Infections among injecting drug users are a growing public health concern in the UK

New figures published by the UK's Health Protection Agency show that infections among injecting drug users (IDUs) are a growing public health concern.

The second annual report, ‘Shooting Up - Infections among injecting drug users in the United Kingdom 2003', brings together information on all infections among this group.

The data published by the Agency shows that the prevalence of hepatitis C has doubled between 2000 and 2003 amongst those who have recently started injecting. The research showed that in 2003 the prevalence among those who had first injected in the last three years was 18% (67 of 365), double the prevalence among this group in 2000 (9%, 66 of 767) and earlier years. The report highlights various infections, which are problematic in this group.

In recent years the Agency has also seen a growing problem with injecting site infections associated with both methicillin resistant Staphylococcus aureus (MRSA) and severe group A streptococcus (GAS) . Between April and December 2003, 18 cases of MRSA blood poisoning have been identified among IDUs. Laboratory tests of the MRSA isolates show they are different to those associated with healthcare. GAS reports amongst IDUs have increased, from less than ten per annum in the early to mid-1990s to 160 in 2003.

Outbreaks caused by poor hygiene and possible environmental contaminations of heroin have also continued. An outbreak of tetanus, which started with 11 cases reported in 2003, has continued into 2004. Whilst during 2003 there were also 14 reports of suspected cases of wound botulism among IDUs, seven of which were confirmed by laboratory tests.

HIV infection remains rare in injecting drug users although there is evidence of ongoing and possibly increased transmission in recent years. In 2003 HIV infection was detected in those who had begun injecting in the last three years amongst this group compared to none in 2000.

Dr Fortune Ncube who compiled the report for the Agency, said, “This report is a timely reminder that injecting drug users are vulnerable to a wide range of infectious diseases. The continued sharing of injecting equipment and the worsening injecting related hygiene are key factors in the ongoing transmission of infections in injecting drug users in particular amongst those who began injecting in the last three years. ”

The report highlights a number of priorities for service providers, which will help reduce the burden of infection. These include developing high-quality needle-exchange services for those unable to stop injecting, with sufficient coverage to prevent the sharing of needles and syringes, provision of clear information, advice on safe injecting, access to regular health checks, vaccination services and ensuring easy access to treatment and support services for all those who wish to cease injecting, or to reduce, or stop their drug use.

Professor Pat Troop, Chief Executive of the Agency concluded, “Most of these diseases are preventable and can be treated. It is vital that we continue to make every effort to encourage and support injectors to protect their health and also that of the wider population.”