The report on quarterly epidemiological data for Clostridioides difficile infection (CDI), Escherichia coli bacteraemia (ECB), Staphylococcus aureus bacteraemia (SAB), and Surgical Site Infection (SSI) in Scotland, January to March (Q1) 2021, was published on 6 July 2021 under the mandatory programmes for surveillance of CDI, ECB, SAB, and SSI in Scotland. Please note that data for SSI are not included due to the pausing of surveillance to support the COVID-19 response.

This report provides data for the first quarter of 2021 in 14 NHS boards and one NHS special health board. In addition, an appendix detailing all cases and denominator data for each NHS board and overall for Scotland.

Travel restrictions and self-isolation (quarantine) rules continue to be enforced in order to help reduce the global spread of COVID-19 and protect the health of the UK public. Within the UK, information on the easing of coronavirus restrictions has been published for Scotland, England, Wales and Northern Ireland.

Since 17 May 2021, a cautious approach to resuming international travel has been underway for people living in Scotland, England, Wales and Northern Ireland. Travelling abroad carries a risk of bringing new cases and variants of COVID-19 back into the UK, therefore travellers are still advised to consider whether their trip abroad is necessary before booking travel. The Foreign, Commonwealth & Development Office (FCDO) continue to advise against non-essential international travel to some countries, and still advise against cruise ship travel.

A traffic light system which categorises countries on to a red, amber or green list, based on their COVID-19 risk, is in place for travellers arriving into the UK. The lists were last amended on 30 June 2021, and may change again at short notice. It should be noted that the traffic light system does not indicate which countries are currently allowing UK travellers to enter their country. Currently, anyone entering Scotland from countries on the international travel green list will not be required to quarantine on arrival, but will have to take a PCR test for COVID-19 and complete a passenger locator form.

Country specific COVID-19 risk

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.

In June 2021, the COVID-19 risk for UK travellers was decreased in Belize and Malta.

Advice for travellers

Prior to booking any international travel, travellers must first check if the country they are travelling to is currently accepting UK travellers. 

• Each country or territory on the FCDO foreign travel advice page provides up-to-date information on their entry rules, in response to coronavirus (COVID-19), under the ‘Entry Requirements’ section. 
• Travellers should be aware that some countries or territories may require proof of COVID-19 vaccination status for entry. For those living in Scotland, England and Wales, guidance for demonstrating COVID-19 vaccination status is available. Information on demonstrating COVID-19 vaccination status has yet to be announced for Northern Ireland.

It is advised that travellers are aware of all travel restrictions, self-isolation rules and precautions they should take, in order to reduce their risk of exposure to coronavirus (COVID-19) before, during and after travel, as detailed on the fitfortravel website.

On return to the UK, travellers should be aware that quarantine rules differ for Scotland, England, Wales and Northern Ireland. Prior to their journey, travellers must ensure they are able to comply with the rules appropriate to the UK nation they will be arriving in and reside in, if different.

Source: TRAVAX, 30 June 2021

The Olympic Games are to be held in Tokyo, Japan between 23 July and 8 August 2021, and the Paralympic Games between 24 August and 5 September 2021. In March 2021, it was announced that overseas spectators would not be allowed entry into Japan for the games, due to the worldwide COVID-19 pandemic and the emergence of variant strains.

The final version of the Tokyo 2020 Playbooks were published in June 2021, outlining the responsibilities and rules that must be followed by all participants in the games, commencing two weeks prior to travelling to Japan and lasting until their departure. Specific health and safety rules and COVID-19 precautionary measures are detailed in the playbooks.

Source: TRAVAX, 1 July 2021

Public Health England’s (PHE) online Green Book contains the latest information on vaccines and vaccination procedures, for vaccine preventable infectious diseases in the UK.

Chapter 2, on consent, has recently been extensively revised and updated. The chapter includes information and links to useful resources on:

• principles of consent for immunisation
• consent in adults
• consent in children and young people
• data protection and recording
• resources to support consent
• professional guidance on consent
• arrangements in devolved nations

Obtaining consent is necessary before commencing any form of treatment, physical intervention or personal care, including vaccination. It is recommended that all healthcare professionals administering travel vaccines should familiarise themselves with the new guidance.

Source: TRAVAX, 24 June 2021

The World Health Organization (WHO) has certified China as having eliminated malaria, the first country in the WHO Western Pacific Region to be awarded the certification in more than three decades.

Globally, 40 countries and territories have been granted a malaria-free certification from WHO, including, most recently, El Salvador in 2021, Algeria and Argentina in 2019, and Paraguay and Uzbekistan in 2018.

Source: WHO, 30 June 2021

The World Health Organization (WHO) and the Global Fund to Fight AIDS, Tuberculosis and Malaria have signed a co-operation and financing agreement to implement ten strategic initiatives to accelerate the end of AIDS, tuberculosis (TB) and malaria as epidemics, and strengthen systems for health. This new agreement, which will cover the 2021 to 2023 implementation period, aims to address some of the persistent challenges that impede progress against the three diseases and protect gains from new pandemics such as COVID-19.

The WHO report that in 2019, a total of 1.4 million people died from TB and an estimated 409,000 people died from malaria. In 2020, approximately 690,000 people died from AIDS-related illnesses.

Through the new agreement, the strategic initiatives seek to: 

• expand TB preventive treatment for people living with HIV in nine countries across Africa 
• strengthen efforts to provide differentiated HIV service delivery 
• accelerate efforts to find people with TB missed by health systems in 20 countries 
• accelerate the introduction of innovation for multi-drug resistant TB treatment through regional operational research in eastern and central Europe 
• support 26 countries and territories to eliminate malaria by 2025 
• improve country data collection and use to develop evidence-informed policy 
• foster the rapid uptake of service delivery innovations with south-to-south learning 
• improve quality of care 
• encourage rapid uptake of procurement and supply chain management innovation 
• increase programme sustainability, facilitate the transition to domestic financing, and improve programme efficiency

Source: WHO, 30 June 2021

The World Health Organization (WHO) has published its first catalogue of mutations in the Mycobacterium tuberculosis genome complex, and their association with drug resistance. The catalogue provides a standard reference for the interpretation of mutations conferring resistance to all first-line and a variety of second-line drugs. The report summarises the analysis of over 38,000 isolates, with matched data on whole genome sequencing and phenotypic drug susceptibility testing from over 40 countries on 13 anti-tuberculous (TB) medicines. The catalogue lists over 17,000 mutations, their frequency, and association with, or not with, drug resistance.

The WHO states that molecular tests have revolutionised TB and drug-resistant TB diagnosis, providing accurate and rapid results to impact clinical management. However, apart from rifampicin, resistance detection is often below 95% for many anti-TB medicines, while for new and repurposed drugs, the gap can be even wider. The catalogue seeks to support TB laboratories around the world to interpret genome sequencing results and guide the development of new molecular drug susceptibility tests, including next-generation sequencing.

The report describes the methods used, the mutations identified, and summarises important findings for each drug. The WHO outline areas for future research, and state that regular updates of the catalogue are planned in the future.

Source: WHO, 25 June 2021

The third joint inter-agency report on integrated analysis of antimicrobial agent consumption and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals (JIACRA), has been published by the European Centre for Disease Prevention and Control (ECDC), the European Food Safety Authority (EFSA), and the European Medicines Agency (EMA).

The report states that antimicrobial resistance (AMR) constitutes a significant public health problem in Europe as well as in other parts of the world, representing a social and economic burden and a threat to animal health and production. The main driver behind AMR is antimicrobial consumption (AMC), in both humans and food-producing animals. Recognising that human and animal health are interconnected, this report is based on a ‘One-Health’ approach.

The report finds a significant fall in antibiotic use in food-producing animals, suggesting that the measures taken at country level to reduce use are proving effective. The use of the polymyxins class of antibiotics, which includes colistin, nearly halved between 2016 and 2018 in food-producing animals, a positive development as polymyxins are also used in hospitals to treat patients infected with multidrug-resistant bacteria.

The picture in the EU is diverse, with the situation varying significantly by country and by antibiotic class. For example, aminopenicillins, third and fourth generation cephalosporins and quinolones are used more in humans than in food-producing animals, while polymyxins such as colistin and tetracyclines are used more in food-producing animals than in humans.

Source: ECDC, 30 June 2021

The European Environment Agency (EEA) has published provisional data, reporting that the average emissions of new passengers cars registered in the EU, Iceland, Norway and the UK in 2020 were 107.8 grams of carbon dioxide per kilometre (g CO2/km), which was 14.5g, or 12%, lower than in 2019 and represents the first decrease observed since 2016. The share of electric vehicles in new registrations tripled from about 3.5% in 2019, to around 11% in 2020.

Approximately 1.4 million new vans were registered in Europe through 2020, with average emissions of 157.7g CO2/km, which is 2.3g, or 1.5%, lower than in 2019. The share of electric vans increased from 1.4% in 2019, to around 2.3% in 2020.

Source: EEA, 29 June 2021