On 14 April 2022, the Eurosurveillance journal published an article based on an ongoing investigation by Public Health Scotland (PHS) into the origin of recent severe hepatitis cases among young children in Scotland. 

As of 21 April 2022, PHS has identified 14 cases of severe hepatitis requiring admission to hospital in children aged between one and 10 years old, across six Scottish NHS health boards in Scotland, with most cases noted since March, although one child was admitted to hospital in early January 2022. 

Each year, around seven or eight cases of non-A to E hepatitis, without other underlying diagnoses, are detected in children in Scotland, therefore the increased number of cases in such a brief time period, combined with the geographical spread and severity of illness, is unusual and requires further investigation. Cases have also been detected in other parts of the UK, while latest reports find detections have also been reported in four European countries and the US, which are being investigated by their own public health agencies. PHS is working closely with the UK Health Security Agency (UKHSA) and their devolved partners to coordinate the investigation. 

At present, all potential causes are being explored, though none has been found, but infection is more plausible based on available evidence. Some of the children were adenovirus PCR-positive and other childhood viruses, including SARS-CoV-2, have also been isolated. The Incident Management Team (IMT) is also looking into whether there are other infections or environmental causes. There is no connection between the COVID-19 vaccination and these cases, with the majority being of an age too young to be vaccinated and none has received a first dose. 

Adenoviruses are a family of common viruses that usually cause a range of mild illnesses and most people recover without complications. They can cause a range of symptoms, including colds, vomiting and diarrhoea, and while they do not typically cause hepatitis, it is a known rare complication of the virus. 

Adenoviruses are commonly passed from person to person and by touching contaminated surfaces, as well as through the respiratory system. 

The most effective way to minimise the spread of adenoviruses is to practice good hand and respiratory hygiene and supervise thorough handwashing in younger children. Parents are advised contact their GP or other healthcare professional if they notice signs of jaundice in their child, which can present as a yellow tinge in the whites of their eyes or on their skin. Other symptoms include dark urine, pale grey coloured poo, itchy skin, muscle and joint pains, tiredness, feeling sick, hot temperature, loss of appetite and stomach pain. 

Source: PHS, 21 April 2022

The Food Standards Agency (FSA), Food Standards Scotland (FSS) and the UK Health Security Agency (UKHSA), along with UK public health bodies and international public health and food safety authorities, continue to investigate an ongoing outbreak of Salmonella linked to certain Kinder egg products and Schoko-Bons produced at one of the Ferrero company’s factories, in Arlon, Belgium, and have issued a reminder to consumers that these products should not be eaten.

As of 20 April 2022, there were 73 cases linked to this outbreak in the UK, with most of these cases being in children under five years of age. 

Symptoms of salmonellosis, or infection with Salmonella, typically resolve themselves within a few days, though more severe symptoms can occur, especially in young children, those who are pregnant and people with weakened immune systems. Salmonella can be spread from person-to-person as well as from food, so anyone affected should adhere to good hygiene practices, such as washing hands thoroughly after using the bathroom and avoiding handling food for others where possible. 

Source: UKHSA, 22 April 2022

The 2022 Rio Carnival, originally scheduled to take place between 25 February and 1 March, was initially postponed until April 2022 due to an increase in COVID-19 cases due to the Omicron variant. Previously, in January 2022, the Rio mayor announced via the media that the street carnivals and events have been cancelled this year also because of the increase in COVID-19 cases due to the Omicron variant. However, the official Samba parade, to be held in Rio’s Sambadrome stadium, is still scheduled to proceed on 22,23 and 30 April 2022, with additional health precautions in place. 

Many other cities in Brazil have cancelled this year’s carnival events. 

Advice for travellers 

Travellers planning on travelling to Brazil for the Rio Carnival should:

• be aware that international travel guidance and event guidance may change at short notice
• review the latest Foreign, Commonwealth & Development Office (FCDO) foreign travel advice for Brazil, including entry requirements and quarantine restrictions
• review and follow the latest travel health advice for Brazil
• be aware of precautions they should take to reduce their risk of exposure to coronavirus (COVID-19) before, during and after travel as detailed on the fitfortravel website 

Furthermore, travellers attending the carnival celebrations should:

• be up to date with routine UK schedule vaccinations, and check if primary vaccination or boosters may be required before travel
• be aware of the mosquito-borne viruses present in some parts of Brazil, including malaria, yellow fever, dengue, chikungunya and Zika virus
• exercise care by using food and water precautions, and practice good respiratory and hand hygiene
• have valid comprehensive travel insurance which covers COVID-19 related illness or unexpected delays
• seek medical advice abroad if they experience any symptoms of infection or illness 

The following TRAVAX advice pages may also be applicable for those travelling to Brazil:

• insect bite avoidance
• personal safety
• accident prevention
• sun safety
• sexual health risks
• travelling with medication

On return to the UK, travellers should seek urgent medical attention if they develop a fever or flu-like illness and should inform a healthcare professional of their recent travel history, particularly if they have travelled in a malaria endemic region.

Sources: TRAVAX, 19 April 2022 and fitfortravel, 19 April 2022

On 15 April 2022, the World Health Organization (WHO) were notified that one index case and six asymptomatic lab positives of circulating vaccine-derived poliovirus type 3 (cVDPV3) have been reported in Israel, following an initial notification on 7 March 2022 of a detection in an unvaccinated child from Jerusalem city. Investigations, including environmental, epidemiological, and virological, are ongoing to determine the origin of cVDPV3 and the scope of circulation. 

In response to the initial detection, immunisation activities with inactivated polio vaccine (IPV) and catch-up vaccination were initiated in Jerusalem, and a bivalent oral polio vaccine (bOPV) campaign started on 4 April 2022 in Jerusalem district, which was extended to the entire country nine days later. Given the high immunisation coverage and robust surveillance system in the country, the WHO consider the risk of national spread as moderate. 

Polio is a highly infectious viral disease that largely affects children under five years of age, especially in areas with poor hygiene and sanitation systems. The virus is transmitted by person-to-person and spread mainly through the faecal-oral route or, less frequently, by a common vehicle, such as contaminated water or food and multiplies in the intestine, from where it can invade the nervous system and may cause paralysis. 

The incubation period is usually between seven to ten days but can range from four to 35 days. Up to 90% of those infected are either asymptomatic or experience mild symptoms and the disease usually goes unrecognized. In symptomatic cases, initial symptoms can include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs, with these symptoms usually lasting between two and ten days, with most people recovering completely. However, in the remaining 10% of cases, the virus causes paralysis, usually of the legs, which is most often permanent. Paralysis can occur as rapidly as within a few hours of infection, with a fatality rate of 5-10% occurring when their breathing muscles become immobilised. 

There is no cure for polio, with prevention only occurring by immunisation. The WHO recommends that all those who travel to, or live in, polio-affected areas should be fully vaccinated against polio in compliance with the national schedule.

As per the advice of the Emergency Committee, convened under the International Health Regulations (2005), efforts to limit the international spread of poliovirus remain a Public Health Emergency of International Concern (PHEIC). Countries affected by poliovirus transmission are subject to temporary recommendations. To comply with the temporary recommendations issued under the PHEIC, any country infected by poliovirus should:

• declare an outbreak as a national public health emergency
• consider vaccination of all international travellers
• ensure such travellers are provided with an international certificate of vaccination
• restrict international travel of any resident lacking documentation of appropriate polio vaccination
• intensify cross-border efforts to increase vaccination coverage of travellers and intensify efforts to increase routine immunisation coverage 

Any country subject to the temporary recommendations should maintain the measures described above until:

• at least six months have passed without new infections
• documentation shows the full application of high-quality eradication activities in all infected and high-risk areas 

Source: WHO, 15 April 2022

On 13 April 2022, the European Centre for Disease Prevention and Control (ECDC) reported that nine cases of measles had been reported across three countries since the previous months report, including countries which had previously eliminated or interrupted endemic transmission. Additionally, the European Surveillance System (TESSy) has reported five cases across four countries in January and February 2022. 

So far, in 2022, no deaths from measles have been reported in the EU and EEA. 

Source: ECDC, 13 April 2022

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 21 April 2022, the ECDC published the fifth virus characterisation period report for the 2021 to 2022 influenza season. As of week 13 of 2022, 90,644 influenza detections across the World Health Organization (WHO) European Region have been reported. Of these, 98% were type A viruses, with A(H3N2) dominating over A(H1N1)pdm09, and 2% were type B viruses, with all but one being 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, but the number of detections is reduced compared to earlier seasons.

Source: ECDC, 21 April 2022

On 8 April 2022, the UN General Assembly passed a resolution welcoming the 2022 FIFA World Cup Qatar football championship and hailed the promotion of the tournament as a public health benchmark for other nations hosting future large sporting events. The assembly further expressed its support for the launch of a multi-year collaboration among the International Federation of Association Football, the World Health Organization (WHO) and Qatar, which aims to make the 2022 World Cup a beacon for the promotion of healthy lives, physical and mental health and psychosocial well-being. 

The project goals are very closely tied to the WHO’s #HealthForAll campaign, which underscores that noncommunicable diseases such as cancer, diabetes and chronic respiratory diseases can be prevented by reducing risk factors such as tobacco use, unhealthy diets, and physical inactivity. After the World Cup ends, the project will be evaluated in an effort to build a legacy aimed at developing and implementing an outreach plan for the WHO to identify new opportunities to apply the benchmarks set by Qatar during the event. 

The World Cup, the first to be held in the Middle East, is scheduled to be held in Qatar from 21 November to 18 December 2022. 

Source: WHO, 14 April 2022

On 19 April 2022, the European Food Safety Authority (EFSA) published their scientific advice related to nutrient profiling. 

In main findings from the report, intakes of energy, saturated fats, sodium and added sugars or free sugars are too high in Europe, so a reduction them would help to combat chronic diseases linked to unhealthy diets. On the other hand, dietary fibre and potassium intakes are too low in most European adult populations, so increasing them would also contribute to improved health. EFSA's nutrition experts have identified the nutrients and non-nutrient food components of public health importance for Europeans, the food groups with important roles in European diets, and scientific criteria to guide the choice of nutrients for nutrient profiling. 

The European Commission requested EFSA’s scientific advice to inform both the development of a future EU-wide system for front-of-pack nutrition labelling and conditions for restricting nutrition and health claims on foods. Importantly, EFSA did not evaluate or propose a particular nutrient profiling model for either of these purposes. 

Prior to publication of their advice, EFSA held a public consultation on the draft opinion from November 2021 to January 2022, generating 529 comments from 83 organisations and individuals in 21 countries. 

As part of the Farm to Fork strategy, the European Commission intends to propose a revision of existing legislation on the provision of food information to consumers at the end of 2022. EFSA’s scientific input will inform the commission’s proposal alongside other evidence collected by the commission, with future updates will be made available on the commission's website. 

Source: EFSA, 19 April 2022