title: Lessons for control of heroin-associated anthrax in Europe from 2009-2010 outbreak case studies, London, UK.
abstract: Outbreaks of serious infections associated with heroin use in persons who inject drugs (PWIDs) occur intermittently and require vigilance and rapid reporting of individual cases. Here, we give a firsthand account of the cases in London during an outbreak of heroin-associated anthrax during 2009-2010 in the United Kingdom. This new manifestation of anthrax has resulted in a clinical manifestation distinct from already recognized forms. During 2012-13, additional cases of heroin-associated anthrax among PWIDs in England and other European countries were reported, suggesting that anthrax-contaminated heroin remains in circulation. Antibacterial drugs used for serious soft tissue infection are effective against anthrax, which may lead to substantial underrecognition of this novel illness. The outbreak in London provides a strong case for ongoing vigilance and the use of serologic testing in diagnosis and serologic surveillance schemes to determine and monitor the prevalence of anthrax exposure in the PWID community.
authors: Aula
authors: A
authors: Abbara
authors: Tim
authors: T
authors: Brooks
authors: Graham P
authors: GP
authors: Taylor
authors: Marianne
authors: M
authors: Nolan
authors: Hugo
authors: H
authors: Donaldson
authors: Maribel
authors: M
authors: Manikon
authors: Alison
authors: A
authors: Holmes
mesh_terms: D000328:Adult; D000881:Anthrax / Q000188:drug therapy* / Q000453:epidemiology*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001408:Bacillus anthracis; D004196:Disease Outbreaks; D005260:Female; D003932:Heroin / Q000009:adverse effects*; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D003932:Heroin
keywords: Europe; London; PWID; anthrax; heroin; injection; persons who inject drugs; sepsis; skin popping; soft tissue infection; subcutaneous