title: Infections with spore-forming bacteria in persons who inject drugs, 2000-2009.
abstract: Since 2000 in the United Kingdom, infections caused by spore-forming bacteria have been associated with increasing illness and death among persons who inject drugs (PWID). To assess temporal and geographic trends in these illnesses (botulism, tetanus, Clostridium novyi infection, and anthrax), we compared rates across England and Scotland for 2000-2009. Overall, 295 infections were reported: 1.45 per 1,000 PWID in England and 4.01 per 1,000 PWID in Scotland. The higher rate in Scotland was mainly attributable to C. novyi infection and anthrax; rates of botulism and tetanus were comparable in both countries. The temporal and geographic clustering of cases of C. novyi and anthrax into outbreaks suggests possible contamination of specific heroin batches; in contrast, the more sporadic nature of tetanus and botulism cases suggests that these spores might more commonly exist in the drug supply or local environment although at varying levels. PWID should be advised about treatment programs, injecting hygiene, risks, and vaccinations.
authors.affiliation: Health Protection Scotland, Glasgow, Scotland. norah.palmateer@nhs.net
authors.forename: Norah E
authors.initials: NE
authors.lastname: Palmateer
authors.forename: Vivian D
authors.initials: VD
authors.lastname: Hope
authors.forename: Kirsty
authors.initials: K
authors.lastname: Roy
authors.forename: Andrea
authors.initials: A
authors.lastname: Marongiu
authors.forename: Joanne M
authors.initials: JM
authors.lastname: White
authors.forename: Kathie A
authors.initials: KA
authors.lastname: Grant
authors.forename: Colin N
authors.initials: CN
authors.lastname: Ramsay
authors.forename: David J
authors.initials: DJ
authors.lastname: Goldberg
authors.forename: Fortune
authors.initials: F
authors.lastname: Ncube
mesh_terms: D000328:Adult; D000881:Anthrax / Q000453:epidemiology* / Q000382:microbiology; D001408:Bacillus anthracis / Q000502:physiology; D001906:Botulism / Q000453:epidemiology* / Q000382:microbiology; D003013:Clostridium / Q000502:physiology; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D003014:Clostridium botulinum / Q000502:physiology; D003017:Clostridium tetani / Q000502:physiology; D004196:Disease Outbreaks; D004340:Drug Contamination; D004739:England / Q000453:epidemiology; D005260:Female; D003932:Heroin / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D008297:Male; D012606:Scotland / Q000453:epidemiology; D013171:Spores, Bacterial / Q000502:physiology*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000382:microbiology; D013742:Tetanus / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D003932:Heroin