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UK case of anthrax in injecting drug user (HPA, July 25 2012)

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  • UK case of anthrax in injecting drug user (HPA, July 25 2012)

    [Source: Health Protection Agency, United Kingdom, full page: (LINK). Edited.]
    UK case of anthrax in injecting drug user

    25 July 2012

    The Health Protection Agency (HPA) is aware of a single case of anthrax in an injecting drug user who has been hospitalised in Scotland.

    The HPA is also aware of an ongoing outbreak of anthrax among people who inject drugs (PWID) affecting a number of countries in Europe. Five cases have been identified since early June: three in Germany, one in Denmark, and one in France. The source is presumed to be contaminated heroin.

    It is unclear as yet whether the case in Scotland is linked to the outbreak in Europe but the HPA will continue to monitor the situation over the coming days and weeks.

    These are the first cases of anthrax among injecting drug users in Europe since the outbreak during 2009/2010 which principally affected Scotland (119 cases), but with cases also reported from England (five cases) and Germany (two cases).

    The European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have jointly prepared a rapid risk assessment which concludes that heroin users in Europe are still at risk of exposure to anthrax.
    Dr Fortune Ncube, an expert in infections among PWID at the HPA, said: ?It is likely that further cases among PWID will be identified as part of the ongoing outbreak in EU countries. The Department of Health has alerted the NHS of the possibility of PWID presenting to Emergency Departments and Walk-in Clinics, with symptoms suggestive of anthrax.

    ?Anthrax can be cured with antibiotics, if treatment is started early. It is therefore important for medical professionals to know what sorts of symptoms and signs to look for, so that there are no delays in obtaining the necessary treatment.

    ?As part of the response to the 2009/10 outbreak, the HPA developed an algorithm for the clinical evaluation and management of PWID with possible anthrax. This algorithm specifies the kinds of presentations where anthrax should be considered, and outlines the actions to take.?

    Anthrax in drug users appears to be very rare - prior to the 2009-2010 outbreak in Scotland, only one previous case had been reported in Norway in 2000. Drug users may become infected with anthrax when heroin is contaminated with anthrax spores. This could be a source of infection if injected, smoked or snorted ? there is no safe route for consuming heroin or other drugs that may be contaminated with anthrax spores.

    Note to Editors:
    1. The Rare & Imported Pathogens Laboratory (RIPL) at HPA Porton is providing diagnostic support to the clinical team in Scotland to assist them with handling this incident.
    2. Public health alert from NHS Lanarkshire, 24 July 2012: gUsers.aspx
    3. Further information on anthrax can be found at:
    4. More information on the European outbreak is available from the European Centre for Disease Prevention and Control (ECDC): 783%2D85742124029a&ID=670&RootFolder=%2Fen%2Fpress %2Fnews%2FLists%2FNews
    5. More information about the 2009/2010 outbreak of anthrax in Scotland is available from Health Protection Scotland:
    6. The Health Protection Agency has produced advice for injecting drug users and guidelines on the clinical evaluation and management of people with possible cutaneous anthrax in England. These are available at:
      The HPA algorithm can be found here:
    7. At the end of June 2012 in consultation with colleagues across the UK the HPA produced a one-page reminder for those who commission and provide services to drug users about severe infections among PWID caused by spore-forming bacteria. This has been cascaded to service providers in England by the National Treatment Agency and is available from the HPA website:
    8. The Health Protection Agency is an independent UK organisation that was set up by the government in 2003 to protect the public from threats to their health from infectious diseases and environmental hazards. In April 2013 the Health Protection Agency will become part of a new organisation called Public Health England, an executive agency of the Department of Health. To find out more, visit our website: or follow us on Twitter @HPAuk . or ?Like? us on Facebook at
    9. For more information please contact the national HPA press office at Colindale on 0208 327 7901 or email Out of hours the duty press officer can be contacted on 0208 200 4400.
    Last reviewed: 25 July 2012
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