HPS Weekly Report
15 May 2018
Volume 52 No. 19
HPS publish norovirus and hepatitis E surveillance reports
Rapid risk assessment - extensively drug-resistant Neisseria gonorrhoeae in the UK and Australia
Between February and March 2018, three cases of gonorrhoea that are resistant to the recommended first line antibiotic treatment have been identified in the UK (one case) and Australia (two cases) (see current note 52/1504).
These are the first cases globally of extensively drug-resistant Neisseria gonorrhoeae with high-level resistance to azithromycin and ceftriaxone. The cases were not epidemiologically linked.
Even a small change in drug resistance may have wide-ranging consequences as those infected continue to transmit the infection without knowing. The spread of extensively drug-resistant strains like the ones identified in the UK and Australia may have a serious impact on the control of gonorrhoea.
A newly published rapid risk assessment presents background information, an outline of the public health issue, a threat assessment for the EU and conclusions and options for response.
Source: ECDC, 7 May 2018
Measles outbreaks across England
Public Health England (PHE) is advising the public to ensure they have had two doses of MMR vaccine after outbreaks of measles were confirmed across England.
Between 1 January 2018 and 9 May 2018, there have been 440 laboratory confirmed measles cases in England, with London (164), the South East (86), West Midlands (78), South West (42) and West Yorkshire (37) reporting the most cases.
The increase in measles circulation is mainly associated with travel to and from Europe where there are large ongoing measles outbreaks.
Young people and adults aged 15 and over who missed out on MMR vaccine when they were younger and some under-vaccinated communities have been particularly affected.
Measles is a highly infectious viral illness that can sometimes lead to serious complications and can be fatal in very rare cases. Anyone who has not received two doses of MMR vaccine is at risk, but young people in environments with close mixing such as festivals are more at risk, as well as unvaccinated people travelling to countries e.g. Romania, Greece, France and Italy, where there are currently large outbreaks.
PHE local health protection teams are working closely with the NHS and local authorities to raise awareness with health professionals and local communities. The MMR vaccine is available to all adults and children who are not up to date with their two doses.
PHE advise that anyone who is not sure if they are fully vaccinated should check with their GP practice who can advise them.
Source: PHE, 11 May 2018
Ukraine restores immunization coverage in large-scale effort to stop measles outbreak
Over 12,000 people have been infected with measles in Ukraine so far this year. Of those affected, 9,158 have required hospitalization and nine have died according to information provided by national health authorities as of 27 April 2018. Large-scale outbreak response measures have been undertaken since the start of the outbreak in 2017 to curb further spread of the disease and restore high routine immunization coverage.
In 2008, 95% of eligible children in Ukraine received their second (and final) recommended dose of measles-mumps-rubella vaccine (MMR) on time according to the national routine schedule. By 2016, this rate had fallen to 31%, the lowest coverage in the World Health Organization (WHO) European region and among the lowest in the world. In addition, in 2016 only 19% of children received the third recommended vaccine dose of diphtheria-tetanus-pertussis (DTP) and 56% of children received the third recommended dose of oral polio vaccine (OPV).
This drop in immunization coverage left an increasing number of children in Ukraine susceptible to dangerous, preventable diseases. Among these dangers, it created the ideal setting for the extensive spread of measles, one of the most infectious diseases affecting humans. Measles can affect people of all ages, but infants, young children and older adults are the most at risk of serious measles-related complications and death.
Since July 2017, a national Measles Task Force, including the Ministry of Health, key stakeholders and partners such as the WHO and the United Nations Children’s Fund (UNICEF), has been working to:
- vaccinate every eligible child as they reach the appropriate age for MMR vaccination according to the national routine immunization schedule
- vaccinate every child who missed routine immunization in the past
- train laboratory staff to ensure early detection of all measles (and rubella) cases
- inform health-care professionals and parents about the disease and the importance of ensuring that children and their families are fully protected
- ensure the availability of vaccines at all vaccination points
By the end of 2017, routine vaccination coverage had drastically improved compared to previous years: 93% of one year olds received the first dose of MMR on time in 2017 and 91% of six year olds received their second dose as recommended. Figures for January and February 2018 indicate that the country is on track to reach at least 95% routine coverage with both doses of MMR vaccine by the end of the year.
If Ukraine can reach and sustain this target, it will prevent the renewed accumulation of susceptible individuals and ultimately protect the population from future outbreaks of measles.
To stop further spread of the disease, those who missed vaccinations in the past also need to be protected. Since September 2017, over 621 000 un- or under-vaccinated children have been identified, and over 80% of them have received their first and/or second MMR dose.
Source: WHO Europe, 4 May 2018
Ebola outbreak in the DRC
The Government of the Democratic Republic of the Congo (DRC) has declared a new outbreak of Ebola virus disease (EVD) after confirmation of two cases in patients at the Institut National de Recherche Biomédicale (INRB) in Kinshasa. This is the ninth outbreak of EVD in the DRC since the discovery of the virus in the country in 1976.
More specimens are currently being collected for testing. The World Health Organization (WHO) is working with the government and other partners to coordinate a response to this current outbreak of EVD.
The UK Government has issued a response to the Ebola cases in the DRC and has said that it is working with the government there and the World Health Organization (WHO) to monitor the situation and be ready to quickly act to tackle the spread of the disease.
Source: WHO, 8 May 2018
Largest cholera vaccine drive in history aims to target spike in outbreaks
A spate of cholera outbreaks across Africa has prompted the largest cholera vaccination drive in history, with more than two million people across the continent set to receive oral cholera vaccine (OCV).
The vaccines, funded by Gavi, the Vaccine Alliance, were sourced from the global stockpile and are being used to carry out five major campaigns in Zambia, Uganda, Malawi, South Sudan and Nigeria. The campaigns, which will be completed by mid-June, are being implemented by the respective ministries of health supported by the World Health Organization (WHO) and partners of the Global Task Force on Cholera Control (GTFCC). They are mostly in reaction to recent cholera outbreaks.
The burden of cholera remains high in many African countries. As of 7 May 2018, many countries are facing cholera outbreaks, with at least 12 areas or countries reporting active cholera transmission in sub-Saharan Africa. Recent developments in the use of OCVs show that the strong mobilisation of countries and partners can effectively tackle the disease when tools for prevention and control are readily available.
Source: WHO, 7 May 2018
Statement of the Seventeenth IHR Emergency Committee regarding the international spread of poliovirus
The seventeenth meeting of the emergency committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened by the director-general on 30 April 2018 at World Health Organization (WHO) headquarters with members, advisers and invited member states attending via teleconference.
The emergency committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPVs). The secretariat presented a report of progress for affected IHR states parties subject to temporary recommendations. The following IHR States provided an update on the current situation and the implementation of the WHO temporary recommendations since the committee last met on 7 February 2018: Afghanistan, Democratic Republic of Congo (DR Congo), Pakistan, Kenya, Somalia and Syrian Arab Republic.
The cpmmittee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of temporary recommendations for a further three months.
Source: WHO, 10 May 2018
Members appointed to Scottish Government expert panel to tackle plastic pollution
Experts from retail, the waste and chemical industries, the public sector and academia have joined a Scottish Government panel tackling plastic pollution.
The government has also appointed current Electoral Commissioner Dame Sue Bruce as chair of the Expert Panel on Environmental Charges and Other Measures, a group that will provide advice on dealing with disposable cups and plastic straws.
She will be joined by behavioural expert Professor Dame Theresa Marteau, economist Professor Liam Delaney, Mike Barry, the director of sustainable business at Marks & Spencer, Roger Kilburn from the biotech and chemical industry, Professor Margaret Bates from the waste industry and Professor Aileen McHarg who will bring legal expertise.
SEPA chief executive Terry A’Hearn, Zero Waste Scotland chief executive Iain Gulland and disability adviser Professor Kate Sang will also sit on the group. A 2050 Climate Group representative will provide a young person’s perspective.
The Expert Panel on Environmental Charging and Other Measures is an advisory group being established to provide advice to Scottish Ministers on charges or other measures which may be adopted in Scotland within devolved competence with the goal of encouraging the long-term and sustainable changes in consumer and producer behaviour required to move to a circular economy. The group will have an initial working life of two years.
Source: Scottish Government, 11 May 2018
UK launches new research and innovation hub to tackle plastic in seas and oceans
The UK, working with other Commonwealth countries, will launch a research and innovation hub for experts to develop solutions to stop plastic waste from entering our oceans and find environmentally-friendly alternatives to plastic.
India, Canada and other Commonwealth nations have already signed up to be part of the new Marine Plastics Research and Innovation Framework – a hub where researchers will be able to connect and collaborate on the latest research and innovations to tackle marine plastics.
The UK will play a leading role in designing and running the Framework, encouraging the world to move towards clean growth through the government’s modern Industrial Strategy. An international steering board will oversee the work.
The Prime Minister recently announced that the UK would contribute £25 million to the Framework during the Commonwealth Heads of Government Meeting in London. Unilever has committed £5 million in research and development, while Waitrose has pledged £500,000 of research.
The British Plastics Federation, which represents more than 500 UK companies, the Ellen MacArthur Foundation, the Waste and Resources Action Programme (WRiAP), RPC Group Plc and engineering giant Mott MacDonald are among those who have given their support, including access to their facilities, networks and expertise.
New environmental law to deliver a green Brexit
The UK government has confirmed a new Environmental Principles and Governance Bill will ensure environmental protections will not be weakened as Britain leaves the EU.
A consultation started on 10 May 2018 on the contents of the Environmental Principles and Governance Bill, which will establish a world-leading body to hold government to account for environmental outcomes.
The body will support the UK government’s commitment to ensure this generation is the first to leave the environment in a better state than that in which it was inherited.
The body will provide scrutiny and advice to protect and enhance precious landscapes, wildlife and natural assets and would be able to hold government to account on environmental legislation.
Subject to consultation, the new body could specifically be responsible for:
- providing independent scrutiny and advice on existing and future government environmental law and policy
- responding to complaints about government’s delivery of environmental law
- holding government to account publicly over its delivery of environmental law and exercising enforcement powers where necessary
The government is also consulting on its intention to require ministers to produce, and then have regard to, a statutory and comprehensive policy statement setting out how they will apply core environmental principles as they develop policy and discharge their responsibilities.
Currently environmental decisions made in the UK, from improving air and water quality to protecting endangered species, are overseen by the European Commission and underpinned by a number of these principles, such as the precautionary principle, sustainable development and the ‘polluter pays’ principle.
While these principles are already central to government environmental policy, they are not set out in one place besides the EU treaties. The new Environmental Principles and Governance Bill will ensure governments continue to have regard to important environmental principles through the policy statement, which would be scrutinised by parliament.
The consultation seeks views on whether or not the principles to be contained in the policy statement should be listed in primary legislation.
New fungus detected in EU salamanders
An emerging pathogenic fungus, Batrachochytrium salamandrivorans (Bsal), has been detected in different species of salamanders across the EU, both kept as pets and in the wild.
Cases have been reported in Belgium, Germany, Spain, the Netherlands and the UK. Bsal has been shown to cause high mortality in some salamander species.
In the scientific opinion published today, European Food Safety Authority (EFSA) experts assessed the risk of establishment and spread of this fungus.
Source: EFSA, 30 April 2018
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