The World Health Organization (WHO) continues to produce daily situation reports containing the latest numbers of confirmed cases of COVID-19. On 23 February 2020, 98% of confirmed COVID-19 cases globally were reported from China, with 28 other countries around the world reporting confirmed cases of COVID-19.

Advice for travellers

Prior to travel, the following should be checked: 

• The Foreign and Commonwealth Office (FCO) website, which provides guidance for UK nationals travelling overseas, including how to seek consular assistance if required. 
• Travel agents or airlines, to provide the latest information on local travel restrictions and local authority guidance relating to COVID-19. 
• Travel insurance policies, as the COVID-19 outbreak may impact travel insurance coverage. 
• The FCO countries or territories webpages, prior to travel for the latest advice, including:
  • Travel advisories and restrictions, as these are subject to change and should be checked regularly. The FCO currently advise against all travel to Hubei Province and all but essential travel to the rest of mainland China (not including Hong Kong and Macao) as well as all but essential travel to Daegu and Cheongdo in South Korea. 
  • Entry requirements for the destination, as a number of countries have announced restrictions on entry by travellers from China in response to the outbreak. 
  • Reports of COVID-19 at the destination. Travellers to countries reporting cases of COVID-19 should follow local public health advice.

Travellers to China, Hong  Kong, Japan, Macao, Malaysia, South Korea, Singapore, Taiwan or Thailand should be aware if they develop symptoms on return to the UK, that are compatible with COVID-19, they should self-isolate and contact one of the following: 

• NHS 111 (England and Wales) 
• 0300 200 7885 (Northern Ireland) 
• NHS24 (call 111) or your General Practitioner (Scotland)

Travellers can access information on COVID-19, including prevention advice, on the fitfortravel website.

Advice for healthcare practitioners

There remains a risk of imported cases to the UK. Health professionals should remain vigilant for symptomatic individuals who may have COVID-19.

Guidance on testing, as well as a range of other resource materials, is available from the Health Protection Scotland (HPS - for Scotland) and Public Health England (PHE – for the rest of the UK) websites.

Health professionals can access information on COVID-19, including prevention advice, on the TRAVAX website.

Source: TRAVAX, 23 February 2020

On 4 February 2020, the Ministry of Health and Social Affairs in Mali reported an outbreak of Crimean-Congo haemorrhagic fever (CCHF) in Mopti District in the south-east of the country near the border with Burkina Faso. Between 5 January and 2 February 2020, a total of 14 suspected CCHF cases, including seven deaths, were reported.

CCHF is a viral haemorrhagic fever found in over 30 countries in Africa, Asia, Europe and the Middle East, which generally presents a low risk to the average traveller. CCHF is spread by infected ticks from an animal reservoir such as cattle, sheep and goats, and can also be transmitted by contact with the blood or body fluids of an infected animal or person. Avoidance of tick bites is essential in risk areas.

Further information on CCHF can be found on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

Source: TRAVAX, 14 February 2020

According to the Nigeria Centre for Disease Control, the outbreak of Lassa fever in Nigeria continues, with 1,708 suspected cases (472 confirmed) including 70 deaths reported from 26 states across the country between 1 January and 9 February 2020.

Lassa fever is rare in travellers to West African countries. The risk is increased in those living in conditions of poor sanitation and overcrowding in rural areas where the reservoir host is usually found. Lassa fever is a zoonotic viral disease transmitted via the excreta of infected Mastomys rats.

Travellers returning from affected areas who develop symptoms of fever, malaise, headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea and abdominal pain should seek medical advice from NHS24 (Scotland) or NHS 111 (rest of the UK).

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

Source: TRAVAX, 14 February 2020

The Program for Monitoring Emerging Diseases (ProMED) reports that the Saudi Arabian Ministry of Health has confirmed 21 cases of MERS-CoV, including six deaths, between 1 January and 13 February 2020.

MERS-CoV is a serious respiratory infection with a high rate of fatalities. It is most common in Saudi Arabia where there are several cases each week.

The risk associated with MERS-CoV to the general UK population and travellers to the Arabian Peninsula and surrounding countries remains very low.

Information and advice is available on the TRAVAX (for travel health professionals) and fitfortravel (for the general public) websites, while further guidance is available on the HPS website.

Source: TRAVAX, 14 February 2020

The World Health Organization (WHO) reports that the outbreak of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC) continues, although new cases are becoming less frequent. In the 21 days leading up to 16 February 2020, there were ten confirmed cases, of which nine were in Beni Health Zone, South Kivu, with the other being reported in Mabalako Health Zone, North Kivu.

From the beginning of the outbreak in August 2018 to 16 February 2020, there have been 3,432 cases of EVD in North Kivu, South Kivu and Ituri Provinces in the eastern part of DRC.

Advice for travellers

When Ebola outbreaks occur, generally the risk of travellers becoming infected or developing EVD is extremely low.

Travellers returning from an Ebola outbreak area should seek rapid medical attention if they develop flu-like symptoms, such as fever, headache, diarrhoea or general malaise, within 21 days after return. They should call either NHS24 (Scotland), NHS111 (England and Wales) or contact their GP by telephone. While EVD is unlikely, the returning traveller should mention any potential exposure to the virus including dates and itinerary of travel.

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

Source: TRAVAX, 21 February 2020

Public Health England (PHE) has recently updated guidance relating to assessment of the need for pre-exposure rabies vaccine booster doses, based on the results of rabies serology testing.

The full guidance relating to risk assessment, post-exposure treatment and management can be found on the PHE website.

The European Centre for Disease Prevention and Control (ECDC) has published a rapid risk assessment due to an increase in OXA-244-producing Escherichia coli (E. coli) in the EU/EEA and the UK since 2013.

Following an enquiry in ECDC’s Epidemic Intelligence Information System-Antimicrobial Resistance and Healthcare Associated Infections (EPIS AMR-HAI) regarding an increasing number of cases of OXA-244-producing E. coli and identification of a cluster of E. coli sequence type (ST) 38 in Germany, national public health reference laboratories in EU/EEA countries were invited to submit whole genome sequencing (WGS) data to ECDC for a European-level analysis. The pooled European data showed that 33 cases of OXA-244-producing E. coli were detected between 2013 and 2015, followed by 31 cases in 2016, 21 cases in 2017, 83 cases in 2018 and 116 cases in 2019. Increased use of WGS may have enabled more discriminatory identification of cases from sample collections and contributed to the observed increase in cases.

The source and the route of transmission of OXA-244-producing E. coli in the EU/EEA and the UK is currently unclear. An overlap in time and place was identified for a few cases in Germany, indicating possible person-to-person transmission. There is a need for further investigation to determine the source and routes of transmission of OXA-244-producing E. coli in the EU/EEA and implement adequate control measures.

Source: ECDC, 18 February 2020

A newly published scientific review by the Food Standards Agency (FSA) has estimated that around 2.4 million cases of foodborne illness occur every year in the UK. This is an increase from the 2009 estimate of approximately one million cases.

The new figures do not indicate an increase in total illness, or any new risk to public health, but provide a better estimation of the proportion of infectious intestinal disease that is due to food. The overall estimate for this type of illness in the UK, from all sources, remains the same, at around 18 million cases per year.

The FSA has also published a five-year study into the extent of norovirus in food carried out by UK scientists, and a paper which reviews and updates the assessment developed during that project.

These new studies and their accompanying models reveal: 

• 380,000 estimated cases of norovirus  linked to food occur in the UK every year. 
• Eating out accounts for an estimated 37% of all foodborne norovirus cases, and takeaways account for 26% of cases. 
• Open-headed lettuce (retail) accounts for 30% of cases, raspberries (retail) account for 4% of cases, and oysters (retail) account for 3% of cases. 
• The revised foodborne norovirus estimate, combined with better analysis of how many illnesses of unknown cause are also likely to be caused by food, suggest around 2.4 million estimated UK cases of foodborne illness occur each year.

Source: FSA, 20 February 2020

The Food Standards Agency (FSA) has published the results of two surveys monitoring antimicrobial-resistant bacteria in fresh chicken on sale in the UK. The first survey reports on certain types of antimicrobial-resistant (AMR) E. coli and the second on AMR Campylobacter. The results are from Year 4 of the surveys (2017-2018). 

Overall, the AMR E. coli contamination in retail chicken has declined in comparison to previous years, which suggests that the tighter control on antimicrobial usage in industry might be having a positive impact although further work is required to explore this. 

The proportion of AMR Campylobacter isolates and multi-drug resistance found were similar to those in Year 3 (August 2016 to July 2017).

Source: FSA, 18 February 2020

The European Chemicals Agency (ECHA) has assessed the safety pigments used in tattoo inks at the request of the European Commission. In January 2020, three EU member states, Norway and the ECHA proposed to restrict over 4,000 substances in tattoo inks and permanent make-up. Some of these substances are already restricted under the EU’s cosmetic products regulation. They are not allowed to be used on the skin and therefore are not safe to be injected under the skin.

Other materials that would be restricted under ECHA’s proposal include carcinogenic, mutagenic and reprotoxic (CMR) substances, skin sensitisers or irritants, substances corrosive or damaging to the eye, metals, and other substances already regulated in cosmetic products.

With regards to Pigment Blue 15 and Pigment Green 7, one option ECHA has recommended is that a two-year transitional period could be granted before banning them. This would allow ink formulators to find safer alternatives while ensuring the availability of green and blue tattoo inks in the meantime.

ECHA’s restriction proposal has been subject to a consultation and scrutiny by its scientific committees. The European Commission is presenting a draft restriction for discussion with EU member states in February.

Source: ECHA, 20 February 2020