Jones J A, Salmon J E, Djuretic T, Nichols G, George R C, Gill O N
Communicable Disease Surveillance Centre, Public Health Laboratory Service, 61 Colindale Avenue, London NW9 5EQ, *Public Health Laboratory, Cardiff, †Respiratory and Systemic Infection Laboratory, Central Public Health Laboratory, ‡Anaerobe Reference Unit, Cardiff Public Health Laboratory and §Food Safety Microbiology Laboratory, Central Public Health Laboratory, 61 Colindale Avenue, London.
J Med Microbiol. 2002 Nov;51(11):978-984. doi: 10.1099/0022-1317-51-11-978.
An outbreak of serious illness and death occurred in injecting drug users during 2000 in Scotland, Ireland and England. National and international collaboration was necessary for the investigation and management of this outbreak. In England and Wales active case-finding was initiated, coupled with standardised data collection and microbiological investigation of cases. Twenty-six definite or probable cases were identified in England between 1 April and 31 Aug. 2000; 17 of these occurred in the North. The overall case fatality was 50% (13/26). The principal apparent risk factor was a history of intramuscular or subcutaneous injection of heroin and the limited duration of the outbreak suggested that the problem might have been related to a particular supply of heroin. Clostridium novyi was isolated from two English cases. Taken in conjunction with contemporaneous microbiological and epidemiological results from Scottish and Irish cases, the probable aetiology for this outbreak was infection with C. novyi associated with both a particular supply of heroin and the method of preparation and injection used. A 'toolkit' was distributed in Sept. 2000 to all Consultants for Communicable Disease Control in England and Wales to assist them with the ongoing surveillance, investigation and management of this condition. Lessons learned have been used to produce guidance for the investigation and management of outbreaks of unexplained serious illness of possible infective aetiology.
2000年期间，苏格兰、爱尔兰和英格兰的注射吸毒者中出现了严重疾病和死亡的疫情。此次疫情的调查和管控需要国家和国际层面的合作。在英格兰和威尔士，启动了主动病例发现工作，并结合了标准化的数据收集以及对病例的微生物学调查。2000年4月1日至8月31日期间，英格兰共确认了26例确诊或疑似病例；其中17例发生在北部地区。总体病死率为50%（13/26）。主要的明显风险因素是有肌肉注射或皮下注射海洛因的病史，且疫情持续时间有限，这表明该问题可能与特定供应的海洛因有关。从两例英格兰病例中分离出了诺维氏梭菌。结合苏格兰和爱尔兰病例同期的微生物学和流行病学结果，此次疫情可能的病因是感染诺维氏梭菌，这与特定供应的海洛因以及所使用的制备和注射方法都有关。2000年9月，向英格兰和威尔士所有传染病防控顾问分发了一份“工具包”，以协助他们对这种情况进行持续监测、调查和管控。吸取的经验教训已用于制定针对可能由感染性病因引起的不明原因严重疾病疫情的调查和管控指南。
