International travel continues to be impacted due to COVID-19, and the number of variant strains which have emerged globally. Guidance on international travel is available for people living in Scotland, England, Wales and Northern Ireland. As of 6 December 2021, eleven countries have been added to the UK international travel red list following concerns about cases of the emerging Omicron variant, first identified in southern Africa.

As of 30 November 2021, fully vaccinated travellers who are entering Scotland from any destination will have to take a PCR test by the end of the second day after arrival, and will have to self-isolate until they get a negative result. They must also complete a Passenger Locator Form (PLF). Additionally, travellers who are not fully vaccinated must take a second PCR test by the end of the eighth day after arrival, and isolate at home or in the place they are staying for ten days.

Travellers returning to Scotland from countries on the international travel red list will be required to self-isolate in managed quarantine accommodation and take two PCR tests, regardless of their vaccination status. Currently, the countries and territories on the UK red list are:

• Angola 
• Botswana 
• Eswatini 
• Lesotho 
• Malawi 
• Mozambique 
• Namibia 
• Nigeria 
• South Africa 
• Zambia 
• Zimbabwe

It should be noted that the travel lists may be amended at short notice, and 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.

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 include a COVID-19 country specific risk-rating, which identifies the risk of exposure to COVID-19 for UK travellers. This information is 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 identifies each country as having either: 

• a high risk of exposure to COVID-19 for UK travellers, or 
• a 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.

In addition to the international travel list, as of 1 December 2021, the following countries have a FCDO advisory warning against travel, and are therefore classified as having a high risk of exposure to COVID-19 for UK travellers: 

• Afghanistan 
• Angola 
• Botswana 
• Burundi 
• Democratic People's Republic of Korea 
• Eswatini (Swaziland) 
• Guinea-Bissau 
• Haiti 
• Lesotho 
• Malawi 
• Mozambique 
• Namibia 
• Nicaragua 
• Papua New Guinea 
• South Africa 
• Timor Leste (East Timor) 
• Turkmenistan 
• Venezuela 
• Yemen 
• Zambia 
• Zimbabwe

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, 3 December 2021

Costa Rican public health authorities report an ongoing outbreak of malaria in the Zona Norte region of the country, near the border with Nicaragua. Malaria is uncommon in this region, but an increase in cases has been reported since September 2021.

During November 2021, there were 138 cases of malaria in the region affecting the communities of Medio Queso, San Gerardo, Cuatro Esquinas, Isla Chica, La Trocha, Las Delicias and Coquita.

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 chemoprophylaxis 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, 8 December 2021

The World Health Organization (WHO) report that the global incidence of dengue has grown dramatically in recent decades, with about half of the world's population potentially at risk.  So far in 2021, there have been 1,472,059 cases reported worldwide, with the majority from Brazil, India, Peru, the Philippines and Vietnam.

Dengue is an infection found in tropical and sub-tropical climates worldwide, with a small number of cases in southern Europe in recent years. It is spread by Aedes mosquito bites, and can cause a severe flu-like illness.

Advice for travellers  

• 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.

Source: TRAVAX, 2 December 2021

The World Health Organization (WHO) reports that measles remains endemic in many countries worldwide, with health services and national vaccination programmes severely impacted by the COVID-19 pandemic, resulting in a risk of increasing numbers of measles outbreaks.

Measles is a highly infectious viral infection spread via airborne or droplet transmission. Symptoms include fever, rash, cough, coryza or conjunctivitis and may lead to serious and potentially life-threatening complications in some people.

Measles is most common in young children, but all ages are at risk if they have not been fully vaccinated or had prior measles infection.

Advice for travellers

Travel may increase an individual’s risk of exposure to measles virus, and facilitate the spread of disease to unvaccinated and susceptible populations. It should be confirmed that children have received their recommended doses of the MMR vaccine at 12 to 13 months of age and again around three years four months. Consider vaccinating all unimmunised adults who have not had the disease themselves, particularly if they are going to be at higher risk. Two doses of MMR vaccine, at least one month apart, are required to give adequate protection.

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

Source: TRAVAX, 2 December 2021

In October and November 2021, public health authorities in South Africa reported six cases of rabies in humans, four in the province of Eastern Cape, one in Kwa-Zulu Natal province and one in Limpopo province, with further suspected cases under investigation.

In total, there have been 17 cases of rabies in South Africa from 1 January to 23 November 2021, all in the provinces named above, with all cases being related to an outbreak of rabies in dogs.

Rabies is a fatal but preventable disease of the central nervous system caused by the rabies virus. People are infected when saliva from an infected mammal comes into direct contact with broken skin or mucous membranes (eyes, nose or mouth), usually from a bite, scratch, or lick. Rabies is invariably fatal once symptoms develop and only a small number of people with the disease are known to have survived.

Advice for travellers

Travellers should be aware that any animal contact in a rabies endemic area poses a potential risk of infection. All travellers to endemic areas should be aware of immediate wound care and are advised to seek medical attention immediately if bitten or scratched by an animal and be aware that an effective rabies vaccination is available.

Further information and advice on rabies can be found on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

Post-exposure rabies guidance is available on the TRAVAX website. 

Source: TRAVAX, 2 December 2021

The World Health Organization (WHO) World Malaria Report 2021 estimates that there were 241 million malaria cases, including 627,000 deaths, worldwide in 2020, which represents around 14 million more cases, and 69,000 more deaths, than 2019. Approximately two-thirds of these additional deaths were linked to disruptions in the provision of malaria prevention, diagnosis and treatment during the COVID-19 pandemic.

Sub-Saharan Africa continues to carry the heaviest malaria burden, accounting for about 95% of all cases and 96% of all deaths in 2020, with around 80% of deaths in the region among children under five years old. Since 2015, the baseline date for the WHO’s global malaria strategy, registered increases in malaria deaths were reported in 24 countries. In the 11 countries that carry the highest burden of malaria worldwide, cases increased from 150 million in 2015 to 163 million cases in 2020, and malaria deaths increased from 390,000 to 444,600 over that same period.

As in previous years, the report includes an up-to-date assessment on the burden of malaria at global, regional, and country levels, and tracks investment in malaria programmes and research, as well as detailing progress across the four intervention areas of prevention, diagnosis, treatment and surveillance. There are also dedicated chapters on malaria elimination and key threats, such as insecticide and drug resistance.

Source: WHO, 6 December 2021

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 7 December 2021, the ECDC published the second virus characterisation period report for the 2021 to 2022 influenza season. As of week 47 of 2021, 2,707 influenza detections across the World Health Organization (WHO) European Region have been reported. Of these, 93% were type A viruses, with A(H3N2) dominating over A(H1N1)pdm09, and 7% were type B viruses, with two having been ascribed to a lineage (B/Victoria). 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, 7 December 2021

The European Centre for Disease Prevention and Control (ECDC) has published its 2020 external quality assessment (EQA) scheme for Neisseria gonorrhoeae antimicrobial susceptibility testing.

In September 2020, 27 laboratories in 26 participating countries received 10 gonococcal isolates for antimicrobial susceptibility testing. The highest level of categorical agreement was seen with spectinomycin (100%) and ciprofloxacin (99.3%), while the lowest was seen with azithromycin (90.4%). Compared to the previous distribution, there was a slight decrease in concordance for azithromycin (90.4% vs. 92.5%), ceftriaxone (95.1% vs. 99.1%) and beta-lactamase production (96.4% vs. 100%), whereas concordance for cefixime (97.3% vs. 96.3%) and ciprofloxacin (99.3% vs. 91.1%) increased. 

Source: ECDC, 8 December 2021

The European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) have published the EU One Health 2020 Zoonoses Report.

Campylobacteriosis was the most reported zoonosis in the EU in 2020, with 120,946 cases compared to more than 220,000 the previous year. This was followed by salmonellosis, which affected 52,702 people, compared to 88,000 in 2019. The number of reported foodborne outbreaks fell by 47%, with the report acknowledging the impact of the COVID-19 pandemic in the drop in reported zoonotic diseases in humans.

The next most commonly reported diseases were yersiniosis, with 5,668 cases, and infections caused by Shiga toxin-producing Escherichia coli, with 4,446 cases. Listeriosis was the fifth most reported zoonosis, mainly affecting people over the age of 64.

Listeriosis and West Nile virus (WNV) infections were the diseases with the highest case fatality and hospitalisation rates, with most locally acquired human infections of WNV reported in Greece, Spain and Italy.

The report also monitors foodborne outbreaks in the EU, events during which at least two people contract the same illness from the same contaminated food. A total of 3,086 foodborne outbreaks were reported in 2020, with Salmonella remaining the most frequently detected agent, causing around 23% of outbreaks. The most common sources of salmonellosis outbreaks were eggs, egg products and pig meat.

The report also includes data on Mycobacterium bovis, Mycobacterium caprae, Brucella, Trichinella, Echinococcus, Toxoplasma gondii, rabies, Q fever and tularaemia.

Source: EFSA, 9 December 2021

A flock of free-range hens from a commercial premises near Gretna, Dumfriesshire, has tested positive for highly pathogenic avian influenza H5N1. In order to limit the further spread of disease, appropriate restrictions have been imposed on the premises and any identified contact premises, plus the area of the surveillance zone, which overlaps into other regions.

As of 4 December 2021, the remaining birds at the premises have been humanely culled and a three kilometre protection zone and ten kilometre surveillance zone have been declared around the infected premises to limit the risk of the disease spreading. Within these zones, a range of different controls are now in place, including restrictions on the movement of poultry, carcasses, eggs, used poultry litter and manure, and restrictions on bird gatherings.

The Scottish Government reminds producers and bird keepers to comply with the order to house birds, which came in to effect on 29 November 2021, or to ensure their birds are kept separate from wild birds. Bird keepers must ensure they follow biosecurity procedures. 

The additional housing measures build on the strengthened biosecurity regulations that were brought in across Great Britain as part of the Avian Influenza Prevention Zone (AIPZ) on 3 November 2021 and in Northern Ireland on 17 November 2021.

Source: Scottish Government, 3 December 2021

The Scottish Environment Protection Agency (SEPA) has published statistics providing details of household waste collected across all Scottish local authorities during 2020. The report includes the following key findings.

• The total amount of household waste generated in Scotland was 2.4 million tonnes in 2020, an increase of 0.3% from 2019.  
• In 2020, the Scottish household waste recycling rate was 42%, a decrease from the 44.9% rate achieved in 2019. The total amount of Scottish household waste recycled was 1.02 million tonnes, a decrease of 66,000 tonnes (6.1%) from 2019.  
• The amount of Scottish household waste landfilled in 2020 was 660,000 tonnes, a reduction of 98,000 tonnes (13%) from 2019, and a reduction of 794,000 tonnes (54.6%) since 2011. This is the ninth consecutive decrease in household waste landfilled. 
• For 2020, the total amount of Scottish household waste managed by other diversion from landfill was 748,000 tonnes, an increase of 171,000 tonnes (29.7%) from 2019. 

Source: SEPA, 7 December 2021