Anthrax outbreaks in Scotland
Anthrax is a rare but serious bacterial infection caused by the Gram-positive, spore-forming, bacterium Bacillus anthracis. Spores are very resistant to damage and can remain dormant in the soil for decades.
The presentation depends on the way in which the heroin is taken by the user. Most commonly this leads to injection anthrax but symptoms of inhalational anthrax may occur if contaminated heroin has been smoked.
Anthrax Outbreak 2009/10
The deadly outbreak of anthrax among injecting heroin users in 2009-2010 was identified starting in Glasgow in December 2009.
The outbreak resulted in Scottish Drugs Forum being involved, for the first time in its history, in the national response to a major public health emergency.
Public health experts drew on Scottish Drugs Forum’s expertise and networks to help tackle the outbreak, which killed 14 people and made 119 people seriously ill across 10 of the 14 Scottish health board areas, over an eight month period.
The outbreak is thought to be due to a single novel strain of anthrax not previously seen in the UK or elsewhere – and related to anthrax strains previously identified in goats in Turkey.
Experts concluded that the contaminated heroin imported to Scotland was from a single batch with anthrax spores via contact with a single infected animal or animal hide somewhere in transit between Afghanistan/Pakistan and Scotland, probably Turkey.
Risk of Repeat
The official Report of the Anthrax Outbreak Control Team has warned that contaminated heroin could be imported into Britain again at any time and cause another outbreak of anthrax or similar infection.
It also called for research into the reasons for the concentration of “significant and unusual” outbreaks of infections among drug users, particularly in West Central Scotland. It said that the number of tests carried out for anthrax indicated “a lot of infection” among drug users during the outbreak period, while a variety of co-infections with other organisms was also noted in anthrax cases.
Most of the confirmed anthrax cases lived in Glasgow/Lanarkshire/Central Scotland, with significant clusters in Dundee and Dumfries.
Yet Lothian and Grampian NHS Board areas, despite having significant heroin-using populations, had few cases, while Highland and the Island areas had no cases.
Scottish Drugs Forum Input
Scottish Drugs Forum made a significant input at strategic and operational levels during the course of the Outbreak, through active involvement via membership of Health Protection Scotland’s multi-agency Outbreak Control Team (OCT).
Scottish Drugs Forum staff, in association with Glasgow Addiction Services, developed posters and flyers containing critical information on symptoms and where to get help and advice.
We distributed around 40,000 flyers and 3000 posters to agencies and public authorities throughout Scotland as the outbreak rolled on.
In association with Health Protection Scotland, we also published a more in-depth guide, Anthrax and Heroin Users: What Workers Need to Know (March 2013) on our website and distributed it to key services.
This was supported by the delivery of more than 30 face-to-face workers briefings, using material contributed to by members of the Volunteer Forum of the National Forum on Drug-related Deaths.
The official Report of the Anthrax Outbreak Control Team thanked Scottish Drugs Forum for our role in assisting with accessing the drug service sector and in targeting information to drug users.