Following the recent outbreak of anthrax amongst 19 Scottish heroin users of whom 9 have died, there has now been one confirmed in an injecting drug user (IDU) in London. Investigations are continuing into the cause of these cases and into any heroin supply routes that may be affected.

This communication alerts healthcare professionals to the possibility of anthrax infection in IDUs presenting with severe soft tissue infections or sepsis, and the local microbiologist should be contacted for advice on management and investigation of any possible cases who present at their GP or A&E. Other services dealing with drug misusers should refer them to an A&E department or to a GP for urgent assessment and management. It is stressed that person to person infection is extremely rare. Any cases of severe soft tissue infection or sepsis in an IDU patient who has died or has been sufficiently unwell to require admission to hospital should be reported to the local Health Protection Unit.

There are algorithms for the clinical evaluation and management of drug users with possible anthrax infections, and advice for drug users at risk, on the Health Protection Agency (HPA) website which can be accessed from the link below.