.
Experts concluded that the contaminated heroin imported to Scotland was from a single batch with anthrax spores via contact with a single infected animal or animal hide somewhere in transit between Afghanistan/Pakistan and Scotland, probably Turkey.
Risk of Repeat
The official Report of the Anthrax Outbreak Control Team has warned that contaminated heroin could be imported into Britain again at any time and cause another outbreak of anthrax or similar infection.
It also called for research into the reasons for the concentration of “significant and unusual” outbreaks of infections among drug users particularly in West Central Scotland.
It said that the number of tests carried out for anthrax indicated “a lot of infection” among drug users during the outbreak period, while a variety of co-infections with other organisms was also noted in anthrax cases.
“The total number of drug user infections that were anthrax negative… indicates that there was a lot of infection experienced by drug users in the outbreak period and could indicate that the heroin then circulating was more microbiologically contaminated than usual”, says the Report.
Most of the confirmed anthrax cases lived in Glasgow/Lanarkshire/Central Scotland, with significant clusters in Dundee and Dumfries.
Yet Lothian and Grampian NHS Board areas, despite having significant heroin using populations, had few cases, while Highland and the Island areas had no cases.
Scottish Drugs Forum Input
Scottish Drugs Forum made significant input at strategic and operational levels during the course of the Outbreak through our active involvement in membership of Health Protection Scotland’s multi-agency Outbreak Control Team (OCT).
Scottish Drugs Forum staff, in association with Glasgow Addiction Services, developed posters and flyers containing critical information on symptoms and where to get help and advice. Our efforts resulted in a letter of thanks from the then Community Safety Minister Fergus Ewing.
We distributed around 40,000 flyers and 3000 posters to agencies and public authorities throughout Scotland as the outbreak rolled on.
In association with Health Protection Scotland, we also published a more in-depth guide, Anthrax and Heroin Users: What Workers Need to Know (2010) on our website and distributed it to key services.
This was supported by the delivery of more than 30 face-to-face workers briefings, using material contributed to by members of the Volunteer Forum of the National Forum on Drug-related Deaths.
We also regularly updated Scottish Drugs Forum members and treatment services listed in our online Directory of drug treatment services www.scottishdrugservices.com about the latest anthrax statistics.
The official Report of the Anthrax Outbreak Control Team thanked Scottish Drugs Forum for our role in assisting with accessing the drug service sector and in targeting information to drug users.
One of the roles of the Scottish Needle Exchange Workers Forum is to allow workers involved in the provision of injecting equipment in Scotland:
- to develop and share good practice on the prevention and treatment of infections acquired through injecting
- act as a conduit for information for the monitoring and response to infection outbreaks.