The Brazilian Ministry of Health has continued to report dengue fever in all five regions of the country. Between 1 January and 11 March 2022, 161,605 cases of dengue, including 29 deaths, were reported, which represents an increase of 44% in cases compared to the same period in 2021, with the Midwest Region being the part of the country most affected. 

Dengue is an infection found in tropical and sub-tropical climates worldwide. Dengue is spread by Aedes mosquito bites and can cause a severe flu-like illness. 

There is no vaccine against dengue fever licensed in the UK. 

Advice for travellers

• All travellers to endemic regions are potentially at risk of dengue fever and should be aware of this infection. Aedes mosquitoes are particularly persistent and aggressive, and bite between dawn and dusk. 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, 24 March 2022

The Brazilian Ministry of Health reports continued transmission of Zika virus in all five regions of the country. Between 1 January and 11 March 2022, there were 756 reported cases of Zika virus disease, an increase of 11.5% compared to the same period in 2021, with the Northern Region being the part of the country most affected. 

Zika virus infection is caused by the Zika virus (ZIKV) and is spread by mosquito bites which in pregnancy may result in congenital Zika syndrome, which may cause severe consequences for the baby. 

Advice for travellers 

Aedes mosquitoes, which transmit ZIKV, are particularly persistent and aggressive, and bite between dawn and dusk. All travellers to countries that have reported ZIKV infection must consider:

• strict mosquito bite avoidance measures, especially travellers who are pregnant or planning pregnancy
• using condoms and contraception if sexually active, to avoid the sexual transmission of ZIKV and the risk of ZIKV in pregnancy, during travel and on return for two months if female or three months if male
• travel insurance, in particular pregnant women, who should check with their travel insurance company that they are covered under the policy before booking their trip, and be aware that the risk of ZIKV in any country may change during the time between planning the trip and travelling
• if there are any additional travel recommendations for pregnant travellers, those planning pregnancy and for preventing onward sexual transmission, which can be found under the Emerging Health Risks tab of individual TRAVAX country pages and the Alerts section of individual fitfortravel country pages 

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

Source: TRAVAX, 24 March 2022

Public health authorities in France have reported a nationwide outbreak of severe Escherichia coli (E. coli) infection, with the outbreak is linked to Fraîch'up brand frozen pizzas made by Buitoni. All frozen pizzas of this brand have been recalled by the manufacturer. Since the beginning of 2022, there have been 58 reported cases, including two child deaths. 

E. coli are bacteria that normally live in the intestines of humans and animals. Bacteria are eliminated into the environment through faeces, and can contaminate water, soil, and food sources. E. coli is a common cause of travellers' diarrhoea. 

E. coli bacteria can survive cold temperatures, such as in food stored in the refrigerator and freezer, but they are destroyed by heat. Transmission is via the faecal-oral route and mainly from consuming contaminated food and water. 

Advice for travellers 

In relation to this particular outbreak, any Fraîch'up branded frozen pizzas should not be eaten and instead be thrown away. 

All travellers, irrespective of destination, are potentially at risk of E. coli infection, and should be advised to seek medical advice if they develop symptoms, such as nausea, vomiting, abdominal pain, diarrhoea, headache and fever. Older travellers and children are at increased risk of developing severe illness from E. coli infection. 

All travellers should be advised to practice good hand hygiene and effective food and water precautions. This includes:

• effective hand washing before eating, food preparation and after using the toilet
• ensuring food is stored correctly, freshly cooked and piping hot
• carefully washing fruit, vegetables, salads and herbs before consumption, and peeling whenever possible
• avoiding unpasteurised milk or dairy products 

Travellers should also avoid contact with animals and their environment, for example, cows, sheep, deer, goats, and should wash hands thoroughly if contact with animals occur. 

More information can be found on the TRAVAX E. coli and travellers’ diarrhoea webpages (for health professionals) and the fitfortravel travellers’ diarrhoea webpage (for the general public). 

Source: TRAVAX, 22 March 2022

According to the latest report on tuberculosis (TB) surveillance and monitoring in Europe, jointly published by the European Centre for Disease Prevention and Control (ECDC) and World Health Organization (WHO), a sharp drop of 24% in reported TB cases between 2019 and 2020 was probably exacerbated by the COVID-19 pandemic, which hindered detection and reporting. 

TB remains one of the world’s deadliest infectious diseases, second only to COVID-19, and drug-resistant TB strains are still a major concern. In the fight against TB, urgent investment is critical, especially in the context of the ongoing pandemic. 

The report finds that in 2020, over 33 000 TB cases were reported in the EU and EEA, and there were over 160,000 notifications of TB cases in the wider European Region. In contrast, 2019 saw around 47,500 cases reported in the EU and EEA, while in the European Region there were 216,000 new TB diagnoses. Although the rates in most countries have been decreasing over the last five years, the 24% drop in notifications of new and relapse TB cases between 2019 and 2020 represents a clear interruption of the downward trend. 

The epidemic patterns and trends vary widely, with most EU and EEA countries approaching the low incidence level of below 10 per 100,000 population, but the European Region overall has nine of the 30 countries in the world with the highest multidrug-resistant tuberculosis (MDR-TB) burden. 

In 2020, there were an estimated 21,000 TB deaths in the WHO European Region, the equivalent to 2.3 deaths per 100,000 population, with around 3,800 of these deaths occurring in the EU and EEA, which equates to 0.8 deaths per 100,000 population. For the first time in over two decades, the number of TB deaths increased because of a delay in, or lack of, diagnosis due to disruptions to services. This compromised the achievement of the End TB Strategy milestone to reduce the number of TB deaths by 35% in 2020. 

In 2020, HIV prevalence in incident TB cases was estimated to be 12%. HIV-TB coinfection has remained unchanged since 2016, with one-in-six TB patients also infected with HIV. There were an estimated 29,000 HIV-positive TB cases in the European Region, while in the EU and EEA, there were 12,327 cases with known HIV status, 4.2% of which were reported as HIV-positive. 

Of all cases notified in 2019 with a treatment outcome reported in 2020, 71.8% were treated successfully in the EU and EEA and 76.5% in the WHO European Region. Nevertheless, the treatment success rate in the region remains below the respective regional targets of 85% for new and relapse cases. Despite the efforts made and the availability of new drugs and treatment regimens, the burden in relation to MDR-TB or rifampicin-resistant TB (RR-TB) and TB and HIV remains considerable, underlining the need for more innovative approaches to the diagnosis and treatment of TB and MDR-TB or RR-TB. Rifampicin is the most potent anti-TB drug. 

In the fight against TB, urgent investment in resources, support and care is vital, particularly in the context of the COVID-19 pandemic, which has jeopardized progress towards milestones in WHO’s End TB Strategy. See CN 56/1205 for a further report on this. 

Sources: WHO, 24 March 2022 and ECDC, 24 March 2022

The World Health Organization (WHO) have used World Tuberculosis (TB) Day, which fell on 24 March 2022, to call for an urgent investment of resources, support, care and information into the fight against TB. Although 66 million lives have been saved since 2000, the COVID-19 pandemic reversed those gains and, for the first time in over a decade, TB deaths increased in 2020. Ongoing conflicts across Eastern Europe, Africa and the Middle East have further exacerbated the situation for vulnerable populations. 

Global spending on TB diagnostics, treatments and prevention in 2020 were less than half of the global target of US $13 billion annually by 2022. For research and development, the WHO believe an extra US $1.1 billion per year is required, in order to develop and expand access to the most innovative services and tools to prevent, detect and treat TB which could save millions of lives each year, narrow inequities and avert huge economic losses. The WHO believe investments in TB programmes have demonstrated benefits not just for people with TB but for health systems and pandemic preparedness. Building on lessons learnt from COVID-19 research, there is a need to catalyse investment and action to accelerate the development of new tools, especially new TB vaccines. 

Progress towards reaching the 2022 targets set in the UN High Level Meeting political declaration and the WHO Director-General’s Flagship Initiative is at risk mainly due to lack of funding. Between 2018 and 2020, 20 million people were reached with TB treatment, which is 50% of the five-year target of 40 million people reached with TB treatment for 2018 to 2022. During the same period, 8.7 million people were provided TB preventive treatment, which is 29% of the target of 30 million for the same period. 

The situation is even worse for children and adolescents with TB. In 2020, an estimated 63% of children and young adolescents below 15 years of age with TB were not reached with, or not officially reported, to have accessed life-saving TB diagnosis and treatment services, with the proportion being even higher (72%) for children under five years of age. Almost two-thirds of eligible children under five years of age did not receive TB preventive treatment and therefore remain at risk of illness. 

COVID-19 has had a further negative and disproportionate impact on children and adolescents with TB or at risk, with increased TB transmission in the household, lower care-seeking and access to health services. The WHO is urging countries to urgently restore access to TB services, disrupted due to COVID-19 pandemic for all people with TB, especially children and adolescents. 

Prior to World TB Day, on 21 March 2022, the WHO published updated guidelines for the management of TB in children and adolescents to highlight new patient-centred recommendations for diagnosis, treatment and prevention. The following list covers the most recent recommendations.

• Diagnostic testing has expanded to include non-invasive specimens, such as stools.
• Rapid molecular diagnostics are recommended as the initial test for TB diagnosis for children and adolescents.
• Children and adolescents who have non-severe forms of drug-susceptible TB are now recommended to be treated for four months instead of six months, as well as TB meningitis, where a six-month regimen is now recommended instead of 12 months. This promotes a patient-centred approach that will reduce the costs of TB care for children, adolescents and their families.
• Two of the newest TB medicines to treat drug resistant TB, bedaquiline and delamanid, are now recommended for use in children of all ages, making it possible for children with drug-resistant TB to receive all-oral treatment regimens regardless of their age.
• New models of decentralized and integrated TB care are also recommended, which will allow more children and adolescents to access TB care or preventive treatment, closer to where they live. 

It should be noted that TB remains one of the world’s deadliest infectious killers, with over 4,100 people losing their lives and close to 30,000 people falling ill with this preventable and curable disease. 

More information on World TB Day can be found on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites. 

Source: WHO, 21 March 2022

On 24 March 2022, the European Centre for Disease Control and Prevention (ECDC) published an annual update on West Nile virus (WNV) cases reported during the 2021 transmission season. The update found that, as of 10 February 2022, there were 164 reported human cases of WMV infection, which included 13 deaths, across the EU, EEA and EU-neighbouring countries in 2021, of which 159 were locally acquired and five were travel related. 

During the 2021 transmission season, EU and EEA countries reported 139 locally acquired human cases of WNV infection with known place of infection, including 10 deaths, through the European Surveillance System (TESSy), with the vast majority of the cases being reported by Greece and Italy. Greece further reported two additional locally acquired human cases with unknown place of infection, and also recorded eight of the ten deaths reported. 

Human WNV infections were reported in seven EU member states and in one EU-neighbouring country (which included three deaths), where seasonal circulation of the virus had been previously reported. Burgenlandkreis and Spree-Neisse in Germany and La Spezia in Italy reported locally acquired human cases of WNV infection for the first time, with all other cases reported through TESSy being from areas that had been affected during previous transmission seasons. 

The first locally acquired case of the season in the EU was notified by Italy in week 26 (26 June to 4 July), with disease two weeks earlier, while the last case was reported by Greece in week 45 (8 to 14 November), with disease onset again two weeks earlier. 

Animal data are collected through the Animal Disease Information System (ADIS) of the European Commission. The distribution reports for WNV outbreaks among equids and birds cover only EU and EEA countries, with seven countries reporting 43 outbreaks among equids during the 2021 transmission season. In addition, eight outbreaks among birds were reported in two countries. 

Source: ECDC, 24 March 2022

On 18 March 2022, highly pathogenic avian influenza (HPAI) H5N1 was confirmed at a premises near Beith, North Ayrshire, while the following day, HPAI H5N1 was confirmed at a premises near Strichen, Aberdeenshire. As a result, three km protection zones (PZ) and ten km surveillance zones (SZ) were declared in both cases, restricting movements of poultry, carcasses, eggs, used poultry litter and manure in order to help prevent any further spread of disease. 

In recent weeks, HPAI H5N1 was also confirmed at various locations in Aberdeenshire, Dumfriesshire and Angus, while cases have been confirmed in parts of England and Wales. 

Keepers can find out if their premises is in the PZ or SZ by viewing the Animal and Plant Health Agency (APHA) interactive map. Premises are in a PZ or SZ if the whole or part of the premises falls within the zone. 

Vigilance by bird keepers is important and any suspicion of disease should be reported immediately to the local Animal and Plant Health Agency (APHA) office, while suspected cases in Scotland can be reported by contacting a local field services office. 

On 29 November 2021, a Great Britain-wide Avian Influenza Prevention Zone (AIPZ) was introduced, with the requirement on all bird keepers, including those who keep pet birds, to practice strict biosecurity measures to help prevent the spread of avian influenza from wild birds or any other source. 

Source: Scottish Government, 23 March 2022

On 18 March 2022, the UK Government, along with the Welsh and Scottish Governments and Northern Ireland Assembly published a report, agreeing a series of commitments to improve outcomes for patients through better genomic testing and access to clinical trials. For the first time, these shared commitments set out priority actions across the UK and are part of wider plans to improve healthcare through genomics, the study of genes and DNA. 

The Genome UK strategy, announced in 2020, built on innovative work already underway to create reportedly the most advanced genomic healthcare system in the world and deliver better healthcare at a lower cost, and formed part of the government’s wider commitment to reform healthcare and ensure the UK and the NHS remain at the forefront of cutting-edge treatment. For example, using research to evaluate the use of whole genome sequencing in new-borns to screen for rare genetic conditions and diagnose rare diseases earlier, enabling more tailored treatment sooner. 

The Genome UK strategy, which aims for UK-wide implementation between 2022 to 2025, includes shared commitments with several clear aims.

• Improving cancer diagnosis and treatment by working across the UK to better integrate genomic testing into healthcare and increase access to clinical trials to provide better, personalised treatment.
• Providing earlier detection of disease by establishing a clear, evidence-based approach to new-born genome sequencing, led by Genomics England in partnership with the NHS, alongside the devolved governments, to ensure learning is shared across the UK to benefit new-borns and their parents nationwide.
• Building on the successful UK-wide partnership in sequencing of COVID-19 to strengthen collaboration on sequencing of other diseases. As part of this, the UK Health Security Agency (UKHSA) will set up a national group on disease genomics with representatives from the four nations.
• Encouraging innovative and cutting-edge industry partnerships in research and development across the UK, to support implementation of Genome UK by bringing together the UK-wide genomics ecosystem to improve collaboration and maximise investment.
• Producing high-quality research by bringing together genomic data sets across the UK and increasing access to clinical trials, as well as ensuring research feeds back into the NHS to improve patient care. 

Building on the collaborative and innovative ways of working during the COVID-19 pandemic, these commitments aim to build on scientific successes, tackling future disease challenges and ensure patients access more tailored treatment. 

The shared commitments build on the vision outlined in Genome UK in September 2020 and the commitments in the first implementation plan for 2021 to 2022, and these will be followed by more detailed implementation plans from each country by the end of 2022. 

Source: UK Government, 18 March 2022

On 24 March 2022, Food Standards Scotland (FSS) and the Food Standards Agency (FSA) published a joint rapid risk assessment, advising consumers that some food products labelled as containing sunflower oil may instead contain refined rapeseed oil. This is happening to maintain the supply of certain food products containing ingredients that have become increasingly difficult to source because of the conflict in Ukraine. 

The majority of the UK’s sunflower oil comes from Ukraine, with Russia making up a substantial portion of the rest. Food businesses are reporting that UK supplies of sunflower oil are likely to run out in a few weeks, with some businesses already experiencing severe difficulties. 

This situation has led to some food manufacturers urgently replacing sunflower oil with refined rapeseed oil before being able to make the change on the label. FSS and the FSA advising that food products labelled as containing sunflower oil may instead have been produced using refined rapeseed oil, and consumers should look out for additional information being provided by retailers and manufacturers. 

The FSA and FSS are working across government and the food industry in order to understand the challenges and ensure food supply is maintained in a way that is safe and in the interests of consumers. 

Sources: FSS, 24 March 2022 and FSA, 24 March 2022

On 22 March 2022, Food Standards Scotland (FSS) launch a campaign aimed at encouraging farmers across Scotland to remain alert to the risks of on-farm lead poisoning for cattle. 

The campaign will include highly targeted social media messaging alongside close engagement with key industry bodies to distribute information on the cause and prevention of livestock incidents, which often peak in spring when cattle are put out to pasture. 

Lead is a highly toxic metal which can cause slow or stunted growth, blindness, infertility, birth defects and death. Not only are the health impacts on livestock distressing, but there are financial implications such as veterinary fees, carcass disposal and loss of market value. 

Contaminated meat, offal and milk containing lead at levels above legal limits is unsafe and illegal to sell. In addition, there is a minimum 16-week withdrawal period which can cause delays across supply chain and incur costs for testing. 

Although there haven’t been any recent incidents, over 400 animals have been restricted from the food chain due to lead poisoning since 2019. 

Lead batteries, old paint, bonfire ash and fly-tipping are the primary causes of lead poisonings. FSS advise that prevention is the best strategy and checking fields regularly and removing animals’ access to these sources are the first steps in achieving this. 

Source: FSS, 22 March 2022

Work to tackle the challenges of human, animal and ecosystem health using a more integrated approach has seen significant progress in the past year, leaders of three international organizations cooperating across these sectors said, as they expanded their group to include a fourth body, the UN Environment Programme (UNEP). 

At its annual executive meeting, the tripartite partnership for One Health, bringing together the Food and Agriculture Organization of the UN (FAO), the World Health Organization (WHO) and the World Organization for Animal Health (OIE), formally became the quadripartite as it signed a memorandum of understanding with the UN Environment Programme (UNEP). 

The One Health approach aims to sustainably balance and optimize the health of people, animals, ecosystems and the wider environment, by mobilising multiple sectors, disciplines and communities to work together, in order to foster well-being and tackle threats to health and ecosystems. Also, it addresses the collective need for clean water, energy and air, safe and nutritious food, action on climate change, and contributing to sustainable development. 

The work of the newly expanded alliance will be focused on a One Health joint plan of action, which includes six main action tracks:

• enhancing countries’ capacity to strengthen health systems under a One Health approach
• reducing the risks from emerging or resurfacing zoonotic epidemics and pandemics
• controlling and eliminating endemic zoonotic, neglected tropical or vector-borne diseases
• strengthening the assessment, management and communication of food safety risks
• curbing the silent pandemic of antimicrobial resistance (AMR)
• better integrating the environment into the One Health approach 

As the world enters the third year of the COVID-19 pandemic, with an estimated cost of $8 to $16 trillion, there is increased awareness and broad recognition of the importance of One Health as a long-term, viable and sustainable approach, and it is now firmly anchored on the global agenda, from the G7 and G20 to the UN Food Systems Summit. To support a global One Health Coalition, a One Health commitment was registered at the UN Food Systems Summit, aimed at building engagement across sectors, disciplines and all levels of society. This commitment will help shape national agrifood systems transformation pathways as part of the summit follow-up. 

Last year saw the tripartite also implement a number of other initiatives on One Health, including AMR, in which the One Health High-Level Expert Panel had an important scientific advisory role. As a result, One Health regional platforms were strengthened, and new ones initiated to share information and best practices. Important progress was also made in establishing a joint framework on AMR, a global leaders’ group on AMR, and in work towards an AMR multi-stakeholder partnership platform, mobilizing resources and action to fight AMR which threatens the lives of millions. These achievements reflect the successful cooperation between the tripartite and UNEP which has now reached an important new milestone with the signature of a formal collaboration agreement. 

Source: WHO, 18 March 2022

On 21 March 2022, the Animal and Plant Health Agency (APHA) published their 2021 end of year report on sheep scab notifications, which reported a total of 120 incidences of sheep scab during the year, an increase of 30 on figures for 2020. 

Sheep scab is a contagious disease of sheep which can seriously affect both welfare and production if left untreated. 

The Sheep Scab (Scotland) Order 2010 places a legal obligation on any person who has reason to believe that sheep in their possession or care have sheep scab, to notify their local APHA office as soon as possible. 

Treatment to control and reduce the incidence of sheep scab is the responsibility of the individual sheep owner and all reported cases are mapped by APHA to provide the sheep industry with an overall picture of the location and distribution of sheep scab in Scotland. 

Source: Scottish Government, 21 March 2022

On 22 March 2022, the Environment Agency published a roadmap which sets out a 25-year vision for flood hydrology across all four countries of the UK, accompanied by an action plan detailing how this vision will be achieved. 

The roadmap considers all sources of inland flooding, including fluvial, pluvial and sewers, groundwater and reservoirs, while further examining all inland flood hydrology activities in the UK, from operational practice to scientific research. Development of the roadmap has been driven by:

• the scale of investment, of around £6 billion over the next six years, that flood hydrology data, methods, models and expertise underpin
• the need to support the implementation of flood risk management strategies across the UK
• the need to improve partnership working and collaboration across the UK flood hydrology community
• the need to improve the translation of science into practice
• the need to deal with known limitations and issues in existing operational flood hydrology methods
• the need for flood hydrology to account for and predict the impacts of future climate and land use change
• the opportunity for flood hydrology to contribute to net-zero carbon targets 

The Environment Agency has led the roadmap project, but the roadmap itself has been developed by, and intended for, the UK flood hydrology community, for the next 25 years and it is believed:

• in this time, society will have improved hydrological information and understanding to manage flood hazard in a changing world
• flood hydrology and whole system process understanding will be underpinned by excellent evidence with quantified uncertainty
• leadership and collaboration will be crucial to achieving this vision

The Environment Agency report the successful long-term delivery of the UK flood hydrology roadmap vision will require strong leadership and improved partnership working and collaboration across the flood hydrology community, with the estimated funding required to implement the roadmap costing between £110 million and £165 million over the next 25 years. 

Source: Environment Agency, 22 March 2022

The Scottish Environmental Incident Surveillance System (SEISS) has recorded the following incident:

• On 20 March 2022 at 19:08, emergency services were called to tackle a huge gorse blaze in Seabank Road, Invergordon. Operations control immediately mobilised four fire engines, a heavy rescue unit and a community response unit to the location and firefighters extinguished the fire. No injuries have been reported from the incident.

More detailed information can be found on the SEISS website.