31 May 2022
Volume: 56 Issue: 21
- Fourth case of monkeypox identified in Scotland
- Update on the ongoing investigation into hepatitis in children
- Dengue in Sao Tome and Principe
- ECDC publishes echinococcosis annual epidemiological reports
- WHO publishes updated guidelines on treatment of DS-TB
- Benin, Uganda and Rwanda eliminate HAT as a public health problem
- G7 health ministers' declaration
- ECDC issues update on Salmonella linked to chocolate products
- EFSA open consultation on updated advice on ADI for copper
- FSS and FSA update on soya lecithin investigation
- World Environment Day
- AFB found in Perthshire beehive
- Scottish Government launches sustainability schemes
- Consultation on ESS draft strategic plan
HPS Weekly Report
31 May 2022
Volume 56 No. 21
Fourth case of monkeypox identified in Scotland
On 30 May 2022, Public Health Scotland (PHS) confirmed the fourth case of monkeypox in the country. As of 29 May 2022, the UK Health Security Agency (UKHSA) identified 172 cases of monkeypox in England, while on 26 May 2022, Public Health Wales (PHW) and the Public Health Agency (PHA) confirmed the first cases of monkeypox in Wales and Northern Ireland respectively, though the UKHSA have reported a second case in Northern Ireland. Further, the European Centre for Disease Prevention and Control (ECDC) reported an additional 118 cases from 12 EU and EEA member states, as of 25 May 2022.
The risk to the UK population remains low, but people are advised to be alert to any new rashes or lesions, which would appear like spots, ulcers or blisters, on any part of their body. Although this advice applies to everyone, the majority of cases identified to date have been among men who are gay, bisexual and men who have sex with men (MSM), so people in these groups in particular, are advised to be aware of the symptoms, particularly if they have recently had a new sexual partner. Anyone with unusual rashes or lesions is advised to contact NHS 24 (Scotland), NHS 111 (England or Wales) or a sexual health service, contacting clinics ahead of visiting and avoiding close contact with others until seen by a clinician.
Monkeypox is a viral infection usually associated with travel to West Africa and has only rarely been reported out with this region. Monkeypox can be transmitted through close contact with a person who already has the infection, including direct contact during sex, and can also be passed on by contact with clothing or linens used by a person who has the disease. Initial symptoms of monkeypox include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. A rash can develop, often beginning on the face, then spreading to other parts of the body, including the genitals. The rash changes and goes through different stages before finally forming a scab, which later falls off.
PHS and the UKHSA are working closely with the NHS and other stakeholders, in order to urgently investigate where and how recent confirmed monkeypox cases were acquired, including how they may be linked to each other. Clinicians should be alert to individuals presenting with rashes without a clear alternative diagnosis and should contact local specialist services for advice, if monkeypox infection is suspected.
Additionally, on 30 May 2022, PHS, the UKHSA, PHW and the PHA have agreed new guidance in helping healthcare professionals and the public respond and manage the monkeypox outbreak, and to help prevent further transmission now that community transmission is occurring in the UK and other countries.
People who have possible, probable or confirmed monkeypox can now isolate at home, if they remain well enough, whilst following measures in the new guidance to reduce further spread and while being monitored by local health protection teams. In addition, the UKHSA has purchased over 20,000 doses of a safe smallpox vaccine called Imvanex and this is being offered to identified close contacts of those diagnosed with monkeypox to reduce the risk of symptomatic infection and severe illness.
The guidance offers the following recommendations:
- People with possible, probable or confirmed monkeypox should avoid contact with other people until their lesions have healed and the scabs have dried off. Cases can reduce the risk of transmission by following standard cleaning and disinfection methods and washing their own clothing and bed linen with standard detergents in a washing machine.
- Cases should also abstain from sex while symptomatic, including the period of early symptom onset, and while lesions are present. Whilst there is currently no available evidence of monkeypox in genital excretions, as a precaution, cases are advised to use condoms for eight weeks after infection and this guidance will be updated as evidence emerges.
- If people with possible, probable or confirmed monkeypox infection need to travel to seek healthcare, they should ensure any lesions are covered by cloth and wear a face covering and avoid public transport where possible.
- Contacts of someone with monkeypox will also be risk assessed and told to isolate for 21 days if necessary.
- Where possible, pregnant healthcare workers and severely immunosuppressed individuals, as outlined in the Green Book, should not assess or clinically care for individuals with suspected or confirmed monkeypox. This guidance will be reassessed as evidence emerges.
- The minimum recommended personal protective equipment (PPE) for staff working with confirmed cases includes fit tested FFP3 respirators, aprons, eye protection and gloves. For possible or probable cases minimum recommended PPE for staff includes fluid repellent surgical facemasks (FRSM), gowns, gloves and eye protection.
- Within non-domestic residential settings, such as adult social care, prisons, homeless shelters and refuges, individuals who are clinically well should be managed in a single room with separate toilet facilities where possible. Close contacts of confirmed cases should be assessed for vaccination.
Separately, a risk assessment has been carried by the Human Animal Infections and Risk Surveillance group (HAIRS) looking at household pets and the risk of transmission.
Sources: PHS, 30 May 2022 and UKHSA, 30 May 2022
Update on the ongoing investigation into hepatitis in children
On 27 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 five further cases being identified in the last week, bringing the total to 31 reported cases in Scotland since onset in January 2022. The total number of cases identified in the UK is now 222, with all children affected presenting to health services between January 2022 and 25 May 2022. The latest technical briefing, on 19 May 2022, highlights that investigations increasingly suggest the adenovirus is one of the leading causes of the higher than usual rates of hepatitis in children.
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, 27 May 2022
Dengue in Sao Tome and Principe
The World Health Organization (WHO) has reported the first-ever outbreak of dengue fever in Sao Tome and Principe, with 103 cases identified between 15 April and 17 May 2022. No deaths have been reported.
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, 27 May 2022 and fitfortravel, 27 May 2022
ECDC publishes echinococcosis annual epidemiological reports
On 23 May 2022, the European Centre for Disease Prevention and Control (ECDC) published annual epidemiological reports on echinococcosis for the years 2018, 2019 and 2020.
- 800 confirmed echinococcosis cases were reported in the EU and EEA. Of these, 411 cases were reported as Echinococcus granulosus, 146 as Echinococcus multilocularis, and 243 as unknown species.
- The notification rate was 0.21 cases per 100,000 population.
- The highest notification rate in males was reported in those between 25 and 44 years of age, and in females among those between 45 and 64 years of age.
- 775 confirmed echinococcosis cases were reported in the EU and EEA. Of these, 419 cases were reported as Echinococcus granulosus, 154 as Echinococcus multilocularis, and 205 as unknown species.
- The notification rate was 0.17 cases per 100,000 population, which was the lowest notification rate in the last five years.
- The highest notification rate in males was reported among those between 25 and 44 years of age and in those over 65 years, and in females among those between 45 and 64 years of age.
- 529 confirmed echinococcosis cases were reported in the EU and EEA. Of these, 243 cases were reported as Echinococcus granulosus, 114 as Echinococcus multilocularis, and 172 as unknown species.
- The notification rate was 0.15 per 100,000 population, which represents a further decrease compared to the rate of 0.17 for 2019, and 0.21 for 2018. The 2020 notification rate is the lowest since EU surveillance of echinococcosis began in 2007.
- The highest notification rate in males was reported among those over 65 years of age, and in females among those between 25 and 44 years of age.
Sources: ECDC, 23 May 2022, ECDC, 23 May 2022 and ECDC, 23 May 2022
WHO publishes updated guidelines on treatment of DS-TB
On 24 May 2022, the World Health Organization (WHO) published updated consolidated guidelines on treatment of drug-susceptible tuberculosis (DS-TB). The guidelines include a new recommendation for the use of a four-month regimen composed of isoniazid, rifapentine, moxifloxacin and pyrazinamide for the treatment and care of DS-TB, with the shorter and effective new regimen reportedly offering improved quality of life for people with TB.
The guidelines incorporate all recommendations on the treatment of DS-TB including the standard six-month regimen. The guidelines are complemented by an operational handbook which is designed to assist the implementation of WHO recommendations by member states, technical partners and others who are involved in the management of patients with DS-TB. The handbook provides practical guidance on how to put in place the recommended treatment options at the scale needed to achieve national and global impact, and further provides practical information and tools that complement the recommendations in the guidelines.
The operational handbook is accompanied with two web annexes, summarizing the results of a series of systematic reviews on dosages of the TB medicines, with the WHO-recommended doses for these medicines remaining valid in adults and children.
The updated guidelines and supporting operational handbook are to be used by national TB programmes, or their equivalents in Ministries of Health, and by policy makers and technical organizations working on TB and infectious diseases in public and private sectors, and in the community. These documents are to facilitate uptake of WHO policy in the field and thus improve the quality of TB services.
Source: WHO, 24 May 2022
Benin, Uganda and Rwanda eliminate HAT as a public health problem
On 24 May 2022, the World Health Organization (WHO) reported that three African countries, Benin, Uganda and Rwanda have received validation that they have eliminated at least one form of Human African trypanosomiasis (HAT).
HAT, otherwise known as sleeping sickness, is a life-threatening disease that afflicts poor rural populations. Carried by tsetse flies, the disease has for a long-time affected communities in West, Central and East Africa, where two different variants of the disease, gambiense and rhodesiense, were rife.
Uganda is the only country where both forms are endemic but has now achieved elimination as a public health problem of the gambiense form. The country remains committed to eliminating the rhodesiense form as well, which affects central and southern regions.
At the beginning of the twenty-first century, large numbers of HAT cases were being reported, which in 2001 led to the WHO launching an initiative to reinforce surveillance and control of the disease in all endemic countries. A progressive decrease in incidence was noted, with cases going below 1,000 annually for the first time in 2018, prompting the WHO to target the elimination of both variants of HAT as public health problems.
There are strict criteria for validation of elimination, whereby countries submit extensive dossiers to the WHO for assessment by an independent group of experts, who determine whether the criteria for elimination have been met.
Togo and Côte d’Ivoire were the first two countries to be validated as having eliminated the gambiense form of HAT as a public health problem, in 2020. Since then, Benin and Uganda, in November 2021 and April 2022 respectively, were validated as having eliminated the gambiense form of sleeping sickness, while Rwanda received validation regarding the rhodesiense form in April 2022.
All three countries have carried out extensive laboratory tests and reactive interventions in areas where cases were diagnosed and have also undertaken interventions to target the vectors of disease, in this case, tsetse flies. They have also demonstrated that they have detailed plans for ongoing HAT surveillance, monitoring for further outbreaks of disease.
Validation of elimination in Benin, Uganda and Rwanda is an important step towards widespread elimination of both forms of HAT as public health problems, as well as working towards the goal of eliminating the transmission of gambiense HAT by 2030 to meet the 2030 NTD road map target.
Source: WHO, 24 May 2022
G7 health ministers' declaration
From May 19 to May 20, 2022, the health ministers of the Group of Seven (G7) met in Berlin, Germany, which concluded with the signing of the G7 Health Ministers’ Declaration.
The declaration comprised of sections on:
- the G7 Pact for Pandemic Readiness
- overcoming the pandemic in 2022
- tackling the silent pandemic of antimicrobial resistance (AMR)
- climate-neutral health systems
The G7 Pact for Pandemic Readiness will see the UK, USA, Japan, Canada, France, Germany and Italy work more closely together, along with relevant multilateral organisations like the World Health Organization (WHO), by sharing the best of their COVID-inspired initiatives, including those on surveillance and rapid response. The pandemic pact aims to help embed a One Health approach, which considers the connection between people, animals, plants, and the environment, in order to help identity emerging health threats across these groups and improve detection of new variants of concern. This should help strengthen global health security with the aim of better protection against another pandemic.
Commitments were also made by health ministers to tackle the silent pandemic of AMR, infections caused by bacteria resistant to antibiotics, including exploring a range of market incentive options which it is hoped will encourage pharmaceutical companies and others to fund research and trials for new antibiotics. AMR is estimated to cause 1.27 million deaths a year worldwide, with around one-fifth of those being amongst children under five years old, making it a leading cause of death globally.
Pledges on climate and health were also made, with G7 members committing to build climate-neutral health systems by 2050 at the latest, and the G7 pledged to support countries across the globe in this effort.
Source: UK Government, 20 May 2022
ECDC issues update on Salmonella linked to chocolate products
As of 19 May 2022, the European Centre for Disease Prevention and Control (ECDC) reported that 324 cases of Salmonella typhimurium type 34 infection, including two distinct strains, have been found in 12 EU and EEA countries, and the UK. A cluster of cases were originally reported in the UK on 17 February 2022.
Most cases have been reported in children under ten years of age and 41% of all cases have been hospitalised. The two strains are multidrug-resistant, and some tested isolates also carry 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 Italian 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, with public warnings being issued by the relevant 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, 19 May 2022
EFSA open consultation on updated advice on ADI for copper
On 24 May 2022, the European Food Safety Authority (EFSA) opened a public consultation, looking for comments on their opinion that the acceptable daily intake (ADI) for copper from all sources in food be reduced from 0.15mg per kg of body weight to 0.07 mg per kg of body weight based on an updated evaluation of the scientific evidence. The consultation will remain open until 1 August 2022.
Copper is an essential micronutrient for all living beings including humans, with both too much or too little copper in the diet potentially leading to health problems. Copper is naturally present in many foods and also enters the food chain through its use in organic and conventional pesticides, feed and food additives, and as a nutrient in fortified foods and food supplements.
EFSA’s Scientific Committee was asked to review the ADI for copper used in the various sectors across their work in line with the 2021 approach for setting health-based guidance values, such as an ADI, for substances which are both nutrients and regulated products. The new ADI is derived from the retention of copper in the liver by adults.
In addition to reviewing the acceptable intake, EFSA scientists have assessed consumers’ exposure to total copper from all sources in the diet for the first time. In the general population, exposure does not exceed this ADI, but due to some uncertainties this may be underestimated for some subpopulations of regular consumers of foods with higher copper content.
Intakes for younger age groups exceed the new ADI, but the scientists concluded this would not pose a lifetime risk for copper toxicity and therefore is not considered a health concern. Young children need more copper for development and use it at a higher rate than adults, therefore copper is less likely to be retained in a child’s liver.
Once finalised, the new ADI will be applicable in relation to pesticides, feed additives and food additives, and the EFSA’s tolerable upper intake level for copper as a micronutrient will be updated.
Source: EFSA, 24 May 2022
FSS and FSA update on soya lecithin investigation
On 23 May 2022, Food Standards Scotland (FSS) and the Food Standards Agency (FSA) responded to concerns raised by a number of people with peanut allergies relating to contaminated soya lecithin, advising that there is currently no evidence of unsafe food on the market.
FSS and the FSA have been engaging with businesses and local authorities to investigate the issue and have been reassured by the evidence provided by industry to date, which suggests that the incident has been controlled.
FSS advise they will continue to work with key partners and provide further updates should there be any change to this guidance. Furthermore, FSS advises those with peanut allergies to continue following allergen information on food products.
More information on food allergy and allergen labelling requirements can be found on the FSS website.
Sources: FSS, 23 May 2022 and FSA, 25 May 2022
World Environment Day
The theme for this year’s World Environment Day, which takes place on 5 June 2022, is Only One Earth, and calls for transformative changes to policies and choices to enable cleaner, greener, and sustainable living, in harmony with nature.
This year celebrates 50 years since the UN General Assembly designated 5 June as World Environment Day, and the theme reflects the same slogan it did for the first campaign in 1974. In the intervening years, World Environment Day has developed as a platform to raise awareness of the problems facing our environment such as air pollution, plastic pollution, illegal wildlife trade, sustainable consumption, sea-level increase, and food security, among others.
More information and details of how to get involved are available on the World Environment Day website.
AFB found in Perthshire beehive
On 19 May 2022, Science and Advice for Scottish Agriculture (SASA) confirmed an outbreak of American Foulbrood (AFB) in an infected hive near Blairgowrie, following an inspection by Scottish Government bee inspectors.
AFB is a notifiable disease that affects colonies of honeybees. The infected hive will be destroyed as there is no permitted treatment for the disease in the UK. Beekeepers within three kilometres of the affected colony will be alerted via BeeBase and encouraged to increase their biosecurity.
In 2021, there were ten honeybee colonies confirmed positive for AFB in Scotland, in ten different apiaries and belonging to three different beekeepers. Trends of AFB through the years are available to view on the BeeBase website.
The Chief Veterinary Officer for Scotland has advised that there are no risks to public health from AFB, and no implications for the quality and safety of Scottish honey.
Source: Scottish Government, 20 May 2022
Scottish Government launches sustainability schemes
On 19 May 2022, the Scottish Government announced the launch of the Low Carbon Manufacturing Challenge Fund, a four-year programme aimed at providing over £25 million towards encouraging ideas to speed up adoption or development of low carbon products, services, technologies or processes. The fund will be administered by Scottish Enterprise and will run until 2026, with the aim of reducing emissions from an industry which supports hundreds of thousands of jobs and accounts for more than half of Scotland’s exports.
Additionally, First Minister Nicola Sturgeon announced the launch of a First Minister’s Award for Manufacturing Leadership, recognising businesses which champion fair work and inclusivity while investing in employee skills and helping tackle climate change. The award will be supported by the National Manufacturing Institute Scotland (NMIS), with successful business being able to show how they have achieved inclusive and sustainable growth and will receive extra support and advice in return.
Source: Scottish Government, 19 May 2022
Consultation on ESS draft strategic plan
Environmental Standards Scotland (ESS) is a new independent public body, established by the UK Withdrawal from the European Union (Continuity) (Scotland) Act 2021, which will monitor the effectiveness of environmental law in Scotland and public authorities’ compliance with it, and to prevent enforcement gaps arising from the UK leaving the EU.
A consultation is seeking views and comments on ESS’ draft strategic plan, which is a statement about how they will work to scrutinise, investigate and secure improvements in public authorities’ compliance with environmental law, the effectiveness of environmental law, and the way it is being implemented and applied in Scotland.
The consultation is open until the 17 August 2022 and responses can be completed online.
Source: Scottish Government, 25 May 2022