23 November 2021
Volume: 55 Issue: 47
- Coronavirus (COVID-19) pandemic update
- Meningitis in DRC
- EVD in DRC
- Monkeypox in DRC and USA
- ECDC publishes reports on antimicrobial resistance and consumption
- ECDC publishes gonococcal AMR susceptibility surveillance for 2019
- ECDC publishes influenza virus characterisation report
- WHO releases new toolkit to support quality HIV testing services
- WHO publishes fourth global tobacco trends report
- COP26: Glasgow Climate Pact
- HIS infection prevention and control standards consultation survey
- Consultation on guiding principles on the environment
HPS Weekly Report
23 Nov 2021
Volume 55 No. 47
Coronavirus (COVID-19) pandemic update
International travel continues to be 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.
As of 1 November 2021, there are no countries or territories on the UK’s international travel red list, however with the policy continuing in Scotland, as in the rest of the UK, some managed quarantine capacity will stay in place, in order to react to any change in assessment that would see a country added to the red list. The travel lists do not indicate which destinations are currently allowing UK travellers to enter their country, nor if the Foreign, Commonwealth and Development Office (FCDO) advises against travel to these countries. Information relating to this can be checked on the relevant FCDO foreign travel advice country pages.
Currently, anyone entering Scotland who is over 18 years and fully vaccinated can take a lateral flow test bought from a private provider, instead of a PCR test, on the second day after their arrival, and will also be required to complete a passenger locator form. Travellers who receive a positive lateral flow test result must isolate and book a confirmatory PCR test immediately.
Testing and quarantine rules may differ in Scotland, England, Wales and Northern Ireland, therefore travellers must ensure they 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, which identifies the risk of exposure to COVID-19 for UK travellers. 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, previously categorised as either high, moderate or low risk, has been changed, with each country now rated as having either a:
- high risk of exposure to COVID-19 for UK travellers
- risk of exposure to COVID-19 for UK travellers
For all countries, travellers should be aware that the risk of COVID-19 may change at short notice. Countries categorised as having a high risk of exposure to COVID-19 either have a high risk of exposure for travellers to COVID-19, or a high risk of emerging or known variants of coronavirus. Travellers should be advised to avoid non-essential travel to high risk countries, even if fully vaccinated against COVID-19.
As of 5 November 2021, the following countries have a FCDO advisory warning against travel and have therefore been classified as having a high risk of exposure to COVID-19:
- Democratic People's Republic of Korea
- Papua New Guinea
- Timor Leste
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.
- The FCDO foreign travel advice country pages have up-to-date information on 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 COVID-19 health considerations for travel page.
Source: TRAVAX, 2 November 2021
Meningitis in DRC
The European Centre for Disease Prevention and Control (ECDC) reports a continuing outbreak of bacterial meningitis in the Democratic Republic of the Congo (DRC). As of 23 October 2021, there has been 2,395 meningitis cases, including 200 deaths, in Banalia District, Tshopo Province, in the north of the country.
Meningococcal meningitis is an acute disease, caused by the bacteria Neisseria meningitides that can cause serious systemic infection and is spread through sneezing, coughing or direct contact with respiratory secretions.
Advice to travellers
Risk of infection for most travellers is very low, particularly for package tourists. Risk is increased for those travelling to a region with an ongoing epidemic:
- who anticipate close, prolonged contact with the local population
- who plan to visit overcrowded areas, such as busy market places, or use public transport
- to attend a mass gathering event
- if they have immunodeficiency including asplenia
All travellers should be aware of the risk of meningococcal disease, its transmission routes and symptoms, and are advised to avoid overcrowded areas and pay strict attention to respiratory hygiene and hand hygiene measures.
Further information on meningitis can be found on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.
Source: TRAVAX, 12 November 2021
EVD in DRC
The World Health Organization (WHO) reports that the outbreak of Ebola virus disease (EVD), which began on 10 October 2021 in North Kivu Province, Democratic Republic of the Congo (DRC), remains stable.
The most recent case was reported on 30 October and discharged on 4 November 2021. As of 13 November 2021, the total number of cases stands at 11, which includes four deaths.
EVD is a type of viral haemorrhagic fever (VHF), which is spread through contact with the blood, body fluids or organs of a person or animal with the infection.
Advice for travellers
The risk to travellers becoming infected or developing EVD is extremely low.
- Travellers to known Ebola outbreak areas must be made aware of the risk of infection and transmission routes of Ebola virus.
- Medical personnel travelling to work in an outbreak region must follow strict infection prevention control guidance.
Travellers returning from an Ebola outbreak area should seek rapid medical attention by contacting NHS 24 (Scotland) or NHS 111 (rest of UK) for advice prior to attending UK medical facilities if they develop fever and have:
- returned to the UK within 21 days from a region or area with a known outbreak of EVD
- had contact with individuals infected with a VHF
Further information and advice on VHFs are available on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.
Source: TRAVAX, 18 November 2021
Monkeypox in DRC and USA
The World Health Organization (WHO) has reported 2,780 cases of monkeypox, including 72 deaths, in the Democratic Republic of the Congo (DRC) in 2021 up to the end of October. Monkeypox is widespread in the DRC.
A case has also been reported by the Maryland Department of Health in a resident who recently returned from Nigeria. The patient is not seriously ill and is currently recovering in isolation.
Monkeypox occurs mainly in forested areas of Central and West Africa, with most infections resulting from direct contact with infected animals, primarily primates and rodents, although person-to-person transmission can occur. Symptoms in humans commence with fever and a flu-like illness, followed by the development of a skin rash.
Advice for travellers
Monkeypox is an uncommon zoonotic infection that is rarely seen in travellers.
Travellers to Central and West Africa should:
- observe meticulous hand hygiene if visiting or caring for ill friends and relatives
- avoid contact with primates and rodents and avoid consuming undercooked meat from these sources
- wear protective clothing, including gloves, if involved in the slaughter or care of animals in these regions
A vaccine against monkeypox is not widely available. While prior smallpox vaccination is protective, first generation smallpox vaccination is no longer available.
Further advice and information on monkeypox is available on the TRAVAX website (for health professionals).
Sources: TRAVAX, 18 November 2021 and TRAVAX, 18 November 2021
ECDC publishes reports on antimicrobial resistance and consumption
On 18 November 2021, the European Centre for Disease Prevention and Control (ECDC) published two new surveillance reports.
- The surveillance of antimicrobial resistance in Europe for 2020 presents an executive summary based on antimicrobial resistance (AMR) data from invasive isolates reported to the Central Asian and European Surveillance of Antimicrobial Resistance (CAESAR), and the European Antimicrobial Resistance Surveillance Network (EARS-Net). Twelve countries and Kosovo reported data to CAESAR, while 29 countries reported data to EARS-Net.
- The antimicrobial consumption annual epidemiological report for 2020 finds the average daily total of the combined community and hospital sector consumption of antibacterials for systemic use in the EU and EEA was 16.4 defined daily doses (DDD) per 1,000 inhabitants. During the period 2011 to 2020, a statistically significant decrease was observed in the EU and EEA overall, as well as eight individual countries, while statistically significant increasing trends were observed in two countries.
Sources: ECDC, 18 November 2021 and ECDC, 18 November 2021
ECDC publishes gonococcal AMR susceptibility surveillance for 2019
The European Centre for Disease Prevention and Control (ECDC) has published its gonococcal antimicrobial (AMR) susceptibility surveillance for 2019. The European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) followed an annual decentralised and centralised testing model, requesting participating laboratories to collect gonococcal isolates during the period September to November 2019. Susceptibility testing was performed on all isolates, where available, for ceftriaxone, cefixime, azithromycin, ciprofloxacin, spectinomycin, and gentamicin, as well as testing for β-lactamase production for detection of high-level penicillin resistance.
In 2019, 26 EU or EEA member states participated in Euro-GASP, 19 via decentralised testing. In total, 4,166 isolates were tested, with 83% of specimens from male patients, and a median patient age of 30 years. Among cases with known sexual orientation and sex, 54.4% were heterosexual men or women, and 45.6% were men who have sex with men (MSM). Among all cases, 14.1% were HIV-positive, and 84.9% of those were MSM.
The ECDC report that decreasing azithromycin susceptibility, combined with the continued detection of ceftriaxone resistance, is a major concern and threatens the effectiveness of the currently effective dual-therapy regimen of ceftriaxone plus azithromycin, and high-dose ceftriaxone monotherapy recently adopted by some European countries. Even though the level of resistance to cefixime has significantly decreased, the ECDC report that cefixime resistance needs to be monitored closely, particularly because gonococcal strains with resistance to both cefixime and ceftriaxone continue to spread internationally.
Source: ECDC, 15 November 2021
ECDC publishes influenza virus characterisation report
The European Centre for Disease Prevention and Control (ECDC) periodically publishes influenza characterisation reports, giving an overview of circulating influenza viruses. These reports provide details on current vaccine strains, summarise the development of viruses since the last report and closely follow the main developments for the ongoing influenza season.
On 16 November 2021, the ECDC published the first virus characterisation period report for the 2021 to 2022 influenza season. As of week 44 of 2021, 965 influenza detections across the World Health Organization (WHO) European Region had been reported. Of these, 86% were type A viruses, with A(H3N2) dominating over A(H1N1)pdm09, and 14% were type B viruses, with none having being ascribed a lineage. This represents an increase in detections compared to the 2020 to 2021 season, following a large increase in the number of samples tested, and is close to the more usual number of detections seen in earlier influenza seasons.
Source: ECDC, 16 November 2021
WHO releases new toolkit to support quality HIV testing services
The World Health Organization (WHO) has released a new toolkit to support countries in their efforts to adopt WHO guidelines and transition to new HIV testing algorithms.
In 2019, in response to changing epidemiology, the WHO recommended countries adopt a standard HIV testing strategy, with three consecutive reactive tests for an HIV-positive diagnosis to ensure quality services as countries move towards achieving the UNAIDS 95-95-95 targets. The guidance also highlighted the need to introduce dual HIV and syphilis rapid diagnostic tests (RDTs), and to phase out older testing technologies, including western blotting methods.
Many countries have since adopted this guidance and in the WHO African Region, compliance to HIV testing strategies increased from 8% in 2014, to 71% in 2021. However, more than a dozen countries are using western blotting methods, which hinder same day diagnoses and immediate access to antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP). Additionally, many settings have yet to fully transition to the WHO’s recommended testing strategy or integrate dual HIV and syphilis RDTs into testing algorithms for pregnant women and key populations.
Source: WHO, 16 November 2021
WHO publishes fourth global tobacco trends report
The World Health Organization (WHO) has published its fourth global tobacco trends report, revealing that there are 1.30 billion tobacco users globally, compared to 1.32 billion in 2015, with the prediction this number will drop to 1.27 billion by 2025.
The report continues several key findings, as listed below.
- In 2020, 22.3% of the global population used tobacco, including 36.7% of all men and 7.8% of all women.
- Currently, 60 countries are on track to achieve the tobacco use reduction target by 2025. Since the last report two years ago, two other regions, the African and South-East Asian regions, have now joined the Americas region on-track to achieve a 30% reduction.
- Approximately 38 million children, aged 13 to 15 years old, currently use tobacco, despite it being illegal in most countries for minors to purchase tobacco products.
- There were 231 million women using tobacco products in 2020, with the highest prevalence rate among the 55 to 64 age group.
Source: WHO, 16 November 2021
COP26: Glasgow Climate Pact
The twenty-sixth UN Climate Change Conference of the Parties (COP26) concluded with 197 countries agreeing to a new climate deal. The Glasgow Climate Pact focuses on the key areas of emissions cuts, fossil fuels, climate finance and adaptation, loss and damage, emissions reporting and transparency, carbon markets, and the Paris Agreement’s 1.5C target.
Under the 2015 Paris Agreement, nations were required to update their carbon-reducing plans every five years. The Glasgow Climate Pact asks countries to come back by the end of 2022, with more ambitious plans to cut their emissions by 2030 in a bid to hold onto the 1.5C goal.
HIS infection prevention and control standards consultation survey
Healthcare Improvement Scotland (HIS) has launched a consultation on its draft Infection Prevention and Control (IPC) Standards, formerly the Healthcare Associated Infection Standards, and are looking for feedback on all aspects of the document, including standard statements, rationale and criteria.
The survey is open until 7 December 2021 and can be completed online. A consultation report will be available when the final IPC standards are published in spring 2022.
Consultation on guiding principles on the environment
The UK Withdrawal from the EU (Continuity) (Scotland) Act 2021 requires government ministers and other public authorities to ensure they pay due regard to the five guiding principles on the environment. These principles sit alongside Scotland’s arrangements for environmental governance, including the establishment of Environmental Standards Scotland and the publication of an environment strategy.
The five guiding principles as set out in the Act are the:
- principle that protecting the environment should be integrated into the making of policies
- precautionary principle as it relates to the environment
- principle that preventative action should be taken to avert environmental damage
- principle that environmental damage should as a priority be rectified at source
- principle that the polluter should pay
The Scottish Government has launched a consultation on draft guidance that has been developed to serve as a practical guide to support public authorities and ministers to implement these legislative duties. The consultation paper is available on the Scottish Government website, and participants can fill in the online form to give their views. The consultation closes on 8 February 2022.