International travel continues to be severely restricted due to the coronavirus (COVID-19) pandemic, with a cautious approach to resumption underway for people living in Scotland, England, Wales and Northern Ireland since late spring 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) continues to advise against travel to red list countries.

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. 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. On 19 July 2021, Scotland, England, Wales and Northern Ireland updated their rules for returning to the UK from amber list countries.

On return to the UK, travellers should be aware that testing and 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.

In July 2021, the COVID-19 risk for UK travellers was decreased in three countries or territories, these being: 

• Germany 
• Greek Islands in the Dodecanese, Ionian, Attica, North Aegean and West Aegean regions 
• North Macedonia

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.

Sources: TRAVAX, 29 July 2021

In July 2021, Swedish public health authorities reported 13 cases of serious wound infections due to vibriosis, with all cases reported from the coasts of Götaland and Svealand, mainly in people aged over 65 years.

Severe soft tissue infections due to vibriosis are caused by the bacteria Vibrio vulnificians, which are found in brackish and salt water, such as the Baltic Sea. The bacteria cannot infect intact skin or minor wounds, but can infect pre-existing larger wounds. The resulting soft tissue infection may develop quickly, be severe and may need surgical treatment alongside antibiotics, with the possibility of septicaemia occurring.

Advice for travellers 

• Those planning open water swimming during travel, particularly if immunocompromised, should be advised to avoid bathing until larger skin wounds have fully healed. 
• Medical attention should be sought quickly for any skin infections that develop after bathing, particularly if they progress quickly.

Source: TRAVAX, 23 July 2021

From 1 January to 11 July 2021, the World Health Organization (WHO) reported 77,122 cases of acute watery diarrhoea in Cox’s Bazar, Bangladesh, with 36 of these cases confirmed as cholera. Cox’s Bazar is the location of the world’s largest refugee camp, which has significant public health challenges.

Cholera is an acute diarrhoeal infection caused by ingestion of faecally contaminated food or water, and occasionally foodstuffs such as shellfish. Acute watery diarrhoea may be caused by infections other than cholera, which are transmitted in the same way.

Advice for travellers

Severe cholera is rare in travellers, however mild cases may present as travellers' diarrhoea. Travellers to the region are advised to only consume safe food and water, and are also advised that good personal hygiene is essential, in particular frequent hand washing.

A vaccine is available to protect against cholera, but as the risk to most travellers is very low, it is only recommended for: 

• volunteers, aid workers and medical personnel in disaster relief situations where cholera outbreaks are likely 
• those travelling to work in slums or refugee camps, areas affected by natural disasters, or countries experiencing cholera outbreaks and where care with food and water is difficult or not possible

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

Source: TRAVAX, 27 July 2021

On 28 July 2021, the European Centre for Disease Prevention and Control (ECDC) published 2019 epidemiological reports for hepatitis B and hepatitis C.

In key findings from the hepatitis B report: 

• In 2019, 30 EU or EEA member states reported 29,996 cases of hepatitis B virus (HBV) infection. When the five countries that only reported acute cases are excluded, the number is 29,518, which corresponds to a crude rate of 7.4 cases per 100,000 of the population. 
• Of all cases, 6% were reported as acute, 48% as chronic, 38% as unknown and 7% could not be classified. The highest rate of acute infections was observed among 35 to 44-year-olds, with the highest rate of chronic infections was among 25 to 34-year-olds. 
• The rate of acute cases has continued to decline over the last few years, which is in accordance with global trends and likely reflects the impact of national vaccination programmes. 
• Among acute cases with complete information, heterosexual transmission was most commonly reported (27%), followed by nosocomial transmission (17%) and transmission due to sex between men (13%). 
• Among chronic cases, mother-to-child transmission and nosocomial transmission were the most common routes of transmission reported, recorded at 36% and 20% respectively.

In key findings from the hepatitis C report: 

• In 2019, 37,733 cases of hepatitis C were reported in 29 EU or EEA member states. When the countries which only reported acute cases are excluded, the number is 37,660, which corresponds to a crude rate of 8.9 cases per 100,000 of the population. 
• Of the cases reported, 6% were classified as acute, 22% as chronic and 69% as unknown. 
• Hepatitis C was more commonly reported among men than women, with a male-to-female ratio of 2.1 to 1. 
• The most affected age group among both males and females was 25 to 34-year-olds. 
• The mode of transmission was reported for just 21% of cases, with the most commonly reported mode being injecting drug use, which accounted for 45% of cases with complete information on transmission status.

The ECDC report finds interpretation of hepatitis C notification data across countries remains problematic, with ongoing differences in surveillance systems and difficulties in defining reported cases as acute or chronic. With hepatitis C, a largely asymptomatic disease until its late stages, surveillance based on notification data is challenging, with data reflecting testing practices rather than true occurrence of disease.

Sources: ECDC, 28 July 2021 and ECDC, 28 July 2021

Together with partner organisations, UNAIDS has published the final report from the Start free, Stay free, AIDS free framework, established with the aim of ending AIDS among children, adolescents and young women by 2020.

The report shows that the total number of children on treatment declined for the first time since the framework was launched in 2015, despite the fact that nearly 800,000 children living with HIV are not currently on treatment. The report also shows that opportunities to identify infants and young children living with HIV early are being missed, with more than one-third of children born to mothers living with HIV not being tested. If untreated, around 50% of children living with HIV die before they reach their second birthday.

Although the 2020 targets were missed, the 21 focus countries in Africa made better progress than non-focus nations. However, there were major disparities between countries, with 11 accounting for nearly 70% of those children living with HIV but not on treatment. There was a 24% decline in new HIV infections among children from 2015 to 2020 in focus countries, against a 20% decline globally. Focus countries also achieved 89% treatment coverage for pregnant women living with HIV, compared to 85% globally, but still short of the 95% target.

Source: UNAIDS, 21 July 2021

The European Centre for Disease Prevention and Control (ECDC) has published a rapid risk assessment focusing on the most common infectious diseases and health risks associated with flood-affected areas, taking into account evidence from previous similar events in Europe.

Extreme rainfall on 14 and 15 July 2021 and subsequent flooding in Belgium, Germany, Luxembourg and the Netherlands has taken a high number of human lives and caused substantial damage to community infrastructure and the environment. In addition to food- and waterborne diseases, zoonoses, vector-borne diseases, vaccine-preventable diseases and other health hazards associated with previous natural disasters in Europe, this risk assessment also considers the challenges of responding to such a complex crisis during the COVID-19 pandemic.

Source: ECDC, 29 July 2021

The World Health Organization (WHO) has published its eighth report on the global tobacco epidemic, tracking the progress made by countries in tobacco control since 2008 and, for the first time, presenting data on electric nicotine delivery systems (ENDS), such as e-cigarettes. 

The WHO’s MPOWER package consists of six policies, with the aim of supporting the fight against the tobacco epidemic, these being to: 

• monitor tobacco use and prevention policies 
• protect people from tobacco smoke 
• offer help to quit tobacco use 
• warn about the dangers of tobacco 
• enforce bans on tobacco advertising, promotion and sponsorship 
• raise taxes on tobacco 

In 2021, 75% of countries and 5.3 billion people are covered by at least one MPOWER measure, more than four times the number who were covered in 2007. However, 49 countries remain without any measures in place at all.

The WHO report that 84 countries lack safeguards to protect from unregulated proliferation of ENDS, and recommend that governments implement regulations to stop non-smokers from starting to use them, in order to prevent the renormalisation of smoking in the community, and to protect future generations. 

Source: WHO, 27 July 2021

Food Standards Scotland (FSS) is to be part of a UK-wide pilot scheme to adopt a One Health approach to the surveillance of foodborne pathogens and antimicrobial resistance (AMR).

The three-year programme aims to establish the infrastructure and sampling frameworks needed to monitor the source and spread of foodborne pathogens and AMR genes between the environment, animals, food, and human populations.

The programme brings together FSS, the Food Standards Agency (FSA), the Department of Environment, Food and Rural Affairs (DEFRA), the Department of Health and Social Care (DHSC), Public Health England (PHE) and the Environment Agency, to test the application of genomic technologies in the surveillance of foodborne pathogens and AMR microbes in all four nations of the UK.

Source: FSS, 28 July 2021

The Scottish Fire and Rescue Service (SFRS) has issued a warning for people to stay safe in and around water this summer, following the deaths of six people in Scotland’s waterways between 23 and 24 July 2021.

Scotland’s many waterways have hidden dangers, such as fast moving currents or obstacles which can present a risk. Additionally, even during high temperatures, the water can still be extremely cold and people can get into difficulty due to cold water shock, which can interrupt breathing, cause loss of strength and coordination and affect swimmers of any age, fitness, or experience level.

Water Safety Scotland is a voluntary association of organisations and individuals, whose main purpose is to understand the risks around water in Scotland, and engage with partners to develop a consistent approach towards the prevention of water related fatalities.

Source: SFRS, 26 July 2021

The Scottish Government has launched a consultation on proposed changes to energy standards within Scottish building regulations, including related topics such as ventilation, overheating and electric vehicle charging provision. These new proposals for the review of energy standards set through building regulations seek to deliver further improvement to the energy efficiency of new buildings and new building work, in-line with Scottish Government’s wider net zero ambitions.

The consultation is open until 15 October 2021 and responses can be completed on the Scottish Government website.

Source: Scottish Government, 26 July 2021