Anthrax case in injecting drug user, Lanarkshire.

 NHS Lanarkshire have issued, on the 24 July 2012,  a public health alert following the confirmation of a case of anthrax in a Lanarkshire injecting drug user.   The patient is in hospital and is in a critical but stable condition.

 Dr David Cromie, Consultant in Public Health Medicine at NHS Lanarkshire said:    “It is possible that heroin contaminated with anthrax may be circulating in Lanarkshire and potentially other parts of Scotland.  There have been recent reports of anthrax from contaminated heroin in other Western European countries, the most recent reported outbreak being in Germany.

 Clinicians and microbiologist are on alert to the possibility of anthrax in heroin users who present with appropriate signs and symptoms.

 Lanarkshire Health Board are contacting drug users known to addiction services to raise their awareness.

Scottish Government advice

This is a single reported case and we are not reporting an outbreak.  (For the purposes of the investigation we are assuming a likely link to the recently reported cases in Western Europe until proven otherwise). This note is  to ensure that all services are aware of this case and reminded of the advice and protocols from the 2009/2010 outbreak.

 In the first instance services should seek advice and support from their local NHS Board.  However, it would be helpful if you would inform the Drugs Policy Unit (DPU) of any information related to anthrax and heroin use via the alcoholanddrugdelivery@scotland.gsi.gov.uk<mailto:alcoholanddrugdelivery@scotland.gsi.gov.uk>   mailbox.

 Background 

 In December 2009 an outbreak of anthrax was identified in Glasgow and the outbreak was declared as ended in December 2010, by which time 208 initially suspected cases had been formally investigated. 

A report was produced with detailed analysis of the outbreak andrecommendations for the Scottish Government, Health Protection Scotland, services and drug users.

 http://www.hps.scot.nhs.uk/pubs/Publication_Search/Publication_Detail.aspx

 The report stated that: “the epidemiological and microbiological evidence supports a conclusion that heroin was the vehicle for transmission of anthrax spores and that exposure was by a variety of routes, particularly by injection but also by smoking (inhalation).”

 It was therefore recommended that:

 “In the event of a future outbreak involving anthrax contaminated heroin, advice to drug users should emphasise that any form of taking heroin (via injection routes or smoking), could result in a fatal anthrax infection and that injecting by any route (IV – intravenous, IM – intramuscular  or SC- subcutaneous) is likely to carry a higher risk. Advice should however avoid suggesting that smoking (or snorting) heroin is a risk free alternative to injection.”

 Therefore the top line  health protection advice must be that there is no safe route for consuming heroin or other drugs contaminated with anthrax.

 In the first instance it is important that anyone concerned about their heroin use has access to advice and support that is right and appropriate for them.

 The Scottish Drugs Forum maintains a list of services across Scotland that can support an individual to make the best possible choice for them; ranging from harm reduction advice and support to referral to care, treatment and recovery services.

 http://www.scottishdrugservices.com/sdd/homepage.htm

 In terms of  immediate practical support and advice,  those using heroin (whether injecting or smoking)  should consider the following:

  •        If you get swelling, redness, or pain where you have injected yourself, or pus collects under the skin, you should get a doctor to check it out immediately, especially if the infection seems different to others you may have had in the past;  

 •        Don’t share needles, syringes, cookers/spoons or other ‘works’ with other drug users;

  •        Use clean works for each injection (don’t re-use needles); 

•        Cleanliness is important: prepare in a clean place and carefully wash hands and skin first; 

 •        If you are in the same room as someone who is smoking heroin you may be at risk even if you are not smoking or injecting.

  Further information on anthrax is available on the HPS (Health Protection Scotland) website:   http://www.hps.scot.nhs.uk/giz/anthraxoutbreakdecember2009december2010.aspx

Please click on the following links to download further information:

Anthrax and Heroin Users July 2012

Anthrax Leaflet Final

Anthrax poster Final

  John Somers

Drugs Policy Unit

Scottish Government