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  1. chillinwill
    Heroin addicts facing ‘deadly threat’

    A WOMAN who injected heroin was being treated for the effects of anthrax today following the death of another drug user.

    Health officials in Glasgow believe the two patients who tested positive for anthrax may have taken contaminated heroin.

    A man died at the city’s Victoria Infirmary on Wednesday, where the woman is now being treated.

    Doctors are waiting for test results of a third drug user at Glasgow Royal Infirmary, although they are not yet linking the cases.

    Anthrax is a bacterial infection and occurs mostly in animals in Asia and Africa, with humans rarely infected.

    An outbreak control team set up by the Greater Glasgow and Clyde Health Board was due to meet today.

    Public health consultant Dr Syed Ahmed said all health agencies working with people who inject themselves have been advised.

    He said the anthrax risk to the general public was “negligible” but all drug-injecting heroin users should seek urgent medical advice if they experience an infection.

    “It is extremely rare for anthrax to be spread from person to person and there is no significant risk of airborne transmission from one person to another,” he said.

    The health board is working with the Procurator Fiscal and Strathclyde Police to identify the source of the anthrax.

    One possibility being investigated is that contaminated heroin, or a contaminated agent used to cut the heroin, may be to blame.

    Heroin is often sourced from countries where anthrax is more prevalent in animals.

    Bone meal is sometimes used as a cutting agent.

    December 18, 2009
    Evening Express
    http://www.eveningexpress.co.uk/Article.aspx/1531757?UserKey=

Comments

  1. anonuser30500
    Wow, if this had not been a heroin addict we might have had front page coverage, perhaps with hints at 'terrorism'.

    News sounded familiar and Swim found this...

    From the New Scientist, May 2000...

    "ANTHRAX is now a prime suspect in a spate of deaths among heroin addicts in Europe. Tests at Britain's lab for dangerous pathogens at Porton Down have found signs of anthrax infection in two Scottish victims. Nine more Scots are ill, and doctors fear the disease—which is hard to monitor among drug users—may be far more widespread.

    "Heroin can contain almost anything in small amounts," says Les King of the Forensic Science Service, which analyses seized heroin in Britain. But no one checks it for infectious agents, he notes. "There could be a long history of this, and we just haven't observed it till now."


    Ten addicts in Glasgow and Aberdeen have died over the past few weeks after injecting the drug into muscle, rather than their veins. They developed a painless, pus-free lesion at the injection site, then died hours after the appearance of more general symptoms including severe oedema, leakage of fluids around the heart and lungs, and soaring white blood cell counts.


    No one knew of a possible contaminant in heroin that could be to blame. But now the spotlight is on anthrax, following the appearance of an anthrax case history on ProMED, the Internet forum for emerging diseases. Per Lausund of the Norwegian Army Medical School posted details of an Oslo addict who died in April after injecting heroin into muscle. He developed an abscess, then fell into a coma 10 days later. After antibiotics failed to save him, tests showed anthrax bacilli in his spinal fluid, which was confirmed by DNA analysis.


    Now scientists at Porton Down have tested blood samples from five Scottish victims. Two tested positive for "protective antigen", the main anthrax toxin. "Nothing else would give that result," says Phil Hanna, an anthrax expert at the University of Michigan at Ann Arbor, who says the symptoms are also typical of anthrax.


    Anthrax bacilli have not shown up in any of the blood samples, but that does not rule out infection. "Antibiotics can wipe out circulating anthrax bacilli, making diagnosis very difficult," says Martin Hugh-Jones of Louisiana State University, who investigated a 1979 anthrax outbreak in Russia. The circulating toxins can still kill patients, even though the bacteria have gone.


    Chris McGuigan of the Greater Glasgow Health Board adds that at least one sufferer in Scotland, who is still alive, has the black scab typical of localised anthrax infection.
    The link with injecting into muscles, rather than veins, is also consistent with an anthrax diagnosis, says Hanna. Infection spreads only when anthrax spores are consumed by macrophages, the roving white blood cells that eat bacteria. They do this much more effectively in muscle than in blood. Hanna adds that intravenous users may succumb later if spores encounter macrophages in the spleen.


    As New Scientist went to press, the Glasgow Health Board was still undecided. "We do not discount anthrax, but we have so far failed to find the bacilli," says Syed Ahmed of the Health Board. It is also considering necrotising fasciitis, or "flesh-eating disease", as some of its symptoms are similar. While investigations continue, addicts have been advised to smoke heroin rather than inject it. No one else is at risk, as neither disease passes from person to person.


    Anthrax is endemic in Pakistan, Afghanistan and Iran, where most of Europe's heroin originates. Hugh-Jones says animal-derived material from the region, such as gelatin or bone meal, may well be contaminated with spores. Such material could have found its way into heroin.


    The National Institute of Public Health in Oslo warns that further cases may occur elsewhere. But addicts might not come forward for treatment, says Hugh-Jones. Many cases may not even be noticed, he adds, because deaths among heroin users are relatively commonplace."
  2. Utsire
    We've had the alert from the Department of Health. It gives some initial symptoms:

    Q6. What are the symptoms?
    A6. Early identification of anthrax can be difficult as the initial symptoms are similar to other illnesses.
    Cutaneous anthrax - Local skin involvement after direct contact.
    · Commonly seen on hands, forearms, head and neck. The lesion is usually single
    · 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
    · The blister then ulcerates and then 2-6 days later the classical black eschar develops
    · If left untreated the infection can spread to cause blood poisoning
  3. chillinwill
    Heroin Addict #2 Killed By Anthrax

    A SECOND heroin junkie has died after injecting an anthrax-infected batch of the drug - and another suspected victim has lost his fight for life.

    Health chiefs last night confirmed the two addicts had passed away in the past 48 hours.

    We exclusively revealed last week how the first victim, a 37-year-old man being treated in Glasgow's Victoria Infirmary, was killed by the deadly bug. The two surviving confirmed anthrax patients were last night responding well to treatment.

    Health bosses in Glasgow and Lanarkshire are working with cops to identify the source of the contamination. Dr Syed Ahmed, consultant in public health medicine, said: "I urge all drug injecting heroin users to be alert and to seek urgent medical advice if they experienced an infection."

    By GAIL CAMERON
    December 23, 2009
    The Scottish Sun
    http://www.thesun.co.uk/scotsol/hom...n-addict-number-two-is-killed-by-anthrax.html
  4. chillinwill
    Second heroin user anthrax death

    Health officials have confirmed that a second heroin user, who tested positive for anthrax, has died.

    The man was being treated at Glasgow Royal Infirmary. Last week, a man with the infection died in the city's Victoria Infirmary.

    A woman who tested positive for anthrax is also being treated there. A further drug user has died but tests have yet to confirm the presence of anthrax.

    Meanwhile, a fourth case of anthrax has been confirmed in Lanarkshire.

    The patient, who is a drug-injecting heroin user, is being treated at Monklands District General Hospital.

    Dr Syed Ahmed, consultant in public health medicine, said: "There have been no new drug injecting heroin users with infections admitted to hospitals in the west of Scotland since the weekend.

    "I urge all drug injecting heroin users to be extremely alert and to seek urgent medical advice if they experience an infection.

    Contaminated batch

    "Drug injecting is extremely risky and dangerous. The possible presence of a batch of heroin contaminated with anthrax makes drug injecting even riskier and even more dangerous."

    Anthrax is an acute bacterial infection most commonly found in hoofed animals such as cattle, sheep and goats.

    It normally infects humans when they inhale or ingest anthrax spores, but cannot be passed from person to person.

    The last previous death from anthrax in Scotland was in 2006 when Christopher Norris died after inhaling the spores.

    The 50-year-old craftsman, from Stobs, near Hawick, made drums with materials such as untreated animal hides.

    December 23, 2009
    BBC News
    http://news.bbc.co.uk/2/hi/uk_news/scotland/glasgow_and_west/8429032.stm
  5. chillinwill
    Heroin user 'negative' for anthrax

    Tests being carried out on a heroin user for anthrax poisoning are so far proving negative, health officials said.


    It had been feared the unidentified male in Cumbria had the disease after injecting from a contaminated batch of the class-A drug.

    There have been two confirmed deaths of drug users in Scotland with anthrax, and tests are ongoing on a third who officials believe died after taking contaminated heroin.

    The unidentified injecting heroin user in England was admitted to Carlisle's Cumberland Infirmary on Christmas Day.

    Blood tests have been conducted on the man who was suffering skin lesions, a typical symptom of anthrax poisoning.

    But initial laboratory tests conducted over the weekend have not shown the presence of anthrax in the Carlisle patient.

    Dr John Ashton, director of Public Health at NHS Cumbria, said: "This is encouraging news but injecting drug users in Cumbria should not let their guard down.

    "Anyone who injects drugs and experiences any unusual symptoms such as swelling or pain at the injection site should seek medical help immediately as anthrax can be lethal."

    December 27, 2009
    Maghull & Aintree Star
    http://www.maghullstar.co.uk/maghul...in-user-negative-for-anthrax-104897-25476569/
  6. chillinwill
    Another Death Attributed to Anthrax in Heroin

    Doctors in Scotland have confirmed another heroin related death in which the drug was contaminated with anthrax, bringing the number of such cases to three.

    So far five people have been identified to have used the anthrax laced heroin with just two of them responding to the treatment. The first death due to the infection was reported at the Glasgow's Victoria Infirmary while two more patients lost their lives at the Royal Infirmary.

    Dr Syed Ahmed, who is a consultant in public health medicine, revealed that drug users who experience infections should immediately seek medical advice.

    “Drug injecting is extremely risky and dangerous. The possible presence of a batch of heroin contaminated with anthrax makes drug injecting even riskier and even more dangerous. I urge all drug injecting heroin users to be extremely alert and to seek urgent medical advice if they experienced an infection”, Dr Ahmed added.

    December 31, 2009
    Med India
    http://medindia.net/news/Another-Death-Attributed-to-Anthrax-in-Heroin-63041-1.htm
  7. chillinwill
    'Anthrax heroin' cases spreading

    Health officials believe contaminated heroin - thought to be responsible for cases of anthrax in Glasgow - may be circulating elsewhere in Scotland.


    It comes after the death of two more drug users with the infection in Glasgow and Tayside.

    A total of 11 cases have now been confirmed in Tayside, Glasgow and Lanarkshire with five fatalities.

    Test results are being awaited from a female patient in Fife who is currently under investigation for anthrax.

    The 11 confirmed cases of anthrax occurred in a male patient in NHS Tayside, three male patients in NHS Lanarkshire and four men and three women in NHS Greater Glasgow & Clyde.

    'Potentially dangerous'

    Health officials believe that contaminated heroin or a contaminated cutting agent mixed with the heroin may be responsible for the infections.

    Dr Colin Ramsay, consultant epidemiologist at Health Protection Scotland, said: "Evidence now suggests that potentially contaminated heroin may be in circulation in other parts of Scotland, not just the Glasgow area.

    "All heroin users need to be aware of the risks contaminated heroin is potentially dangerous taken by any route, not just injection.

    "I would advise heroin users to stop using heroin and seek advice from local harm reduction and drug services for support."

    January 6, 2010
    BBC News
    http://news.bbc.co.uk/2/hi/uk_news/scotland/glasgow_and_west/8443809.stm
  8. johnnyyen
    a tragic situation..Johnny would like to ask Dr Colin Ramsey about how he would provide the 'support' he mentions with the waiting lists for treatment services being months long in some areas??..perhaps the good doctor would be happy to scribe some uncontaminated heroin in the mean time??..
  9. catseye
    Also there is apparently one confirmed case in Sterling, with others being tested...

    Ahhh spoken like a true soldier of the drug war, Dr Ramsay...*rolls eyes because we all know it's just THAT simple*
  10. JessRobinson3
    Bad batch of Heroin Cut with Anthrax!

    Health officials say contaminated heroin may have caused at least a dozen recent cases of anthrax including six deaths in Glasgow.
    The rising toll has prompted Health Protection Scotland, the national agency for protecting the public from infectious and environmental hazards, to issue a warning to all heroin users to stop using the drug, regardless of whether they inject it or take it by other means.
    Officials told the Times of London that the risk to others, including immediate family members of those infected, remained low.
    Police and doctors believe contaminated heroin or heroin mixed with a contaminated cutting agent could be responsible for the cases, which began to come to light three weeks ago.
    Anthrax is an acute bacterial infection most commonly found in hoofed animals such as cattle, sheep and goats. It usually infects humans when they inhale or ingest anthrax spores, but cannot be passed from person to person.
    "Evidence now suggests that potentially contaminated heroin may be in circulation in other parts of Scotland, not just the Glasgow area," said Dr. Colin Ramsay, consultant epidemiologist at Health Protection Scotland, referring to the country's most populous city.
    Signs of infection include soreness at the injecting site developing into redness and then spreading into a black "scar." If not treated the infection can spread into the blood and other organs.
    Gordon Meldrum, director general of the Scottish Crime and Drug Enforcement Agency, and drugs spokesman for the Association of Chief Police Officers in Scotland, said a major national investigation had been launched into the latest deaths.
    "The deaths associated with anthrax are disturbing and are being treated very seriously by all the relevant authorities," he said.
  11. chillinwill
  12. Motorhead
    Re: Bad batch of Heroin Cut with Anthrax!

    Hello JessRobinson3, thank's for posting your article.

    Please note that the way we post news has changed, because of our main news page.

    The most important changes are:


    • Articles are no longer posted in quotes.
    • The introduction of the article should be in bold.
    • Images should be added if possible and placed in the article, following the instructions linked to above and here.
    • Information about the article, like link, author, date should be posted below the article.
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  13. Terrapinzflyer
    France alarmed over anthrax-tainted heroin in Europe

    PARIS — The French health ministry issued a warning on Tuesday after eight people died and seven fell sick in two European countries from using heroin contaminated by anthrax.

    "Since December 6, there have been 15 confirmed cases of anthrax among heroin users, 14 in Scotland and one in Germany," the ministry's General Directorate for Health (DGS) said in a statement.

    "Eight people died," it said. "The likeliest source is heroin contaminated by anthrax spores."

    Most of the casualties had injected the heroin, but others also inhaled it or smoked it.
    Anthrax is a potentially lethal bacterium that exists naturally in the soil and can also occur among cattle. It is also, more notoriously, a potential bio-terror weapon.

    The ministry said the contaminated drug may also be circulating in France and other European countries.

    "There is no outward sign or colour enabling the user to tell whether the heroin has been contaminated by anthrax, and contaminated heroin dissolves or is used in the same way as uncontaminated heroin," it said.

    AFP
    January 19 2010

    http://www.google.com/hostednews/afp/article/ALeqM5jANqUgbmrlnbml5uS09QMjWqxDCQ
  14. heronlysin
    Has there been anything said about London so far ? This is, obviously, pretty damn scary...
  15. chillinwill
    Anthrax-Tainted Heroin Linked to 10th Drug-User Death in Europe

    Doctors probing an anthrax outbreak among heroin users in Europe identified the first of 10 fatal cases, widening the hunt for the source of the tainted drug.


    Health Protection Scotland confirmed yesterday an anthrax infection in a heroin user who died in the Glasgow area on Dec. 12. The first death was previously reported to have occurred in the city’s Victoria Infirmary on Dec. 16.

    At least 18 drug users in Scotland and one in Germany have been infected in the outbreak, probably from injecting or smoking heroin contaminated by anthrax spores. Health Protection Scotland said in a statement yesterday that there is no evidence of person-to-person transmission of the bacterium, which killed five people in the U.S. in a 2001 anthrax attack.

    “While public health investigations are continuing to attempt to identify the source of the contamination, no drug samples tested to date have shown anthrax contamination, although a number of other types of potentially harmful bacteria have been found,” Colin Ramsay, an agency epidemiologist, said in the statement. “It must therefore be assumed that all heroin in Scotland carries the risk of anthrax contamination and users are advised to cease taking heroin by any route.”

    The risk to the general public is “very low,” Ramsay and colleagues said in a Jan. 14 study in the journal Eurosurveillance. About 55,000 people in Scotland use illicit drugs, including heroin.

    Flesh-Eating Disease

    The anthrax-infected patients mostly had inflammation or abscesses around the injection site at least one or two days following administration of the opiate and were hospitalized about four days later, according to the study. In the most severe cases, the lesions developed a flesh-eating disease known as necrotising fasciitis.

    Anthrax mostly occurs in wild and domestic animals such as cattle, sheep, goats, camels and antelopes, according to the Centers for Disease Control and Prevention in Atlanta. It can infect the skin, lungs and digestive system of humans when they are exposed to infected animals or infected animal tissue.

    The disease can be fatal if it isn’t treated early with effective antibiotics, the CDC said. Anthrax bacteria are found globally, especially in developing countries in South and Central America, Southern and Eastern Europe, Asia, Africa, the Caribbean and the Middle East.


    Jason Gale
    January 30, 2010
    Business Week
    http://www.businessweek.com/news/20...linked-to-10th-drug-user-death-in-europe.html
  16. BA
    Anthrax Heroin Toll Rises as England Marks First Death

    English authorities announced Wednesday that a Blackpool heroin user died of anthrax, making him the first fatality in England from what is apparently a batch of heroin contaminated with anthrax. The bad dope has been blamed for nine deaths in Scotland and one in Germany since the outbreak began in December.
    The anthrax fatality announcement from the National Health Service (NHS) in Blackpool came just five days after the Health Protection Agency issued a statement warning that a female heroin user in London had been hospitalized with anthrax.
    The spate of anthrax cases among heroin users is baffling police and health experts, who have yet to actually come up with any heroin samples containing anthrax spores. There is speculation that the heroin could have been contaminated at its likely source in Afghanistan, perhaps from contaminated soils or animal skins, or that it was present in a cutting agent added there or at some other point on its transcontinental trek to northern Europe.
    The cases in Germany and England have no known link to those in Scotland, leading to fears that tainted dope could be widespread. On the other hand, the numbers infected remain relatively small.
    Although harm reductionists and drug user advocates have called for measures including public information campaigns among users, swift access to drug treatment, and making prescription heroin more widely available, British health officials continue to do little more than tell users to quit. Dr. Arif Rajpura, director of public health at NHS Blackpool, was singing from the same official hymnal this week.
    He repeated warnings for users to stop using and advised them to be on the lookout for symptoms of anthrax, including rashes, swelling, severe headaches, and high fevers. "Heroin users are strongly advised to cease taking heroin by any route, if at all possible, and to seek help from their local drug treatment services. This is a very serious infection for drug users and prompt treatment is crucial," he said.
  17. Terrapinzflyer
    Re: Anthrax Heroin Toll Rises as England Marks First Death

    see also: Heroin alert as anthrax linked to drug user’s death


    Thanks for posting this.

    Please note that the way we post news has changed, because of our main news page.

    The most important changes are:


    • Articles are no longer posted in quotes.
    • The introduction of the article should be in bold.
    • Images should be added if possible and placed in the article, following the instructions linked to above and here.
    • Information about the article, like link, author, date should be posted below the article.
    • Your personal comments about the article can be posted either in quotes at the end of the article or in a separate post.
    • The news forums may contain news articles only.
  18. BA
    Re: Anthrax Heroin Toll Rises as England Marks First Death

    Thanks for the heads up.
  19. 10outof10
    Re: Anthrax Infected Heroin

    24 cases of anthrax have been confirmed in Scotland as of today with sadly the number of deaths totalling 10.

    Anthrax can be cured if treatment is started at an early stage


    There's really useful information contained in the Scottish drug Forums site, including free download of the latest leaflet. Here's the link http://www.sdf.org.uk/sdf/CCC_FirstPage.jsp


    here's the link for the scottish equivalent of hpa for up-to date statistics:


    http://www.hps.scot.nhs.uk/anthrax/index.aspx



    10outof10 added 17 Minutes and 50 Seconds later...

    Ps As SWIY-helene mentioned, it would be interesting to find out how many cases are IV users and how many are smokers. SWIM believes most cases were injecting users as far as she knows. Infection at the injection site has been the most common presentation in this outbreak. According to SDF/NHS :

    Infection among heroin users is most likely to be acquired through:

    - spores entering the skin or tissues under the skin such as fat or muscle,
    including via injecting contaminated heroin into the body
    - breathing in spores while smoking or snorting contaminated heroin
    (inhalation).

    Information from the current outbreak in Scotland is still emerging so it is
    difficult to say definitely who is particularly at risk.

    • All 16 confirmed cases have a history of recent heroin use
    • Some have deliberately injected into veins or to muscle - or accidentally
    injected into muscle or the fatty tissue just beneath the skin
    • Some may have smoked or snorted heroin
    • Some have been homeless, others were in settled accommodation
    • Some – not all - have been on methadone treatment
    • Ages range from late 20s to mid 50s
    • More men have been affected (11) than women (4)

    Because the picture is very mixed so far, public health experts say that all forms
    of heroin use carry a risk of infection if the heroin is contaminated with anthrax.
    No heroin can be considered safe.

    Some – but not all - of the anthrax survivors in Scotland reckon the heroin they
    used was darker in appearance, but that may not be the case every time. This is
    not a reliable guide to which heroin is more dangerous.

    The full leaflet is available for download at the above link for SDF.
  20. h2uk
    Re: Anthrax Infected Heroin

    Communicated by:
    ProMED-mail
    ==================================================

    Heroin is often produced in regions of the world where anthrax is
    rather common in animals. In order to manufacture the drug, animal
    bone meal is occasionally used as a cutting substance. Bone meal,
    made from crushed and coarsely ground animal bones, is predominantly
    used as an organic fertiliser.


    While contaminated bone meal is a natural suspect, colleagues with
    more knowledge of recreational drugs than myself say that any
    non-soluble residue would be noticed by the users and generate very
    negative attitudes towards their suppliers. Also if bone meal were
    used further back in the processing chain, the probability would
    exist of many more sick heroin addicts than just these in Glasgow.
    The results of the ongoing international investigations are awaited. - Mod.MHJ]

    ------------------------------------------------

    From the ancillary information provided by the BBC, we might
    speculate that the 24-year-old's dealer was the 36 year old Blackpool
    woman, possibly on evidence provided by the other 2 individuals from
    Liverpool and Blackpool respectively. Multiple deliveries of the
    original contaminated material in Glasgow have been made, and on that
    basis, other cases elsewhere in England can be expected. - Mod.MHJ]

    -----------------------------------------------------------------------------------------------------


    [This slow trickle of new cases is what we can expect for some 4-6
    months until they cease. - Mod.MHJ]


    One of the problems with cutaneous anthrax is the black escar, and
    those not used to seeing cases take it as pathognomonic.
    Unfortunately, staph skin infections can and do produce a similar
    appearance, thus the necessity of getting laboratory confirmation.
    Something else to keep very much in mind is that these heroin-related
    infections from injecting a mess of soluble acidic chemicals result
    in extensive deep tissue necrosis.

    Injection infections are not uncommon with heroin addicts and usually
    involve surface pathogens and clostridia. There is an awareness now
    in the UK to think one step further on the assumption that singular
    cases of anthrax may be occurring and are being missed. However these
    bacillus spores get into the cut drug, it is probable that the mixing
    is by hand. This will result in an uneven mix such that some addicts
    will get no spores, others large acutely lethal doses, and the
    majority something in between. When there is a cluster of cases,
    their geographic and temporal proximity make it easy to recognize an
    unusual event. But when they are strung out -- as in one here, one
    there, a swollen injection site somewhere else, and maybe a number of
    just happy addicts -- the existence of such a contaminated product
    can be hard to perceive and observe.

    If you add to that the empirical treatment with antibiotics by a GP
    prior to the individual presenting himself or herself at their local
    hospital, you have further reduced the chances of recognition.

    At the start, the reports were optimistic about the survival of cases
    after the index lethal case. To date, the lethality rate is 60
    percent. Normally, cutaneous anthrax cases have a CFR of 0-10
    percent. This should bring home the appreciation that these
    heroin-related cases are not your usual occupational cutaneous
    infections resulting from the contamination of a scratch.

    -------------------------------------------------------------------------------------------

    Taking into account that there are some 50 000 heroin addicts in
    Scotland and the majority are in the Glasgow <-> Edinburgh corridor,
    Scotland clearly got off very lightly. The spatial distribution and
    paucity of cases suggests a chunky contamination unevenly distributed
    in the product, that is, the affected were not just getting a
    collection of individual spores, occasionally acquiring too many, but
    more likely there were small chunks of stuff with spores imbedded in
    them, rather like the lanolin chunks with spores that you find in
    contaminated wool. Most didn't get them but sometimes someone did, and
    when they do there are a lot of spores.

    The Scottish authorities have yet to identify any spore-positive
    heroin samples. However they have had cases who had shared their
    heroin with others but only the individual case was affected. The
    apparently unaffected are being followed up.


    -------------------------------------------------------------------------------------------

    [Many people, professional medics and vets included, think that
    _Bacillus anthracis_ infections are easy to diagnose. I wish that
    were so. My late lamented Russian colleague claimed that they could only
    culture some 30 percent of the human cases they saw.
    And the Russians see more than most, unfortunately.
    We have found over the years of field investigations that it is not
    unusual for a veterinary diagnostic lab to come up with negatives of
    patently obvious cases with prior positives. PCR analyses are a great
    help in this field. And remember that some 5-9 percent of all
    cultures will be penicillin resistant and/or phage resistant. It is
    only in textbooks that it is simple.


    -------------------------------------------------------------------------------------------

    At this time 9 suspicious heron-related deaths are being reported in
    Coimbra, Portugal, but that means nothing until there is confirmation other
    than there is widespread awareness of the risk in Europe. As heroin in the
    Americas does not come from Afghanistan the perception of risk in the
    Americas is seen as minimal for the present.

    -----------------------------------------------------------------------------------------------
    Given the confirmation of cases outside the Glasgow conurbation, the
    outbreak investigation has now been upgraded to a national OCT [outbreak
    control team], coordinated by Health Protection Scotland. Representatives
    of agencies working with drug users have also been co-opted to the national
    OCT including the Scottish Drugs Forum and Scottish Drug Deaths Forum. The
    most likely cause of the outbreak is considered to be exposure by injection
    (or other routes) to heroin either directly contaminated at the source or
    contaminated as a result of mixing with other substances contaminated with
    anthrax at some point in the supply chain. The distribution of cases
    suggests either that small batches of contaminated heroin may still be
    circulating in Scotland or that there is a continuing source of
    contamination in material used to cut (dilute down) the heroin before
    supply to end users. Further investigations are proceeding to try to trace
    the supply network and validate the existing hypothesis.

    Risk assessments have been undertaken regarding the potential risks to
    others including health service staff, police and others involved in
    searching premises and in handling the cases and belongings. To date, there
    has been no evidence to suggest a risk to the general public or any other
    parties who have had access to clothing, belongings or the living quarters
    of cases. No special protective measures are, therefore, being advised at
    present, and there are no plans to decontaminate any such personal items or
    premises, on the basis that the risk to date has been confined to an
    association with personal intake of heroin, not other casual exposure
    --------------------------------------------------------------------------------------------------------
    Archive Number 20100120.0231
    Published Date 20-JAN-2010

    Progress of investigation

    Given the confirmation of cases outside the Glasgow conurbation, the
    outbreak investigation has now been upgraded to a national OCT [outbreak
    control team], coordinated by Health Protection Scotland. Representatives
    of agencies working with drug users have also been co-opted to the national
    OCT including the Scottish Drugs Forum and Scottish Drug Deaths Forum. The
    most likely cause of the outbreak is considered to be exposure by injection
    (or other routes) to heroin either directly contaminated at the source or
    contaminated as a result of mixing with other substances contaminated with
    anthrax at some point in the supply chain. The distribution of cases
    suggests either that small batches of contaminated heroin may still be
    circulating in Scotland or that there is a continuing source of
    contamination in material used to cut (dilute down) the heroin before
    supply to end users. Further investigations are proceeding to try to trace
    the supply network and validate the existing hypothesis.

    Risk assessments have been undertaken regarding the potential risks to
    others including health service staff, police and others involved in
    searching premises and in handling the cases and belongings. To date, there
    has been no evidence to suggest a risk to the general public or any other
    parties who have had access to clothing, belongings or the living quarters
    of cases. No special protective measures are, therefore, being advised at
    present, and there are no plans to decontaminate any such personal items or
    premises, on the basis that the risk to date has been confined to an
    association with personal intake of heroin, not other casual exposures.

    Discussion
    ----------
    Although rare, outbreaks or cases of illness among injecting drug users
    (IDUs) have been documented in recent years. In 2000, an outbreak among
    IDUs, involving 60 cases and 20 deaths, occurred in Scotland. The most
    frequently isolated pathogen among the cases was _Clostridium novyi_, and
    transmission was believed to have occurred via a contaminated batch of
    heroin [2,3]. Similarly in 2000, a case of injectional anthrax was
    identified in a heroin-injecting drug user in Norway. A contaminated batch
    of heroin was believed to be the source of the infection [4].

    Between December 2003 and April 2004, reports of _C. hystoliticum_ from 12
    cases of infection in IDUs were identified in England and Scotland. Again,
    it was believed that the source of the infection was a contaminated batch of heroin distributed across the UK [5].

    Setting an appropriate diagnostic threshold for this outbreak is a
    challenge in that about 34 per cent of IDUs per year report signs of an
    infected injection site. Hence, wound infections in this population are not
    unusual. However, none of the cases have presented with a classical
    cutaneous anthrax pattern. It is perhaps surprising given the source and
    nature of heroin preparation and anecdotal reports that heroin is
    transported in animal skins that more cases of infections in heroin users
    has not been identified before now.


    ******
    Date: 18 Jan 2010
    Source: Dumfermlinepress [edited]

    Fife police have seized more than GBP 10 000 [USD 16 300] of heroin dumped
    in Inverkeithing after an anonymous tip-off from a local resident. The
    force acted on information that there was a suspicious number of packages
    located on open ground in Inverkeithing and moved to recover the items. The
    incident occurred last Friday afternoon, and the force is currently
    investigating how the drugs came to be in the location and who they belong too.

    Head of South West Fife Villages CID, DI Derek McEwan, said, "Thankfully
    these drugs were able to be removed from circulation prior to exposing any
    member of the public, whether it be adult or child, to the hazards of
    coming into contact or taking this particular type of drug. I would
    emphasise to any member of the public who believes they know the
    whereabouts of any controlled drugs or persons involved in that drug trade
    to contact Fife police, as we are committed to reducing the harm caused by
    illegal drugs."

    ============================================================

    From MERCK . com website

    Inhalation Anthrax (Woolsorter's Disease): This form is the most serious. It results from inhaling anthrax spores. Spores may stay in the lungs for weeks but eventually enter white blood cells, where they germinate, and the resulting bacteria multiply and spread to lymph nodes in the chest. The bacteria produce toxins that make the lymph nodes swell, break down, and bleed, spreading the infection to nearby structures. Infected fluid accumulates in the space between the lungs and the chest wall.

    Diagnosis

    Samples from infected skin, fluids around the lungs, or stool are removed and examined with a microscope or cultured (enabling bacteria, if present, to multiply). Anthrax bacteria, if present, can be readily identified. If people have inhalation anthrax, doctors may also take samples of the sputum or blood or do a spinal tap (lumbar puncture) to obtain a sample of the fluid that surrounds the brain and spinal cord (cerebrospinal fluid). The samples are examined and analyzed. Blood tests may be done to check for fragments of the bacteria's genetic material or antibodies to the toxins produced by the bacteria.

    If inhalation anthrax is suspected, chest x-ray and computed tomography (CT) are done.

    Treatment
    *
    Inhalation or gastrointestinal anthrax is treated with a combination of antibiotics, including intravenous ciprofloxacin Some Trade Names
    CILOXANCIPRO or doxycycline Some Trade Names VIBRAMYCIN plus clindamycin Some Trade Names CLEOCIN
    , with or without rifampin Some Trade Names RIFADINRIMACTANE . Corticosteroids may help relieve symptoms of inhalational anthrax.

    Symptoms develop 1 to 43 days after exposure. Initially, they are vague and similar to those of influenza, with mild muscle aches, a low fever, chest discomfort, and a dry cough. After a few days, breathing suddenly becomes very difficult, and people have chest pain and a high fever with sweating. Blood pressure rapidly becomes dangerously low (causing shock), followed by coma. These severe symptoms probably result from a massive release of toxins. Infection of the brain and the fluid around the meninges (an infection called meningoencephalitis) frequently develops. Many people die 24 to 36 hours after severe symptoms start, even with early treatment. Without treatment, all people with inhalation anthrax die. In the 2001 outbreak in the United States, 5 of the 11 people treated for inhalation anthrax died.

    Last full review/revision September 2008 by Matthew E. Levison, MD



    -------------------------------------------------------------------------------------------

    SWIM thinks that the doctors should just offer diamorphine to any requiring this as an alternative to methadone and buprenorphine which would potentially save many lives, SWIM took 11 days off using when hearing about the local UK case as the gear is from same town, had a lapse yesterday and the tackle was very dark almost black beetle which was worrying ended up throwing half away shame as the h was laughing but as it was smoked inhalation is worse type of anthrax and if presenting with severe symptoms mortality rate is very high.

    Extremly worried and think should be offered more information about getting on early antibiotics etc.

    There is a drug called RAXIBACUMAB which is supposed to be able to improve the chances of inhalation post exposure its also in the ABThrax vaccine but only issued to US military and stockpiled by US governement.

    +++++++++++++++++++
    From HGSI DOT COM
    ++++++++++++++++++

    Raxibacumab is a human monoclonal antibody drug that HGS discovered and developed for the treatment of inhalation anthrax.[1-4] Raxibacumab represents a new way to address the anthrax threat. While antibiotics can kill the anthrax bacteria, they are not effective against the deadly toxins that the bacteria produce. Raxibacumab is a first-in-class treatment that targets anthrax toxins after they are released by the bacteria into the blood and tissues. These toxins are the real culprits in most anthrax-related deaths.[5] In an inhalation anthrax attack, people may not know they are infected with anthrax until the toxins already are circulating in their blood, and it may be too late for antibiotics alone to be effective.
    In July 2009, The New England Journal of Medicine published the results of two pivotal animal efficacy studies, which showed that a single dose of raxibacumab, administered without the use of antibiotics, improved survival rates by up to 64 percent – even when administered after animals were already showing clinical symptoms as a result of inhalation exposure to massively lethal doses of anthrax spores.[6-9] These dramatic and statistically significant findings demonstrated a survival benefit in two animal species, which is the requirement for establishing the efficacy of new drugs used to counter bioterrorism.[10] The results of these and other clinical and preclinical studies to date provide strong support for the potential of raxibacumab to provide significant survival benefit with minimal side effects in the event of an anthrax attack.[7-18]
    In April 2009, HGS completed the delivery of 20,000 doses of raxibacumab to the U.S. Strategic National Stockpile.[19] In July 2009, HGS received a second order for 45,000 doses to be delivered over a period of three years, beginning near the end of 2009.[20] Raxibacumab is being developed under a contract with the Biomedical Advanced Research and Development Authority (BARDA) of the Office of the Assistant Secretary for Preparedness and Response (ASPR), U.S. Department of Health and Human Services (HHS).[21-22]
    [h2]How Raxibacumab Works[/h2]
    Anthrax infection is caused by a spore-forming bacterium, Bacillus anthracis, which multiplies in the body and produces lethal toxins. Most anthrax fatalities are caused by the irreversible effects of the anthrax toxins.
    Research has shown that Bacillus anthracis protective antigen is the key facilitator in the progression of anthrax infection at the cellular level.[3] The other two anthrax toxin components are lethal factor and edema factor. After the three anthrax toxin components are produced by the bacteria, protective antigen binds to the anthrax toxin receptor on cell surfaces and forms a protein-receptor complex that makes it possible for lethal factor and edema factor to enter the cells (see Figure 1).
    Raxibacumab blocks the binding of protective antigen to cell surfaces and prevents the anthrax toxins from entering and killing the cells (see Figure 1).
    Raxibacumab Prevents Anthrax Toxin-Mediated Cell Death


    [​IMG]

    Figure 1. Raxibacumab specifically recognizes and neutralizes protective antigen (PA). By neutralizing PA, raxibacumab effectively blocks the binding of PA to cell surfaces and prevents the anthrax toxins from entering and killing the cells.
    U.S. Government Contract to Supply Raxibacumab to the Strategic National Stockpile

    Raxibacumab is being developed under a contract with the Biomedical Advanced Research and Development Authority (BARDA) of the Office of the Assistant Secretary for Preparedness and Response (ASPR), U.S. Department of Health and Human Services (HHS).[18-19] In April 2009, HGS fulfilled its commitment under this contract to deliver 20,000 doses of raxibacumab to the U.S. Strategic National Stockpile for emergency use in the treatment of inhalational anthrax.[16] In July 2009, HGS received a second order for 45,000 doses to be delivered over a period of three years, beginning near the end of 2009.[17] Both purchase awards were made under the Project BioShield Act of 2004, which is designed to accelerate the development, purchase and availability of medical countermeasures for the Strategic National Stockpile.[20] HGS recognized $162.7 million in raxibacumab revenue in the first half of 2009.[21] The Company also filed a Biologics License Application (BLA) with the FDA in May 2009[22-23], and will receive an additional $10 million under the contract upon licensure. ​
    Potential Treatment Setting

    Two options have been available up until now for the prevention or treatment of anthrax infections – a vaccine and antibiotics. Both are essential to dealing with anthrax, but both have limitations. The anthrax vaccine takes several weeks following the initial doses before immunity is detectable, and requires multiple injections over a period of eighteen months, in addition to annual booster vaccination, to maintain protective immunity. Antibiotics are effective in killing anthrax bacteria, but are not effective against the anthrax toxins once those toxins have been released into the blood. Antibiotics also may not be effective against antibiotic-resistant strains of anthrax. ​
    Raxibacumab is a first-in-class treatment that targets anthrax toxins after they are released by the bacteria into the blood and tissues. In contrast to the anthrax vaccine, the protection afforded by a single dose of raxibacumab would be immediate following the rapid achievement of appropriate blood levels of the antibody. In contrast to antibiotics, raxibacumab acts against the deadly toxins produced by anthrax bacteria. It may also prevent and treat infections by antibiotic-resistant strains of anthrax. ​
    Survival Analysis
    Rabbit Model of Inhalation Anthrax


    [​IMG]
    Figure 2. In an experimental model of inhalation anthrax in rabbits, a single injection of raxibacumab administered at five different dose levels 48 hours prior to spore challenge or within one hour after spore challenge, significantly improved 14-day survival compared to the control group (p< 0.0001). In addition, a single injection of raxibacumab at the highest dose administered within one hour after spore challenge provided 100% protection against lethality.[17]
    [h2]Efficacy and Safety Data [/h2]
    In December 2007, HGS announced that the results of two animal studies demonstrated the life-saving potential of raxibacumab for the treatment of inhalation anthrax disease.[9] The results, which were published in July 2009 along with data from other studies of raxibacumab in the New England Journal of Medicine, showed that a single dose of raxibacumab, administered without the use of antibiotics, improved survival rates by up to 64 percent – even when administered after animals were already showing clinical symptoms as a result of inhalation exposure to massively lethal doses of anthrax spores.[6-9] These dramatic and statistically significant findings demonstrated a survival benefit in two animal species, which is the requirement for establishing the efficacy of new drugs used to counter bioterrorism.

    In one of the animal studies, three groups of monkeys were exposed by inhalation to massively lethal amounts of anthrax spores and treated with either raxibacumab or placebo after they showed clinical signs of anthrax disease.[6-9] After 28 days, the study found that:


    • 64.3 percent of monkeys that received a single high dose of raxibacumab survived (p=0.0007 vs. placebo).



    • 50 percent of those that received a low dose survived (p=0.0064 vs. placebo).



    • None of the monkeys in the placebo control group survived.


    A separate study that measured 14-day survival in rabbits also demonstrated a statistically significant survival benefit versus placebo.[6-9] All raxibacumab-treated animals that survived in both studies were rapidly cleared of anthrax toxin and bacteria following intravenous administration of a single dose of raxibacumab as a single agent. In contrast, all placebo-treated animals remained bacteremic or toxemic and died.
    The results of these two studies provide the scientific evidence required to establish the efficacy of raxibacumab in the treatment of inhalation anthrax. Because the design of the studies required that the animals not be treated until after showing clinical symptoms resulting from exposure to massively lethal doses of anthrax spores, HGS believes that the results closely simulate what might take place in the event of an actual inhalation anthrax attack. In addition, the new data are consistent with the results of previous studies in multiple animal models, which demonstrated that a single dose of raxibacumab given prophylactically provided up to 100% protection against death.[17]
    HGS has also completed safety studies of raxibacumab in more than 400 human volunteers. The clinical results to date suggest that raxibacumab was generally safe and well tolerated. In addition, clinical data have demonstrated that co-administration of raxibacumab with the antibiotic Cipro (ciprofloxacin) did not affect the pharmacokinetics of either Cipro or raxibacumab, and suggested that raxibacumab can be administered in combination with antibiotics. This is a key finding given the important role that antibiotics are expected to continue to play in the treatment of anthrax disease.[5]
    Pharmokinetics After a Single IV Infusion

    [​IMG]
    Figure 3. Pharmacokinetic analysis of data from a Phase 1 clinical trial in healthy adults shows that the half-life of raxibacumab is 15 to 20 days following IV administration and 15 to 22 days following IM administration. Raxibacumab exhibited a positive safety profile, and achieved the blood levels predicted in animal studies as necessary to afford significant protection.[10]

    [h2]How Raxibacumab Was Discovered[/h2]
    Raxibacumab is a human monoclonal antibody to Bacillus anthracis protective antigen that was discovered and developed by HGS. Raxibacumab was developed using technology that HGS has integrated into the Company as part of its collaboration with Cambridge Antibody Technology{CAT}. Raxibacumab is produced in Human Genome Sciences’ manufacturing facilities in Rockville, Maryland.

    -------------------------------------------------------------------


    If thats Cambridge UK {CAT}? have helped develop raxibacumab do the UK have any available to doctors i wonder?


    The docs at HPA site list only the usual antibiotics only:


    Antibiotic treatment to cover B. anthracis

    Ciprofloxacin intravenously in combination with one or two other anitibiotics (agents with in vitro activity include rifampicin, vancomycin, gentamicin, chloramphenicol, penicillin, amoxicillin, imipenem, meropenem and clindamycin) until sensitivity testing is available
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