Case of Anthrax identified in injecting drug user in Scotland
NHS Lanarkshire has today confirmed the identification of a single case of systemic anthrax infection in an intravenous drug user (IDU) in Scotland. The patient is in hospital and is currently in a critical but stable condition (text of full alert available at http://www.nhslanarkshire.org.uk/news/news/Pages/NHSLanarkshireissuepublichealthalerttoInjectingDrugUsers.aspx).
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."
A recent European cluster of anthrax in intravenous drug addicts was identified involving three cases in Germany, one in Denmark and one in France. The European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) issued a rapid risk assessment about this cluster and concluded that "The risk of exposure for heroin users in European Union (EU) countries is … still present" indicating that all EU countries should be aware of the possibility of such cases arising in their jurisdiction. Clinicians and Public Health Physicians in Ireland have been alerted to these recent cases.
An extensive anthrax outbreak in Scotland in 2009-10 was also found to be linked to contaminated heroin. This outbreak resulted in 119 cases of anthrax among IDUs and a total of 14 deaths. The Final Report into that outbreak concluded that it resulted from the importation of contaminated heroin, contamination probably occurring “somewhere in transit between Afghanistan/Pakistan and Scotland, probably in Turkey”.
Further information on the original Scottish outbreak is available at http://www.iduoutbreak.hps.scot.nhs.uk
Useful Scottish FAQs on anthrax and IDUs are available here http://www.documents.hps.scot.nhs.uk/giz/faqs/anthrax-humans.pdf
The latest ECDC Risk Assessment (13/7/2012) on the Continental European cluster is available at http://ecdc.europa.eu/en/publications/Publications/Rapid-risk-assessent-anthrax-IDUs-July-13.pdf
HPSC’s website has information on anthrax available at http://www.hpsc.ie/hpsc/A-Z/Zoonotic/Anthrax