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.

A cautious approach to resuming international travel has been underway for people living in Scotland, England, Wales and Northern Ireland since May 2021.  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 to further 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. The UK Government has announced that guidance on travel to and from amber list countries to England will change on 19 July 2021.

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.

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.

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. Guidance for demonstrating COVID-19 vaccination status is available for those living in Scotland, England, Wales and 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.

Source: TRAVAX, 30 June 2021

In the weeks leading up to the beginning of July 2021, a large Salmonella outbreak affected 442 people, including 377 children, in Jyväskylä, Finland. Most of the cases affected those who attended or worked in pre-school or daycare centres, with the outbreak linked to fresh salad, in particular iceberg lettuce imported from Sweden.

Advice for travellers

Salmonella is one of the major causes of diarrhoeal disease and is widely distributed throughout the world. All travellers are advised to:

• practice strict food and water precautions, including avoiding uncooked, partially cooked, cold or reheated meats, raw eggs, and unpasteurised milk or cheese 
• wash their hands thoroughly with soap, or use alcohol hand gel, prior to eating or drinking, after contact with animals (particularly reptiles), and after going to the lavatory 
• rinse salad leaves under clean running water, discard any outer leaves and dry with a clean cloth or paper towel prior to eating

Until this outbreak is over, travellers should check country labelling of salad and avoid eating iceberg lettuce imported from Sweden.

Source: TRAVAX, 7 July 2021

A new study, by the World Health Organization’s Regional Office for Europe (WHO Europe) and the European Centre for Disease Prevention and Control (ECDC), examined variations in antibiotic consumption in countries across the WHO European Region, between 2014 and 2018.

The report found some differences in the use of antibiotics between two sets of countries, those in the ECDC’s European Surveillance of Antimicrobial Consumption Network (ESAC-Net) and those in the WHO Europe’s Antimicrobial Medicines Consumption (AMC) Network. In 2018, the total consumption of antibiotics per 1,000 inhabitants daily, ranged from 8.9 defined daily doses in Azerbaijan, to 34.1 in Greece, with similar ranges of estimates for ESAC-Net and the WHO Europe AMC Network. However, there were considerable differences in the consumption of various antibiotic groups, with a larger consumption of penicillins and tetracyclines, and a lower consumption of cephalosporins and quinolones in ESAC-Net countries than in WHO Europe AMC Network countries.

The WHO Europe and ECDC found that between 2014 and 2018, there were statistically significant decreases in the total consumption of antibiotics in eight ESAC-Net countries, those being Denmark, Finland, Germany, Luxembourg, the Netherlands, Norway, Sweden, and the UK, which is believed  may be due to the longstanding programmes and commitment of these countries toward the prudent use of antibiotics. The WHO Europe AMC Network data were characterised by less consistent patterns, with only one country showing a significant increasing consumption trend between 2014 and 2018. This may reflect the nature of the data collection in these countries, as well as shorter histories of interventions tackling antimicrobial resistance.

The study calls for more detailed analysis of specific groups and individuals within countries, which may help identify useful national interventions to improve the use of antibiotics and promote alignment of clinical practices with international guidance on their responsible use.

Sources: WHO, 7 July 2021 and ECDC, 7 July 2021

The World Health Organization (WHO) has issued an update to its consolidated guidelines on the detection of tuberculous (TB) and drug-resistant TB. The guidelines are accompanied by an operational handbook to facilitate implementation and roll out of rapid molecular tests by national TB programmes, ministries of health and technical partners.

Globally, diagnosis remains a challenge, with a third of people with TB and two-thirds of people with drug-resistant TB not being detected. Instead of sputum smear microscopy, the WHO recommend use of rapid molecular assays as the initial test to diagnose TB, as they have been reported to have high diagnostic accuracy and should lead to major improvements in the early detection of TB and drug-resistant TB. The WHO state that bacteriologically confirmed diagnosis of people with TB should be accelerated, with the expansion of access to rapid molecular tests.

Source: WHO, 7 July 2021

The Lancet has published a new study, which highlights the high global prevalence of syphilis among men who have sex with men (MSM) and underscores the need to advance stalled progress toward eliminating syphilis as a public health threat by 2030.

Findings from this global review show that MSM have a high burden of syphilis infection, with significant variation across countries and regions. The global pooled prevalence of syphilis among MSM was 7.5% during 2000-2020, as compared to the most recent estimate of syphilis among men in the general population in 2016, that being 0.5%. The proportion of MSM with syphilis was highest in settings where HIV prevalence was greater than 5% and in low and middle-income countries.

Globally, there were an estimated seven million new syphilis infections in 2020. The World Health Organization (WHO) has set ambitious targets to reduce incidence of syphilis by 90% by 2030, but the global response has been slow. While there have been modest reductions in congenital syphilis because of the scale-up of interventions in antenatal care, such as syphilis screening and treatment for pregnant women, there is a reported urgent need to galvanize momentum and better serve other priority populations disproportionally impacted by the disease.

Source: WHO, 9 July 2021

Since leaving the EU earlier this year, Food Standards Scotland (FSS) and the Food Standards Agency (FSA) have taken on responsibility for assessing food and animal feed safety in the UK. On July 6 2021, a new register and public record for risk analysis issues and regulated products applications currently under review in the UK was published.

The register of risk analysis issues gives information about those issues being considered through the food and animal feed risk analysis process, providing a summary of each issue and their current status. The register of regulated products is a list of applications received through the regulated products application service that are currently being assessed. Regulated products include:

• extraction solvents 
• feed additives 
• feed detoxification processes
• feed for particular nutritional uses (PARNUTS) 
• flavourings 
• food additives 
• food contact materials 
• food enzymes 
• genetically modified organisms (GMOs) as food and feed 
• irradiated food 
• novel foods 
• smoke flavourings

Source: FSS, 6 July 2021

The World Health Organization (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus, released new estimates on the public health impact of chemicals as part of the ministerial dialogue held on 7 July 2021.

The new estimates show a continuing increase compared to earlier years, with two million lives and 53 million disability-adjusted-life-years lost in 2019 due to chemical exposures. Nearly half of deaths attributable to chemical exposures in 2019 were due to lead exposure and resulting cardiovascular diseases. The other largest contributors were chronic obstructive pulmonary disease (COPD) from occupational exposure to particulates, and cancers from occupational exposure to carcinogens.

Source: WHO, 6 July 2021

The World Health Organization (WHO) has published a report presenting estimates on household access to safely managed drinking water, sanitation and hygiene services over the past five years. Also included in the report is an assessment of progress made towards achieving the sixth sustainable development goal, of ensuring the availability and sustainable management of water and sanitation for all by 2030.

In 2020, the WHO found that around one-in-four people globally lacked safely managed drinking water in their homes, and nearly half the world’s population lacked safely managed sanitation. COVID-19 has highlighted the urgent need to ensure everyone can access good hand hygiene, but at the onset of the pandemic three-in-ten people worldwide could not wash their hands with soap and water within their homes.

The report notes some progress towards achieving universal access to basic water, sanitation and hygiene (WASH) services. Between 2016 and 2020, the global population with safely managed drinking water at home increased from 70% to 74%, safely managed sanitation services grew from 47% to 54%, and handwashing facilities with soap and water increased from 67% to 71%.

The report highlights that if current trends persist, billions of children and families will be left without critical WASH services, and by 2030: 

• 1.6 billion people will not have access to safe drinking water at home 
• 2.8 billion people will not have access to safe sanitation services 
• 1.9 billion people will not have basic handwashing facilities

Source: WHO, 1 July 2021

The Scottish Environment Protection Agency (SEPA) is warning of an increasing water scarcity situation across the country, with Northwest Scotland, Clyde, Ayrshire, Orkney and the Western Isles moving to the alert level on the water scarcity index. Most of the rest of Scotland is moving to the early warning tier, with Irvine and Ayr both raised to moderate scarcity level.

SEPA report that June 2021 saw below average rainfall across the country, and ground conditions have continued to dry rapidly over late June and early July. Groundwater levels are falling, but so far remain within the normal range for the time of year. The longer-term forecast suggests that there is an increased likelihood of hot, dry weather compared to normal, with a greater chance of impact on water levels.

Source: SEPA, 2 July 2021