Germany - Scotland anthrax link

05 February 2010

Tests carried out by the UK Health Protection Agency (HPA) and Germany's Robert Koch Institute (RKI) and Friedrich-Loeffler Institute (FLI) on the strain of anthrax isolated from a heroin user who died in Germany in mid December have shown it is indistinguishable from strains isolated from anthrax cases in Scotland.

This suggests that the anthrax contamination in both countries, thought to originate in the heroin supply, could share a common source. This could suggest that the contamination of the heroin may have occurred prior to distribution of the heroin in Scotland and Germany, however it does not offer definitive proof.

Of 18 confirmed anthrax isolates from Scottish cases by the HPA's Special Pathogens Reference Laboratory at Porton Down, 14 have so far been confirmed as being of the same strain, with further isolates awaiting confirmation. Typing on the isolate from the German patient has now confirmed it is also of the same strain. These results suggest that the outbreak may be associated with anthrax contamination from a single source.

To date in Scotland there have been a total of nineteen confirmed cases in Scotland, of whom a total of nine individuals have died. A further case of anthrax in a patient living in London with a history of heroin use has also been confirmed by the Health Protection Agency. This individual developed symptoms at the end of January 2010. Investigations are continuing but no obvious connections to Scotland have been identified.

Evidence suggests that contaminated heroin may still be in circulation, and drug users all across Scotland must remain vigilant. The outbreak began with the identification of cases in NHS Greater Glasgow & Clyde in December, with cases now having been identified in six NHS board areas across the country, and represents the first known outbreak of anthrax to have occurred in conjunction with drug use.

Dr Colin Ramsay, Consultant Epidemiologist at Health Protection Scotland and head of the national Outbreak Control Team, said:

"Drug users are advised to cease taking heroin by any route if at all possible. While we appreciate that this may be extremely difficult advice to follow, it remains the only public health protection advice possible based on current evidence.

"Users are encouraged to find out more about support services in their area by calling Know the Score on 0800 587 5879 or visiting http://www.scottishdrugservices.com/. Those who do continue to use heroin should follow current harm reduction advice, which says that fresh filters should be used on each occasion and that filters should not be re-used.

"It must be noted however that filters will not make heroin safe or remove all traces of anthrax contamination, so the best advice remains not to use heroin by any method. Users should seek urgent medical attention in the event of symptoms such as redness or swelling at or near an injection site or other symptoms of general illness such a high temperature, chills or a severe headache, as early antibiotic treatment can be lifesaving." 

The image is courtesy of the US Centers for Disease and Prevention 

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