Health officials across Europe have issued warnings after 2 new cases of anthrax have been reported this week among injecting drug users (IDUs) in Denmark and France, in addition to 3 cases in Germany. Reported dates of onset in all 5 cases range between early June 2012 and 11 July 2012.
The cases in Germany have already been connected to an earlier outbreak in the UK in 2010, but no connection has yet been found in the most recent cases. The 2009-2010 anthrax outbreak among drug users, which primarily affected Scotland, was called the largest in the UK in 50 years, which is the reason behind grave concern regarding the most recent outbreak.
A report released in January 2012 by Health Protection Scotland (HPS) recorded a total of 119 anthrax cases during 2009-10, with a total of 14 deaths. HPS’ investigation determined that heroin use was “the vehicle for transmission of anthrax spores" and that exposure was by a variety of routes, particularly injection (cutaneous) but also by smoking (inhalation). The report also said that the outbreak was the first associated with heroin use anywhere in the world. HPS warned in their report that “as long as the trade in illegal drugs exists, so does the risk of a similar occurrence.”
During the 2010 outbreak, drug users were warned that they would not be able to tell whether or not a given supply of the drug was tainted and that either injecting or smoking the drug could be dangerous. But there was no further action taken to help those at risk, which has since raised questions about the connection to the recent cases.
Anthrax is a very rare but serious bacterial infection caused by the organism Bacillus anthracis. Bacillus anthracis infects most farm animals and is usually spread to humans through a break in the skin. Anthrax can be treated with antibiotics if caught early enough, and doesn’t usually spread from person to person. However, if left untreated, anthrax can be fatal.
It is thought that the current and previous cases derive from a common geographical source. There are dozens of strains of bacillus anthracis that exist naturally in the world, with certain types being endemic to specific geographic regions, all of which are distinguishable by their DNA. It was through studies like these that led experts to suspect that the anthrax-affected drug users from 2009-10 in Scotland and England were all infected by heroin that was contaminated while being smuggled through Turkey in an infected goat-hide. Health Protection Scotland concluded that a single batch must have come into contact with anthrax spores somewhere between the Af-Pak region and its destination, Scotland. Gordon Meldrum, director general of the Scottish Crime and Drug Enforcement Agency said in a statement: “Production processes (of heroin) can be basic and are often conducted in areas where there is contamination from animal carcasses or faeces.”
Following the latest reports of anthrax-related deaths among heroin users, health officials across Europe are on guard. The Danish authorities have already called for heroin users with skin lesions to report to a health clinic to be tested for anthrax, which is likely to be copied by other nations in the coming weeks. Officials have warned that “there can be difficulty in distinguishing anthrax lesions from frequent soft tissue infections common in intravenous users.” There are also concerns that users with lesions will switch from injecting to smoking, which could be more deadly coming from a batch that contains anthrax spores, so they are desperately urging governments and the public to take this issue as a serious health threat.
But what is quite disconcerting, is the general lack of public awareness about this critical endemic. Health officials are concerned that the outbreak is at risk of being categorised as being merely another skin or soft tissue infection, which are common health problems suffered by the IDU population. Therefore, most government officials have disregarded the importance of the outbreak, which could mean that it will continue to spread and worsen across the continent.
It is thus vital that governments act quickly to warn those who are most at-risk, particularly the IDU population. Too often in these cases government officials delay releasing critical information about drug supplies, despite enough warnings that the drug supply is tainted and potentially deadly. It should be the duty of local governments to act swiftly, respectfully and with accurate information for drug users. The IDU community are challenging to reach out to – therefore by taking this issue seriously it will be a large step in combatting the outbreak.
Examples of how this could be achieved were exemplified by the European Centre for Disease Prevention and Control (ECDC), who claim that the European authorities should consider providing more detailed information regarding healthcare and drug treatment, with descriptions of the symptoms of anthrax infection to ensure early treatment. They should also consider the provision of appropriately-dosed opiate substitution treatment to prevent further anthrax cases.