International travel continues to be significantly impacted due to COVID-19, and a number of variant strains have emerged globally, with information on such travel available for people living in Scotland, England, Wales and Northern Ireland. To prevent new COVID-19 variants being exported and imported, the Foreign, Commonwealth & Development Office (FCDO) currently advise against travelling to red list countries.

From 4 October 2021, the current traffic light system for travel to the UK is set to be simplified, with the green and amber lists merging, and a red list remaining for countries with high case numbers and variants of concern. It should be noted that neither the current traffic light system, nor the list changes that will come into effect in October 2021, indicate which destinations allow UK travellers to enter their country.

Currently, anyone entering Scotland from countries on the international travel green list will not be required to self-isolate on arrival, but will have to complete a passenger locator form, take a COVID-19 test before travelling to Scotland, then another within two days of arriving in Scotland. Isolation is only required if the COVID-19 test taken on day two after arriving back in Scotland is positive or NHS Scotland Test and Protect makes contact to inform of the need to isolate due to travel with someone who has tested positive for COVID-19.

On 22 September 2021, Scotland, England, Wales and Northern Ireland updated their rules regarding return travel to the UK from eight current red 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.

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, 10 September 2021

New cases of dengue have been reported in Bangladesh, the Dominican Republic and Pakistan.

In Bangladesh, the media reports that dengue continues to be transmitted across the country. Since the beginning of the year until 18 September 2021, 15,460 people have been admitted to hospital with dengue, including 59 deaths reported in the months of July, August and September.

Media sources in the Dominican Republic also highlight continuing transmission, reporting that over the weekend of 18 and 19 September 2021, 12 children were admitted to hospital with dengue. In the past four weeks, 314 cases have been reported in the country, bringing the total for this year to 1,207, including 13 deaths. The areas most affected are Santo Domingo Este, Distrito Nacional, Santo Domingo Norte, Santo Domingo Oeste and Bani.

Additionally, media reports in Karachi, Pakistan, report 1,255 cases of dengue in the first 17 days of September 2021, with at least three deaths in the week ending 17 September 2021. Public health staff are carrying out mosquito control activities in Karachi in an attempt to control the spread of the disease. 

Advice for travellers

Dengue is an infection spread by mosquito bites that can cause a severe flu-like illness. 

• All travellers to endemic regions are potentially at risk of dengue fever, and should be aware of this infection. Prevention relies on avoiding mosquito bites at all times. 
• Travellers developing a fever during or on return from travel are advised to seek medical attention as soon as possible.

Information and advice for travellers on dengue fever is available on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

Sources: TRAVAX, 21 September 2021, TRAVAX, 21 September 2021 and TRAVAX, 21 September 2021

Between 1 January 2021 and 31 July 2021, the World Health Organization (WHO) reported 1,082 suspected cases of yellow fever in Nigeria. The disease continues to be transmitted in 37 states, including the Federal Capital Territory.

Yellow fever is widespread in tropical Africa and is transmitted by day-biting Aedes mosquitoes.

Advice for travellers

Yellow fever is an acute viral haemorrhagic disease which is transmitted through the bite of an infected mosquito, and is found in tropical areas of Africa and Central and South America. All travellers to these areas are advised to practice mosquito bite avoidance at all times.

A traveller's risk of yellow fever is determined by their individual risk assessment. Factors that will influence their risk includes: 

• country or countries to be visited 
• length of stay 
• rate of transmission at destination 
• immunisation status 
• planned activities

Unvaccinated travellers that visit yellow fever endemic areas are at risk of becoming infected, so yellow fever vaccine is recommended, unless contraindicated, for travellers at risk.

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

Source: TRAVAX, 22 September 2021

According to Spanish media, on 22 September 2021, an outbreak of malaria has been reported in the settlement of La Trocha (Huetar Norte region) on the border between Costa Rica and Nicaragua.

There have been eight cases on the Costa Rica side of the border and seven in Nicaragua. Malaria is unusual in this area and this outbreak is thought to be linked to cross-border travel through La Trocha.

Advice for travellers

While higher than expected cases of malaria continue to be reported, travellers to this area should: 

• be made aware of the risk of malaria, given the current increase in cases 
• practise strict mosquito bite avoidance 
• consider antimalarial chemoproprophylaxis if in a group at higher risk from malaria

Travellers returning from malarious areas should seek prompt medical advice if they develop a fever during travel or on their return, ensuring they highlight their potential exposure to malaria.

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

Source: TRAVAX, 22 September 2021

The Florida Department of Health has reported 22 cases, which includes eight deaths, of vibriosis from 1 January 2021 to 17 September 2021.

Vibriosis is caused by Vibrio species of bacteria which are found in brackish and salt water environments. Infection can occur through eating raw or undercooked shellfish, resulting in vomiting and diarrhoea. Vibrio vulnificus (V. vulnificus) may also cause wound and soft tissue infections if a wound is exposed to water contaminated with the bacteria. Those affected usually have compromised immune systems. The resulting soft tissue infection may develop quickly, be severe and may need surgical treatment alongside antibiotics. In some cases, septicaemia may occur.

Advice for travellers

All travellers should be given advice on: 

• maintaining safe food and water precautions, including avoidance of raw or undercooked seafood 
• following basic steps in self-treating diarrhoea, particularly remaining adequately hydrated 
• avoiding bathing until larger skin wounds have fully healed, if planning open water swimming during travel, particularly if immunocompromised

Medical attention should be sought quickly for any skin infections that develop after bathing, particularly if they progress quickly.

Source: TRAVAX, 22 September 2021

The Travel and International Health Team of Public Health Scotland (PHS) has reviewed the most up-to-date information available on the occurrence of Hepatitis A infection in every country worldwide. Based on this review, some of the Hepatitis A vaccine recommendations on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites have recently changed.

The revised Hepatitis A vaccine recommendations can be found in the 'vaccination advice' section of each TRAVAX country page, and the hepatitis A page can also be consulted for further information on the disease. On the fitfortravel website, information on hepatitis A vaccine recommendations can be found under the ‘vaccinations’ section of each country page, with additional information available on the hepatitis A page.

Sources: TRAVAX, 16 September 2021 and fitfortravel, 16 September 2021

World Rabies Day is held each year on 28 September, the anniversary of Louis Pasteur’s death. Created and co-ordinated annually by the Global Alliance for Rabies Control (GARC), World Rabies Day aims to increase awareness of the disease and its prevention.

This year's theme is ‘Rabies: facts, not fear’, urging people to focus on the facts about rabies and dispel any myths or misconceptions. The theme acts as a reminder of the key current global issues that also affect rabies elimination. 

• The GARC encourage the sharing of accurate facts about rabies, as well as ensuring decisions about rabies control in separate countries are based on the correct, most up-to-date information. 
• By sharing facts regarding the benefits of vaccinating animals against rabies, and by ensuring that exposed people receive post-exposure prophylaxis, it is hoped myths about rabies vaccination will start to dispel, helping to ensure everyone is protected. 

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

Source: TRAVAX, 20 September 2021

Food Standards Scotland (FSS) and the Food Standards Agency (FSA) are urging reptile owners who have purchased certain feeder mice for their pets, take extra precautions in order to avoid contracting salmonellosis.

Scientists have again confirmed a link between Salmonella detected in feeder mice distributed across the UK by Monkfield Nutrition, and an outbreak of human cases of Salmonella. Retailers must now legally provide customers buying these feeder mice with an information leaflet about the risks of Salmonella infection, and advise on good practice for handling animal food, and ensuring good hygiene in the home.

The outbreak was first investigated in 2015 and has so far resulted in almost 850 reported human cases, mostly, but not exclusively, in those living in households with one or more pet reptiles. FSS and the FSA advise that the risk to the general public is considered to be very low.

Source: FSS, 20 September 2021

The World Health Organization (WHO) has published a report on novel and emerging tobacco products, exploring the harm caused by toxic ingredients and nicotine exposure, and examining how these products are marketed to potential users, including children and adolescents. The tobacco products examined in the report include electronic nicotine delivery systems (ENDS), electronic non-nicotine delivery systems (ENNDS), and heated tobacco products (HTPs).

One of the main recommendations made by the WHO is for policy-makers to maintain focus on evidence-based measures to reduce tobacco use, as outlined in the WHO Framework Convention on Tobacco Control, including novel and emerging tobacco products.

The report also recommends: 

• to apply the most restrictive tobacco control regulations to HTPs, including the devices, as appropriate under national laws, taking into account a high level of protection for human health 
• to prohibit all manufacturers and associated groups from making claims about reduced harm of HTPs, as compared to other products 
• to ensure that the public is well informed about the risks associated with using HTPs, including the risks of dual use with conventional cigarettes and other smoked tobacco products 
• to rely on and support independent data and research on the health impact of using heated tobacco products 
• to require tobacco manufacturers to disclose all product information 
• to ban all commercial marketing of e-cigarettes and HTPs, including social media and through organisations funded by, and associated with, the tobacco industry 
• to prohibit the sale of e-cigarettes, in which the user can control device features and liquid ingredients 
• to prohibit the addition of pharmacologically active substances, such as cannabis and tetrahydrocannabinol, in jurisdictions where they are legal, to e-cigarettes

Source: WHO, 22 September 2021

The World Health Organization (WHO) has published a set of global air quality guidelines, recommending new levels to protect the health of populations by reducing the amounts of key air pollutants, some of which also contribute to climate change.

The overall objective of the updated guidelines is to offer quantitative health-based recommendations for air quality management, expressed as long- or short-term concentrations for a number of key air pollutants, including particulate matter (PM), ozone (O₃), nitrogen dioxide (NO₂) sulfur dioxide (SO₂) and carbon monoxide (CO). Exceedance of the air quality guideline (AQG) levels is associated with important risks to public health, with the WHO reporting that the global burden of disease associated with air pollution exposure is exacting a toll on human health worldwide, with exposure to air pollution estimated to cause millions of deaths and lost years of healthy life annually.

The guidelines aim to provide WHO member states with an evidence-informed tool, which they can use to update legislation and policy, helping reduce levels of air pollutants, in order to decrease the health burden resulting from exposure to air pollution worldwide.

Source: WHO, 22 September 2021

The European Environment Agency (EEA) has published a report offering an overview of the main drivers and pressures that are at the core of key water management challenges in Europe.

The EEA find that overall, better and more coherent implementation of the existing legislation would reduce key pressures on water. Moreover, they recommend that all water-using sectors, such as agriculture, energy, mining, aquaculture and navigation, should adopt management practices that can keep water ecosystems healthy and resilient. These include farming programmes that reduce the use of pesticides, hydropower that ensures passage for fish, stringent fuel standards for navigation, and preservation of river banks.

Currently, the key problems the EEA highlight include pollution from urban and industrial waste water, diffuse pollution from agriculture, and pollution from mining and dwellings that are not connected to a sewage system. Overall, 22% of Europe’s surface water bodies and 28% of the groundwater area are significantly affected by diffuse pollution from agriculture, both by nutrients and pesticides. Deposition of air pollutants, particularly mercury, leads to the poor chemical status of Europe’s water bodies.

Source: EEA, 23 September 2021