On 28 April 2022, the World Health Organization (WHO) reported a new outbreak of Ebola virus disease (EVD) in the city of Mbandaka, Equateur province, in the northwest of the Democratic Republic of the Congo (DRC). This is the third outbreak of EVD in Equateur province since 2018. 

As of 29 April 2022, there have been cases of EVD in two people, both resulting in death. The first person became ill on 5 April and died on 21 April 2022, while the second person, a member of the same family, died on 25 April 2022. As of 27 April 2022, 267 contacts have been identified and a vaccination programme is underway. 

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 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. 

Sources: TRAVAX, 29 April 2022 and fitfortravel, 29 April 2022

The National Environment Agency of Singapore continues to report increasing numbers of dengue fever incidence in the country, with 4,713 cases in the first 15 weeks of 2022, a greater number than in the equivalent time period in any of the past four years. 

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, with treatment being supportive only. 

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. 

Sources: TRAVAX, 22 April 2022 and fitfortravel, 22 April 2022

The National Institute for Communicable Diseases (NICD) has reported continuing incidences of rabies in South Africa people, with four cases being reported across three provinces between 1 January and 24 March 2022. An ongoing outbreak of rabies in dogs continues to place people at risk in the affected provinces. 

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, as only a small number of people with the disease are known to have survived. 

Advice for travellers

• All travellers to rabies endemic areas should be aware of the risk of rabies and advised to avoid contact with wild and domestic animals, particularly dogs and cats. Travellers should follow advice on how to prevent and manage animal bites.
• Children are more vulnerable to rabies than adults, as they are less likely to understand the risk of interacting with animals, less able to defend themselves from an animal attack and may not report a potential exposure.
• All travellers to endemic areas should be aware of immediate wound care and advised to seek medical attention immediately following potential exposure. Effective rabies vaccines, which can be used pre- and post-exposure, are available and prevent clinical rabies from developing. 

Further information for health professionals is available from the TRAVAX rabies and rabies post-exposure guidance webpages, while the general public can access information on the fitfortravel rabies webpage. 

Sources: TRAVAX, 22 April 2022 and fitfortravel, 22 April 2022

World Malaria Day fell on 25 April 2022, with its campaign theme being 'Harness innovation to reduce the malaria disease burden and save lives'. This campaign highlighted the fact that no single tool is available that will reduce the burden of malaria and worldwide investment and innovation is needed to consider new vector control approaches, diagnostics, antimalarial medicines and other tools to speed up the pace of progress against malaria. 

According to the latest World Malaria Report, there were an estimated 241 million cases of malaria and 627,000 malaria-related deaths worldwide in 2020, which is an increase of 14 million cases, and 69,000 deaths compared to 2019, although approximately two-thirds of the additional malaria deaths in 2020 were linked to disruptions in malaria prevention, diagnosis and treatment services during the COVID-19 pandemic. 

The report also showed that 95% of malaria cases and deaths occurred in the World Health Organization (WHO) African region, with more than half of all malaria deaths occurring in Nigeria, Democratic Republic of the Congo, United Republic of Tanzania and Mozambique. 

Children under five years of age are the most vulnerable group affected, accounting for approximately two-thirds of all global deaths from malaria in 2020. 

Advice for travellers 

Malaria, a preventable and treatable disease, is spread by the bite of female Anopheles mosquito. Most Anopheles species prefer to feed between dusk and dawn, which is when most transmission of malaria occurs. 

Country-specific malaria risk can be found on individual TRAVAX destination webpages. If malaria is present, a map and accompanying prevention advice is provided, following the A, B, C, D format of malaria prevention.

• Awareness of risk - a summary description of the malaria risk for that country.
• Bite prevention - practical measures to take to avoid mosquito bites.
• Chemoprophylaxis - country specific chemoprophylaxis advice.
• Diagnosis and treatment - information on the signs and symptoms of malaria and the importance of prompt treatment. 

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

Sources: TRAVAX, 22 April 2022 and fitfortravel, 22 April 2022

On 27 April 2022, the World Health Organization (WHO) and UNICEF issued a joint news release, warning of a heightened risk for the spread of vaccine-preventable diseases which could trigger larger outbreaks, particularly of measles, affecting millions of children this year. 

Pandemic-related disruptions, increasing inequalities in access to vaccines and the diversion of resources from routine immunisation, are leaving too many children without protection against measles and other vaccine-preventable diseases. 

The risk for large outbreaks has increased as communities relax social distancing practices and other preventive measures for COVID-19 implemented during the height of the pandemic. In addition, with millions of people being displaced due to conflicts and crises including in Ukraine, Ethiopia, Somalia and Afghanistan, disruptions in routine immunisation and COVID-19 vaccination services, lack of clean water and sanitation, and overcrowding increase the risk of vaccine-preventable disease outbreaks. 

Worldwide, 17,338 measles cases were reported in January and February 2022, an increase of 79% from the 9,665 cases noted during the first two months of 2021. As measles is very contagious, cases tend to show up quickly when vaccination levels decline, raising concerns that outbreaks of measles could also forewarn outbreaks of other diseases that do not spread as rapidly. 

Apart from its direct effect on the body, which can be lethal, the measles virus also weakens the immune system and makes children more vulnerable to other infectious diseases, such as pneumonia and diarrhoea. Most cases occur in settings that have faced social and economic hardships due to COVID-19, conflict, or other crises, and have chronically weak health system infrastructure and insecurity. 

In 2020, 23 million children missed out on basic childhood vaccines through routine health services, the highest number since 2009 and 3.7 million more than in 2019. 

As of April 2022, there were 21 large and disruptive measles outbreaks around the world reported in the previous 12 months, although these figures are likely higher as the pandemic has disrupted surveillance systems globally, with potential underreporting. Countries with the largest measles outbreaks in the past year included Somalia, Yemen, Nigeria, Afghanistan, and Ethiopia, with insufficient measles vaccine coverage being the major reason for outbreaks. 

As of 1 April 2022, 57 vaccine-preventable disease campaigns in 43 countries that were scheduled to take place since the start of the pandemic are still postponed, impacting 203 million people, most of whom are children. Of these, 19 are measles campaigns, which put 73 million children at risk of measles due to missed vaccinations. In Ukraine, the measles catch-up campaign of 2019 was interrupted due to the COVID-19 pandemic and thereafter due to war. Routine and catch-up campaigns are needed wherever access is possible to help make sure there are not repeated outbreaks as in 2017 to 2019, when there were over 115,000 cases of measles and 41 deaths in the country, which was the highest incidence in Europe. 

Coverage at or above 95% with two doses of the safe and effective measles vaccine can protect children against measles. However, COVID-19 pandemic related disruptions have delayed the introduction of the second dose of the measles vaccine in many countries. 

As countries work to respond to outbreaks of measles and other vaccine-preventable diseases, and recover lost ground, UNICEF and WHO, along with partners such as Gavi the Vaccine Alliance, the partners of the Measles & Rubella Initiative (M&RI), the Bill & Melinda Gates Foundation and others, are supporting efforts to strengthen immunisation systems by utilising the following measures.

• Restoring services and vaccination campaigns so countries can safely deliver routine immunisation programmes to fill the gaps left by the backsliding.
• Helping health workers and community leaders communicate actively with caregivers to explain the importance of vaccinations.
• Rectifying gaps in immunisation coverage, including identifying communities and people who have been missed during the pandemic.
• Ensuring that COVID-19 vaccine delivery is independently financed and well-integrated into overall planning for immunisation services so that it is not carried out at the cost of childhood and other vaccination services.
• Implementing country plans to prevent and respond to outbreaks of vaccine-preventable diseases and strengthening immunisation systems as part of COVID-19 recovery efforts. 

Sources: WHO, 27 April 2022 and UNICEF, 27 April 2022

The European Centre for Disease Prevention and Control (ECDC) has published the final report of a scoping review undertaken as part of a wider study on the assessment of point-of-care testing (POCT) devices for infectious disease surveillance, prevention and control, commissioned by ECDC and undertaken by RAND Europe between November 2019 and April 2020. 

The objective of the wider project was to assess the availability, use and impact of POCT in EU and EEA member states and the UK for communicable diseases under EU surveillance, with the reviewed literature covering 44 of the diseases or pathogens of interest. The most frequent disease of focus was HIV, followed by influenza and tuberculosis. The diseases with the largest number of available POCT devices were influenza, HIV and hepatitis C. 

Source: ECDC, 27 April 2022

On 25 April 2022, the Chief Veterinary Officers for the UK, Scotland, Wales and Northern Ireland issued a joint statement confirming that, following a recent risk assessment, mandatory housing measures for poultry and captive birds, which were introduced across the UK to help stop the spread of bird flu, will be lifted on 2 May 2022. 

Poultry and other captive birds will no longer need to be housed, unless they are in a Protection Zone, and will be allowed to be kept outside. While the risk of bird flu has been reduced to medium for premises with poor biosecurity, the enhanced biosecurity requirements that were brought in as part of the Avian Influenza Prevention Zone (AIPZ) will remain in force as infection may still be circulating in the environment for several more weeks. All poultry gatherings remain banned. Disease control zones can be located by using the online Animal and Plant Health Agency (PHA) interactive map. 

Those who intend to allow their birds outside are advised to use the upcoming days to prepare their outside areas for the release of their birds. Preparation advice includes cleansing and disinfection of hard surfaces, fencing off ponds or standing water and reintroduction of wild bird deterrents. 

The Chief Veterinary Officers advise that maintaining high standards of biosecurity is the most effective method of disease control available, and all bird keepers should apply enhanced measures at all times to help prevent the risk of future outbreaks. This follows the largest ever outbreak of bird flu in the UK, with over 100 cases confirmed across the country since October 2021. 

As the AIPZ will remain in force across the UK, all bird keepers, whether they have pet birds, commercial sized or backyard flocks, must continue to be diligent in taking effective and precautionary biosecurity measures including cleansing and disinfecting equipment, clothing and vehicles, limiting access to non-essential people on their sites, and should change clothing and footwear before entering, and when leaving, bird enclosures. 

Poultry and captive bird keepers must be vigilant for any signs of disease in their birds or in any wild birds and seek prompt advice from their vet if they have any concerns. 

Public health advice is that the risk to human health is very low, with Food Standards Scotland (FSS) advising that avian influenza poses a very low food safety risk for UK consumers. 

Source: Scottish Government, 25 April 2022

On 26 April 2022, a report published by Scotland’s Centre of Expertise for Waters (CREW) found that 97% of the 142 monitored Scottish lochs and reservoirs recorded an increase in temperature between 2015 and 2019. While most warmed by up to 1.0°C per year over this period, 9% recorded a greater increase, with rises of up to 1.3°C per year noted. 

Researchers warn that these changes increase the risk of harmful algal blooms developing, which could impact on the use of lochs and reservoirs for recreation, water supply, and as a safe habitat for wildlife. 

The report suggests that waters in the south and east of Scotland are expected to warm the most at first, but the climate-related impact will reach all parts of the country by 2040. 

The report makes a number of recommendations to address these impacts in the immediate term, such as reducing the amount of phosphorus and nitrogen, the main driver of algal blooms, entering lochs and reservoirs from their catchments. Sources of these plant nutrients, which are present in synthetic fertilisers as well as human and animal waste, include farm runoff and wastewater discharges. Actions, such as the creation of buffer strips and constructed wetlands aimed at reducing nutrient inputs, have started in many catchments across Scotland. Further recommendations, as well as further research to improve understanding of climate impacts on the complex functioning of lochs and reservoirs, are also included in the report. 

Source: Scottish Government, 26 April 2022

On 28 April 2022, the Department for Environment, Food and Rural Affairs (DEFRA) published an annual update on concentrations of major air pollutants in the UK. This publication summarises the concentrations of major air pollutants as measured by the Automatic Urban and Rural Network (AURN). This release covers annual average concentrations in the UK of:

• nitrogen dioxide (NO2)
• particulates (PM2.5)
• particulates (PM10)
• ozone (O3) 

The publication also covers the number of days when air pollution was moderate or higher for any one of the following five pollutants:

• nitrogen dioxide (NO2)
• particulates (PM2.5)
• particulates (PM10)
• ozone (O3)
• sulphur dioxide (SO2) 

These statistics are used to monitor progress against the UK’s reduction targets for concentrations of air pollutants. Improvements in air quality help reduce harm to human health and the environment. 

Air quality in the UK is strongly linked to anthropogenic emissions of pollutants. More information on UK emissions data and other information can be found on the UK Government website. 

The statistics in this publication are based on data from the Automatic Urban and Rural Network (AURN) of air quality monitors. The UK-AIR website contains the latest air quality monitoring data for the UK and detailed information about the different monitoring networks that measure air quality. The website also hosts the latest data produced using Pollution Climate Mapping (PCM), which is a suite of models that uses both monitoring and emissions data to model concentrations of air pollutants across the whole of the UK. The UK-AIR website also provides air pollution episode updates and information on Local Authority Air Quality Management Areas as well as a number of useful reports. 

The monitoring data is continuously reviewed and subject to change when issues are highlighted, meaning that the time series for certain statistics may vary slightly from year to year. 

Source: DEFRA, 28 April 2022

On 22 April 2022, legislation to improve fire safety and boost Scotland’s net-zero ambitions was presented to the Scottish Parliament. Under the legislation, developers will be banned from using combustible cladding on high-rise buildings. 

Since 2005, new cladding systems on high rise blocks of flats have either had to use non-combustible materials or pass a large-scale fire test. The building standards legislation removes the option of a fire test, completely prohibiting such materials from use on domestic and other high-risk buildings over the height of 11 metres such as care homes and hospitals, which contain:

• a dwelling
• a building used as a place of assembly
• a building used as a place of entertainment or recreation
• a hospital
• a residential care building or sheltered housing complex, or a shared multi-occupancy residential building 

Further, the highest risk metal composite cladding material will be banned from any new building of any height, with replacement cladding also required to meet the new standards. 

The legislation also includes improvements to energy performance standards, aiming to make buildings easier to heat while ensuring they are well ventilated and comfortable to live in.

Changes to requirements on fire safety of cladding systems will be introduced on 1 June 2022, while improvements to energy and environmental standards will apply from 1 October 2022. The changes have been brought in following public consultations in 2021 on the fire safety of cladding systems and on energy and environmental standards. Supporting technical handbooks, which set out the full detail of changes, will be published from the start of May. 

Source: Scottish Government, 22 April 2022

On 25 April 2022, the UK Government published a policy paper, announcing their intention to introduce mandatory digital waste tracking across the UK, as previously committed to in their resources and waste strategy for England. It is believed that the digital tracking will provide information about where and how waste is created, who is handling it, what is done to it, and where it ends up, and will:

• provide a comprehensive way to see what is happening to the waste produced in the UK
• help support more effective regulation of waste
• help businesses comply with their duty of care with regards to waste
• help the towards a more circular economy by enabling us to maximise the value extracted from resources
• reduce the ability for waste criminals to operate and undercut legitimate businesses through their systemic mishandling of waste, illegal exports, and flytipping 

The UK Government is working towards a target date of 2023 to 2024 in launching the digital waste tracking service, though exact timings will depend on progress with IT development and the transition needs of businesses. 

The policy paper sets out:

• vision and mission
• benefits of change
• working in partnership
• developing the new system
• delivery timeline
• impact on existing systems
• government strategy and commitment
• supporting legislation
• progress updates 

Source: UK Government, 25 April 2022

On 26 April 2022, the European Environment Agency (EEA) published a briefing, finding that the EU is not on track with its aim to halve the amount of municipal waste by 2030. Additionally, the EEA published a second briefing, which examined increasing amounts of municipal waste and improper waste management in Western Balkan countries. 

The EEA has analysed recent municipal waste trends in the EU in the light of achieving two key waste targets, those being the obligation for each EU member state to recycle at least 60% of municipal waste by 2030, and the EU goal of halving residual municipal waste that is landfilled or incinerated by 2030. 

The amount of residual municipal waste has remained relatively stable in the EU over the past five years, at about 113 million tonnes, because the recycling rates and the amount of waste generated have increased approximately with the same pace. In 2020, about 48% of municipal waste in the EU was recycled. 

EEA analysis finds that if more municipal waste keeps getting generated, the EU would have to recycle about 72% of this to meet the target of halving the amount of non-recycled municipal waste by 2030. Alternatively, the target could be achieved by reducing the amount of waste generated by around one-third and achieving the 60% recycling rate in all EU member states. 

Reaching the 72% recycling rate would require significant improvement in waste collection systems and recycling infrastructure, as well as a widespread redesign of consumer products for easier recycling, the EEA briefing states. However, preventing waste generation in the first place would deliver the greatest benefits for the environment. This would require, for example, increasing the lifespan of consumer goods and ensuring strong support for product re-use. 

As part of the European Green Deal and the Circular Economy Action Plan, the European Commission has recently made a package of proposals to make goods on the EU market more friendly to the environment, circular, and energy efficient, as well as a new strategy to make textiles more durable, repairable, reusable and recyclable. 

The second EEA briefing finds that most municipal waste in the Western Balkans is still sent to landfill and there is an urgent need to invest in separate collection systems and recycling infrastructure. Western Balkans' waste legislation and targets are increasingly following EU directives but data on waste generation and management remain largely insufficient. The EEA warns that, while there are many initiatives to improve data quality, illegal, substandard and informal activities hinder the proper funding and functioning of the legal infrastructure and its improvement. Extended producer responsibility schemes could provide additional funding for improving waste management in the region, if they are designed, governed and implemented well. 

Source: EEA, 26 April 2022