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Anthrax Presentation April9703

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Early version of the Anthrax briefing, delivered in response to the bactrial infection outbreak in injecting drug users in Scotland

Early version of the Anthrax briefing, delivered in response to the bactrial infection outbreak in injecting drug users in Scotland

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  • 1. Stephen Malloy National Training/Development officer Critical Incidents [email_address] May 2010 Co-ordinating Action on Drug Issues Scottish drugs Forum
  • 2. Why the briefing?
    • Early Dec 2009- 1 st identified cases of Anthrax infection in drug user in Glasgow.
    • 12 th Dec 2009- 1 st case of drug user dying as a result of Anthrax infection in Glasgow
    • By 20 st August 2010- Confirmed 47 cases of Anthrax infection across 8 HB areas in Scotland, with 13 of those infected now deceased.
    • 100+ Suspected/possible cases across Scotland
    • 3 confirmed cases in England, 2 deaths
    • 2 cases in Germany, 1 Death
    Scottish drugs Forum Co-ordinating Action on Drug Issues
  • 3. Latest figures across health board areas
      • Confirmed cases in Scotland
    • NHS Ayrshire and Arran – 1
    • NHS Dumfries and Galloway - 6
    • NHS Fife – 3
    • NHS Forth Valley – 1
    • NHS GG&C – 20
    • NHS Lanarkshire – 9
    • NHS Tayside – 5
    • NHS Lothian- 2
    • Deaths caused by Anthrax in Scotland
    • NHS Forth Valley – 1
    • NHS Fife - 1
    • NHS GG&C – 7
    • NHS Tayside – 2
    • NHS Lanarkshire- 2
    Scottish drugs Forum Co-ordinating Action on Drug Issues
  • 4. What is Anthrax?
    • Anthrax is a bacterial infection caused by the organism Bacillus anthracis. The disease occurs most often in wild and domestic animals in Asia, Africa and parts of Europe; humans are rarely infected. The organism can exist as spores that allow survival in the environment, e.g. in soil, for many years.
    Scottish drugs Forum Co-ordinating Action on Drug Issues
  • 5. Who is affected?
    • No specific profile
    • Age range is from late 20’s – mid 50’s
    • Majority of those infected have been long term injecting drug users
    • snorting/smoking as possible route of infection
    • Some linked to homelessness, but not all
    • To date, more men infected than women
    • We must reiterate that ALL forms of heroin use carry a risk of infection and no heroin can be considered free of contamination
  • 6. Routes of infection in drug users
    • Definite route
    • Via injecting contaminated heroin into a vein (or intending to inject into a vein and ‘missing’), injecting under the skin or into a directly into a muscle
    • Other routes
    • Inhalation- via smoking or snorting contaminated heroin
    • Ingestion- swallowing heroin (less common practice)
    Scottish drugs Forum Co-ordinating Action on Drug Issues
  • 7. Increased risk of Anthrax infection from injecting practices?
    • Injecting under skin or into muscle (also missing vein or experiencing ‘leakage’ known to increase risk for MANY infections
    • Excessive use of citric acid causes tissue/vein damage and increases risk of infections
    • Injecting contaminated heroin into a vein presents route for possible systemic (spread throughout) infection
    • Poor filtration or re using filters
    Scottish drugs Forum Co-ordinating Action on Drug Issues
  • 8. Barriers to presenting when symptomatic?
    • Fear?
    • Stigma?
    • Failure to Identify Signs/symptoms?
    • Being ‘struck off’ or substitute prescribing implications?
    • Poor experience of medical care/treatment?
    • Ambivalence?
    • Any others????
    Scottish drugs Forum Co-ordinating Action on Drug Issues
  • 9. Signs/Symptoms of infection
    • CURE DEPENDS ON EARLY IDENTIFICATION AND TREATMENT
    • If injected into a vein- flu-like illness (fever, headache, muscle aches ) which may develop into systemic infection. Can develop within 1-7 days
    • If injected under skin, into muscle or a vein ‘miss’ – same as above may be experienced, also ;
    • Severe soft tissue infection, could also include necrotizing fasciitis and Cellulitis, abscess and pronounced swelling
    • Signs of severe sepsis even without evidence of soft tissue infection*
    • Meningitis (especially haemorrhagic meningitis)
    • ON SKIN- 1-7 days after exposure a raised, itchy, inflamed pimple appears followed by a papule that turns vesicular (into a blister). Extensive oedema or swelling accompanies the lesion – the swelling tends to be much greater than would normally be expected for the size of the lesion and this is usually PAINLESS
    • If left untreated the infection can spread to cause blood poisoning
    Scottish drugs Forum Co-ordinating Action on Drug Issues
  • 10. Signs/Symptoms of infection cont;
    • FROM SMOKING/SNORTING
    • symptoms may begin with a flu-like illness (fever, headache, muscle aches and non-productive cough) followed by severe respiratory difficulties and shock 2-6 days later. Untreated disease is usually fatal, and treatment must be given as soon as possible to reduce mortality. (GGCHB-Jan 2010)
    Scottish drugs Forum Co-ordinating Action on Drug Issues
  • 11. Signs/symptoms cont. *Sepsis
    • • Temperature above 38°C (101°F) or below 36°C (96°F)
    • • Heart rate above 90 beats per minute
    • • Breathing more than 20 breaths per minute
    • • Low blood pressure
    • • Decreased urine output
    • • Change in mental status with confusion or delirium
    • ( Hildreth C J; Cassio L; Richard M. Glass M R., JAMA, June 17, 2009—Vol 301, No. 23)
    Scottish drugs Forum Co-ordinating Action on Drug Issues
  • 12. Action – (what to do if someone has symptoms of Anthrax infection or other infection)
    • STRONGLY advise to visit GP or A&E urgently – assist in accessing these services
    • Accompany to hospital or GP where possible
    • Try to arrange for family member or friend to accompany
    • *Early diagnoses and treatment can save lives!!
    Scottish drugs Forum Co-ordinating Action on Drug Issues
  • 13. Other important information
    • Minimal risk through intimate physical/sexual contact
    • Potential risk from touching skin lesions, especially where open wound is present
    • Minimise risk of infection further by:
    • Avoiding contact with leaking or dried out wounds or abscesses
    • Keeping them covered
    • Clean up any leakages with domestic bleach or suitably diluted disinfectant
    Scottish drugs Forum Co-ordinating Action on Drug Issues
  • 14. How Services can help
    • DISCUSS RISKS WITH INJECTING DRUG USERS
    • Continue safer injecting advice (one hit kits (if available), no sharing of injecting equipment (or drugs?), spoons, filters or water, filtration etc)
    • Encourage injecting users to limit use of citric acid
    • Offer/support quick access to individually tailored and effective treatment programs
    • Review whether dosage levels of those on substitute prescribing are adequate to reduce the risk of “topping up” with street heroin
    Scottish drugs Forum Co-ordinating Action on Drug Issues
  • 15. Useful Links
    • www.hps.scot.nhs.uk/anthrax
    • www.scottishdrugservicesdirectory.com
    • www.scottishdrugsforum.org.uk
    Scottish drugs Forum Co-ordinating Action on Drug Issues
  • 16. Finally
    • Thank you for your attention
    • Stephen Malloy
    • [email_address]
    Scottish drugs Forum Co-ordinating Action on Drug Issues

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