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Anthrax cases among drug users in Europe: third update

Further to the recent cases of anthrax among people who inject drugs (PWID) in the UK and elsewhere in Europe [1], a third case in England (Oxford) has now been confirmed. This brings the total to twelve confirmed cases in Europe since early June 2012: four cases in Germany, three in England, two in Denmark, one in France, one in Scotland, and one in Wales.

The case in Oxford is recovering; however, the two previous cases in England, which occurred in Blackpool, both died. All three cases were in adults who were known to have injected drugs.

It is possible that further cases may be seen. People who use drugs may become infected with anthrax when the heroin they use 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.

NHS staff were made aware of the possibility of cases of anthrax in PWID following the first UK case in Scotland. This was done via an NHS Central Alert cascade on 27 July 2012. The key message was to be alert to the possibility of anthrax infection in heroin users presenting with severe soft tissue infections or sepsis, or with signs/symptoms of inhalation anthrax, or with haemorrhagic meningitis.

Targeted information, including posters and leaflets aimed at heroin users, was sent by the National Treatment Agency for Substance Misuse to local drug partnerships for distribution to all organisations in touch with drug users on 27 July 2012. The importance of ensuring that the messages about the risk of anthrax from heroin were conveyed by partnerships was reinforced in August following the first case in England.

Clinicians with concerns about heroin injectors with severe illness that might be anthrax, should be advised to call the Rare and Imported Pathogens Laboratory (RIPL), Porton Down, to discuss the case. Similarly, microbiology laboratories processing clinical samples from suspect cases can contact RIPL at HPA Porton for further advice.

Updated information about this outbreak is available on the HPA website at:http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Anthrax/AnthraxOutbreak2012/

Information for microbiologists and clinicians can be found at:http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Anthrax/ 
AnthraxOutbreak2012/Anthrax2012InformationForHealthcareProfessionals/

Information for those working in drug services and for people who use heroin can be found at:http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Anthrax/ 
AnthraxOutbreak2012/Anthrax2012InformationForDrugUsersAndDrugWorkers/

Reference

1. Communicable disease threats report, 16-22 September 2012, week 38. ECDC, Stockholm 22 September 2012.

More information can be found online.