Fatal anthrax case in England confirmed

 The Health Protection Agency (HPA) has confirmed that an injecting drug user with an anthrax infection has died in hospital in Blackpool. The case is the eighth to be identified since June, with one in Scotland (DDN, August, page 4), three in Germany, two in Denmark and one in France. The HPA says it remains ‘unclear’ whether the UK cases are

linked to those on mainland Europe but in all instances the source is presumed to be contaminated heroin. The cases are the first among injecting drug users since the Scottish outbreak of 2009-10, which was the largest UK ‘common source’ anthrax outbreak in humans for half a century (DDN, January, page 6). Before that, only one case of a drug user infected with anthrax had ever been reported, in Norway in 2000. A rapid risk assessment by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and European Centre for Disease Prevention and Control (ECDC) concluded that heroin users in Europe remain at risk of anthrax exposure, and that ‘it is possible’ that the batch of contaminated heroin has the same source as that of the 2009 Scottish outbreak. ‘It’s likely that further cases in people who inject drugs (PWID) will be identified as part of the ongoing outbreak in EU countries,’ said HPA expert in zoonotic infections, Dr Dilys Morgan. ‘The Department of Health has alerted the NHS of the possibility of PWID presenting to emergency departments and walk-in clinics, with symptoms suggestive of anthrax. Anthrax can be cured with antibiotics, if treatment is started early. It is therefore important for medical professionals to know the signs and symptoms to look for, so that there are no delays in providing the necessary treatment.’