Influenza vaccination coverage among high-risk groups has dropped in the European Region over the last seven years, and half the countries report a decrease in the number of vaccine doses available. These are the results of the first comprehensive overview of seasonal influenza vaccine coverage in the European Region of the World Health Organization (WHO) between 2008-09 and 2014-15, conducted by the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe. The two organisations have warned that low uptake of seasonal influenza vaccination in Europe jeopardises the capacity to protect people during annual epidemics and the next pandemic.

The overview appears in a peer-reviewed scientific article published in Vaccine in January 2018, based on data from the Vaccine European New Integrated Collaboration Effort (VENICE III) and WHO surveys. As the 2017-18 influenza season peaks in western Europe, a number of countries have seen a rapid increase in severe cases and, according to EuroMOMO, the organisation for European monitoring of excess mortality for public health action, some are reporting excess mortality among the elderly.

Source: ECDC News Release, 7 February 2018

In Scotland, provisional data to week 3 suggest a positive public response by adults to increased publicity about influenza. Vaccine uptake rates this month (January) have increased and are similar or greater than 2016-17:

• 72.5% in people aged 65 years and over, compared with 72.0% in 2016-17
• 43.4% in under 65’s at-risk, compared with 43.5% in 2016-17
• 46.4% in pregnant women (without other risk factors), compared with 44.8% in 2016-17
• 60.0% in pregnant women (with other risk factors), compared with 55.5% in 2016-17
• 55.1% in preschool children (two to under five year olds), compared with 56.3% in 2016-17
• 71.1% in primary school children, compared with 71.7% in 2016-17

The next update of influenza vaccine uptake will be published in week 7.

The country-specific recommendations for the use of typhoid vaccine in travellers have been revised and updated on both the TRAVAX (for health professionals) and fitfortravel (for the general public) websites. These recommendations take into account data on imported typhoid cases, recently published academic literature on typhoid epidemiology and international reviews of typhoid incidence and vaccine use.

Typhoid is most commonly spread through ingestion of food and drink that has been contaminated with faeces or urine from a human case or carrier. Travellers to all destinations should be advised to practice good food and water hygiene to reduce the risk of all food- and water-borne infections.

An HPS review determined that the majority of typhoid illness in travellers is acquired in Central and South Asia. Consequently TRAVAX will recommend that typhoid vaccine only be ‘usually advised’ for Afghanistan, Bangladesh, Bhutan, India, Nepal, and Pakistan. For travellers to other countries where a lower risk of typhoid has been identified, vaccination may be ‘sometimes advised’ if they are:

• venturing off the usual tourist routes to visit smaller villages, cities and rural areas where access to adequate sanitation and safe water may be limited
• visiting friends and relatives
• unable to take sufficient care with food and drink, including children
• considered to have increased susceptibility to infection or to severe outcome, i.e. travellers with achlorhydria or immunocompromised
• long stay travellers

For some countries, typhoid vaccination is not recommended.

Country specific advice on the need for typhoid vaccination can be found on the individual country pages of TRAVAX and fitfortravel.

Source: TRAVAX News Release, 6 February 2018

South Sudan declared the end of its longest and largest cholera outbreak on 7 February 2018, with no new cases of cholera reported in over seven weeks.

The fight against cholera in South Sudan has involved a range of partners working together to enhance surveillance, deploy rapid response teams to investigate and respond to cases, provide clean water, promote good hygiene practices and treat cholera patients.

To enhance outbreak response efforts, the government worked with the European Union Humanitarian Aid (ECHO), GAVI, the Vaccine Alliance, the United States Agency for International Development (USAID) and the World Health Organization (WHO), securing 2.2 million doses of the oral cholera vaccine (OCV) from the GAVI-funded global stockpile.

In 2017 more than 885,000 people at higher risk of cholera were immunised in the first round and nearly 500,000 people also received a second round of the vaccine. Due to security challenges, not everyone was able to receive the recommended two doses, which would significantly decrease their risk of being affected by cholera.

The outbreak was declared on 18 June 2016 and spread to many parts of the country, including the capital Juba. By the time the last confirmed cholera case was discharged on 18 December 2017, over 20,000 suspected cholera cases and 436 deaths were reported.

The country is dealing with several complex health emergencies with 5.1 million people in need of health assistance. Armed conflict has forced almost 4 million people to flee their homes. Nearly 5 million people, more than 40% of the population, are severely food insecure. These challenges place a huge burden on the country’s health system, while the sanitation infrastructure needs further strengthening. In a few months a new rainy season will begin, increasing the risk of a new cholera outbreak.

Source: WHO Regional Office for Africa News Release, 7 February 2018

On 9 February 2018, Food Standards Scotland (FSS) published research demonstrating that chicken remains the biggest source of Campylobacter infection in Scotland.

FSS had commissioned the University of Aberdeen to compare clinical strains of Campylobacter from the Grampian area with strains isolated from chickens, cattle, sheep, pigs and wild birds. This was used to determine the proportion of infections in Scotland from these potential sources.

While Campylobacter remains the most common source of foodborne illness there has been a reduction in those contracting Campylobacter from chicken. The proportion of cases attributed to chicken decreased from 55-75% to 52-68% when compared to data collected between 2012-2015.

These findings will assist FSS in developing a new Campylobacter strategy for Scotland aimed at achieving a continued decline of Campylobacter cases from chicken. FSS will also identify opportunities to work with other organisations to reduce the risks from sources other than chicken which may be caused by environmental exposure.

FSS stressed that chicken is safe as long as good food hygiene practices are followed at home.

Source: FSS News Release, 9 February 2018

Wales has become the first country in the UK to introduce a nationwide ban on the intimate piercing of under 18s.

The new law, which came into force on 1 February 2018, makes it an offence for piercing practitioners to arrange and carry out an intimate piercing on those under 18. The aim of the new law is to protect children and young people from the potential health harms which can be caused by an intimate piercing. 

The change will come under the Public Health (Wales) Act 2017, prohibiting the intimate piercing of persons under the age of 18 in Wales. It will also be an offence to ‘make arrangements’ to perform an intimate piercing on a child or young person under the age of 18 in Wales.

The intimate piercing of children and young people under 18 could also be considered a child protection issue. By undergoing an intimate piercing procedure, young people under the age of 18 may be placed in a vulnerable position.

A study in England found that amongst individuals aged 16-24 complications were reported with around a third of all body piercings. The same study found a higher incidence of complications in connection with certain types of body piercings, including intimate piercings. Problems were most likely to be reported in the case of tongue piercing (50%), followed by piercings of the genitals (45%) and the nipples (38%).

As young people continue to grow during their teenage years, an intimate piercing performed at a young age could result in further complications arising as their bodies develop. Young people may also be less likely to have the experience or knowledge of how to clean or maintain an intimate piercing, leading to an increased risk of infection.

Source: Welsh Government News Release, 1 February 2018

National guidelines for Ireland for the Prevention of Nosocomial Aspergillosis (January 2018) have been published on the Health Protection Surveillance Centre (HPSC) website and replace the previous guidance published in 2002. The guidance is intended for use by those involved in hospital renovation and building construction or demolition activities and by clinical staff caring for patients at increased risk of aspergillosis. This includes, but is not limited to, contractors, technical services/maintenance/site foremen, design teams, HSE Estates, management of healthcare facilities, infection prevention and control teams (IPCT) and other healthcare personnel from relevant clinical area(s).

The risk of aspergillosis occurring as a complication of building or renovation works on the sites of healthcare facilities continues, particularly where there are major building projects occurring on existing hospital campuses with a significant population of immunocompromised patients.

The original guidelines have therefore been reviewed and updated taking note of important changes in practices in relation to isolation facilities, antifungal therapies and fungal diagnostics. Added to these is the emergence of Aspergillus fumigatus strains with triazole resistance. All of these topics, and more, have been addressed taking note of recent additions to the literature.

The continuing need for a multidisciplinary approach to prevention of aspergillosis is emphasised, as is the importance of good communication between departments in advance of any potentially hazardous maintenance or new works. A grading system is presented which is intended to aid risk assessment and identify appropriate preventive measures.

The HPS website details current guidance on Aspergillus outbreak prevention, preparedness and management.

Source: Epi-Insight, February 2018

Scottish Water was fined £17,000 at Airdrie Sheriff Court on 7 February 2018 for causing sewage to discharge to the Red Burn from Dunnswood Sewage Treatment Works, Cumbernauld in July 2014.

Between 13 and 14 July 2014, a failure occurred at the Dunnswood Sewage Treatment Works which resulted in the release of an estimated two million litres of untreated sewage into the Red Burn. Scottish Water reported the discharge to the Scottish Environment Protection Agency (SEPA) and environment protection officers launched an investigation into the cause. The incident resulted in a number of fish mortalities across the Red Burn and in the Bonny Water which is used for fishing.

The farm partnership David McCreery and Sons was also fined £1,200 in January 2018 for repeatedly discharging slurry and silage to unnamed tributaries of the Gifford Water, causing pollution to the receiving waters and harm to fish and invertebrate populations. The incident was investigated by SEPA and a report sent to the Procurator Fiscal.

SEPA first became aware of the incident when a local resident reported on 22 September 2014 that the Gifford Water was discoloured (dark green/brown), foaming and smelt strongly of slurry.

A survey carried out by SEPA ecologists demonstrated that the slurry and silage effluent had resulted in a significant volume of polluting substances being released into the water environment, causing serious pollution to the receiving waters and fish fatalities. They concluded that the dead fish in the Gifford Water are likely to have died as a result of the slurry spill, due to a severe drop in dissolved oxygen to levels which were lethal to salmonids.

SEPA considers that the prosecutions highlight the importance of managing farm effluents and maintaining critical water treatment infrastructure.

Source: SEPA Media Release, 12 February 2018

The British Compressed Gases Association (BCGA) has recently published guidance that can be used in the assessment of risk associated with gases in enclosed workplaces, to identify where hazardous atmospheres may occur and the appropriate control measures.

Ambient air is primarily composed of two gases, nitrogen at approximately 78% and oxygen at 20.9%. Changes to the air composition can result in a potentially hazardous atmosphere. Human senses cannot detect different compositions in the atmosphere and are not a valid indicator.

Changes to the composition of the air will occur from the release of gas(es) into the local environment. Examples include evaporation, leakage and process exhaust. There is also the potential for gases to enter the workplace from external sources. Examples include the release of gases from neighbour sites, or concentrations of naturally occurring gases. The changes will be more pronounced in an enclosed space and where there is inadequate ventilation.

It should also be borne in mind that even before the introduction of stored gases into certain workplace situations, gases and low oxygen concentrations may have been generated within an enclosed space by natural decay mechanisms such as the production of hydrogen sulphide from stagnant water, or the corrosion (oxidation) of some metals which can deplete the available oxygen. Atmospheric checking prior to entry to an enclosed space is therefore vital.

Incidents can occur unexpectedly, and may be serious, and sometimes fatal. The BCGA has stressed that all personnel accessing an enclosed workplace should be aware of the hazard(s) associated with non-respirable atmospheres and be given the necessary equipment, information, instruction and training.

Source: BCGA News Release, 5 February 2018

The Scottish Environmental Incident Surveillance System (SEISS) recorded the following incident in the past week:

• Emergency services were called to the supported housing facility in York Street, Wishaw, around 2.35pm on 10 February 2018. Following reports of the incident involving a chemical cleaning agent, residents from the surrounding area were removed. No casualties were reported and emergency services remained on the scene to ventilate the property. This was reported by STV news.

For more detailed information, visit the SEISS website, or contact either Ian Henton or Colin Ramsay at HPS on 0141 300 1100.