The World Health Organization (WHO) has published new consolidated guidelines on HIV testing services, which aims to help countries treat the 8.1 million people that have undiagnosed HIV.

HIV testing is important to ensure people are quickly diagnosed with HIV, thus ensuring they can receive appropriate treatment. Good testing services also ensure that people who test HIV negative are linked to appropriate prevention services. It is believed following these new guidelines will reduce the 1.7 million new HIV infections that occur every year around the world.

The WHO guidelines were released ahead of World AIDS Day on 1 December 2019, and the International Conference on AIDS and Sexually Transmitted Infections in Africa, which takes place in Kigali, Rwanda from 2-7 December 2019. Currently, two-thirds of all people with HIV in the world live in Africa.

The new guidelines recommend a range of new approaches.

• Encouraging all countries to adopt a standard HIV testing strategy which uses three consecutive reactive tests to provide an HIV positive diagnosis. 
• Recommending countries use HIV self-testing as a gateway to diagnosis based on new evidence that people who are at higher HIV risk and not testing in clinical settings are more likely to be tested if they can access HIV self-tests. 
• Recommending social network-based HIV testing to reach key high-risk populations who have less access to services. These include men who have sex with men, people who inject drugs, sex workers, transgender population and people in prisons. 
• Highlighting the use of peer-led, digital communications, such as short messages and videos, to build demand and increase uptake of HIV testing. 
• Recommending focused community efforts to deliver rapid testing, through lay providers, for relevant countries in the European, South-East Asian, Western Pacific and Eastern Mediterranean regions, where the longstanding laboratory-based method called ‘western blotting’ is still in use. 
• Promoting the use of HIV/syphilis dual rapid tests in antenatal care to help eliminate mother-to-child transmission of both infections. It is hoped this will help close the testing and treatment gap, and combat the second leading cause of stillbirths globally. 
• More integrated approaches for HIV, syphilis and hepatitis B testing is also encouraged.

Source: WHO, 27 November 2019

A report published on 28 November 2019 by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe, shows that women accounted for one-third of the new 141,000 HIV diagnoses in Europe in 2018.

Many women in the WHO European Region, particularly those in their 40s, are diagnosed at a late stage of HIV infection, when their immune system is already starting to fail, and are three to four times more likely to be diagnosed late than younger women.

The HIV epidemic in Europe is driven by a persistent problem with late diagnosis, which affects 54% of known cases among women. Large proportions of late diagnoses are partly a result of relatively low HIV testing coverage and uptake. This indicates that sexual risks, including HIV and other sexually transmitted infections, are not being adequately addressed in older adults.

Two-thirds (60%) of the HIV diagnoses among women in 2018 were in the 30–49 age group. Heterosexual sex was the most commonly reported HIV transmission mode (92%) among women.

Early diagnosis of HIV allows people to start HIV treatment sooner, which increases their chances of living a long and healthy life. It also reduces the risk of transmitting HIV to others because effective treatment results in an undetectable viral load, meaning that the virus can no longer be transmitted.

Enhanced strategies and systems, which make HIV testing more widely available and user-friendly are required to ensure early diagnoses.

The WHO consolidated guidelines on HIV self-testing and partner notification and ECDC’s evidence-based guidance on integrated testing for HIV and viral hepatitis recommend approaches that include self-testing and community-based testing by lay providers as part of overall HIV testing services.

Enhanced strategies to diagnose women earlier include: 

• increasing awareness among women and health-care providers 
• offering counselling and testing services adapted to the needs of women 
• notifying partners of men who are diagnosed with HIV 
• providing HIV testing based on specific health conditions, such as other sexually transmitted infections, viral hepatitis, tuberculosis or certain cancers 
• providing testing and treatment services in the community and closer to populations

Source: WHO, 28 November 2019

On 28 November 2019, the World Health Organization (WHO) reported the deaths of four workers responding to the Ebola outbreak in the Democratic Republic of the Congo (DRC). Five other workers were injured.

Two separate attacks took place in the east of the DRC on the night of 27 November 2019. The attacks occurred overnight at a shared living camp in Biakato Mines and an Ebola response coordination office in Mangina.

The dead include a member of a vaccination team, two drivers and a police officer, while one WHO staff member was injured.

On 1 December 2019, WHO Director-General, Dr Tedros Adhanom Ghebreyesus, visited health workers affected by the attacks and called for improved security in the region to protect the health workers trying to contain Ebola.

Sources: WHO, 28 November 2019 and 1 December 2019

A new rapid risk assessment from the European Centre for Disease Prevention and Control (ECDC) shows that twenty-one cases of Listeria monocytogenes IVb sequence type ST 6 infections have been reported in the Netherlands (19 cases) and Belgium (two cases). This outbreak was identified using whole genome sequencing (WGS) analysis.

The patients involved had onset of illness between 2017 and August 2019. Three patients died and one suffered a miscarriage due to the infection. The close genetic relatedness of the strains, and the temporal distribution of the cases suggests a prolonged, intermittent, common source food-borne outbreak which occurred in at least two EU member states.

Nine isolates from six sliced ready-to-eat (RTE) meat products, produced between 2017 and 2019 by the Dutch manufacturing company A, were found to be contaminated with L. monocytogenes strains matching the outbreak strain. 

Although the exact points of contamination have not yet been identified, the results of the investigation suggest that the contamination may have happened at the Dutch company, which was the only common manufacturing point of the contaminated products. The company distributed products to several EU countries as well as to countries outside the EU.

Company A stopped production in October 2019, and finalised the withdrawals and recalls of all RTE meat products. This measure lowered the risk of new cases occurring, which may be associated with this company’s products.

Pregnant women, the elderly and immunocompromised people are at higher risk of invasive listeriosis, which is associated with severe clinical course and potential death.

Specific attention should be paid to the administration of RTE meat products to people in hospitals, nursing homes and those belonging to vulnerable population groups.

Source: ECDC, 26 November 2019

Public Health England (PHE) has updated the Green Book chapter 18, covering Hepatitis B.

The updated chapter includes recommendations for reinforcing doses of vaccine for those who have received pre-exposure immunisation, with most individuals expected to require long-lasting protection.

The Green Book includes the latest information on vaccines and vaccination procedures, for vaccine preventable infectious diseases in the UK.

Source: PHE, 18 November 2019

Darwin’s Dairy, located in Barnsley, South Yorkshire, has recalled all of its milk and cream products, as they may not have been effectively pasteurised. This means that these products may contain harmful bacteria such as E. coli.

Details of the products affected can be found on the Food Standards Agency (FSA) website. Point-of-sale notices will be displayed in all retail stores selling the products. The notices explain to customers why the products are being recalled and what to do if they have bought the products.

The dairy has also contacted delivery customers to advise them of the product recall.

Source: FSA, 27 November 2019

The European Environment Agency (EEA) has published a new briefing which analysed the actions EU member states have made to reduce greenhouse gas emissions, and achieve climate and energy targets.

The briefing found that member states reported improved and more complete information about their climate policies, including their expected emission savings. However, evidence on the achieved emission cuts and costs of these policies is still insufficient.

EU member states reported 1,925 climate change mitigation policies and measures. More than 400 of these policies are new since 2017, and are mostly at the planning stage.

The EEA data shows that most EU member states’ climate policies are either economic instruments (44%), such as subsidies or feed-in tariffs, or regulations (43%), such as energy efficiency.

The reported policies mainly target energy-related greenhouse gas emissions (GHG), including enhancing buildings’ energy efficiency (18%), deploying more renewable energy (16%), switching to low carbon fuels or electric vehicles (8%), or by improving vehicles’ fuel efficiency (7%). More than 10% of the measures related to agriculture, including many of the new actions reported. In the agriculture sector, the data shows that the most common objectives are reducing fertilizer or manure use on cropland and improving animal waste management.

The EEA recently estimated that the EU and its member states have reduced their total greenhouse gas emissions by 23.2% from 1990 to 2018. At the same time, member states’ projections are not yet in line with the target of at least a 40% reduction in GHG emissions by 2030.

According to the EEA analysis, member states’ current policies will deliver a 30% reduction by 2030, while implementing all reported planned policies could bring the total reduction to 36%.

The briefing is underpinned by a more detailed analysis in a report prepared by the European Topic Centre on Climate change Mitigation and Energy (ETC/CME), with further details of the policies are presented via an online database.

Source: EEA, 27 November 2019