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Anthrax Outbreak December 2009 - December 2010

13 March 2013

This webpage summaries the events associated with the investigation and management of the anthrax outbreak involving drug users in Scotland between December 2009 and December 2010. The resources and guidance below were prepared in response to the outbreak. Some of these resources have been updated in light of new cases since June 2012 in Scotland, England, Germany, Denmark and France. For these updated resources and guidance on managing anthrax infection in PWID see here: Guidance for managing anthrax among people who inject drugs.

Outbreak report

• An Outbreak of Anthrax Among Drug Users in Scotland, December 2009 to December 2010.
  A report on behalf of the National Anthrax Outbreak Control Team

The following resources where developed and used during the outbreak to provide advice and guidance to those managing the outbreak.

General Resources

• Anthrax in drug users: Questions and Answers HPS, Version 1, 18 January 2010 (95 KB )
• Anthrax Alert Poster 13 January 2010 (869 KB ) (updated version now available on the Scottish Drugs Forum website)
• Drug Users Information on Anthrax 13 January 2010 (1.02 MB ) (updated version now available on the Scottish Drugs Forum website)
• Anthrax and Heroin Users: What Workers Need to Know Scottish Drug Forum (SDF) 01 February 2010 (67 KB ) (updated version now available on the Scottish Drugs Forum website)

Guidance for Health Professionals

General

• CMO letter 'Outbreak of Anthrax Infections in Heroin Injecting Drug Users' 28 January 2010 (external website)
• CMO letter 'Outbreak of Anthrax Infections in Heroin Injecting Drug Users' 22 January 2010 (external website)
• CMO letter 'Outbreak Of Anthrax Infections In Heroin Injecting Drug Users' 11 January 2010 (external website)
• Ramsay CN, Stirling A, Smith J, Hawkins G, Brooks T, Hood J, Penrice G, Browning LM, Ahmed S, on behalf of the NHS GGC, on behalf of the Scottish National Outbreak Control Teams. An outbreak of infection with Bacillus anthracis in injecting drug users in Scotland. Euro Surveill. 2010;15(2):pii=19465. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19465

Case Investigation

• HPS Anthrax Questionnaire Drug related incidents in Scotland HPS, Version 3, 26 January 2010 (141 KB )

Case Management

• HPS-HPA SPRU Case Definitions Mapping HPS, Version 4, 01 June 2010 (252 KB )
• Interim Clinical Guidance for the Management of Suspected Anthrax in Drug Users HPS, Version 12.1, 19 Mar 2010 (235 KB )
• Clinical Algorithm - Clinical Evaluation and Management of Drug Users with Possible Anthrax HPS, Version 12, DRAFT, 17 Mar 2010 (54 KB )
• Algorithm for the Clinical Evaluation and Management of Persons with Possible Cutaneous Anthrax
  HPS, Version 1.1, 13 January 2010 (116 KB )
• Case Definitions for Anthrax in Drug Users HPS, Version 5, 13 January 2010 (95 KB )

Infection Control

• Infection Control Precautions during the Clinical Management of Drug Users with Probable or Confirmed Anthrax
  HPS, Version 0.7, 18 January 2010 (63 KB )
• Controlling the risks of infection at work from human remains HSE (external website)
• Infection at Work: controlling the risks HSE (external website)
• Safe working and prevention of infection in mortuary and post mortem room HSE (external website)
  [Note access to this resource can also be obtained through Barbour Environment, Health and Safety]

Laboratory Investigation

• Laboratory Investigation of Possible Anthrax in Drug Users HPS, Version 1,18 January 2010 (487 KB )

Forensic Investigation

• Risk Assessment for forensic investigation of drug-related Anthrax HPA, 15 January 2010
• Centers for Disease Control and Prevention. Medical examiners, coroners, and biologic terrorism: a guidebook for surveillance and case management. MMWR 2004;53(No. RR-8)(external website)
• Guidance on Post Mortem Examination of Possible, Probable and Confirmed Cases of Anthrax, HPS, Version 5.1, 21 December 2011 (61 KB ).

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