On 1 October 2019, Health Protection Scotland (HPS) published quarterly epidemiological data on Clostridioides difficile infection (CDI), Escherichia coli bacteraemia (ECB), Staphylococcus aureus bacteraemia (SAB), and surgical site infection (SSI) in Scotland for April to June (Q2) 2019, under the mandatory programmes for surveillance of CDI, ECB, SAB, and SSI in Scotland.

This report provides data for the second quarter of 2019 in 14 NHS boards and one NHS special health board. Further, a summary detailing all cases and denominator data for each NHS board and overall for Scotland, is provided.

On 24 September 2019, the first World Health Organization (WHO) Strategic Response Plan (SRP) for a measles emergency was launched, in order to ensure financial commitment to stop the spread of measles in the WHO European Region.

Over 120,000 measles cases were reported in the region between August 2018 and July 2019, which is more than the total number for a 12-month period reported in over a decade. Of the region’s 53 countries, 48 reported cases in this period.

As measles continues to circulate in Europe, the WHO has urged a stronger response by the international community. In May 2019, the WHO classified measles outbreaks across the region as a grade two emergency. 

The newly launched SRP provides a resource mobilization tool to accelerate tailored interventions in measles-affected and at-risk countries, where investments will have the greatest possible impact. Current capacity in many European countries is not sufficient to control measles outbreaks and achieve the regional measles elimination goal. It is hoped the SRP will represent a turning point for many countries in the region in stopping measles transmission and strengthen their health systems to prevent outbreaks in the future.

The SRP covers the period of September 2019 to December 2020, and will be reviewed and updated if necessary. Actions include: 

• bringing the outbreaks under control 
• providing safe care to patients 
• increasing high-level commitment 
• strengthening vaccine acceptance and demand 
• increasing preparedness and risk mitigation 
• reviewing outbreak response

The outputs of this SRP will complement and accelerate regional action to reach targets for measles elimination as defined in the European Vaccine Action Plan.

Source: WHO Europe, 24 September 2019

Health authorities in the Democratic Republic of the Congo (DRC) have announced plans to introduce a second experimental Ebola vaccine, manufactured by Johnson & Johnson, from mid-October 2019.

The vaccine, which is given as a two-dose course with a 56 day cycle, will be provided under approved protocols to targeted at-risk populations in areas that do not have active Ebola transmission, as an additional tool to extend protection against the virus.

The new vaccine will complement the current vaccine (rVSV-ZEBOV-GP, manufactured by Merck), which has proven highly effective and safe, and which has helped protect thousands of lives. The Merck vaccine will continue to be provided to all people at high risk of Ebola infection including those who have been in contact with a person confirmed to have Ebola, all contacts of contacts and others determined to be at high risk of contracting Ebola. 

Over 223,000 people have received this vaccination during the current outbreak.

In May 2019, the World Health Organizations’ (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) reviewed the use of vaccines in the ongoing Ebola outbreak and issued several recommendations, which included:

• adjusting the dose of the Merck vaccine 
• evaluating a second vaccine under appropriate protocols 
• changing strategies when insecurity makes it difficult to reach people 
• increasing the number of people vaccinated within communities with ongoing transmission

The main vaccination strategy used with the Merck vaccine is a ‘ring strategy’ where all people who have come into contact with someone with a confirmed case of Ebola are given the vaccine. Where people are stigmatized or feel under threat, temporary ‘pop-up’ vaccination sites are set up, often at health posts, rather than near the homes of individuals infected with Ebola. In addition to providing vaccination access at a safe, more anonymous site, this strategy also increases protection for vaccinators in areas where there is ongoing conflict and insecurity.

Another approach being used to offer vaccination for people with a high-risk of contracting Ebola is ‘targeted geographic vaccination’. This involves vaccinating everyone in the neighbourhood, rather than vaccinating only the known contacts and contacts of contacts. Targeted geographic vaccination was used successfully when the outbreak spread to Chowe in South Kivu, with over 90% of people accepting vaccination. 

Since the start of the outbreak, the WHO and its partners have worked to recruit and train Congolese nationals from within Ebola-affected communities as vaccinators to increase community acceptance and also transfer skills to the region. The majority of ring vaccination team members are now trained healthcare workers, doctors and medical students from affected communities who speak local languages and understand community concerns.

Source: WHO, 23 September 2019

Global Handwashing Day, on 15 October 2019, aims to increase awareness and understanding regarding the importance of handwashing with soap, as an effective and affordable way to prevent diseases and save lives. 

The theme for Global Handwashing Day 2019 is ‘Clean Hands for All’, a reminder that inclusivity is important when addressing handwashing disparities, while working towards the United Nations (UN) Sustainable Development Agenda.

Lack of access to handwashing facilities and effective handwashing promotion programs can put individuals at higher risk for diseases which may impact on their health, education and economic outcomes.

The UK’s Chief Medical Officer (CMO), Professor Dame Sally Davies, has announced funding for projects to help combat antimicrobial resistance (AMR) and achieve global universal health coverage. The announcement was made at the September 2019 United Nations (UN) General Assembly in New York.

The funding will include: 

• £6.2 million to strengthen existing surveillance systems tracking AMR trends across Africa and Asia. 
• £12 million to improve collaborations on health systems research between low- and middle-income countries and the UK.

Professor Davies warned that the world cannot achieve universal health coverage without addressing the threat of AMR, pointing to infection prevention and control measures, such as immunisation, good hygiene and appropriate antibiotic use, as crucial to achieving both universal healthcare coverage and eliminating the threat of AMR.

Universal health coverage is a UN ambition, and aims for every person across the globe to have access to basic healthcare by 2030, whatever their situation. Achieving universal healthcare coverage requires rigorous research to inform health policy and health systems.

AMR is involved in 700,000 deaths around the world every year, and this is expected to rise to 10 million deaths a year by 2050. If AMR continues to follow current trends, common infections will become complex and expensive to treat, affecting tens of millions of people.

The £6.2 million in UK Aid investment will come from the Fleming Fund. This will help improve AMR data quality, collection, and sharing across Africa and Asia, with the aim of developing policy and action from that data. 

The invitation to apply for a share of £12 million of funding is being made by the National Institute of Health Research (NIHR) Global Health Research programme, which will enable experts from low- and middle-income countries and the UK to form partnerships, in order to contribute to universal health coverage and sustainable development goals.

Source: Department of Health and Social Care (DHSC), 25 September 2019

The Scottish Health Survey (SHeS) provides a detailed picture of the health of the Scottish population in private households and is designed to make a major contribution to the monitoring of health in Scotland. The 2018 report presents statistics on mental health, food insecurity, diet, smoking, asthma, general health, alcohol intake, obesity, diabetes and other issues.

Key findings from the report include:

• Around two-thirds (65%) of adults in Scotland were overweight, including 28% who were obese. These levels have been relatively stable since 2008. 
• Prevalence of children at risk of obesity in 2018 was 16%. The level has fluctuated between 13% and 17% since 1998. 
• 24% of adults drank at hazardous or harmful levels, the same as in 2017 and down from 34% in 2003. 
• The percentage of men drinking more than four units on their heaviest drinking day declined significantly between 2003 (45%) and 2018 (36%). The percentage of women drinking more than three units on their heaviest drinking day also declined significantly between 2003 (37%) and 2018 (28%). 
• Around two-thirds of adults (66%) met the guidelines for physical activity (150 minutes of moderate or 75 minutes of vigorous activity per week) in 2018, the highest level to date though the proportion has not changed significantly since 2013 (64%). 
• In 2018, 16% of adults had a cardiovascular condition, 7% had doctor diagnosed diabetes, 5% had ischaemic heart disease, and 3% had suffered a stroke. There was no significant change since 2017. 
• The proportion of adults providing unpaid care for a family member, friend or someone else in 2017-2018 remained at 15% among those aged 16 and over and 4% among children aged 4-15.

Source: Scottish Government, 24 September 2019

On 25 September 2019, the Climate Change Bill was passed in the Scottish Parliament, with the hope that Scotland’s contribution to climate change will end within a generation.

The legislation commits Scotland to becoming a net-zero society by 2045, five years before the rest of the UK, and in line with the advice from the government’s independent expert advisors, the UK Committee on Climate Change (CCC). The Scottish Government has also adopted a new target to reduce emissions by 75% by 2030. 

Other new measures which aim to strengthen efforts include: 

• The Scottish Government will commission new advice from the CCC on the UK-wide pathway to 2030. 
• Accountability for meeting the targets will be strengthened, with ministers now required to report on progress to tackle climate change in every sector, every year. 
• A Citizens’ Assembly on Climate Change will be created to make recommendations to ministers on how Scotland’s net-zero transition should be achieved.

Source: Scottish Government, 25 September 2019

The European Environment Agency (EEA) has published a briefing which sums up evidence on the effect of financial schemes to promote the uptake of cars with lower carbon dioxide (CO2) emissions in seven European countries.

The briefing is based on a recent study by the European Topic Centre on Air Pollution, Transport, Noise and Industrial Pollution and shows that European countries that have actively promoted electric vehicles have significantly reduced the average CO2 emissions from new cars. This has also resulted in other benefits, such as reduced emissions of air pollutants, including nitrogen oxides (NOx) and particulate matter.

However, the effects of tax incentives that promote conventional fuel-efficient cars are less clear. These incentives are based on type-approval emissions tested in the laboratory, which are lower than the real-world emissions on the road.

As the gap between type-approval CO2 emissions and real-world emissions has increased, the real-world emissions of new cars have decreased significantly less than expected.

Source EEA, 24 September 2019

On 24 September 2019, the UK Government announced a new global alliance to help safeguard the world’s ocean and protect its wildlife, highlighted by the #30by30 hashtag.

Plastic pollution, warming sea temperatures and human activity are having a significant impact on the world’s marine environments and even putting certain species at risk of extinction.

The #30by30 initiative is pushing for at least 30% of the global ocean to be protected in Marine Protected Areas (MPA) by 2030, and has so far been supported by Belize, Costa Rica, Finland, Gabon, Kenya, Seychelles, Vanuatu, Portugal, Palau and Belgium.

The initiative aims to treble the existing globally-agreed targets, in the hope that at least a third of the ocean is safeguarded in MPA’s over the next decade. It is hoped these protections will help sensitive species such as seahorses, turtles and corals to thrive, and can help fight climate change by protecting key carbon habitats such as mangrove forests and seagrass meadows. 

The UK will also call for the #30by30 initiative to be adopted at the next Convention on Biological Diversity conference in China and for it to be introduced into international law through the High Seas Treaty in 2020.

Source: Department for Environment, Food and Rural Affairs (DEFRA), 24 September 2019