ANTHRAX BRIEFING-

UPDATE JULY 2012

Stephen Malloy

National Training/Development officer

Critical Incidents

stephen@sdf.org.uk

May 2010 (updated July 2012)

WHY THE BRIEFING UPDATE?

New (single) confirmed case of anthrax infection,

found in a female injecting drug user in NHS

Lanarkshire.

Treated in Hospital, serious but stable condition

5 recent confirmed cases in Europe; 3 Germany, 1

Denmark, 1 France

ANTHRAX IN PWUD IN SCOTLAND- BRIEF

HISTORY

Early Dec 2009- 1st identified cases of Anthrax infection in drug user in Glasgow.

12th Dec 2009- 1st case of drug user dying as a result of Anthrax infection in Glasgow

Confirmed 47 cases of Anthrax infection across 8 HB areas in Scotland, with 13 of those infected now deceased.

208 Suspected/possible cases across Scotland

3 confirmed cases in England, 2 deaths

2 cases in Germany, 1 Death

WHAT IS ANTHRAX?

Anthrax is a bacterial infection caused by the organism Bacillus anthracis.

The disease occurs most often in wild and domestic animals in Asia, Africa

and parts of Europe; humans are rarely infected. The organism can exist

as spores that allow survival in the environment, e.g. in soil, for many

years.

(09-10 CASES) WHO WAS AFFECTED?

No specific profile

Age range is from late 20’s – mid 50’s

Majority of those infected had been long term injecting drug users

Snorting/smoking seen as possible route of infection

Some linked to homelessness, but not all

More men infected than women

We must reiterate that ALL forms of heroin use carry a risk of

infection and no heroin can be considered free of contamination

ROUTES OF INFECTION IN DRUG USERS

Definite route

Via injecting contaminated heroin into a vein (or intending to inject into a vein and ‘missing’), injecting under the skin or directly into a muscle

Other routes

Inhalation- via smoking or snorting contaminated heroin

Ingestion- swallowing heroin (less common

practice)

INCREASED RISK OF ANTHRAX INFECTION FROM

INJECTING PRACTICES?

Injecting under skin or into muscle, also missing vein or experiencing ‘leakage’ which is known to increase risk for MANY infections

Excessive use of citric acid causes tissue/vein damage and increases risk of infections

Injecting contaminated heroin into a vein presents route for possible systemic (spread throughout) infection

Poor filtration or re using filters

BARRIERS TO PRESENTING WHEN

SYMPTOMATIC?

Fear?

Stigma?

Failure to Identify Signs/symptoms?

Being ‘struck off’ or substitute prescribing

implications?

Poor experience of medical care/treatment?

Ambivalence?

Any others????

SIGNS/SYMPTOMS OF INFECTION CURE DEPENDS ON EARLY IDENTIFICATION AND TREATMENT

If injected into a vein- flu-like illness (fever, headache, muscle aches ) which may develop into systemic infection. Can develop within 1-7 days

If injected under skin, into muscle or a vein ‘miss’ – same as above may be experienced, also ;

Severe soft tissue infection, could also include necrotising fasciitis and Cellulitis, abscess and pronounced swelling

Signs of severe sepsis even without evidence of soft tissue infection*

Meningitis (especially haemorrhagic meningitis)

ON SKIN- 1-7 days after exposure a raised, itchy, inflamed pimple appears followed by a papule that turns vesicular (into a blister). Extensive oedema or swelling accompanies the lesion – the swelling tends to be much greater than would normally be expected for the size of the lesion and this is usually PAINLESS

If left untreated the infection can spread to cause blood poisoning

SIGNS/SYMPTOMS OF INFECTION CONT;

FROM SMOKING/SNORTING

symptoms may begin with a flu-like illness (fever, headache, muscle aches and non-productive cough) followed by severe respiratory difficulties and shock 2-6 days later. Untreated disease is usually fatal, and treatment must be given as soon as possible to reduce mortality. (GGCHB-Jan 2010)

SIGNS/SYMPTOMS CONT.

*SEPSIS

• Temperature above 38°C (101°F) or below 36°C (96°F)

• Heart rate above 90 beats per minute

• Breathing more than 20 breaths per minute

• Low blood pressure

• Decreased urine output

• Change in mental status with confusion or delirium

(Hildreth C J; Cassio L; Richard M. Glass M R., JAMA, June 17, 2009—Vol 301, No. 23)

ACTION – (WHAT TO DO IF SOMEONE HAS SYMPTOMS OF

ANTHRAX INFECTION OR OTHER INFECTION)

STRONGLY advise to visit GP or A&E urgently –

assist in accessing these services

Accompany to hospital or GP where possible

Try to arrange for family member or friend to

accompany

*Early diagnoses and treatment can save

lives!!

OTHER IMPORTANT INFORMATION

Minimal risk through intimate physical/sexual

contact

Potential risk from touching skin lesions,

especially where open wound is present

Minimise risk of infection further by:

Avoiding contact with leaking or dried out wounds

or abscesses

Keeping them covered

Clean up any leakages with domestic bleach or

suitably diluted disinfectant

HOW SERVICES CAN HELP

DISCUSS RISKS WITH INJECTING DRUG USERS

Continue safer injecting advice (one hit kits (if available), no sharing of injecting equipment (or drugs?), spoons, filters or water, filtration etc)

Encourage injecting users to limit use of citric acid

Offer/support quick access to individually tailored and effective treatment programs

Review whether dosage levels of those on substitute prescribing are adequate to reduce the risk of “topping up” with street heroin

USEFUL LINKS

www.hps.scot.nhs.uk/anthrax

www.scottishdrugservicesdirectory.com

www.scottishdrugsforum.org.uk

FINALLY

Thank you for your attention

Stephen Malloy

stephen@sdf.org.uk

ScottishdrugsForum

Co-ordinating Action on Drug Issues