Health Protection Scotland, NHS National Services Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland.
Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland.
Harm Reduct J. 2018 Jul 11;15(1):36. doi: 10.1186/s12954-018-0243-9.
People who inject drugs (PWID) are at an increased risk of wound botulism, a potentially fatal acute paralytic illness. During the first 6 months of 2015, a large outbreak of wound botulism was confirmed among PWID in Scotland, which resulted in the largest outbreak in Europe to date.
A multidisciplinary Incident Management Team (IMT) was convened to conduct an outbreak investigation, which consisted of enhanced surveillance of cases in order to characterise risk factors and identify potential sources of infection.
Between the 24th of December 2014 and the 30th of May 2015, a total of 40 cases were reported across six regions in Scotland. The majority of the cases were male, over 30 and residents in Glasgow. All epidemiological evidence suggested a contaminated batch of heroin or cutting agent as the source of the outbreak. There are significant challenges associated with managing an outbreak among PWID, given their vulnerability and complex addiction needs. Thus, a pragmatic harm reduction approach was adopted which focused on reducing the risk of infection for those who continued to inject and limited consequences for those who got infected.
The management of this outbreak highlighted the importance and need for pragmatic harm reduction interventions which support the addiction needs of PWID during an outbreak of spore-forming bacteria. Given the scale of this outbreak, the experimental learning gained during this and similar outbreaks involving spore-forming bacteria in the UK was collated into national guidance to improve the management and investigation of future outbreaks among PWID.
注射吸毒者（PWID）感染伤口肉毒杆菌病的风险增加，这是一种潜在致命的急性麻痹性疾病。在 2015 年的前 6 个月中，苏格兰的 PWID 中确认了一起大规模的伤口肉毒杆菌病暴发，这是迄今为止欧洲最大的一次暴发。
一个多学科的事件管理小组（IMT）被召集来进行暴发调查，其中包括加强对病例的监测，以确定危险因素并确定潜在的感染源。
在 2014 年 12 月 24 日至 2015 年 5 月 30 日期间，苏格兰六个地区共报告了 40 例病例。大多数病例为男性，年龄在 30 岁以上，居住在格拉斯哥。所有的流行病学证据都表明，受污染的一批海洛因或切割剂是此次暴发的源头。由于 PWID 的脆弱性和复杂的成瘾需求，管理他们中的暴发存在很大的挑战。因此，采取了实用的减少伤害方法，重点是降低继续注射的人的感染风险，并限制已感染者的后果。
这次暴发的管理突显了实用的减少伤害干预措施的重要性和必要性，这些措施支持 PWID 在孢子形成细菌暴发期间的成瘾需求。鉴于这次暴发的规模，在英国涉及孢子形成细菌的这次和类似暴发中获得的实验性学习被整理成国家指南，以改善 PWID 未来暴发的管理和调查。
