HPS Weekly Report
29 May 2018
Volume 52 No. 21
Measles outbreaks in Europe – update
On 18 May 2018, the European Centre for Disease Prevention and Control (ECDC) reported that transmission of measles continues across Europe.
Within the European Union:
- Austria has reported 43 cases from 1 January to 4 May 2018
- Bulgaria has reported four cases, up to 13 May 2018
- the Czech Republic has reported 103 cases between 1 January and 30 March 2018. The majority of cases were reported in Prague and more than half of the cases were not vaccinated
- France reported 2,173 cases from 1 January to 13 May 2018. Nearly half of the case total has been reported from the Nouvelle Aquitaine region. Highest incidence is in the very young and most are unvaccinated
- Finland has reported three cases, up to 17 May 2018
- Germany has reported 176 cases from 1 January to 21 April 2018
- Greece has reported 1,948 cases (including two deaths) from 1 January to 17 May 2018. Most cases are in southern Greece among Roma children and young Greek adults. An increase of cases in northern Greece has also been observed
- Hungary has reported 16 cases, as of 6 May 2018
- Ireland has reported 72 cases from 1 January to 12 May 2018
- Italy has reported 805 cases (including two deaths) between 1 January and 31 March 2018. Among the cases there were 38 healthcare professionals. More than 87% of cases were from Sicily, Lazio, Campania, Calabria and Lombardy. Most cases were unvaccinated (92%) or had received only one vaccine (2%)
- Poland has reported 44 cases from 1 January to 30 April 2018
- Portugal has reported 111 cases from 1 January to 8 April 2018, nearly all in the north of the country. All but one case are adults and 79 of them are healthcare professionals
- Romania has reported 2,712 cases (including 15 deaths) from 1 January to 11 May 2018
- the UK has reported 440 cases from 1 January to 9 May, 2018. Fifty-four percent of cases are aged over 15 years
Neighbouring countries outside the European Union:
- According to media reports, Albania has reported over 600 cases up to 25 April 2018
- Belarus has reported 67 cases from 1 January to 25 March 2018
- Georgia has reported 517 cases from 1 January to 19 April 2018
- Russia has reported 843 cases from 1 January to 31 March 2018
- Serbia has reported 5,167 cases (including 15 deaths) from October 2017 to 10 May 2018
- According to media reports, Turkey has reported 44 cases up to 30 March 2018
- Ukraine has reported 15,261 cases (including eight deaths) from 1 January to 15 May 2018. Sixty percent of cases are adults. The majority of cases have been reported in Chenivetsk, Ivano-Frakivsk, Zakarpatie, Lviv and Odessa regions.
Advice for healthcare professionals
Travel may increase an individual’s risk of exposure to measles virus, and facilitate the spread of disease to unvaccinated and susceptible populations. The travel consultation provides healthcare practitioners with a valuable opportunity to ensure individuals are protected against the measles virus. Consider vaccinating:
- all travellers who have not previously had two doses of a measles containing vaccine or prior measles infection
- children and those who will be living or working closely with the local population at their destination, in countries with high endemnicity or recent outbreaks
Further information and advice for clinicians advising travellers can be accessed on TRAVAX.
Advice for travellers
It should be confirmed that children have received their recommended doses of MMR at 12-13 months of age and again pre-school around three years four months. Consider vaccinating all unimmunised adults who have not had the disease themselves, particularly if they are going to be at higher risk. Two doses of MMR vaccine, at least one month apart, are required to give adequate protection.
Information for travellers to Saudi Arabia for Hajj pilgrimage in 2018
The Saudi Ministry of Health (MoH) have issued their requirements and recommendations for entry visas for the Hajj and Umrah in 2018. These are updated annually.
In addition, the Saudi MoH website includes useful health information and resources for pilgrims to Saudi Arabia.
The Saudi MoH strongly recommends that the following people postpone their Hajj and Umrah in 2018, for their own safety:
- the elderly (above 65 years of age)
- those with chronic diseases (e.g. heart disease, kidney disease, respiratory disease, diabetes)
- immune deficiency (congenital and acquired)
- those with malignant disease
- those who are terminally ill
- pregnant women
- children (under 12 years)
It is strongly recommended that all pilgrims obtain comprehensive travel and medical insurance (including repatriation) before travel.
Meningococcal meningitis vaccine
Visitors arriving for Umrah, Hajj or for seasonal work in Hajj zones, are required to submit a valid vaccination certificate with a Quadrivalent (ACWY) meningococcal vaccine administered no less than 10 days prior to arrival to Saudi Arabia.
Vaccination with one of the following vaccines is acceptable:
- Quadrivalent (ACWY) polysaccharide vaccine within the last three years
- Quadrivalent (ACWY) conjugate vaccine within the last five years
If the vaccine type is not indicated in the certificate, the certificate will be valid for three years.
Vaccination with Quadrivalent (ACWY) conjugate vaccine is also required for:
- domestic pilgrims
- residents of the two holy cities (Mecca and Medina)
- any person who may be in contact with pilgrims including personnel in healthcare settings
The Saudi MoH may opt to administer prophylactic antibiotics to some travellers at the points of entry if deemed necessary.
There are certain other vaccinations which may be recommended for personal protection, including hepatitis A, influenza and measles. In addition, the Saudi MoH has compulsory vaccination requirements for Hajj pilgrims entering from certain countries other than the UK, for example yellow fever and poliomyelitis.
Full details on recommended vaccines and malaria advice for travellers from the UK are on the TRAVAX Saudi Arabia country page.
Guidance from ECDC & EMCDDA on active case finding of communicable diseases in prisons
The European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have published guidance on active case finding of communicable diseases among people in prison. This guidance advises offering testing for hepatitis B, hepatitis C and HIV to all people in prison and to conduct universal testing for tuberculosis on entry to prison.
Compared to the general public, people in prison have a higher rate of communicable diseases such as hepatitis B, hepatitis C, HIV, syphilis, gonorrhoea, chlamydia and tuberculosis. This constitutes a health risk for those living and working in prison settings as well as for the general population, given that the majority of people in prisons return to their communities after a short period of incarceration (median length of detention in Europe is less than nine months).
The ECDC–EMCDDA Guidance is based on consultations with a panel of prison experts, and identifies the most cost-effective approaches with the aim to interrupt transmission in, and between, prison settings as well as the community, by first testing and then offering treatment to those infected.
Source: ECDC, 23 May 2018
Ebola outbreak (DRC): ECDC risk assessment update and WHO news page
An update to the current ECDC risk assessment on the Ebola outbreak in the Democratic Republic of the Congo (DRC), was published on 25 May 2018. This is due to cases in urban areas in the Equateur province in DRC which may increase the risk of spread to neighbouring countries. The risk to the EU remains very low.
In addition the updated risk assessment has also states that:
- there is a very low risk for EU travellers/residents in DRC areas not known to have cases
- there is a low risk for travellers entering the affected area (the Equateur province)
Source: ECDC, 25 May 2018
A news page covering the Ebola outbreak in DRC has been established by the World Health Organisation (WHO), and is being updated regularly. The page includes news on efforts by the DRC Ministry of Health and WHO to control the outbreak as well as an overview of the situation and information on the vaccination programme.
For more information on the current Ebola outbreak in the DRC, see current note 52/1905.
Climate Change Bill
The Scottish Government has introduced the Climate Change (Emissions Reduction Targets) (Scotland) Bill. The new Bill will immediately set a target of a 90% reduction by 2050 but the draft Bill sets out that the Scottish Government intends to go further still and achieve a 100% reduction in emissions, known as net-zero, as soon as possible.
Ministers will be legally required to keep the net-zero target date under review by seeking expert advice on the issue every five years. The target date will become legally-binding, subject to the consent of the Scottish Parliament, as soon as there is sufficient evidence to demonstrate the date is credible and achievable.
As well as increasing long term ambition, the new Bill also includes the most ambitious interim targets in the world, as well as stretching annual targets for every year between now and 2050. This means action will need to increase immediately, across every sector of the Scottish economy. It will also require action by individuals, communities and businesses – as well as government.
Scotland’s existing targets are for a 42% reduction in greenhouse gas emissions by 2020 and an 80% reduction by 2050. The new interim targets will be 56% by 2020, 66% by 2030, and 78% by 2040 and are set out on a dedicated website.
Scotland’s bathing waters continue to meet strict environmental standards
Ahead of the new season, the Scottish Environment Protection Agency (SEPA) has revealed that 75 of the country’s 86 designated bathing waters (87%) meet strict environmental standards for water quality.
The report highlighted:
- 87% of Scotland’s designated bathing waters meet strict environmental water quality standards
- water quality data available by 10.00 am every day during the season for 31 bathing water locations on the bathing water website, SEPA’s website, via Beachline and live electronic beach signage
- partnership projects underway to improve bathing waters including 11 rated as ‘poor’
- Nairn bathing waters achieve the sufficient EU classification for the first time after two years of poor rating
Source: SEPA, 25 May 2018