Since early December 2009 increasing numbers of anthrax cases have been identified among drug users in at least two, possibly three European countries due to people using heroin contaminated with anthrax. The majority of infections and deaths so far have occurred in Scotland where the outbreak was first identified. There have now been 10 deaths in Scotland with at least 19 cases confirmed in total.

Up to 4 February 2010 deaths and cases in Scotland appeared to be limited to the area in and around Glasgow. On 13 April however, AIVL was informed of a further anthrax case from contaminated heroin in Edinburgh in the Lothian region.

In Germany there has been one fatal case of anthrax in a 42 year old male injecting drug user, who presented with oedema of the leg after intravenous drug injection (probably heroin). The death occurred due to multi-organ failure after necrotizing fasciitis. The pathogen was isolated and characterized by laboratory (wound swab specimen) as anthrax. It is not clear whether there was a link to the anthrax outbreak among injecting drug users in Scotland. As far as known, the man had no travel history to Scotland.

In Coimbra, Portugal 9 persons reportedly died from infections resulting from use of contaminated heroin. Although these deaths have been reported to AIVL through our international networks, we have not been able to confirm through the relevant authorities as to whether the deaths in Portugal are due to anthrax. Further information will be posted if it becomes available.

The deaths of two drug users in Sweden were being investigated by authorities as possible anthrax contaminations but as at 4 February 2010 these deaths were confirmed as NOT being anthrax related.

Information for Drug Users in Australia

To date there have been no reported cases of anthrax infection among people using heroin in Australia and there have been no indications that heroin contaminated with anthrax is in the Australian illicit drugs market.

Information obtained by AIVL suggests that all confirmed cases have involved the use of ’Afghan’ brown heroin - a form of heroin rarely available in Australia.

Australian drug users who are travelling, intending to travel or have recently returned from Europe (particularly Scotland) should stay informed on this situation and read the other information on anthrax infection from Australian and Scottish health authorities provided on this site.

AIVL’s networks in Europe have confirmed it is impossible to see the anthrax in the contaminated heroin with the naked eye. As anthrax spores can also be inhaled deaths in Scotland have involved people who have smoked or ’chased’ heroin as well as injectors.

As the national drug user organisation AIVL believes it was important to provide ongoing up-to-date information for drug users in Australia about this tragic situation unfolding in Europe. As the situation develops we willcontinue to provide you with the latest facts.

This information is real. It is not a hoax, a ’beat-up’ or conspiracy theory. The deaths and infections in Scotland and Germany have been confirmed in laboratory testing and by authorities as anthrax infection via contaminated heroin use.

The risk of anthrax contaminated heroin in Australia remains low largely due to the different heroin sources. AIVL encourages drug users in Australia to remain informed but don’t panic.

If you would like further information on anthrax, how to recognise signs of anthrax infection and what to do if you are concerned please read the information from the Victorian and South Australian Health Departments and the ’Anthrax Workers Guide’ from the Scottish Drugs Forum provided onthis site.

If you have questions or concerns you can contact AIVL or your local drug user’s organisation - contact details can be found here.

References:

• anthrax_heroin - Vic Health Alert
• Cutaneous Anthrax Risk in Heroin Users - SA Health
• anthrax-press-release-2010-01-25
• anthrax-press-release-2010-01-22
• link: Scottish Drugs Forum - Workers’ anthrax briefing aims to save lives
• download: anthrax - workers guide final 25.1.10
• link: UK Health Protection Authority alert
• download: HPA advice