Unexplained illness and deaths among injecting drug users in England: a case control study using Regional Drug Misuse Databases

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Abstract
In April to June 2000 an outbreak of unexplained illness in injecting drug users (IDUs) in parts of the UK led to hospitalisation and usually death among those affected.1 For investigation purposes a new syndrome-based case definition was constructed as, extensive inflammation at a subcutaneous or intramuscular injection site and, either severe system toxicity or, postmortem evidence of a diffuse toxic or infectious process.2 Between 1 April and 19 June investigation of 88 hospitalised or dead IDUs with injection site soft tissue inflammation found 35 met the case definition. Despite very high mortality (34, 97%) only limited epidemiological information is available.1 However, empirical evidence identifying the characteristics of IDUs most at risk is fundamental to, better understanding the outbreak, preventing re-occurrence and developing appropriate advice should one occur in the UK or elsewhere. By the end of June, 14 confirmed cases (12 fatal) were identified in the …
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