HPS Weekly Report
20 Mar 2018
Volume 52 No. 11
World TB Day, 24 March 2018
The theme of World TB Day 2018, ‘Wanted: Leaders for a TB-free world’, focuses on building commitment to end TB, not only at the political level with heads of state and ministers of health, but at all levels from mayors, governors, parliamentarians and community leaders, to people affected with TB, civil society advocates, health workers, doctors or nurses, NGOs and other partners. All can be leaders of efforts to end TB in their own work or terrain.
This is a critical theme, given the political importance of the upcoming UN General Assembly high-level meeting on TB this year, which will bring together heads of state in New York.
Last year, WHO reported that 10.4 million people fell ill with TB and there were 1.8 million TB deaths in 2016, making it the top infectious killer worldwide. This disease is deeply rooted in populations where human rights and dignity are limited. While anyone can contract TB, the disease thrives among people living in poverty, communities and groups that are marginalized, and other vulnerable populations.
These include: migrants, refugees, ethnic minorities, miners and others working and living in risk-prone settings, the elderly, marginalized women and children in many settings etc. Factors such as malnutrition, poor housing and sanitation, compounded by other risk factors such as tobacco and alcohol use and diabetes, affect vulnerability to TB and access to care. Furthermore, this access is often hindered by catastrophic costs associated with illness, seeking and staying in care, and lack of social protection, resulting in a vicious cycle of poverty and ill-health. The transmission of multidrug-resistant TB (MDR-TB) adds great urgency to these concerns.
Tuberculosis surveillance and monitoring in Europe, 2018
On 19 March 2018, the European Centre for Disease Prevention and Control (ECDC) published its annual tuberculosis surveillance and monitoring report presenting the key figures and trends and providing an overview of the TB situation in the EU/EEA and the WHO European Region.
In 2016, 58,994 cases of TB were reported in 30 EU/EEA countries (Liechtenstein did not report). While the decreasing notification rates observed in most countries are considered reassuring, annual rates of decline are still insufficient to achieve the WHO target of TB elimination by 2050 in European low-incidence countries. Of all notified TB cases, 70.4% were newly diagnosed and 71.0% were confirmed by culture, smear or nucleic acid amplification test. Thirty-three per cent of all TB cases were of foreign origin, mostly residing in low-incidence countries.
Overall, adult age groups were equally affected by TB. Children under 15 years of age accounted for 4.1% of all TB cases, corresponding to a notification rate of 3.0 per 100,000 population. Higher-incidence countries also had the highest age-specific notification rates in children. Males were over-represented in all EU/EEA member states.
Multidrug-resistant (MDR) TB was reported for 3.7% of 36,071 cases with drug susceptibility testing (DST) results and continues to be highest (more than 10%) in the three Baltic countries. Extensively drug-resistant (XDR) TB was reported for 20.1% of 984 MDR TB cases tested for second-line drug susceptibility. The drug resistance for the second line anti-TB drugs has slightly increased compared to recent years.
Data on HIV co-infection remained very incomplete, and the number of countries reporting HIV status was similar to 2015. Of all TB cases with known HIV status, 4.5% were co-infected with the virus.
TB in prisons remains poorly reported. For the 18 EU/EEA countries reporting data, the notification rate amounted to 163.8 per 100,000 inmates, i.e. an incidence ratio of 11.1 compared to the general population in the same countries.
Further related resources can be accessed on the ECDC website.
Immunisation web pages updates
On 19 March 2018, Health Protection Scotland (HPS) updated its immunisation web pages to reflect the most recent quarterly surveillance data on:
- meningococcal disease
- invasive pneumococcal disease
- Haemophilus influenzae
- herpes zoster
- human papillomavirus
Diphtheria vaccination campaign in Yemen
The World Health Organization (WHO), UNICEF and national health authorities have completed a large-scale vaccination campaign to control the spread of diphtheria in Yemen.
The campaign targeted nearly 2.7 million children aged six weeks to 15 years in 11 governorates.
It focused on locations reporting suspected cases of diphtheria and areas at high risk of spread of the infectious respiratory disease. More than 6000 health workers were mobilised during the campaign, including for community engagement and the administration of the vaccine.
First reported in October 2017, the outbreak has spread rapidly across the country, infecting more than 1300 people and killing over 70. Children and young adults under 25 represent almost 80% of the caseload.
The rapid spread of diphtheria in Yemen highlights major gaps in routine vaccination coverage in recent years and signifies a collapsing health system. Only 50% of all health facilities are partially or fully functioning.
In November and December 2017, WHO and UNICEF vaccinated almost 450,000 children under seven years of age against diphtheria in Ibb, the worst affected governorate accounting for nearly 35% of all cases reported.
Source: WHO News Release, 16 March 2018
Low Emission Zone (LEZ) - consultation responses
Further to Current note 51/3603, the analysis of responses to Transport Scotland’s consultation ‘Building Scotland’s Low Emission Zones’ has now been published. The consultation asked key questions relating to the design of low emission zones (LEZ) in Scotland. The responses should help inform national standards for LEZ and the development of supporting legislation.
LEZ are a form of vehicle access regulation which sets an environmental limit on certain road spaces, to improve air quality by allowing access to only the cleanest vehicles, particularly at locations where there is public exposure. The Scottish Government has committed to introduce LEZs into Scotland’s four biggest cities between 2018 and 2020, and into all other Air Quality Management Areas by 2023, where the National Low Emissions Framework supports this approach.
In total, 967 responses were received. There was a high level of consensus among respondents with 95.5% supporting the principle of LEZs to help improve air quality in Scotland. In addition, 62.3% of respondents agreed with the proposed minimum mandatory Euro emission criteria for Scottish LEZs. The proposed minimum criteria as set out in the consultation document is Euro 6 for diesel cars, Euro 4 for petrol cars and Euro VI for buses (including older retrofitted engines which would be improved to operate as Euro VI).
The views provided showed that the most popular suggestion was for LEZs to operate 24 hours, seven days a week. The views provided also showed a high level of consensus with 91.6% in favour of using automatic number plate recognition (ANPR) to enforce LEZs. Those who disagreed had privacy concerns with the use of ANPR. 82.7% of respondents considered that emergency vehicles should be exempt. The majority of respondents, 86.3% agreed that LEZ exemptions should be consistent across all Scottish local authorities.
UK call for a new Clean Air Act
On 15 March 2018, the Environment, Food and Rural Affairs, Environmental Audit, Health and Social Care, and Transport Committees of the UK Parliament published their joint report on improving air quality. The unprecedented joint inquiry was launched amid concerns over the inadequacy of the government’s plan to improve air quality in the UK, as demonstrated by a series of successful judicial challenges in recent years.
The report from the four-way inquiry calls for a new Clean Air Act, a clean air fund financed by the transport industry, a national air quality support programme for councils, and for the government to require manufacturers to end the sale of conventional petrol and diesel cars earlier than the current 2040 target.
Chemicals in our life website
Many consumers in Europe are concerned about the possible risks posed by chemicals in their lives. A 2016 Eurobarometer study of almost 28,000 people in 28 countries showed that 65% of respondents were concerned about being exposed to hazardous chemicals.
To specifically address consumers with information on chemicals, the European Chemicals Agency (ECHA) launched the ‘Chemicals in our life’ website on World Consumer Rights Day (15 March 2018). The website, available in 23 EU languages, is intended to provide useful information on the benefits and risks of using chemicals and explains how EU legislation on chemicals protects us.
The website has a trending section for topical news and is connected to ECHA’s chemicals database, which claims to be the world’s largest database of its kind.
Users can also explore parts of the European Observatory for Nanomaterials. Several articles on nanomaterials related to health, the workplace and consumer products are available. Readers can navigate through a 360-degree interactive apartment, which shows where and why nanomaterials are used in our lives.
Source: ECHA News Release, 15 March 2018
SEPA response to fly-tipping site
Officers from the Waste Crime Team of the Scottish Environment Protection Agency (SEPA) were in Fort William over the past week to investigate, and help address, fly-tipping at an illegal site at Mount Alexander, Camaghael.
The visits to local businesses were continued to gather information, check permits and reinforce the responsibilities and obligations that apply to anyone producing, carrying or managing waste. Information Notices will be issued to any businesses unable to provide details of how they are disposing of their waste.
A previous multi-agency week of activity spanning the end of January and beginning of February 2018, which also involved Police Scotland and Highland Council, has already been successful in raising awareness of relevant legislation and gaining some understanding of the potential origins of the waste.
Building and construction materials are among the various types of waste that have been accumulating at the illegal site in Camaghael for a considerable time. It is evident that tradesmen in the area are persistently dumping waste materials at the site to avoid paying the cost of disposal at legitimate waste management sites. This is clearly for financial gain, with complete disregard for the law and the possible environmental consequences.
Remediation work for the site is likely to be complicated given the scale of waste, the unknown nature of older deposits and the risk of it becoming unstable. SEPA has estimated the cost of removal could be as much as £50,000, depending on the types of waste involved.