Re: Europe - Several die as anthrax infects heroin users
http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,82177
Archive Number 20100409.1154
Published Date 09-APR-2010
Subject PRO/AH> Anthrax, human - UK (09): (Scotland) comment
ANTHRAX, HUMAN - UNITED KINGDOM (09): (SCOTLAND) COMMENT
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Date: Tue 6 Apr 2010 7:28 AM
From: Ramsay Colin <colin.ramsay@nhs.net> [edited]
With reference to speculation by authors in the US that the present
outbreak of anthrax in drug users in "Europe (actually only the UK
and Germany to date)" may be due to a "bio-terrorist attack", we
considered the possibility of "deliberate" contamination of heroin at
a very early stage. However, while this might legitimately be
considered as a theoretical possibility, I do not believe there is
any particular reason to suppose this is a particularly likely
explanation. We have in effect discounted this on the basis that we
have no verifiable evidence to support a speculative theory that the
outbreak is the result of a deliberate "attack". Unless evidence is
identified to substantiate such a theory, based on intelligence or
other corroborative evidence, it must remain only an outside
theoretical possibility. As a means of mounting an "attack", such a
mechanism might seem inconsistent with knowledge about past targets
and strategies. However, further speculation on this is academic and
not necessarily helpful in the context of this investigation.
On the basis of information on past outbreaks of other infections
associated with contamination of heroin with a variety of other
organisms (including species of clostridia and tetanus) the most
plausible explanation remains that the route of transmission has been
via "inadvertently" contaminated heroin. The most plausible means of
contamination is still considered to be either at source, in the
country where initial preparation from contaminated poppies occurred
during harvesting the raw material, or at some point further down the
processing and distribution chain for heroin involving the use of
anthrax contaminated materials. What is known is that the processing
and distribution chain is very complex and multi-linked, involving
potentially a variety of countries at different stages between source
and final destination. Identifying the relevant chain(s) poses one of
the most significant challenges in the investigation and may never be resolved.
In support of our contention that it is "accidental" contamination,
there is anecdotal evidence to support the possibility of anthrax
contamination during transportation involving goat hides, a well
known source of anthrax spores. The nature of such historical
anecdotal information regrettably precludes its validation. It could
be completely erroneous. However, we have had similar information
from more than one independent unsolicited source, which suggests
that it is at least likely to be plausible.
The distribution of cases in Scotland predominantly, with scattered
cases elsewhere, remains a puzzle. We continue to work in
collaboration with Police in the UK and Europe to try to identify
distribution networks which may help in clarifying why cases have
been restricted to selected locations. This is however very complex
work and may not yield a conclusive answer.
As in previous outbreaks of infection associated with contaminated
drugs it may not ultimately be possible to "prove" how the outbreak
occurred and we may be left with many unanswered questions.
--
Colin Ramsey
Consultant Epidemiologist
Health Protection Scotland
Glasgow, UK
colin.ramsay@nhs.net
[Our deep-felt thanks to Colin for this update. A moment's thought
might persuade people that these Afghan drug lords are achieving more
and at a good profit by selling drugs to thousands of western addicts
than by erratically killing a mere handful with a contaminated
product. Maybe I could remind our members that drug exporting has a
long history of hundreds, if not thousands of years. And it was in
the early 19th century when the East India Company shipped opium to
China to get access to and control of the China tea trade. It
devastated China but I think that my mother's grandfather, a Marine
Major in 'Jack' Company, would object to being labeled a member of a
terrorist organization. - Mod.MHJ]
