Home > Infection with Bacillus anthracis - Injecting drug users potential presentations and case definitions.

Health Protection Surveillance Centre, Health Service Executive. [HSE Website] (2013) Infection with Bacillus anthracis - Injecting drug users potential presentations and case definitions. Dublin: Health Protection Surveillance Centre. 6 p.

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In Scotland in December 2009, an outbreak of anthrax was identified among injecting drug user (IDUs) centred in Glasgow. The initial Scottish cluster of infection in IDUs began in 2009 and resulted in 119 patients being classed as having anthrax, with 47 of these being confirmed. Fourteen of these cases died. In addition, there were three related cases in England. The responsible isolates had an indistinguishable genetic signature (Ba4599 single-nucleotide polymorphism genotype).

In investigating strain origin, it was subsequently determined that this clone was prevalent in Turkey. Initial UK police and Europol investigations suggested that hide bags used to transport raw opium from production areas in Afghanistan to processing plants (most likely in Turkey) were the source of the anthrax spores. After a lull, in summer 2012, a cluster of five anthrax bloodstream infection cases was identified in Germany, Denmark and France (this cluster was suspected as being caused by illegal importation of heroin from Scotland to Germany). This low-grade outbreak is continuing; to date (March 2013) 13 cases now identified since early June 2012. Seven cases have been affected in the UK – five in England (including four fatalities), one in Scotland and one in Wales. The causative strain of this cluster was again indistinguishable from that responsible for the Scottish cluster. To date, there have been no similar cases in Ireland.

The aim of this guidance is to assist clinicians in Ireland in clinical and microbiological assessment of suspected cases of infection with B. anthracis in IDUs.


Item Type:Evidence resource
Publication Type:Guideline
Drug Type:Opioid
Intervention Type:AOD disorder harm reduction
Source:HSE Website
Date:September 2013
Pages:6 p.
Publisher:Health Protection Surveillance Centre
Corporate Creators:Health Protection Surveillance Centre, Health Service Executive
Place of Publication:Dublin
EndNote:View
Accession Number:HRB (Electronic Only)
Related URLs:
Subjects:T Demographic characteristics > Intravenous / injecting drug user
VA Geographic area > Europe > Ireland
J Health care, prevention and rehabilitation > Patient care management
G Health and disease > Disorder by cause > Communicable disease > Bacterial disease
J Health care, prevention and rehabilitation > Health related prevention > Health information and education > Communicable disease control
J Health care, prevention and rehabilitation > Substance use prevention > Substance use harm reduction

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