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Dear Colleague
1. Further to any previous alerts you have received, as of today 20 January, there are a total of 14 confirmed cases of anthrax in drug users of whom 7 have died (10 males, 6 deaths; 4 females, 1 death). The average age of confirmed cases is 38. Cases have been confirmed in the Greater Glasgow and Clyde area, Lanarkshire, Forth Valley, Fife, and Tayside. Approximately 50 additional possible cases under investigation have been identified in these board areas as well as in Lothian, Grampian and Ayrshire and Arran. The evidence suggests that contaminated heroin may be widespread across Scotland and still circulating.
2. Guidance materials have been posted on the HPS micro-site http://www.hps.scot.nhs.uk/anthrax/index.aspx. These include case definitions, a clinical investigation algorithm and management protocol, infection control guidance, a general Q&A and various other documents. Clinical staff are encouraged to familiarise themselves with this site. It is important that accurate and complete information on the drug taking behaviours of any suspected cases be collected to assist the investigation. A standard investigation questionnaire for use by local NHS Board public health investigators will also be posted on the website.
3. The clinical algorithm now also includes a reminder that any case coming to the attention of medical services should be offered the opportunity to access local drug treatment services to assist in giving up heroin, in line with the advice being given. Given the possibility of increased demand for access to these services as a consequence of this outbreak, Directors of Public Health/Medical Directors and local drugs services will wish to take this opportunity to reflect on the current provision and capacity of such services locally. In areas where there are waiting lists for access to drug treatment and in particular substitute medication contingency measures may be required to ensure that all those who wish to stop using heroin, in order to avoid being infected with anthrax, have the means to do so.
4. The Scottish Drug Forum are actively engaged in providing advice to drug users and drug service workers and have developed materials jointly with the national Outbreak Control Team. They are a small organisation and have limited capacity to ensure that drug service staff have been adequately briefed. They wish to emphasise the need for close liaison between NHS service providers and local voluntary and other agencies including Local Authority social work departments to make sure that all staff have access to relevant briefing materials. A specific Q&A for this group of staff will also be provided on the HPS website.
5. Finally many of those presenting with injection wounds have no history of being tested in line with current blood borne virus policy. This situation may provide an opportunity to offer testing for blood borne virus infections in injecting drug users who present for advice or treatment
6. I should be grateful if you would ensure that this letter is fully cascaded within your NHS Board to all relevant A&E staff, ITU staff and in particular to surgeons (orthopaedic, general and plastic).
Yours sincerely
Harry Burns
DR HARRY BURNS
ADDITONAL RESOURCES
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Dr Harry Burns MPH FRCS(Glas) FRCP(Ed) FFPH
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Enquiries to:
Policy Issues
Gareth Brown
3ES, St Andrew’s House
0131 244 6910
Medical Issues
Dr Andrew Riley
2N.07, St Andrew’s House
0131 244 2158
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22 January 2010
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SGHD/CMO(2010)2
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Addresses
For action
Directors for Public Health
CPHM (CD&EH)
Medical Directors, for circulation to all staff in Accident and Emergency
Departments
Intensive Care Units
High Dependency Units
Microbiologists
Services dealing with drug use
General Practitioners (including practice nurses, non-principals and Out of Hours Services)
NHS 24
Scottish Ambulance Service
Community Pharmacists
Scottish Drugs Forum to cascade to Services for Drug Users run by voluntary or other agencies
Crown Office for circulation to Procurators Fiscal
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