Botulism outbreaks in Scotland

Botulism is a very rare but life-threatening condition caused by toxins produced by Clostridium botulinum bacteria.

These toxins are some of the most powerful known to science. They attack the nervous system (nerves, brain and spinal cord) and cause paralysis (muscle weakness).

Most people will make a full recovery with treatment, but the paralysis can spread to the muscles that control breathing if it’s not treated quickly.

Drugs can be contaminated with this bacterium at any point from being manufactured, during transportation, when being cut with adulterants and during preparation for injection.


Botulism Outbreak 2014/15

This outbreak of wound botulism was associated with injecting heroin use. The first case was identified in December 2014 and the outbreak was declared over in July 2015.

Between 24th December 2014 and 30th May 2015 a total of 47 cases of suspected wound botulism were reported across six NHS Boards. Further cases of botulism were also reported in England (n=1) and Norway (n=6), though at the time there was no information to suggest a link with the Scottish cases.

17 cases were confirmed microbiologically as botulism and 23 cases classed as probable. Two cases were classed as possible and five cases were discounted.

Public health experts drew on Scottish Drugs Forum’s expertise and networks to help tackle the outbreak, which killed four people.


Risk of Repeat

Public Health England stated in the Health Protection Report Vol 9 (2015) that the contamination of heroin with Clostridium Botulinum spores is thought to be an on-going and probably common occurrence, as the spores are widely found in the environment.

As Clostridium Botulinum is an anaerobe, infection only occurs when the spores enter a suitable anaerobic environment, such as can be found in damaged tissues. In people who inject drugs, such tissue damage can result from missed ‘hits’ (i.e. missing the vein when trying to inject intravenously) or when intentionally injecting intramuscularly or subcutaneously. Most people who inject drugs do so intravenously and are unlikely to become infected when exposed to botulism spores because of the aerobic environment in the blood stream.


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 in the Incident Management team.

Scottish Drugs Forum staff developed postcards containing critical information on symptoms and where to get help and advice.

In association with Health Protection Scotland, we also published a more in-depth guide, Wound Botulism and Drug Use: What Workers Need to Know on our website and distributed it to key services.

This was supported by the delivery of more than 30 face-to-face workers briefings.