A new report from Public Health England (PHE) shows that the UK is one of the first countries to meet the UNAIDS 90-90-90 targets, highlighting that prevention efforts are working in the UK. New estimates reveal that in 2017, 92% of people living with HIV in the UK have been diagnosed, 98% of those diagnosed were on treatment, and 97% of those on treatment were virally suppressed.

In 2017, an estimated total of 102,000 people were living with HIV in the UK, with 8% (8,200) unaware of their infection. As a result of treatment, 87% of all people living with HIV have an undetectable viral load and are unable to pass on their infection to other people (this is widely known as ‘Undetectable equals Untransmissible’ or ‘U=U’).

New HIV diagnoses continue to decline in the UK, falling 17% from 5,280 in 2016 to 4,363 in 2017. The reduction in new diagnoses continues the downward trend in HIV transmission among gay and bisexual men that started in 2012.

Following the publication of the new data in the UK report on HIV, Scotland acknowledges success in achieving the UNAIDS 2020 targets of 90-90-90 with an estimated 91% knowing their diagnosis, 98% of those diagnosed on antiviral therapy and 97% on treatment being virally suppressed (more detail available in our news section).

‘Progress towards ending the HIV epidemic in the UK: 2018 report’ can be accessed on the GOV.UK website

Source: PHE, 29 November 2018

Glasgow is the first city in Scotland to become a HIV Fast Track city. On 29 November 2018, the council’s City Administration Committee (CAC) agreed to sign Glasgow up to the Fast Track Cities initiative - a global partnership which aims to help end the threat of AIDS by 2030. It follows in the footsteps of Manchester, London, Amsterdam, Melbourne and New York who have already joined the movement to end new HIV infections by 2030 and stop stigma and discrimination.

Launched on World AIDS Day 2014, the Fast Track Cities aims to build upon, strengthen and leverage existing HIV programmes and resources to accelerate locally co-ordinated, city-wide responses to end AIDS as a public health threat by 2030.

Becoming a Fast Track city means Glasgow will strive to deliver the UN’s 90:90:90 HIV targets. These are to have 90% of people living with HIV know their status; to have 90% of people with HIV on treatment and to have 90% of people on treatment with suppressed viral loads.

To achieve this, an implementation plan will be put in place, including the setting up of a leadership group made up of key partners and organisations, as well as representatives of the community living with, or at risk of, HIV.

Source: Glasgow City Council, 29 November 2018

The European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe have released the latest data on the HIV epidemic in the European Region. Publication of ‘HIV/AIDS surveillance in Europe 2018 - 2017 data’ marks the 30th anniversary of World AIDS Day.

HIV transmission remains a major public health concern and affects more than two million people in the WHO European Region, particularly in the eastern countries. This report finds that, while epidemic patterns and trends vary widely across European countries, nearly 160,000 people were diagnosed with HIV in the European Region in 2017. The eastern part of the region recorded over 130,000 new HIV diagnoses, the highest number ever. In contrast, the European Union and European Economic Area (EU/EEA) countries reported a decline in rates of new diagnoses (25,000), mainly driven by a 20% decrease since 2015 among men who have sex with men.

The report calls for urgent action for countries and areas (especially in the eastern part) to revamp their political commitment and scale up efforts to implement the action plan for the health sector response to HIV in the WHO European Region.

The ECDC report, accompanying data and infographics can be accessed on their website

Source: WHO Europe, 28 November 2018

On 30 November 2018, the Scottish Health Protection Network (SHPN) Public Health Microbiology Group launched ‘A Public Health Microbiology Strategy for Scotland’. According to the strategy, Scotland is in an ‘unrivalled position’ to create a world renowned Public Health Microbiology service and this document sets out the context and steps needed to provide a Public Health Microbiology capacity and capability in line with the current ECDC strategy for all European member states.

The strategy outlines the components of Public Health Microbiology in Scotland, then identifies the functions of the service, setting out its aims and objectives, and finally maps a route forward through co-ordination, integration and governance so that the operational capability can progressively grow and achieve a ‘best for Scotland’ service which could be a model to other countries.

The delivery of progress against the goals of the Public Health Microbiology Strategy will be coordinated by the Public Health Microbiology Group, which is encompassed in the Scottish Health Protection Network (SHPN).

World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) have jointly published a new report, ‘Progress toward regional measles elimination - worldwide, 2000–2017’. According to this publication, reported measles cases spiked in 2017, as multiple countries experienced severe and protracted outbreaks of the disease. Because of gaps in vaccination coverage, measles outbreaks occurred in all regions, while there were an estimated 110,000 deaths related to the diseases.

Using updated disease modelling data, the report provides the most comprehensive estimates of measles trends over the last 17 years. It shows that since 2000, over 21 million lives have been saved through measles immunisations. However, reported cases increased by more than 30 percent worldwide from 2016.

The Americas, the Eastern Mediterranean Region, and Europe experienced the greatest upsurges in cases in 2017, with the Western Pacific the only World Health Organization (WHO) region where measles incidence fell.

Source: WHO, 29 November 2018

On 29 November 2018, the European Food Safety Authority (EFSA) published its third EU summary report on the monitoring of TSEs in cattle, sheep and goats

TSEs are a group of diseases that affect the brain and nervous system of humans and animals. With the exception of classical Bovine Spongiform Encephalopathy (BSE), there is no scientific evidence that TSEs can be transmitted to humans.

The report provides results on data collected by all EU member states, Iceland, Norway and Switzerland for 2017.

The main findings of the report are:

• no cases of classical BSE in cattle were reported in the EU, out of 1,312,714 animals tested
• six cases of atypical BSE were reported
• 933 cases of scrapie in sheep (out of 314,547 tested)
• 567 cases of scrapie in goats (out of 117,268 tested) in the EU
• no cases of chronic waste disease (CWD) in any of the 3,585 cervids tested (e.g. reindeer, elk and moose) reported in the EU
• in Norway, 11 cases of CWD were reported - nine in wild reindeer, one in moose and one in red deer

Source: EFSA, 29 November 2018

The European Centre for Disease Prevention and Control (ECDC) has published its annual epidemiological report concerning communicable disease threats to public health in the European Union (EU)

The report covers the events, threats and actions taken in 2017 related to the findings of routine activities carried out by the ECDC epidemic intelligence team. The objective of epidemic intelligence at ECDC is to rapidly detect and assess public health events of any origin to ensure EU health security.

Source: ECDC, 28 November 2018

Poultry farmers and pet bird keepers across the UK are being urged to prepare for winter avian influenza threat through biosecurity measures. The Chief Veterinary Officers across the UK are encouraging all poultry keepers to take action now to reduce the risk of disease over the winter.

Since June 2017, there have been no detections of avian influenza in poultry or kept birds in the UK, and the UK has retained its OIE country freedom status since September 2017.

There are some simple measures that all bird keepers, whether running a large commercial farm, keeping a few birds in their back garden or rearing game birds, should take to protect their animals against the threat of avian influenza in the coming winter months. These include:

• keep the area where birds live clean and tidy, control rats and mice and regularly disinfect any hard surfaces;
• clean footwear before and after visits;
• place birds’ feed and water in fully enclosed areas that are protected from wild birds, and remove any spilled feed regularly;
• put fencing around outdoor areas where birds are allowed and limit their access to ponds or areas visited by wild waterfowl;
• where possible, avoid keeping ducks and geese with other poultry species.

Guidance on avian influenza (bird flu) from the Department for Environment, Food & Rural Affairs (Defra), updated on 29 November 2018, can be accessed on their website.

On 28 November 2018, Defra published ‘Disease risk considerations supporting the definition of Avian Influenza Higher Risk Areas in England, Scotland and Wales’.

Source: Defra, 27 November 2018

The Department for Environment, Food & Rural Affairs (Defra) have published an evaluation and lessons identified from Exercise Blackthorn, the UK’s national foot and mouth disease exercise. The purpose of the exercise was to test the four UK governments’ contingency plans for a UK-wide, medium-to-large outbreak of foot and mouth disease (see previous Weekly Report news from 20 February 2018 - CN 52/0704)

Exercise Blackthorn, which was conducted over a period of ten months, was organised by Animal and Plant Health Agency’s (APHA) Contingency Planning Division on behalf of Defra, the Scottish Government, Welsh Government and the Department of Agriculture, Environment and Rural Affairs for Northern Ireland. It evaluates the exercise and records the lessons identified for further action.

The national foot and mouth disease exercise evaluation and lessons identified report can be accessed on the GOV.UK website.

According to the European Environment Agency’s (EEA) updated environmental indicator report published on 28 November 2018, the European Union (EU) continues to fall short of achieving a number of environmental objectives by 2020, especially in areas aimed at protecting biodiversity and natural capital.

This annual report provides an updated scoreboard that monitors progress in 29 selected environmental objectives that are relevant to achieving the three key priority objectives under the 7th Environment Action Programme (EAP) that address: natural capital; sustainable, resource efficient, low-carbon economy; and people’s health and well-being.

The report suggests that environment and climate policy implementation needs to be stepped up across the EU to meet the 2020 objectives. The results also highlight the need for mainstreaming environmental and climate objectives further into those policy domains that contribute most to the degradation of natural capital, human health impacts, inefficient use of natural resources and climate change. These policy domains include energy supply and demand, food production and consumption, transport and mobility and urban infrastructure development.

The EEA Environmental Indicator Report 2018 can viewed on the EEA website

Source: EEA, 29 November 2018

On 28 November 2018, the European Commission (EC) adopted a strategic long-term vision for a prosperous, modern, competitive and climate neutral economy by 2050, ‘A clean planet for all’.

The strategy shows how Europe can lead the way to climate neutrality by investing in realistic technological solutions, empowering citizens, and aligning action in key areas such as industrial policy, finance, or research – while ensuring social fairness for a just transition.

Following invitations by the European Parliament and the European Council in March 2018, the commission’s vision for a climate-neutral future covers nearly all EU policies and is in line with the Paris Agreement objective to keep the global temperature increase to well below 2°C and pursue efforts to keep it to 1.5°C. This must be achieved by 2050, if the EU is to lead the world towards climate neutrality.

Source: EC, 28 November 2018

The World Health Organization (WHO) has published ‘WHO Housing and health guidelines’ which bring together the most recent evidence to provide practical recommendations to reduce the health burden due to unsafe and substandard housing. Based on newly commissioned systematic reviews, the guidelines provide recommendations relevant to inadequate living space (crowding), low and high indoor temperatures, injury hazards in the home, and accessibility of housing for people with functional impairments. The guidelines also identify and summarise existing WHO guidelines and recommendations related to housing, in relation to water quality, air quality, neighbourhood noise, asbestos, lead, tobacco smoke and radon. The guidelines take a comprehensive, intersectoral perspective on the issue of housing and health and highlight co-benefits of interventions addressing several risk factors at the same time.

The guidelines aim to inform housing policies and regulations at the national, regional and local level and emphasise the importance of collaboration between the health and other sectors and joint efforts across all government levels to promote healthy housing. The guidelines’ implementation at country-level will in particular contribute to the achievement of the Sustainable Development Goals on health (SDG 3) and sustainable cities (SDG 11). WHO will support member states in adapting the guidelines to national contexts and priorities to ensure safe and healthy housing for all.