HPS Weekly Report
31 Jul 2018
Volume 52 No. 30
Sexually transmitted infections 2017: annual reports
The annual sexually transmitted infection (STI) reports presenting data for 2017 on infectious syphilis, Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhoea) diagnoses in Scotland were published on 31 July 2018 by Health Protection Scotland (HPS), along with a report on antimicrobial resistance monitoring in gonorrhoea infection published jointly with the Scottish Bacterial Sexually Transmitted Infections Reference Laboratory (SBSTIRL).
Genital chlamydia remains the most frequently diagnosed STI in Scotland with 15,685 diagnoses reported in 2017, a 4% increase compared to 2016. This STI predominates in women (59% of all diagnoses) and in young people (67% of all diagnoses were made in those aged less than 25 years), which mirrors patterns observed over the past decade.
In 2017, 2,610 diagnoses of gonorrhoea were reported, a 10% increase compared to the previous year and, using the data from clinical recording, the largest annual total recorded since the late 1980s. In contrast to genital chlamydia, three-quarters of gonorrhoea diagnoses were among men, 62% of whom were aged 25 and over. Over the past five years, a 64% increase has been observed in gonorrhoea diagnoses which is considered to be due, largely, to an increase in transmission among men who have sex with men (MSM). Rectal gonorrhoea, a marker of condomless anal intercourse (CAI), remained high in 2017.
In addition, the number of infectious syphilis diagnoses increased from 356 in 2016 to 397 in 2017. This is the highest annual total in nearly 70 years. While infection among heterosexual men and women remains stable, the burden of infection is among MSM (84%) and the number of diagnoses has increased threefold in the last few years. The rise in infectious syphilis and gonorrhoea diagnoses mirrors the epidemiological picture in England, where increases of 20% and 22% respectively have also been reported.
Among heterosexual men and women, rates of STIs remain stable and diagnoses of gonorrhoea and syphilis remain relatively uncommon. However, these reports highlight that the numbers of diagnoses of STIs (particularly chlamydia and infectious syphilis) among MSM continue to increase and gonorrhoea infection remains high.
Gonococcal antibiotic surveillance in Scotland (GASS): prevalence, patterns and trends in 2017
The Gonococcal antibiotic surveillance in Scotland (GASS) report was published on 31 July 2018, showing the patterns and trends of antibiotic resistance in 2017. In the UK, the current recommended treatment for gonorrhoea is dual therapy with ceftriaxone and azithromycin, with patterns of resistance measured each year to ensure treatment remains effective. In 2017, no resistance to ceftriaxone was observed, however decreased susceptibility to azithromycin was observed in a small proportion (3.4%) of isolates. Of concern, however, was the observation that a small number (21, 1.6%) of gonococcal isolates demonstrated high level resistance (HL-AziR) to azithromycin. This is an increase on previous years and is the highest number and proportion since a similar observation was made in 2007.
High level azithromycin resistant strains are also circulating in England. Encouragingly, to date in Scotland, no treatment failures have been formally reported. However, it is essential that resistance monitoring continues to help guide effective antibiotic therapy. An expert group has been established by HPS to examine the data further and make recommendations on treatment based on emerging patterns of decreased susceptibility and resistance.
Ebola virus outbreak in DRC ends
24 July 2018 marked the end of the ninth outbreak of Ebola virus in the Democratic Republic of the Congo (DRC). Unlike previous Ebola virus outbreaks in the country, this one involved four separate locations, including an urban centre with river connections to the capital and to neighbouring countries, as well as remote rainforest villages. There were initial concerns that the disease could spread to other parts of DRC and to neighbouring countries.
The World Health Organisation (WHO) congratulated the country and all those involved in ending the outbreak, while urging them to extend this success to combatting other diseases in DRC.
Source: WHO, 24 July 2018
WHO highlights appropriate testing and treatment as key to eliminating viral hepatitis
The World Health Organisation (WHO) has highlighted universal access to testing and treatment as the key to eliminating viral hepatitis in Europe.
Viral hepatitis affects tens of millions of people in the WHO European Region, more than two-thirds of whom live in eastern Europe and central Asia. Every day, thousands of people become infected due to factors such as unsafe injection practices and insufficient information and tools for prevention.
Chronic viral hepatitis B and C can lead to severe diseases such as cirrhosis and liver cancer. These infections may not show symptoms for a long time, sometimes decades, and slowly damage the liver. Globally, at least 60% of liver cancer cases are due to late testing and treatment of viral hepatitis B and C. An estimated 170,000 people die from causes related to hepatitis B and C each year.
The WHO recommends that all people at risk of hepatitis B and C should be offered testing. People diagnosed with chronic hepatitis B virus infection need to be regularly checked and assessed and offered treatment when needed. New WHO hepatitis C guidelines recommend that all people diagnosed with chronic hepatitis C should be offered treatment with direct-acting antivirals (DAAs).
Source: WHO, 27 July 2018
Preventing blood-borne viruses in prison settings: ECDC and EMCDDA guidance
The European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have published new guidance to prevent blood-borne viruses in prison settings. People in prison experience a higher burden of communicable diseases such as hepatitis B (HBV), hepatitis C (HCV) and HIV, often linked to a history of injecting drug use. In addition, incarceration can result in a higher risk of transmission of communicable diseases, due to factors such as overcrowding, poor healthcare facilities and delayed diagnosis.
The ECDC–EMCDDA Guidance is based on a series of comprehensive reviews and analyses of the published literature and consultation with a scientific expert panel. It identifies the most (cost-)effective approaches with the aim to interrupt transmission in, and between, prison settings as well as the community.
Source: ECDC, 23 July 2018
Multi-country outbreak of Salmonella Agona infections possibly linked to ready-to-eat food
The European Centre for Disease Prevention and Control (ECDC) and the European Food Safety Authority (EFSA) have published a rapid outbreak assessment following a multi-country outbreak of Salmonella enterica subspecies enterica serovar Agona (S. Agona) in the EU.
Overall, 147 outbreak cases have been reported by five EU countries, namely, Denmark, Finland, Germany, Ireland and the UK. Cases have retrospectively been identified back to 2014.
Based on the information available, the microbiological evidence suggests ready-to-eat products containing cucumbers as a possible vehicle of infection but, at present, there is insufficient epidemiological information available to support the microbiological evidence. Epidemiological investigations in the other affected countries did not generate any strong hypothesis about the vehicle or source of infection.
Source: ECDC, 26 July 2018
High levels of shellfish toxin
Monitoring work undertaken on behalf of Food Standards Scotland (FSS) has identified raised levels of shellfish toxins in Loch Leurbost in Lewis.
Eating shellfish such as mussels, cockles, or razor fish from these areas may pose a risk to human health and notices to warn the public and casual gatherers have been posted at various locations on the shore. Commercial shellfish harvesters in these areas have been contacted by the Comhairle (Western Isles Council) and steps taken to postpone harvesting until algae levels subside.
The Comhairle is monitoring the situation and will remove warning notices when it improves.
Pesticides in food: latest figures remain steady
On 25 July 2018, the European Food Safety Authority (EFSA) published its annual report on pesticide residues in food. The report analysed the results of 84,657 food samples from the EU member states, Iceland and Norway and concluded that 96.2% of the samples fell within legal limits.
The main findings of the report were that:
- the reporting countries analysed 84,657 samples for 791 pesticides
- 96.2% (81,482) of the samples were within limits permitted in EU legislation and 50.7% of the tested samples were free of quantifiable residues. In the previous reporting year (2015), 97.2% of samples were within the legal limits and 53.3% were free of quantifiable residues. The difference is mainly attributed to the finding of chlorate residues, a compound that was included for the first time in the 2016 control programmes to support on-going work to establish maximum residue levels (MRLs)
- the majority of the tested samples (67%) originated from EU member states, Iceland and Norway, while 26.4% concerned products imported from third countries. For 6.6% of the samples, the origin of the products was unknown
- legal limits were exceeded in 2.4% of samples for products from EU and EEA countries, legal limits were exceeded in 7.2% of the samples from non-EU countries
- of the 1,676 samples of food intended for infants and young children, 98.1% were within the limits permitted in EU legislation. 89.8% of the samples were free of quantifiable residues
- 5,495 samples of organic food were taken in 2016, of which 98.7% were within legal limits. 83.1% of the samples were free of quantifiable residues
Source: EFSA, 25 July 2018
Plastic bag sales in ‘big seven’ supermarkets down 86% since 5p charge
Plastic bag sales in England’s ‘big seven’ supermarkets have dropped by 86% since the UK Government introduced its 5p plastic bag charge in 2015. This is the equivalent to 19 bags per person in England, compared to 140 bags since the government introduced a 5p charge in 2015, a reduction of 86%.
Plastic bags have a significant impact on the environment. Government scientists believe plastic in the sea is set to treble in a decade unless marine litter is curbed - with one million birds and over 100,000 sea mammals dying every year from eating and getting tangled in plastic waste.
Source: UK Government, 26 July 2018