The report on quarterly epidemiological data on Clostridioides (formerly Clostridium) difficile infection (CDI), Escherichia coli bacteraemia (ECB), Staphylococcus aureus bacteraemia (SAB), and surgical site infection (SSI) in Scotland, July to September (Q3) 2018, has been published on 8 January 2019 under the mandatory programmes for surveillance of CDI, ECB, SAB, and SSI in Scotland. This report provides data for the third quarter of 2018 in 14 NHS boards and one NHS Special Health Board.

The report and an appendix detailing all cases and denominator data for each NHS board and overall for Scotland can be accessed on our website.

The World Health Organization (WHO) has updated its report on the ongoing outbreak of extensively-drug resistant (XDR) typhoid in Sindh province in Pakistan. The outbreak began in November 2016 and since then until December 2018, there have been 5,274 cases of XDR typhoid out of 8,188 cases of typhoid reported within Sindh province. Of these cases:

• 69% were reported in Karachi
• 27% in Hyderabad district
• 4% in other districts of Sindh province

The increasing trend of typhoid fever caused by antimicrobial resistant strains of Salmonella enterica serovar typhi poses a public health concern. The risk of XDR S. typhi at national level is considered high in Pakistan due to insufficient water, poor sanitation and hygiene practices, and low vaccination coverage. Globally, the risk is considered low, although there is potential for travellers from Pakistan to spread disease.

There have been six travel-associated cases of XDR typhoid in travellers:

• one in the UK
• one in Northern Ireland
• four in the USA

The full report, including case definitions, is available on the WHO website.  

Advice for travellers

Typhoid is spread by the faecal oral route, therefore precautionary measures should be taken to avoid consumption of potentially contaminated drinks, drinking water and ice and to ensure food is uncontaminated or cooked thoroughly. Personal hygiene when eating and drinking is also important including hand washing prior to eating and using clean plates, cups and utensils.

It is recommended that all travellers to Pakistan should be vaccinated.

Further information and advice is available on the Travax (for health professionals) and fitfortravel (for the general public) websites.

The European Centre for Disease Prevention and Control (ECDC) has published six reports in its series of annual epidemiological reports on communicable diseases in Europe.

• Anthrax annual epidemiological report reported five laboratory-confirmed anthrax cases in Romania and one in Spain.
• Campylobacteriosis annual epidemiological report reported 248,752 confirmed cases of campylobacteriosis in 29 European Union or European Economic Area (EU/EEA) countries. Campylobacteriosis is a very common gastrointestinal disease in the EU/EEA.
• Cryptosporidiosis annual epidemiological report reported 13,691 cryptosporidiosis cases in 21 EU/EEA countries, of which 13,623 cases were confirmed.
• Listeriosis annual epidemiological report reported 2,555 confirmed listeriosis cases in 30 EU/EEA countries.
• Shigellosis annual epidemiological report reported 5,631 confirmed shigellosis cases in 29 EU/EEA countries. Although Shigellosis is a relatively uncommon disease in the EU/EEA, it remains of concern in some countries and for some population groups.
• Typhoid and paratyphoid fevers annual epidemiological report reported 1,161 confirmed cases in 22 EU/EEA countries. Typhoid and paratyphoid fevers are relatively rare in the EU/EEA and mainly acquired during travel to countries outside the EU/EEA, particularly in south Asia.

Source: ECDC, 21 December 2018

According to a new report from the European Centre for Disease Prevention and Control (ECDC), none of the European Union (EU) member states could demonstrate that they reach the EU target of 75% influenza vaccination coverage for vulnerable groups. Only a few of the EU member states that participated in the survey came close to achieving the 75% vaccination coverage target, set by the EU to protect tens of thousands of people at risk of death and serious illness.

Influenza vaccination coverage remains low in many countries, and if there are no improvements in the vaccine uptake, significant burden on the healthcare systems can be expected also during this upcoming winter season.

Nineteen member states provided influenza vaccination coverage rates for the 2015 to 2016, 2016 to 2017 and 2017 to 2018 seasons. Detailed information was provided for specific risk groups such as:

• the elderly
• individuals with chronic medical conditions
• pregnant women
• healthcare workers
• residents of long-term care facilities

These groups are the most likely to suffer serious complications, which is why most countries prioritise them for vaccination.

More encouragingly, about half of the EU member states reported increased use of newer influenza vaccines that provide broader protection during the 2017 to 2018 season. Also, six member states reported using newer immunisation strategies which target additional age groups such as children. Whether the newer vaccines and vaccination strategies will provide better overall protection will be studied by ECDC in the coming winter seasons.

‘Seasonal influenza vaccination and antiviral use in EU/EEA Member States - Overview of vaccine recommendations for 2017-18 and vaccination coverage rates for the 2015–16 and 2016–17 influenza seasons’ is available on the ECDC website.

Source: ECDC, 18 December 2018

The European Centre for Disease Prevention and Control (ECDC) has launched two R packages for analysing infectious disease surveillance data. The tools can support public health experts in creating epidemiological reports or detecting outbreaks.

• The EpiSignalDetection tool will help to detect possible outbreaks. Statistical methods are applied to routine surveillance data to identify any changes in disease incidence. This can allow for an early detection and investigation of possible outbreaks.
• The EpiReport tool enables public health experts to draft epidemiological reports for a given disease, based on surveillance data. Outputs similar to those of the ECDC annual epidemiological report, such as tables of cases distribution, trend and seasonality plots, can be created.

The R packages, which can be downloaded free of charge, are available on the ECDC website.

Radon is a colourless, odourless radioactive gas that is formed by the radioactive decay of elements that occur naturally in rocks and soils. Radon is the single biggest source of radiation exposure to the UK population in both homes and workplaces.

‘The National Radon Action Plan’ describes the national radon strategy and arrangements for managing exposure to radon in homes and workplaces. It fulfils relevant requirements in the 2013 European Union Basic Safety Standards Directive on protection against ionising radiation (EURATOM, 2013).

The action plan includes:

• information on the health risks from public exposure to radon
• national strategy and arrangements for managing exposure to radon, in homes and workplaces
• arrangements for the government and private industry to communicate radon guidance to the public and local authorities

Source: Public Health England, 18 December 2018

The Scottish Government has published the conclusions and recommendations of the review of the Scottish Fire Safety Regime established by the Building and Fire Safety Ministerial Working Group.

The purpose of the review was to ensure that the fire safety regime and regulatory framework in Scotland provides comprehensive protection to residents of high rise domestic buildings and is robust and fully fit for purpose. The focus has been reviewing existing fire safety legislation and associated frameworks to identify and recommend whether any changes or improvements are required to the legislation in order to improve, if necessary, fire safety for those who live in high rise domestic properties in Scotland.

‘Review of the Scottish Fire Safety Regime for Domestic High Rise Property’ can be accessed on the Scottish Government website.

The Scottish Environment Protection Agency (SEPA) has opened a consultation on its water supply and waste water treatment sector plan. The draft plan details how SEPA is going to regulate the water sector and work with it to protect and improve the environment. The plan covers both public and private water supply and waste water treatment. Its focus is on building a circular economy that helps minimise the impact of the sector on the environment and strengthens Scotland’s resilience to climate change.

The consultation is open until 15 February 2019 and is available on the SEPA website.

Source: SEPA, 21 December 2018

The first phase of Glasgow’s Low Emission Zone (LEZ) has gone live on 1 January 2019 (see current note 52/1305). Glasgow is the first city to implement a zone, working with the bus industry to respond to the particular air quality challenges within Glasgow city centre. This first phase affects local service buses and the eighth round of the Scottish Green Bus Fund has resulted in £1.14 million being awarded to First Glasgow and Glasgow Airport to encourage more low carbon emission buses onto Scotland’s roads.

The previous seven rounds of the fund have been successful in providing over £16 million, resulting in over 360 low carbon emission buses joining the Scottish Fleet.

In addition, almost £350,000 has been awarded to Dundee by Transport Scotland and the Scottish Government to explore the impact on traffic of a low emission zone.

National information on Scotland’s low emission zones is available  on the Low Emissions Scotland website.

Sources: Transport Scotland, 31 December 2018 and Dundee City Council, 31 December 2018