Stephen Malloy  National Training/Development officer Critical Incidents [email_address]   May 2010 Co-ordinating Action o...
Why the briefing? <ul><li>Early Dec 2009- 1 st  identified cases of Anthrax infection in drug user in Glasgow. </li></ul><...
Latest figures across health board areas  <ul><ul><li>Confirmed cases in Scotland </li></ul></ul><ul><li>NHS Ayrshire and ...
What is Anthrax? <ul><li>Anthrax is a bacterial infection caused by the organism Bacillus anthracis. The disease occurs mo...
Who is affected? <ul><li>No specific profile  </li></ul><ul><li>Age range is from late 20’s – mid 50’s </li></ul><ul><li>M...
Routes of infection in drug users <ul><li>Definite route </li></ul><ul><li>Via injecting contaminated heroin into a vein (...
Increased risk of Anthrax infection from injecting practices? <ul><li>Injecting under skin or into muscle (also missing ve...
Barriers to presenting when symptomatic? <ul><li>Fear? </li></ul><ul><li>Stigma? </li></ul><ul><li>Failure to Identify Sig...
Signs/Symptoms of infection <ul><li>CURE  DEPENDS ON EARLY IDENTIFICATION AND TREATMENT </li></ul><ul><li>If injected into...
Signs/Symptoms of infection cont; <ul><li>FROM SMOKING/SNORTING </li></ul><ul><li>symptoms  may  begin with a flu-like ill...
Signs/symptoms cont.  *Sepsis <ul><li>•  Temperature above 38°C (101°F) or below 36°C (96°F) </li></ul><ul><li>•  Heart ra...
Action –  (what to do if someone has symptoms of Anthrax infection or other infection) <ul><li>STRONGLY advise to visit GP...
Other important information <ul><li>Minimal risk through intimate physical/sexual contact </li></ul><ul><li>Potential risk...
How Services can help <ul><li>DISCUSS RISKS WITH INJECTING DRUG USERS </li></ul><ul><li>Continue safer injecting advice (o...
Useful Links <ul><li>www.hps.scot.nhs.uk/anthrax </li></ul><ul><li>www.scottishdrugservicesdirectory.com </li></ul><ul><li...
Finally <ul><li>Thank you for your attention </li></ul><ul><li>Stephen Malloy </li></ul><ul><li>[email_address] </li></ul>...
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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

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Anthrax Presentation April9703

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

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