24 May 2022
Volume: 56 Issue: 20
- Update on the ongoing investigation into hepatitis in children
- CCHF in Turkey
- Changes made to UK action plan on AMR
- WHO publishes 2020 to 2021 results report
- COVID-19: ECDC reclassifies Omicron sub-lineages BA.4 and BA.5 to variants of concern
- ECDC publishes update on the multi-country outbreak of monophasic Salmonella Typhimurium linked to chocolate products
- FSS updates tools on smoked fish and fresh produce
- Scottish Government provides funding to reduce carbon footprint
- Scottish Government updates cladding remediation programme
- EEA briefing examines consumer role in the circular economy
- Foresters urged to adapt woodlands to minimise risks of climate change
- SEPA publishes annual operating plan
HPS Weekly Report
24 May 2022
Volume 56 No. 20
Update on the ongoing investigation into hepatitis in children
On 20 May 2022, Public Health Scotland (PHS) issued an update on the active investigation into cases of sudden onset hepatitis (liver inflammation) in children aged ten years and under, with 26 identified cases reported in Scotland since onset in January 2022. The total number of cases identified in the UK is now 197, with all children affected presenting to health services between January 2022 and 16 May 2022. The latest technical briefing highlights that investigations increasingly suggest the adenovirus is one of the leading causes of the higher than usual rates of hepatitis in children.
As of 19 May 2022, the European Centre for Disease Prevention and Control (ECDC) reported 125 cases in 14 EU or EEA countries, and at least a further 313 cases worldwide, outside the UK, EU and EEA. There have been 14 reported deaths worldwide.
Jaundice and vomiting are the most common symptoms experienced by the children affected. If a child shows signs of jaundice, where there is a yellow tinge in the whites of the eyes or on the skin, then parents should contact their GP or other healthcare professional. Other symptoms can include dark urine, pale grey coloured poo, itchy skin, muscle and joint pains, tiredness, feeling sick, a high temperature, loss of appetite and stomach pain.
The usual viruses that cause infectious hepatitis, hepatitis A to E, have not been detected, while there is no evidence of any link to the COVID-19 vaccine. The majority of cases are in children under five years old, who are too young to have received the vaccine.
PHS advise that the current risk to children of severe hepatitis remains low. Furthermore, parents and caregivers are encouraged to ensure children practice good hand and respiratory hygiene, in order to help reduce the spread of common infections.
Source: PHS, 20 May 2022
CCHF in Turkey
On 14 May 2022, Turkish media reported that a person died of Crimean-Congo haemorrhagic fever (CCHF) in the town of Sivas, Turkey, and also reported that a further three people are currently being treated for CCHF in the same part of the country. There have been 27 cases of CCHF in Turkey from 1 January to 16 May 2022.
CCHF is a potentially fatal tick-borne viral haemorrhagic fever (VHF), found in over 30 countries in Africa, Asia, the Middle East and Eastern and Southern Europe. There is no vaccine available for use in the UK.
Advice for travellers
CCHF is spread by ticks infected from an animal reservoir such as cattle, sheep and goats, and can also be transmitted by having contact with the blood or body fluids of an infected animal or person.
While CCHF is extremely rare in travellers, there is an increased risk to those visiting an endemic region who may:
- have an increased likelihood of tick bites during activities such as hiking, camping in rural areas or visiting farms
- be involved in animal slaughter, for example during religious or cultural events
- be travelling for veterinary or medical work reasons
Travellers with an increased risk of infection should be aware of the disease and prevent transmission by:
- practicing tick bite avoidance when partaking in outdoor activities
- following appropriate infection control procedures if working in a healthcare setting
- wearing gloves and other protective clothing while handling animals or their tissues, notably during slaughtering, butchering and culling procedures
Further information on CCHF can be found on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.
Sources: TRAVAX, 17 May 2022 and fitfortravel, 17 May 2022
Changes made to UK action plan on AMR
On 16 May 2022, the UK Government announced changes to the commitments made in the UK five-year national action plan in tackling antimicrobial resistance (AMR). The national action plan is in its third year of delivery and these changes were required to make the commitments:
- more specific, measurable, achievable, realistic and time-bound (SMART)
- reflect lessons learned from the coronavirus (COVID-19) pandemic
- reflect progress that has already been made against ambitions to reduce antibiotic prescribing in food-producing animals
- work towards new sector targets
The Department of Health and Social Care (DHSC) has worked with other government departments and agencies, as well as the devolved governments in Scotland, Wales and Northern Ireland to consider, review and update the commitments published in the national action plan. Changes to the human health commitments were approved by a sub-group of the expert committee for Antimicrobial Prescribing, Resistance and Healthcare Associated Infections (APRHAI). Animal, plant, and environment commitments were reviewed, and changes approved, by the Cross-Defra Steering Group. The changed commitments maintain the overall ambition of the UK AMR programme and will support progress towards the UK’s vision to contain and control AMR by 2040.
In total, 93 commitments have been reworded, 17 new commitments have been added, and eight commitments have been removed. As well as reflecting lessons learned during the COVID-19 pandemic, the proposed changes aim to:
- improve the surveillance of AMR and antimicrobial use
- improve the availability of data to better understand the prevalence of AMR across human-health and animals, and linking of this data to enable analysis of AMR and our approach to managing infection through dashboards and research
- reflect priorities identified by the UK AMR Research Programme to explore and evaluate antimicrobial use, prescribing, new therapeutics, diagnostics, stewardship and resistance across both human health and animals
- reflect the particular role the UK is playing internationally in non-traditional and informal political groupings including supporting the UK Special Envoy on AMR and taking a lead role in AMR interest groups
- introduce four new commitments to reduce urinary tract infections (UTIs), in support of the national action plan ambition to halve healthcare associated Gram-negative bloodstream infections (GNBSIs) by 2024
Source: UK Government, 16 May 2022
WHO publishes 2020 to 2021 results report
On 16 May 2022, ahead of the forthcoming World Health Assembly, the World Health Organization (WHO) published its results report for 2020 to 2021, which tracked significant achievements by the WHO across the global health spectrum, in the face of the COVID-19 pandemic.
During 2020 to 2021, the WHO led the largest-ever global response to a health crisis, working with 1600 technical and operational partners, and helped galvanise the biggest, fastest and most complex vaccination drive in history, as well as spending US$1.7 billion on essential supplies to the COVID-19 response.
The ACT-A partnership delivered over one billion COVID-19 vaccine doses by January 2022. The global rollout of crucial health materials included nearly US$500 million worth of personal protective equipment, US$187 million in oxygen supplies, US$4.8 million in treatments and 110 million diagnostic tests. It is noted, however, that much remains to be done for the world to get on track in achieving the WHO’s target of each country vaccinating 70% of its population by July 2022.
The results report reveals several achievements, finding:
- mandatory policies prohibiting the use of trans fatty acids, a hazardous food compound linked to cardiovascular disease, are in effect for 3.2 billion people in 58 countries, with 40 of these countries having best practice policies, including the UK
- tobacco use is decreasing in 150 countries
- fifteen countries have achieved elimination of mother-to-child transmission of HIV or syphilis
- the WHO’s recommendation of widespread use of the world’s first malaria vaccine (RTS,S) has been delivered to over one million children, with an expected saving of between 40,000 to 80 000 lives a year, when used with other malaria control interventions
However, the report also finds that, due to myriad disruptions caused by the COVID-19 pandemic, countries have fallen behind on the WHO’s triple billion targets, which provide critical pathways to attain Sustainable Development Goals (SDGs) by 2030. Progress on universal health coverage and healthier populations are at about one quarter or less of the pace needed to reach the SDGs by 2030, and no country was fully prepared for a pandemic of such scale.
COVID-19 also caused huge disruptions to health services, with 117 of 127 surveyed countries surveyed reporting disruption to at least one essential health service because of COVID, whilst the average disruption across those countries was 45%.
Going forward, fulfilling the triple billion targets will be the WHO’s overriding goal, as a measurable means of reducing health equity gaps.
Source: WHO, 16 May 2022
COVID-19: ECDC reclassifies Omicron sub-lineages BA.4 and BA.5 to variants of concern
As of 12 May 2022, the European Centre for Disease Prevention and Control (ECDC) has reclassified Omicron sub-lineages BA.4 and BA.5 from variants of interest to variants of concern.
BA.4 and BA.5 were first detected in South Africa in January and February 2022, respectively, and since then they have become the dominant variants there. Both lineages contain the amino-acid substitutions L452R, F486V, and R493Q in the spike receptor binding domain compared to BA.2. Preliminary studies suggest a significant change in antigenic properties of BA.4 and BA.5 compared to BA.1 and BA.2, especially compared to BA.1. Additionally, there is an increasing trend in the variant proportions for BA.5 observed in Portugal the recent weeks, accompanied by an increase in COVID-19 case numbers and test positivity rate.
The Portuguese National Institute of Health estimated that BA.5 already accounted for 37% of the positive cases as of 8 May 2022. The estimated daily growth advantage for BA.5 over BA.2 is 13%, which is similar to the 12% daily growth advantage previously reported by South Africa. Assuming such growth rate, BA.5 will become the dominant variant in Portugal by 22 May 2022.
The currently observed growth advantage for BA.4 and BA.5 is likely due to their ability to evade immune protection induced by prior infection or vaccination, particularly if this has waned over time. Limited available data from in vitro studies evaluating sera from unvaccinated individuals who have experienced a prior BA.1 infection indicate that both BA.4 and BA.5 are capable of escaping immune protection induced by infection with BA.1. Such unvaccinated individuals are unlikely to be protected against symptomatic infection with BA.4 or BA.5. Whilst sera from vaccinated individuals performed better in invitro studies done thus far, protection derived from currently available vaccines does wane over time against the Omicron variant.
There is currently no indication of any change in severity for BA.4 and BA.5 compared to previous Omicron lineages.
Taken together, this indicates that the presence of these variants could cause a significant overall increase in COVID-19 cases in the EU and EEA in the coming weeks and months. The overall proportion of BA.4 and BA.5 in the EU and EEA is currently low but the high growth advantages reported suggest that these variants will become dominant in the coming months. Based on the limited data currently available, no significant increase in infection severity compared to the circulating lineages BA.1 and BA.2 is expected. However, as in previous waves, if COVID-19 case numbers increase substantially, some level of increased hospital and ICU admissions is likely to follow.
The ECDC encourages countries to remain vigilant for signals of BA.4 and BA.5 emergence. Early variant detection critically relies on sensitive and representative testing and genomic surveillance, with timely sequence reporting. Representative testing policies are required to reliably estimate the contribution of these variants to ongoing viral circulation, as well as to accurately determine the extent these variants may contribute to any observed increases in severe outcomes in the population, such as increases in hospital or ICU admissions.
The public health benefit of administering a second mRNA COVID-19 booster dose was recently assessed by the ECDC to be clearest in those aged 80 years and above and immediate administration of a second booster dose in this population was found to be optimal in situations of continued high or increasing viral circulation.
Continued close epidemiological and vaccine effectiveness monitoring is essential in order to rapidly detect signals of increased SARS-CoV-2 circulation or risk of severe disease among vaccinated individuals. If such signals emerge, a second booster may be considered for some or all adults 60 years and older and for other vulnerable groups. Countries should have plans in place for the rapid deployment of booster doses in these population groups.
For all age groups, it remains a priority to improve COVID-19 vaccine uptake of the primary course and first booster dose in populations who have yet to receive them.
Source: ECDC, 12 May 2022
ECDC publishes update on the multi-country outbreak of monophasic Salmonella Typhimurium linked to chocolate products
The European Centre for Disease Prevention and Control (ECDC) has published its first update on the multi-country outbreak of monophasic Salmonella Typhimurium sequence type 34 linked to chocolate products. As of 18 May 2022, 324 cases have been reported in 12 EU or EEA countries and the UK, including two distinct strains.
Most cases are in children under ten years of age and 41% of all cases have been hospitalised. The two strains are multidrug-resistant, with some tested isolates also carrying resistance to disinfectants that are based on quaternary ammonium compounds and hydrogen peroxide, but remain susceptible to azithromycin, ciprofloxacin, meropenem, and third generation cephalosporins. Epidemiological investigations suggested specific chocolate products of Brand A, produced by Company A in Processing Plant B in Belgium, as likely vehicles of infection.
Two strains of monophasic Salmonella Typhimurium matching the outbreak strains were identified in the buttermilk line at Plant B between December 2021 and January 2022. The buttermilk was provided by an Italian supplier where Salmonella was not detected. The supplier delivered the buttermilk to other plants of Company A where, based on the available evidence, Salmonella was not detected.
On 8 April 2022, based on official controls, the food safety authority in Belgium decided to withdraw the authorisation for production of the Plant B due to lack of transparency and insufficient guarantees for safe production. Company A globally recalled all products of Brand A produced at Plant B. Public warnings were issued by the competent national authorities in different countries.
This outbreak has evolved rapidly, with children most at risk for severe infection. The closure of Plant B and the global recall of all their products have reduced the risk of exposure. However, eight cases cannot be explained by consumption of chocolate products such as those manufactured at Plant B, suggesting that there may also be other sources of infection.
Source: ECDC, 18 May 2022
FSS updates tools on smoked fish and fresh produce
On 17 May 2022, Food Standards Scotland (FSS) published two updated free online tools, one to aid fresh produce growers assess their produce growing practices, with the other aimed at helping smoked fish manufacturers assess their fish smoking practices. Each tool has several quick, multiple choice, industry specific assessments, as well as a large collection of resource pages and glossaries.
Both tools, initially published around 2015, used the most recent scientific evidence and legal regulations, and were designed to help relevant food business operators assess their specific working environment, and provide clear and objective advice to reduce the risk of microbiological contamination of their products. At the time, these tools were welcomed by industry and local authorities as providing a concise, web-based resource for providing guidance on the safe production of their products. However, after seven years, there was a need to update the guidance, encompass new evidence, advise on regulatory changes and add further information that has been requested from industry.
Source: FSS, 17 May 2022
Scottish Government provides funding to reduce carbon footprint
On 17 May 2022, the Scottish Government announced £100 million of new funding to help public bodies improve energy efficiency and install low and zero carbon heat systems in buildings across Scotland. The funding will be provided through the Scottish Central Government Energy Efficiency Grant scheme during the current parliamentary session, with the first £15 million provided to eligible public bodies during 2022 to 2023.
The funding launch coincides with the publication of the latest analysis of public bodies’ emissions, which shows a 5.8% reduction in reported emissions in 2020 to 2021 compared to the previous period, with public bodies’ reported emissions having now fallen by a third since reporting began six years ago. Over the same period, emissions generated by electricity use have more than halved across public bodies.
There has been a 64% cut in NHS buildings emissions since 1990, with the £10 billion, ten-year NHS capital programme supporting its net zero commitment. Scotland’s first net-zero hospital, NHS Balfour Hospital, opened in 2019. Furthermore, carbon emissions across Scottish Government operations have fallen by 45% between the 2009 to 2010 and 2019 to 2020 periods, with the Scottish Government being the first in the world to hold the Carbon Trust Triple Standard.
Source: Scottish Government, 17 May 2022
Scottish Government updates cladding remediation programme
On 12 May 2022, the Scottish Government announced an expansion to their Single Building Assessment programme, which will provide a further 80 high-rise buildings with help in addressing safety issues caused by cladding. This builds on a pilot programme announced last year, in which the cladding of 26 buildings was examined.
Under the Scottish Safer Buildings Accord, developers will be expected to fund works to properties they have built to address safety issues identified through the assessment programme with public funding being prioritised for buildings that are not linked to an existing developer. The Accord is being developed with Homes for Scotland, a membership body for housing developers, alongside homeowners and other key partner organisations. These groups will work collaboratively to identify solutions for domestic buildings affected by cladding issues. The Scottish Government hopes that a new streamlined process for commissioning the assessments will help identify at-risk buildings more quickly.
A Single Building Assessment is a comprehensive inspection of whole blocks of domestic residential buildings, looking at fire safety and suitability for mortgage lending. There is no cost to property owners for these assessments, which identify what needs to be mitigated or remediated on a building-by-building basis, and in line with the most current building standards.
Legislation banning combustible cladding on high-rise buildings, and the highest risk metal composite cladding material from all buildings, was laid last month. This is the third set of changes made to fire safety standards for cladding in Scotland since the Grenfell Tower Fire.
Source: Scottish Government, 12 May 2022
EEA briefing examines consumer role in the circular economy
On 17 May 2022, the European Environment Agency (EEA) published a briefing, which finds that consumers play a key role in raising demand for goods and services that have adopted circular economy principles, despite the influence of companies in shaping the demand for products.
The briefing finds that consumers adopting circular economy principles are most effective if they are designed by addressing factors shaping individual behaviour, and the briefing examines how policies can enable more circular-economy friendly consumer behaviour, by understanding the factors that influence it.
Consumers and companies both influence demand for products. Producers not only respond to but also shape consumer demand through the products offered and how the products are marketed. Consumer choices shape decisions made by actors upstream, such as product designers, and downstream, such as recyclers, in product supply chains, according to the EEA briefing.
Economic factors, like the price of products, are often the most important in consumer decision-making, while the importance of the other factors is less clear. Other factors that come into play include to what extent the available products meet consumer needs, the information available to consumers, social factors, such as adherence to social norms, community values and examples from role models, and individual preferences and beliefs related to, for instance, prestige, brand loyalty or personal values. Traditionally, policies have aimed to give consumers information, such as eco-labels, and to a lesser extent, to make circular alternatives more economically attractive.
The briefing finds that there are opportunities to explore a range of future policy options across different governance levels, including tax breaks and subsidies, legally binding regulations, avoiding greenwashing, making circular options more convenient, and using eco-labels and measures targeting consumers to, for instance, enhance emotional attachment to products.
The EU has already put in place measures to make circular economy-friendly choices more attractive and convenient for consumers, such as the European Commission's sustainable products initiative, which focuses on providing information through labelling and product passports, and placing product requirements focusing on durability and recyclability, among others. This initiative recognises the key role of consumers in establishing a circular economy and is expected to enable an acceleration of circularity in the EU economy.
Source: EEA, 17 May 2022
Foresters urged to adapt woodlands to minimise risks of climate change
A new practice guide published by the UK Forest Research Agency reports that future-proofing Scotland's forests and woodlands to be more resilient will ensure they continue to provide environmental, social and economic benefits, and play a key role in achieving net-zero by 2045.
Increasing tree species and diversity, creating mixed woodlands, using natural regeneration, careful design plans and careful selection of tree provenance are some of the measures being advised.
Trees play a huge role in climate mitigation as they remove carbon dioxide (CO2) from the atmosphere and store the carbon in solid form as wood, with around 6.2 million tonnes of harmful CO2 are removed from Scotland’s atmosphere each year, around 10% of the country’s gross greenhouse gas emissions.
The harvesting and use of wood from sustainably managed forests transfers the carbon into wood products where it can continue to be stored, often over long periods, in materials such as those used for construction and furniture. Wood products can also be used as an alternative to other materials that release greenhouse gases in their production, such as concrete and plastics, and woody biomass can be used directly as a source of energy to replace fossil fuels.
The guide finds that mitigation and adaptation measures for Scotland’s woodlands need to be considered together to ensure that adaptation actions do not solve one problem while creating another.
The guide was published during National Plant Health Week, which ran from 9 to 15 May 2022, which aims to raise awareness of the importance of plant and tree health.
Source: Scottish Forestry, 14 May 2022
SEPA publishes annual operating plan
On 12 May 2022, the Scottish Environment Protection Agency (SEPA) published its annual operating plan, which set out priorities for regulation, climate resilience and recovery and the budget available to deliver their work across the 2022 to 2023 period. The report also set clear performance measures for delivery.
The plan supports Scotland’s transition to net-zero and continued adaption to a post-EU policy environment, while prioritising regulatory focus on permitting, compliance checking, tackling non-compliance and illegal activities, environmental monitoring and beyond compliance opportunities.
In climate resilience, the plan focused on helping Scotland avoid the risk of flooding, protect existing communities and businesses from the effects of climate change, and warn if flooding is imminent, so action can be taken to reduce the impact.
The plan also supports Scotland's recovery and supports SEPA’s recovery in building back better, supporting staff, developing new systems, including progressive working practices and committing to become a regenerative organisation by 2030.
The launch of SEPA’s plan reflects the realism of recovery from the COVID pandemic, a serious and significant criminal cyber-attack and a change of leadership within the organisation. Throughout these challenges, the agency has continued to prioritise public service delivery around its two core services of environmental regulation and flooding.
SEPA is moving regulation from individual sites to a sectoral approach in supporting this aim and to help as many businesses as possible achieve the environmental, economic and social benefits that come from voluntarily moving beyond compliance and adopting more sustainable business practices.
Source: SEPA, 12 May 2022