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In October 2011, a joint ECDC-EMCDDA guidance document was released on "Prevention and control of infectious diseases among people who inject drugs".

The Key Intervention Components of this guidance are:

1. Provision of, and legal access to, clean drug Injection Equipment, including sterile needles and syringes free of charge.
2. Vaccination against Hepatitis A and B, tetanus, influenza vaccines, and, in particular for HIV-positive individuals, pneumococcal vaccine.
3. Treatment of Drug dependence: Opioid substitution treatment and other effective forms of drug dependence treatment.
4. Testing: Voluntary and confidential Testing with informed consent for HIV, HCV (HBV for unvaccinated) and TB.
5. Infectious disease treatment: including antiviral treatment for those who are HIV, HBV or HCV infected and treatment/prophylaxis of TB.
6. Health promotion focused on safer injecting behaviour; sexual and infectious disease prevention.
7. Targeted delivery of services according to user needs and local conditions.

Management Advice
The Health Protection Agency in the UK has useful Advice for doctors on diagnosis, management and reporting Severe systemic sepsis related to soft tissue inflammation in injecting drug users. This document highlights the important fact that the severe and occasionally fatal syndrome of severe sepsis related to soft tissue inflammation may be difficult to distinguish from other types of injection site infection in its early stages.  

Epi-Insight Articles

Anthrax identified in heroin users in Scotland - Epi-Insight, Volume 11, Issue 2, February 2010

Tetanus in injecting drug users in the UK: Update - Epi-Insight, Volume 5, Issue 3, March 2004

Tetanus in injecting drug users in England - Epi-Insight, Volume 4, Issue 9, December 2003

Botulism in injecting drug users - Epi-Insight, Volume 3, Issue 6, June 2002

Journal Articles

Epidemiological findings and medical, legal, and public health challenges of an investigation of severe soft tissue infections and deaths among injecting drug users -- Ireland, 2000 - Epidemiol Infect. 2006 Aug;134(4):894-901.

Unexplained illness among injecting drug users in Dublin: a case-control study - J Epidemiol Community Health. 2002 Aug;56(8):575-6

Last updated: 20 September 2018

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