Helping Scotland Investigate, Treat Anthrax Among Heroin Users

Posted on by Nicki Pesik
Drs. Shadomy and Stauffer standing in the snow.
Drs. Shadomy and Stauffer. Click on the image to see the full picture.

On December 17th, Health Protection Scotland contacted the Bacterial Zoonosis Branch (BZB) to discuss 3 cases of anthrax in heroin users. They requested assistance with the epidemiologic investigation and patient treatment options, such as adjunctive therapy with anthrax immune globulin. Because immunotherapy is of potential benefit in anthrax, the U.S. Department of Health and Human Services and CDC provided immune globulin for patients with anthrax.

On December 19th, Senior Epidemiologist Dr. Sean Shadomy, Epidemic Intelligence Service Officer Dr. Kendra Stauffer, and I arrived in Scotland to assist with the epidemiologic investigation and to provide consultation on administration of the immune globulin. Several doses of anthrax immune globulin were delivered by the CDC Division of Strategic National Stockpile and arrived on December 19th as well. In Atlanta, Dr. Theresa Smith, Branch Chief, BZB, and Principal Investigator for anthrax immune globulin, led and coordinated support activities with the CDC Regulatory Affairs program.

A map of Scotland.
Map showing areas of Scotland with confirmed anthrax cases. Click on the image to see the full picture.

Initial epidemiologic investigations and case identification revealed that anthrax cases associated with heroin use were confined to a limited area in Glasgow and Lanarkshire. As of February 3rd, Health Protection Scotland has confirmed 19 cases of anthrax with 9 deaths. Cases have been identified in health boards outside of the immediate area of Glasgow, including in Glasgow, Stirling, Kirkcaldy, Dundee, Airdrie, and Kilmarnock.

Investigation surrounding the source of contamination of heroin or a mixing substance continues. All patients report a recent history of heroin use, predominantly by injection (either intravenous injection or intramuscular injection intentionally or by accident) but also by other routes, including smoking and snorting. There have been a number of presentations among patients. Some have presented with severe localized infection at injection site, proceeding to necrotizing fasciitis requiring debridement. Others have had less severe tissue infections. A number have presented with more of a meningitis type pattern with headache and systemic illness. Our program continues to actively assist Health Protection Scotland in both its epidemiologic investigation and consultation on adjunctive therapy.

Heroin in power and pill forms.

In 1990, it was estimated that there were 8500 intravenous drug users in Glasgow, Scotland. Several instances of infections resulting from injections into soft tissue associated with spore-forming bacilli are reported in the literature. In 2000, one case of anthrax associated with injecting heroin was reported in Oslo, Norway. Also in 2000, CDC provided assistance during an outbreak of Clostridium novyi resulting in severe illness among injecting drug users in Scotland. During that outbreak, 60 cases were identified—23 confirmed, 37 likely.

International collaborations on these types of outbreaks are providing CDC’s anthrax experts with important information on clinical presentation and course of illness in patients exposed to Bacillus anthracis spores through a rare and unusual exposure route. The IV drug-using community and the medical community are being informed about the potential risk of exposure to B. anthracis spores associated with heroin use. Clinical guidance on the need to initiate appropriate therapy with antimicrobial agents as quickly as possible is being emphasized.

For More Information

The Bacterial Zoonosis Branch continues to actively assist Health Protection Scotland in both its epidemiologic investigation and consultation on treatment. For updates on case counts, check out Health Protection Scotland’s website at At this website, you’ll also find guidance documents developed to assist in the investigation and management of cases.

What Is Anthrax and How Do You Get It?

Anthrax is a serious disease caused by Bacillus anthracis, a bacterium that forms spores. Spores are cells that are dormant (asleep) but that can come to life with the right conditions. When people are exposed to Bacillus anthracis, they can develop three types of anthrax: skin (cutaneous), lungs (inhalation), and digestive (gastrointestinal).

Anthrax is not known to spread from one person to another, but it can be spread from animals. For example, people have been infected with anthrax when they handled products from infected animals or by breathing in anthrax spores from infected animal products (like wool or drums made from animal hides). People also can become infected with gastrointestinal anthrax by eating undercooked meat from infected animals.

Anthrax also has been used as a weapon, as we saw in 2001, when letters with powder containing anthrax were deliberately spread through the postal system. Twenty-two people got sick, and 5 of them died. For more information about anthrax, visit CDC’s website:

Posted on by Nicki PesikTags , , , , , , ,

7 comments on “Helping Scotland Investigate, Treat Anthrax Among Heroin Users”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Question: I am wondering if from any of these three cases of heroin/antharx there was the opportunity to do any DNA testing? I am saying this because if any DNA trace were present, it can tell us a bit more about the handleing of this toxic heroin and possible clues from where is coming.

    Thanks for your intriguing article. One other problem is that mesothelioma cancer is generally attributable to the inhalation of materials from mesothelioma, which is a positivelly dangerous material. It truly is commonly found among workers in the structure industry with long experience of asbestos. It is also caused by residing in asbestos covered buildings for some time of time, Genes plays an important role, and some folks are more vulnerable for the risk in comparison with others.

    I should say also believe that mesothelioma cancer is a unusual form of melanoma that is generally found in individuals previously familiar with asbestos. Cancerous cellular material form while in the mesothelium, which is a protecting lining that covers most of the body’s bodily organs. These cells ordinarily form inside lining in the lungs, stomach, or the sac which encircles the heart. Thanks for expressing your ideas.

    Oh my goodness! a tremendous article dude. Thanks Nonetheless I’m experiencing challenge with ur rss . Don know why Unable to subscribe to it. Is there anyone getting similar rss drawback? Anyone who knows kindly respond. Thnkx

    Hello there, just became alert to your blog through Google, and found that it’s truly informative. I am going to watch out for brussels. I will appreciate if you continue this in future. A lot of people will be benefited from your writing. Cheers!

    Another reason is simple economics, if you are building a boat out of your wooden tool box filled with hand tools it will be a whole lot cheaper than if you used power tools for the reason discussed previously. It is not an easy goal but with a little planning you can put your health at the top of your list. If you want honesty, give it and demand it!

Post a Comment

Your email address will not be published. Required fields are marked *

All comments posted become a part of the public domain, and users are responsible for their comments. This is a moderated site and your comments will be reviewed before they are posted. Read more about our comment policy »

Page last reviewed: April 30, 2012
Page last updated: April 30, 2012