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Confirmed case of Anthrax in injecting drug user in England

17 August 2012

The Health Protection Agency (HPA) is aware that a person who injected drugs (PWID) has died in hospital in Blackpool with confirmed anthrax infection.

The Health Protection Agency (HPA) is aware that a person who injected drugs (PWID) has died in hospital in Blackpool with confirmed anthrax infection.

The HPA is also aware of an ongoing outbreak of anthrax amongst PWID affecting a number of countries in Europe. Seven cases have been identified since early June: one in Scotland, three in Germany, two in Denmark, and one in France. The source is presumed to be contaminated heroin.

It is unclear as yet whether this case and a case in Scotland at the end of July are linked to the outbreak in Europe but the HPA will continue to monitor the situation over the coming days and weeks.

These are the first cases of anthrax among injecting drug users in Europe since the outbreak during 2009/2010 which principally affected Scotland (119 cases), but with cases also reported from England (five cases) and Germany (two cases).

The European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have jointly prepared a rapid risk assessment which concludes that heroin users in Europe are still at risk of exposure to anthrax.

Dr Dilys Morgan, an expert in zoonotic infections at the HPA, said: “It’s likely that further cases among PWID will be identified as part of the ongoing outbreak in EU countries. The Department of Health has alerted the NHS of the possibility of PWID presenting to Emergency Departments and Walk-in Clinics, with symptoms suggestive of anthrax.

“Anthrax can be cured with antibiotics, 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.

“As part of the response to the 2009/10 outbreak, the HPA developed an algorithm for the clinical evaluation and management of PWID with possible anthrax. This algorithm specifies the kinds of presentations where anthrax should be considered, and outlines the actions to take.”

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.


Notes to editors:

  1. Further information can be found on the Health Protection Agency (HPA) anthrax page.  
  2.  More information on the European outbreak is available from the European Centre for Disease Prevention and Control (ECDC) website [external link].
  3. More information about the 2009/2010 outbreak of anthrax in Scotland is available from Health Protection Scotland website [external link].
  4. The Health Protection Agency has produced advice for injecting drug users and guidelines on the clinical evaluation and management of people with possible cutaneous anthrax in England. see the HPA website for the anthrax page and the HPA algorithm.
  5. At the end of June 2012 in consultation with colleagues across the UK the HPA produced a one-page reminder for those who commission and provide services to drug users about severe infections among PWID caused by spore-forming bacteria. This has been cascaded to service providers in England by the National Treatment Agency and is available from the HPA website.
  6. The Health Protection Agency is an independent UK organisation that was set up by the government in 2003 to protect the public from threats to their health from infectious diseases and environmental hazards. In April 2013 the Health Protection Agency will become part of a new organisation called Public Health England, an executive agency of the Department of Health. To find out more, visit our website: or follow us on Twitter @HPAuk or ‘Like’ us on Facebook at [external link].