Health Protection Agency (HPA) reveals that drugs users face an increased risk from wound botulism and tetanus

10 November 2011

Prior to 2000, no cases of wound botulism had been associated with PWID in the UK, but in the past decade 163 suspected cases have been reported to the HPA. Tetanus infections show a similar trend, very rarely reported among PWID before 2003, with 34 cases having been reported since.

These types of bacteria can cause wound infections that produce very severe wound infections. Wound botulism can lead to paralysis, and tetanus can cause ‘Lockjaw’ and painful spasms. Both of these infections can result in serious problems with breathing, which on rare occasions can be fatal.

The bacteria that cause these infections can end up in drugs like heroin through environmental contamination. Batches of drugs can become contaminated during production or transit. This can result in clusters of cases along the distribution networks. Infection may also result from injecting equipment becoming contaminated when an injection is being prepared in a place where bacterial spores are present in the soil.

The report also found that a range of other bacterial infections, including MRSA, and viral infections, such as HIV and hepatitis C, are continuing to occur among people who inject drugs.

Dr Fortune Ncube, a consultant epidemiologist at the HPA and one of the report’s authors, said:

“This latest report shows that people who use drugs face an ever increasing range of potential risks if they continue to inject. These bacterial infections can cause serious illness and even death in some circumstances.

“The best advice is to avoid injecting drugs and for users to seek treatment for their drug use. If people choose to continue to use drugs, then they should have access to healthcare services that will help them avoid potential infections, and support them in accessing suitable treatments options for their drug use.

“Regular testing is helpful in the early identification of viral infections, such as HIV and hepatitis C. It is also important for PWID to seek prompt medical advice for symptoms of a possible bacterial infection in order to avoid developing severe complications.

“The majority of these infections among people who inject drugs are preventable.
Vaccines are available against tetanus and hepatitis B, and clean syringes, sterile swabs and good hygiene can help prevent bacterial infections and blood borne viruses like Hepatitis C and HIV.

“Healthcare workers are advised to be on the lookout for these infections when caring for people who inject drugs, prompt identification and treatment means a better outcome for patients”

This annual report is produced in collaboration with Health Protection Scotland, Public Health Wales, and Public Health Agency Northern Ireland The report identifies trends in infections among PWID to help inform commissioning community based service.

Notes to Editors:

1. To see the full report please go to: http://www.hpa.org.uk/Publications/InfectiousDiseases/BloodBorneInfections/

2. Infections are common among people who inject drugs. Around one-third of them report having a symptom of a bacterial infection (such as a sore or abscess) at an injecting site in the past year.

3. Staphylococcus auerus and Group A Streptococcal infections continue to cause severe illness among people who inject drugs in the UK.

4. Since 2000 there have been 163 cases of wound botulism, 93 of Clostridium novyi infection, 52 confirmed cases of anthrax and 35 of tetanus associated with injecting drug use in the UK. Cases from the UK make up the vast majority of reported cases of these four infections associated with injecting drug use in Europe.

5. Around one half of people who inject drugs in the UK have been infected with hepatitis C and one sixth with hepatitis B.

6. The prevalence of HIV among those who have injected drugs remains comparatively low in the UK. It is estimated that around one in every 100 has HIV.

7. Needle and syringe sharing is lower than a decade ago, although one fifth of people who inject drugs continue to share needles and syringes.

8. For current advice on the immunisation of PWID please refer to The 'Green book' via www.immunisation.nhs.uk  

9. People who inject drugs are members of wider communities and infection among this group may have an impact on other community members such as family members, sexual partners and healthcare workers.

10. 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, subject to the usual approvals procedures for establishing new bodies, 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: www.hpa.org.uk  

11. For more information please contact the HPA press office at Colindale on 020 8327 7901 or email pressoffice@hpa.org.uk . Out of hours the duty press officer can be contacted on 020 8200 4400.
 

Last reviewed: 10 November 2011