Europe - Several die as anthrax infects heroin users

[alert]

Re: Europe - Several die as anthrax infects heroin users - new fatality reported in Bavaria

Re: Europe - Several die as anthrax infects heroin users - new fatality reported in Bavaria

http://www.promedmail.org/

Published Date: 2012-06-23 19:58:11
Subject: PRO/AH/EDR> Anthrax, human - Denmark: German heroin associated RFI
Archive Number: 20120623.1178659

ANTHRAX, HUMAN - DENMARK: GERMAN HEROIN ASSOCIATED REQUEST FOR INFORMATION
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Sent: Fri 22 Jun 2012
From: Robert Spencer [edited]



I understand that there is a probable case of cutaneous anthrax in Jutland, Denmark, in a 69-year-old injection drug user (IDU), who is said to have purchased heroin in Germany 3 weeks ago.

I also understand that the 2 German strains of _Bacillus anthracis_ are most likely identical by genotyping.

These are unconfirmed reports.

--
Robert Spencer, MB,BS,MSc,FRCPath
Consultant Medical Microbiologist
University Hospital Bristol NHS Foundation Trust
Queen's Building, Bristol Royal Infirmary
Bristol, BS2 8HW, UK


[We would appreciate getting an independent confirmation from our Danish members in regard to Bob's communication. He is sound and in a position to be privy to such information, but confirmation is needed.

Thanks to Bob for this heads up. - Mod.MHJ

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1ZJN.]

 

[alert]

Re: Europe - Several die as anthrax infects heroin users - new fatality reported in Bavaria

Re: Europe - Several die as anthrax infects heroin users - new fatality reported in Bavaria

http://www.promedmail.org/

Published Date: 2012-06-24 19:05:51
Subject: PRO/AH/EDR> Anthrax, human - Denmark (02): NOT
Archive Number: 20120624.1179204

ANTHRAX, HUMAN - DENMARK (02): NOT
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Date: 24 Jun 2012
From: Kare Molbak [edited]


The mentioned case was not confirmed to be anthrax, but rather a streptococcal infection. Furthermore, investigations of the origin of the heroin did not confirm a link with Germany but suggested that the heroin was bought in Copenhagen. Hence, there is not a confirmed "Danish link" to the 2 German cases.

--
Kare Molbak
Director, Department of Infectious Disease Epidemiology
State Epidemiologist for Denmark
Statens Serum Institut
Artillerivej 5
2300 Copenhagen S
Denmark


[I am very grateful to our Danish colleagues for clarifying this so quickly and authoritatively. Instead of being _Bacillus anthracis_, it is a haemolytic Group A streptococcus. According to the Danish police, this heroin has been circulating in the Copenhagen area for the last 3 months. - Mod.MHJ

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1ZJN.]

 

[alert]

Re: Europe - Several die as anthrax infects heroin users - new fatality reported in Bavaria

Re: Europe - Several die as anthrax infects heroin users - new fatality reported in Bavaria

http://www.promedmail.org/

Published Date: 2012-06-24 21:57:16
Subject: PRO/AH/EDR> Anthrax - Germany (03): strain identified
Archive Number: 20120624.1179225

ANTHRAX - GERMANY (03): STRAIN IDENTIFIED
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Date: 22 Jun 2012
Source: Robert Koch Institute [in German, trans. Sabine Zentis, edited]
http://www.rki.de/DE/Content/Service/Presse/Pressemitteilungen/2012/09_2012.html


In the Regensburg area, there are 2 recent cases of anthrax in drug users (heroin), one fatal, and the current anthrax strain has been confirmed to be identical to the 2009/2010 outbreak strain associated with cases in the UK.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[The German press has been quick to say that this contaminated heroin came from the UK. I suspect that the genesis of this latest contaminated batch may be more complicated. But for those interested, here are some links to the German press:
http://web.de/magazine/gesundheit/p...roin-milzbrand-verunreinigt-toter-bayern.html, http://web.de/magazine/gesundheit/psychologie/15252064-rekordwert-neuartigen-drogen-europa.html. - Mod.MHJ

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1zJl.]

 

[Giuseppe]

Re: Europe - Several die as anthrax infects heroin users - new fatality reported in Bavaria

Re: Europe - Several die as anthrax infects heroin users - new fatality reported in Bavaria

[Source: European Centre for Disease Prevention and Control, full text: (LINK).]

Anthrax cases among injecting drug users: ECDC and EMCDDA updated risk assessment


09 Jul 2012 / ECDC



In June, ECDC and EMCDDA jointly assessed the risk associated with two cases of anthrax among injecting drug users (IDU) in Regensburg (Bavaria, Germany).
Another case of anthrax in a injecting drug user has been reported from Berlin. The first two cases, one of which was fatal, are likely linked through exposure to heroin contaminated by a most likely identical Bacillus anthracis strain. The link with the third case, though probable, needs to be confirmed.

The geographical distribution of the contaminated heroin is unknown at this time, but it is possible that the batch has the same source as the contaminated heroin incriminated in the 2009/2010 outbreak in Scotland, with cases also reported from Germany and England.

The risk of exposure for heroin users in Germany and other countries is still present and therefore additional cases among IDUs may occur in the future.

As anthrax has rarely been associated with severe infection among drug users, clinicians may not consider anthrax in the differential diagnosis of severe infections in this population and this consequently may result in undiagnosed cases. Clinical awareness in healthcare settings of the risk of injection-related infection with rare pathogens among the IDU population is therefore crucial.

ECDC and EMCDDA will continue to monitor the evolution of this situation in terms of the epidemiological information available.

Read full joint rapid risk assessment: Anthrax cases among injecting drug users - Germany, June-July 2012 - Update, 6 July 2012



Read more on ECDC website:

Anthrax health topic page

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) website

Robert Koch Institute: Dritter Milzbrandfall bei Heroinkonsument (Berlin) (in German)
​

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[alert]

Re: Europe - Several die as anthrax infects heroin users - new fatality reported in Bavaria

Re: Europe - Several die as anthrax infects heroin users - new fatality reported in Bavaria

Published Date: 2012-09-07 14:03:11
Subject: PRO/AH/EDR> Anthrax, human - UK (06): (Wales) new heroin case
Archive Number: 20120907.1285521

ANTHRAX, HUMAN - UK (06): (WALES) NEW HEROIN CASE
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Date: Thu 6 Sep 2012
Source: Public Health Wales [edited]
http://www.wales.nhs.uk/news/24028


Public Health Wales can confirm that a Gwynedd man who has injected drugs is currently an inpatient in a hospital in the North West of England with confirmed anthrax infection. The patient's condition is stable. [This is north west Wales. - Mod.MHJ] It is not yet clear whether this case is linked to recent cases of anthrax infection in people who inject drugs in Blackpool [England] and Scotland.

Public Health Wales and Health Boards have issued alerts to local substance misuse groups across Wales to warn them of the danger of contaminated heroin. Alerts have also been sent to health professionals to remind them of the symptoms of anthrax infection.

There is an ongoing outbreak of anthrax in intravenous drug users in Europe. A total of 8 cases have been identified since early June [2012]. The source is presumed to be contaminated heroin.

The Rare and Imported Pathogens Laboratory at Health Protection Agency, Porton Down (Salisbury, England), is providing diagnostic support to clinical teams to assist them with the handling of anthrax incidents.

Dr Chris Whiteside, Consultant in Communicable Disease Control for Public Health Wales, said: "It's likely that further cases among people who inject drugs will be identified as part of the ongoing outbreak in EU countries. The Department of Health has alerted the NHS of the possibility of drug users presenting to Emergency Departments and Walk-in Clinics, with symptoms suggestive of anthrax.

"Although a very serious disease, anthrax responds to antibiotics and patients have a better chance of recovery if treatment is started early. It is therefore important for medical professionals to know the signs and symptoms to look for, so that there are no delays in providing the necessary treatment."

People can become infected with anthrax through either the skin, inhalation, injection, or by ingestion of anthrax spores. The symptoms of anthrax vary depending on the route of infection. Anthrax in drug users was considered 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.

Further information about anthrax is available from http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=25408.

--
Communicated by:
Sabine Zentis
Castleview Pedigree English Longhorns
Gut Laach
52385 Nideggen
Germany


[There is a BBC Wales report but it is essentially just a rewrite of the NHS news release and adds nothing of relevance:
http://www.bbc.co.uk/news/uk-wales-north-west-wales-19510933.

An inquest on the Blackpool case was called and then postponed for another day. Hopefully this Welsh addict can provide some useful information on the source of his heroin. Presently these cases are presenting more questions than answers, though if the affected addicts present themselves early their chances of survival are much greater because of the knowledge gained from previous cases. One of which is the aggressive draining of the lesion to remove the anthrax toxins there. Antibiotics by themselves are insufficient.- Mod.MHJ]

[Also see http://www.flutrackers.com/forum/showthread.php?p=467290#post467290 for more on this latest case. - alert]

 

[alert]

Re: Europe - Several die as anthrax infects heroin users

Published Date: 2012-09-18 13:04:05
Subject: PRO/AH> Anthrax, human - UK (09): (England) addict experience
Archive Number: 20120918.1298718

ANTHRAX, HUMAN - UK (09): (ENGLAND) ADDICT EXPERIENCE
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Date: Fri 14 Sep 2012
Source: The Guardian [edited]
http://www.guardian.co.uk/world/2012/sep/14/anthrax-heroin-blackpool


'Having anthrax didn't make me think I should stop taking heroin'
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As a 2nd drug user dies of anthrax in Blackpool, a former addict explains why warnings about the disease are ignored. [C.], a former addict injected herself with anthrax, at the Pierpoint addiction centre in St Annes-on-Sea, Lancashire.

When she injected herself with heroin, unaware it had been contaminated by anthrax, her wrist immediately began to swell and turn red. The pain was shocking. But she felt only anger and irritation. "I wanted my usual buzz," she said. "I'd been a heroin addict for 23 years. I knew I'd spiked my vein properly. I couldn't understand why the gear wasn't working."

So she injected herself a 2nd time. This time her entire arm swelled up. The red turned to purple. It spread up towards her elbow and down towards her fingers. The pain intensified but the drug high still didn't come.

It was 2010 and [C.] had infected herself with anthrax at the height of the largest single common-source outbreak of human anthrax in the UK in more than 50 years. The deaths spread across Europe: 126 cases were eventually identified, including 119 in the UK. At least 14 people died. This week [week of 10 Sep 2012] health experts said a 2nd drug user had died of anthrax in Blackpool, weeks after the 1st such death in the town.

[snip, but read the whole article!!!]

[Byline: Amelia Hill]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[For those of us with drug addictions no worse than for nicotine or caffeine, it is puzzling why these heroin addicts put themselves at risk. This article begins to explain the problems that Public Health officers face when the heroin is contaminated. Let us learn from it.

And frankly C. was very lucky to have been treated successfully with just antibiotics after 3 i.v. injections of contaminated heroin. - Mod.MHJ]