Intended for healthcare professionals


Heroin contaminated with anthrax has killed 11 people

BMJ 2010; 340 doi: (Published 15 February 2010) Cite this as: BMJ 2010;340:c937
  1. Bryan Christie
  1. 1Edinburgh

    Eleven people have died from the first ever drug related outbreak of anthrax caused by contaminated heroin, which is thought to be still circulating in Europe.

    Since December 10 deaths have been reported among injecting drug users in the United Kingdom and one in Germany. Only one case of anthrax infection in a drug user has ever been reported previously—from Norway in 2000.

    The problem first appeared in Scotland in early December, and since then 21 cases have been confirmed in six separate Scottish health board areas, leading to nine deaths. Tests have shown that the German victim, who died in Aachen in December, injected the same strain of anthrax as in the Scottish cases. This suggests that it came from a single source and that the contamination occurred before the heroin was distributed.

    The latest death was reported by the UK Health Protection Agency on 10 February and involved a drug user from Blackpool. This was the second case in England, after infection was confirmed in a drug user from London, who is being treated in hospital.

    Health authorities across the UK are now working on the assumption that all heroin in circulation carries the risk of anthrax infection. They have issued warnings to drug users to stop taking heroin by any route and to seek help from their local drug treatment services.

    Colin Ramsay, head of the outbreak control team at Health Protection Scotland, said, “Users should seek urgent medical attention in the event of symptoms such as redness or swelling at or near an injection site or other symptoms such as a high temperature, chills, or a severe headache, as early antibiotic treatment can be life saving.”

    Meanwhile the European Centre for Disease Prevention and Control has assessed the situation and says it is likely that additional cases will be identified in future in the UK, potentially in Germany, and in other parts of Europe.

    It has identified a number of measures in response to the problem, including increased awareness in hospitals and drug services to detect possible further cases and to provide information on the contaminated products. It is also seeking action at a national and European level to identify contaminated batches of heroin and limit the risk of further cases of anthrax infection.

    Anthrax is most commonly found in hoofed animals such as cattle, sheep, and goats in Asia or Africa. The heroin may have been contaminated at its probable original source in Afghanistan through contact with infected soil or animal skins.


    Cite this as: BMJ 2010;340:c937

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