Injecting drug users face increasing risk of bacterial infections

27 October 2008

Crack cocaine users can inject many times a day at various sites on the body. This increases the risk of infection, as does injecting into the groin which has become increasingly common among injecting drug users. Poor hygiene and dirty injecting equipment cause the bacterial infection; which are easily preventable if the injection site is cleaned before using a sterile needle.

These insights into the infection risks among injecting drug users are presented in 'Shooting Up', the Health Protection Agency's annual report examining infections among injecting drug users in the UK.

The report found:

• Bacterial infections seen among injecting drug users range from localised site infections through to invasive disease, and include: Staphylococcus aureus (including community associated MRSA), Severe Group A streptococci, wound botulism and tetanus. Severity can vary from minor skin infections to life threatening bacteraemia.
• HIV infections among injecting drug users remain relatively uncommon in the UK probably as a result of prompt community and public health responses. The overall prevalence of HIV seen among injecting drug users in 2007 was similar to that seen in recent years, with around one in 90 infected overall in England and Wales. Within London this increases to one in 20 while outside London, around one in 150 are infected.
• hepatitis C, the blood borne virus which can lead to cirrhosis and liver cancer. Prevalence also varies according to sub-groups of injecting drug users - those injecting crack-cocaine or cocaine are more likely to have hepatitis C, as are those who inject drugs into their groin.
• Encouraging results were noted in terms of an increase in uptake of hepatitis B vaccine. Uptake has increased from 25% ten years ago to 66% in 2007. However, transmission continues and one in six injecting drug users are thought to be infected.
• High numbers of current and former injecting drug users have reported making use of needle exchange services, with more than 90% of injecting drug users in England, Wales and Northern Ireland reporting access to these services at some point. The sharing of needles and syringes (direct sharing) is a key route by which infections may be transmitted among injecting drug users. Results of a 2007 survey showed that 23% of injecting drug users reported sharing in the four weeks before the survey, compared to the 34% who reported sharing in the same survey in 2002.

Dr Fortune Ncube, Consultant Epidemiologist at the Health Protection Agency and one of the report's authors said:

"Injecting drug users are vulnerable to a wide range of infections which can result in high levels of illness and death. It is important that services to reduce injecting related harm continue and injecting drug users have access to the healthcare services they need. Needle exchange services are key to preventing these infections and the harm they cause.

"Further research needs to be done exploring the risk factors that impact on injecting risk behaviour, such as homelessness, groin injection and crack cocaine use and how these interact with one another.

"The majority of these infections are preventable. A vaccine is available against Hepatitis B and transmission of blood borne viruses like Hepatitis C and HIV are preventable with the use of clean syringes, and using sterile swabs correctly injecting equipment. These will also help stop bacterial infections from occurring. In addition, regular testing can identify the early stages of infectious diseases, resulting in more effective treatment."

Ends

Notes to editors

1. The 'Shooting up: Infections among injecting drug users in the United Kingdom 2007' report, is produced annually by the Health Protection Agency, Health Protection Scotland, National Public Health Service for Wales, CDSC Northern Ireland, and the London School of Hygiene and Tropical Medicine.

The report is available to view at:

http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1224833091685

2. Examples of bacterial infections that can affect IDUs include botulism and tetanus. Wound botulism occurs when wounds are infected with Clostridium botulinum. Clinical symptoms can progress rapidly from blurred vision, slurred speech and muscle weakness to paralysis and respiratory failure. This can result in hospitalisation and lengthy recovery periods and in some cases can be fatal. Botulinum antitoxin is effective at reducing symptoms if given early in the course of the infection.

3. The spores from Clostridia bacteria may end up in drugs such as heroin, through envionmental contamination. Wound infections may result, particularly if the spores enter through an injection into the muscles, where they produce toxins causing illness such as tetanus or gas gangrene.

4. Tetanus can present with muscle rigidity and painful spasms confined to the area at the site of injury or injection, or generalised tetanus which can include respiratory difficulties and severe painful spasms. Tetanus is a vaccine preventable disease, and the vaccine is routinely offered in childhood and adolescence as well as to adults. Potential sources for tetanus infection in IDUs are contaminated drugs, injecting equipment and skin.

5. For further information on this press release please contact the Health Protection Agency's Centre for Infections press office on:

Kate Swan   020 8327 7097
David Daley  020 8327 6647
Louise Brown….  020 8327 7080
Georgina Fletcher  020 8327 6690
Alexandra Baker   020 8327 7098

Last reviewed: 27 October 2008