As the coronavirus (COVID-19) outbreak continues to evolve, the Foreign, Commonwealth & Development Office (FCDO) advises British nationals against all but essential travel, exempting some countries that no longer pose an unacceptably high risk for British travellers. This advice is being kept under constant review and may change at short notice.

The fitfortravel (for the general public) and TRAVAX (for health professionals) country pages have been updated to include a COVID-19 country specific risk-rating, with every country being identified as high, moderate or low risk and each rating accompanied by appropriate travel advice. This information will be listed in the ‘Alerts’ section on each country page of fitfortravel and the 'Emerging Health Risks' section of every TRAVAX country page. This risk-rating is based on a robust public health assessment of the COVID-19 risks for travellers to each country and is regularly reviewed.

This week, the following risk-ratings have changed: 

• Increased risk (from moderate to high) 
  • Canada 
    
    
• Decreased risk (from high to moderate) 
  • Bonaire 
  • Israel 
  • Namibia 
  • Rwanda 
  • Saba 
  • Sint Eustasias 
  • Uruguay

The COVID-19 risk rating and travel advice from the FCDO is being kept under constant review and may change at short notice. All travellers are advised to continue following sensible precautions and consider the following sources of information listed below.

Advice for travellers

Before planning or booking international travel, please check: 

• the UK Border Control website, in order to check current rules regarding self-isolation (quarantine) before your planned return to the UK 
• the Foreign, Commonwealth & Development Office (FCDO) website, for country specific Travel Advisory Notices regarding travel and entry restrictions, and review the local medical care available at your destination 
• the COVID-19 risk-rating at your destination, which will be listed in the ‘Alerts’ section of all fitfortravel country pages and the ‘Emerging Health Risks’ section of all TRAVAX country pages 
• the TRAVAX travel insurance page, as such insurance should be considered essential 
• the fitfortravel COVID-19 health considerations for travel page 
• physical distancing and hygiene measures in the country you are visiting

Information relating to travel and COVID-19 is available on the TRAVAX (for healthcare practitioners) and fitfortravel (for the public) websites.

Information on COVID-19 for the general public is available on the NHS Inform (Scotland) and the NHS.UK (rest of the UK) websites.

Information and resources on COVID-19 for health professionals is available on the Health Protection Scotland (HPS) (Scotland) and Public Health England (PHE) (rest of the UK) websites.

During the virtual session of the seventy-third World Health Assembly, the World Health Organization (WHO) endorsed a new road map for neglected tropical diseases (NTDs) for 2021 to 2030, which set out global targets and actions to align and re-focus the work of countries, partners and stakeholders during the next decade, including cross-cutting targets aligned with the Sustainable Development Goals.

The overarching 2030 global targets are to:

• reduce by 90% the number of people requiring treatment for NTDs 
• eliminate at least one NTD in 100 countries 
• eradicate two diseases, dracunculiasis and yaws 
• reduce by 75% the disability-adjusted life years (DALYs) related to NTDs

Source: TRAVAX, 16 November 2020

On 18 November 2020, to coincide with World Antimicrobial Awareness Week, Public Health England (PHE) published the report of its surveillance programme for antimicrobial utilisation and resistance (ESPAUR) in England.

The report finds that, in 2019, there were an estimated 65,162 antimicrobial resistance (AMR) infections in England, an increase from 61,946 in 2018. The most common bloodstream infection remains Escherichia coli, rising 14% from 68.3 cases per 100,000 of the population in 2015, to 77.5 in 2019.

PHE is urging people to help tackle AMR by taking the advice of their doctor, pharmacist or nurse and only take antibiotics when needed.

Source: PHE, 18 November 2020

On 18 November 2020, the European Centre for Disease Prevention and Control (ECDC) published two new surveillance reports.

The antimicrobial resistance in the EU/EEA (EARS-NET) annual epidemiological report for 2019 is based on data reported for the period 2015 to 2019, retrieved from the European Surveillance System (TESSy) and ECDC’s decentralised data storage for antimicrobial resistance and healthcare-associated infections (ARHAI) on 10 September 2020.

Thirty EU/EEA countries reported data for 2019 to the European Antimicrobial Resistance Surveillance Network (EARS-Net). Twenty-nine countries reported data for all eight bacterial species under surveillance, while one country reported data for all bacterial species except Streptococcus pneumoniae (S. pneumoniae). The most commonly reported bacterial species were: 

• Escherichia coli (44.2%) 
• Staphylococcus aureus (20.6%) 
• Klebsiella pneumoniae (11.3%) 
• Enterococcus faecalis (6.8%) 
• Pseudomonas aeruginosa (5.6%) 
• S. pneumoniae (5.3%) 
• Enterococcus faecium (4.5%) 
• Acinetobacter species (1.7%)

The ECDC has also published its antimicrobial consumption annual epidemiological report for 2019. This report finds the average total of the combined community and hospital sector consumption of antibacterials for systemic use in the EU/EEA was 19.4 defined daily doses (DDD) per 1,000 inhabitants, per day. During the period 2010 to 2019, a statistically significant decrease was observed for the EU/EEA overall. Statistically significant decreasing trends were observed for 13 countries, while statistically significant increasing trends were observed for four countries.

Sources: ECDC, 18 November 2020 and ECDC, 18 November 2020

The European Centre for Disease Prevention and Control (ECDC) periodically publishes influenza characterisation reports, giving an overview of circulating influenza viruses. These reports provide details on the current vaccine strains, summarise the development of the viruses since the last report and closely follow the main developments for the ongoing influenza season.

On 19 October 2020, the ECDC published the first virus characterisation period report for the 2020 to 2021 influenza season. As of week 44 of 2020, 39 influenza detections across the World Health Organization (WHO) European Region had been reported. Of these, 59% were type A viruses, with A(H3N2) prevailing over A(H1N1)pdm09, and 41% were type B viruses, with none having been ascribed to a lineage. This represents a 97% drop in detections compared with the same period in 2019.

Source: ECDC, 13 November 2020

In collaboration with the Kirby Institute at the University of New South Wales, the World Health Organization (WHO) has published a systematic review and meta-analysis of the prevalence and incidence of hepatitis C virus (HCV) in men who have sex with men (MSM).

The findings from this review show that MSM populations globally have a high burden of HCV infection, with substantial variations across countries and regions. In this review, the overall pooled HCV prevalence in MSM was 3.4%.

The WHO has set targets to eliminate HCV by 2030. There are currently an estimated 71 million people globally who have chronic HCV infection, and each year there are an estimated 1.75 million new infections.

Source: WHO, 17 November 2020

The World Health Organization (WHO) has launched a global strategy to accelerate the elimination of cervical cancer as a public health problem. The strategy focuses on successfully implementing the three key steps of vaccination, screening and treatment, with the aim of reducing more than 40% of new disease cases by 2050.

Meeting the following targets by 2030 will place all countries on the path toward elimination: 

• 90% of girls fully vaccinated with the HPV vaccine by 15 years of age 
• 70% of women screened using a high-performance test by age 35 and again by 45 
• 90% of women identified with cervical disease receive treatment (90% of women with pre-cancer treated and 90% of women with invasive cancer managed)

The launch of this new campaign comes as the WHO release new estimates of the global burden of cervical cancer associated with HIV, with women living with HIV having a six-fold increased risk of cervical cancer when compared to women without HIV. The WHO report that this higher risk manifests throughout the lifecycle, starting with an increased risk of acquiring human papillomavirus (HPV) infection, more rapid progression to cancer, lower chances of regression of pre-cancer lesions and higher rates of recurrence following treatment.  Globally, an estimated 5% of all cervical cancer cases are attributable to HIV, with these statistics varying by world region.

Sources: WHO, 17 November 2020 and WHO, 16 November 2020

The European Environment Agency (EEA) report that the EU has fallen behind in achieving its objective to reduce the greenhouse gas emission intensity of fuels sold for road transport to 6% below 2010 levels, as set out in the EU’s 2020 climate and energy targets.

According to the EEA’s fuel quality data indicator, the emission intensity decreased by 3.7 % between 2010 and 2018, mostly due to the increased use of biofuels. The emission intensity of fuels sold in the EU increased between 2017 and 2018, when considering the effects of indirect land use change due to the increased use of oil crops as feedstocks.

Source: EEA, 19 November 2020

The European Environment Agency (EEA) has published the following four briefing papers on the implications of emerging trends for the environment and environmental policies in Europe: 

• Artificial meat and the environment 
• Blockchain and the environment 
• Delivery drones and the environment 
• Synthetic biology and the environment

The briefings present the results of a horizon-scanning exercise, which drew on a range of sources to identify emerging trends of special relevance for the environment. Although there are currently limited data available to characterise these societal developments, the EEA believe it is crucial to anticipate their potential implications as early as possible.

Source: EEA, 20 November 2020