HPS Weekly Report
27 Mar 2018
Volume 52 No. 12
Hepatitis E virus in Scotland
While previous studies have shown low levels of circulating hepatitis E virus (HEV) in Scotland, a study in the current issue of Eurosurveillance attempts to reassess current Scottish HEV epidemiology.
Blood donor samples from five Scottish blood centres, the minipools for routine HEV screening and liver transplant recipients were tested for HEV antibodies and RNA to determine seroprevalence and viraemia. Blood donor data were compared with results from previous studies covering 2004-2008. Notified laboratory-confirmed hepatitis E cases (2009-2016) were extracted from national surveillance data. Viraemic samples from blood donors (2016) and chronic hepatitis E transplant patients (2014-2016) were sequenced.
The study concludes that the seroprevalence, number of viraemic donors and numbers of notified laboratory-confirmed cases of HEV in Scotland have all recently increased. The causes of this change are unknown, but need further investigation. The authors further conclude that clinicians in Scotland, particularly those caring for immunocompromised patients, should have a low threshold for testing for HEV.
Listeriosis outbreak in EU member states
On 22 March 2018, the European Centre for the Prevention and Control of Disease (ECDC) and the European Food Safety Authority (EFSA) issued a rapid outbreak assessment concerning an outbreak of Listeria monocytogenes which has affected five EU member states (Austria, Denmark, Finland, Sweden, and the UK) since 2015. As of 8 March 2018, 32 cases including six deaths have been reported.
Whole genome sequencing (WGS) was used to define the multi-country outbreak of L. monocytogenes serogroup IVb, multi-locus sequence type 6 and to identify the implicated food source. The investigations pointed towards frozen corn packed in Poland and processed and produced in Hungary. The report recommends further investigations to identify the exact point of contamination in the food chain.
Food business operators in Poland, Finland, Sweden and Estonia have withdrawn and recalled the implicated products. These measures are likely to reduce the risk of human infections in these countries. However, new cases may be identified due to the long incubation period of listeriosis (up 22 to 70 days), the long shelf-life of frozen corn products and the potential consumption of frozen corn bought before the recall was implemented. To reduce the risk of L. monocytogenes infection from frozen corn, consumers are being urged to adequately heat frozen vegetables that are not ready-to-eat products. This applies especially to consumers at the highest risk of contracting listeriosis, such as the elderly, pregnant women, new-borns and adults with weakened immune systems.
Source: ECDC News Release, 22 March 2018
WHO action on listeriosis across Africa
Further to Current note 52/1003, the World Health Organization (WHO) has been reaching out to 16 African nations to provide support for preparedness and response to a listeriosis outbreak that started in South Africa in 2017 but is now threatening other countries on the continent.
Nearly 200 South Africans have died since January 2017 as a result of contaminated ready-to-eat meat products that are widely consumed in South Africa and may also have been exported to two West African countries and 14 members of the South African Development Community (SADC).
South African health authorities recently declared the source of the outbreak as a factory in Polokwane, South Africa. This prompted a national and international recall of the food products. However, in light of the potentially long incubation period of listeriosis and the challenges relating to large scale nationwide recall processes, further cases are likely to occur.
WHO’s Health Emergencies programme, the Global Outbreak alert and Response Network (GOARN) and the International Food Safety Authorities Network (INFOSAN) are working with the 16 priority countries to improve their ability to prepare for, detect and respond to potential outbreaks.
Immediate steps will include increasing awareness on listeriosis, enhancing active surveillance and laboratory diagnosis, ensuring readiness of Rapid Response Teams, and strengthening coordination and contingency planning. Experts have been deployed to South Africa, Lesotho and Swaziland to support these efforts.
WHO urges scale-up of HCV treatment
A report recently published by the World Health Organization (WHO) shows that the annual number of people receiving hepatitis C cure increased from around 1 million in 2015 to 1.5 million in 2016. However, global access to hepatitis C treatment remains uneven, with a small number of countries accounting for the bulk of the increase. Egypt and Pakistan accounted for about half of all people starting direct-acting antiviral (DAA) treatment to cure hepatitis C in 2016. There has also been encouraging progress in countries as diverse as Australia, Brazil, China, France, Georgia, Mongolia, Morocco, Rwanda and Spain.
The report also reviews the progress made in expanding access to life-saving treatment for hepatitis C infection in 23 low- and middle-income countries, and provides information from innovator and generic medicine manufacturers and multiple partner organizations working in the field of viral hepatitis.
According to the report, the overall number of people initiating DAA treatment has reached three million. However, this progress also points to a long road ahead, as it is estimated that 71 million people worldwide have hepatitis C infection, with all requiring treatment.
WHO’s progress report details the experiences of a diverse set of countries in overcoming barriers to achieve rapid progress. It calls for wider international action to help achieve the 2030 targets to eliminate hepatitis.
Source: WHO News Release, 8 March 2018
SEPA prosecution - illegal waste tyre site
An East Lothian sole trader was fined £40,000 and given a Community Payback Order to undertake 240 hours of unpaid work, at Edinburgh Sheriff Court on 14 March 2018, for illegally storing waste tyres.
Alistair Marshall trading as A. M. Transport pled guilty to depositing and keeping waste tyres on his site at Fenton Barns, Drem, and another site at Annfield Farm, Tranent, without the required Waste Management Licence. The case was investigated by the Scottish Environment Protection Agency (SEPA) and a report was sent to the Procurator Fiscal. Mr Marshall pled guilty at the Intermediate Diet on 12 September 2017 and the Sheriff deferred sentence for a period of time.
Mr Alistair Marshall first came to the attention of SEPA officers in April 2013 when they initially attended his site at Annfield Farm, Tranent. At that time, he was allowed to have 1000 tyres but had greatly exceeded that amount. Later that year, Mr Marshall made enquiries about licensing requirements for storing waste tyres and was advised by SEPA that he would require a Waste Management Licence.
In September 2015, SEPA became aware of Mr Marshall storing tyres at another site in Fenton Barns, East Lothian. Upon investigation, SEPA established Mr Marshall had been depositing and storing tyres there since 2010. There were estimated to be between 65,000 and 75,000 tyres stored at the site.
SEPA attempted to work with Mr Marshall but despite verbal and written requests for the site to be cleared, Mr Marshall did not comply. An enforcement notice was served, to force him to remove the tyres and he was allowed time to do so. Mr Marshall did not comply and the only option SEPA had was to report the case to the Procurator Fiscal. When the report was submitted the vast majority of the waste tyres remained at the site.
SEISS annual report for 2017
The Scottish Environmental Incident Surveillance System (SEISS) provides a national level knowledge management system designed to manage information on a wide range of environmental incidents. The aim is to create a source of information that agencies can interrogate to discover who else has had to manage incidents, what information was helpful in managing incidents and what lessons were learned. SEISS is a database holding details of incidents reported by participating agencies, on situations involving a risk to public health due to the release into the environment of chemical, microbiological, radiation or other physical agents.
The annual SEISS report for 2017, published on 27 March 2018, notes:
- smoke was the most commonly reported chemical hazard
- Cyanobacteria (blue-green algae) continues to be the most commonly reported microbiological agent
- residential sites were the most common locations for incidents involving chemical hazards
- recreational sites were the most common locations for incidents involving microbiological agents
- Region 4 (NHS Greater Glasgow & Clyde and associated Local Authorities) recorded the highest number of incidents
Environmental incidents - SEISS reports (major fires – Robroyston, Sauchiehall Street, Glasgow)
The Scottish Environmental Incident Surveillance System (SEISS) recorded the following incidents in the past week:
- On 19 March 2018, firefighters tackled a large blaze at a building site in the Robroyston area of Glasgow. The Scottish Fire and Rescue Service said crews were sent to the scene at about 7.25pm. Pictures on social media showed flames and large plumes of smoke coming from the scene. The fire was extinguished but officers monitored the site overnight before leaving on Tuesday morning. There were said to be no casualties. This was reported by BBC news.
- On 22 March 2018, a major fire broke out in Glasgow’s Sauchiehall Street. At its height, more than 120 firefighters and 20 fire engines were mobilised to the city centre and, by the weekend, firefighters remained at the scene dealing with continuing fires and damping down. The service reassured the public that testing has shown there is no risk from asbestos. This was reported by BBC news.
For more detailed information, visit the SEISS website, or contact either Ian Henton or Colin Ramsay at HPS on 0141 300 1100.