Case of anthrax confirmed in Oxford

2 November 2012

The Health Protection Agency (HPA) is aware that a person who injected heroin has been diagnosed with anthrax infection in Oxford. The patient is recovering.

This case has occurred after two people who injected drugs died from confirmed anthrax infection in Blackpool within a month of each other in August and September this year.

There is an ongoing outbreak of anthrax among people who inject drugs in a number of countries in Europe with 12 cases now identified since early June. The latest case in Oxford brings the total number affected in the UK to five – three in England (two fatal, one recovering), one in Scotland and one in Wales (both recovering).The source is presumed to be contaminated heroin.

It is unclear as yet whether these recent cases are linked to the cases in Europe (four in Germany, two in Denmark and one in France) but the HPA is continuing to monitor the situation.

The European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have concluded that heroin users in Europe are still at risk of exposure to anthrax.

Dr Fortune Ncube, an expert in infections among people who inject drugs at the HPA, said: “Anthrax can be cured with antibiotics, if treatment is started early. It is therefore important for medical professionals to be alert to the possibly of anthrax infection in heroin users presenting with signs and symptoms – which include severe soft tissue infections or blood poisoning – to prevent any delays in providing treatment.

“It is possible that further cases may be seen in people who inject heroin. People who use drugs may become infected with anthrax when the heroin they use is contaminated with anthrax spores. This could be a source of infection if injected, smoked or snorted - There is no safe route for consuming heroin or other drugs that may be contaminated with anthrax spores.”

NHS staff were made aware of the possibility of cases of anthrax in people who inject heroin following the first UK case earlier this year. Targeted information, including posters and leaflets aimed at heroin users were also sent out by the National Treatment Agency to local drug partnerships for distribution to all organisations in touch with drug users, including hostels, housing departments, needle exchanges, benefit offices, community pharmacies and social work departments.

Dr Éamonn O’Moore, director of the HPA’s Thames Valley Health Protection Unit, said: “In light of this recent case in Oxford, we have advised local Drug and Alcohol Action Teams to talk to their service users who inject drugs about the risk of anthrax infection.

“Injecting drug users often experience skin infection but we strongly advise them not to ignore signs such as redness or excessive swelling around injection sites, or other symptoms of general illness such a high temperature, chills, severe headaches or breathing difficulties. They should seek medical advice quickly in such circumstances generally but particularly now because we have concerns that some batches of heroin in circulation in Oxfordshire and the wider Thames Valley may be contaminated with anthrax. Early treatment with antibiotics is essential for a successful recovery.”

ENDS

Notes to editors

1. The Rare and Imported Pathogens Laboratory at HPA Porton, is providing diagnostic support to clinical teams across the UK to assist them with the handling of anthrax incidents.
2. Further information on anthrax can be found on the anthrax page. 
3. More information on the European outbreak is available at the European Centre for Disease Prevention and Control (ECDC) website [external link]. 
4. More information about the 2009/2010 outbreak of anthrax in Scotland is available at the Health Protection Scotland website [external link]. 
5. The Health Protection Agency has produced advice for injecting drug users and guidelines on the clinical evaluation and management of people with possible cutaneous anthrax in England. These are available on the anthrax page.
6. At the end of June 2012 in consultation with colleagues across the UK the HPA produced a one-page reminder for those who commission and provide services to drug users about severe infections among PWID caused by spore-forming bacteria. This has been cascaded to service providers in England by the National Treatment Agency. See the: Anthrax, botulism & tetanus among drug users - a reminder June 2012 (PDF, 65 KB) for more details. 
7. 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 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 or follow us on Twitter @HPAuk or ‘Like’ us on Facebook at www.facebook.com/HealthProtectionAgency [external link]. 
8. For more information please contact the national HPA press office at Colindale on 0208 327 7901 or email colindale-pressoffice@hpa.org.uk. Out of hours the duty press officer can be contacted on 0208 200 4400. Alternatively contact the communications team at HPA South East on 01403 229074 or 07789 295 454.
    

Last reviewed: 2 November 2012