Danish health officials suspect contaminated heroin, not terrorism, is behind the death of a man whose blood tested positive for anthrax.
The man, a 55-year-old heroin addict, died Sunday after being treated for several days. Danish authorities suspect the man was using heroin contaminated with the bacillus anthracis strain of anthrax.
The case is being compared to similar cases earlier this summer where three heroin users in Germany were infected with anthrax, according to media reports and a recent statement released by the Danish Health Protection Agency. Only one survived.
The cases in Germany were connected to an earlier outbreak in Great Britain in 2010, but no connection has been found in the recent case.
During the 2010 outbreak, 14 died and 47 tested positive for anthrax. An investigation by the Health Protection Scotland, a division of NHS National Services Scotland, determined that heroin use was “the vehicle for transmission of anthrax spores" and that exposure was by a variety of routes, particularly injection (cutaneous) but also by smoking (inhalation).
The strain of anthrax in the 2010 cases is the same strain seen in goats in Turkey. Health Protection Scotland concluded that a single batch must have come in contact with anthrax spores somewhere between the Af-Pak region and its destination, Scotland.
After the latest death, both Danish and Swedish health officials are on guard. The Danes are asking heroin users with skin lesions to report to a health clinic to be tested for anthrax. There can be difficulty in distinguishing anthrax lesions from frequent soft tissue infections common in intravenous users, officials say.
There are also concerns that users with lesions will switch from injecting to smoking, which could be more deadly coming from a batch that contains anthrax spores.
"With previous bacterial infections affecting heroin injectors the harm reduction has been obvious; smoke rather than inject. But with anthrax this isn't as simple, we know a major route of infection is via inhalation, in fact this is the most deadly form," wrote Nigel Brunsdon of InjectingAdvice.com, an information blog for needle and syringe program workers and intravenous drug users, during the 2010 outbreak. The heroin-anthrax link was actually leaked to Brunsdon weeks before the government announced it, he said.
Inhalation anthrax has a 75 percent mortality rate, even with antibiotic treatment, according to The U.S. Department of Health and Human Services.
Swedish health officials have been on heightened alert since the German anthrax cases and have an on-call emergency lab standing by should any suspected anthrax cases be reported in Sweden.
Drug Policy Alliance, a U.S.-based nonprofit that advocatesdrug policy reform, says it's vital that governments act swiftly to warn at-risk populations.
"Too often government officials delay releasing critical information about the local drug supply, even when they know the drug supply is tainted or potentially deadly...But when local governments act swiftly, respectfully and with accurate information for drug users, they take an enormous step forward in building trust and better relationships with these communities that can be so hard to reach," said Drug Policy Alliance Harm Reduction Coordinator Meghan Ralston.
Gadejuristerne, a Danish social justice organization, has also launched a poster campaign warning drug users around Copenhagen that anthrax infected heroin may still be in circulation.
photo: Heroin seized in Helmand Province, Afghanistan in July 2010 from ISAFMedia