On 7 June 2022, Public Health Scotland (PHS) updated their immunisation and vaccine-preventable diseases web page to reflect the latest quarterly data on:

• Haemophilus influenzae
• human papillomavirus
• invasive pneumococcal disease 
• measles 
• meningococcal disease 
• mumps 
• pertussis 
• rotavirus 
• rubella 
• shingles

On 5 June 2022, Public Health Scotland (PHS) confirmed there have been ten laboratory-confirmed cases of monkeypox reported since 23 May 2022 in Scotland. On 6 June 2022, the UK Health Security Agency (UKHSA) reported 287 confirmed cases in England, three in Wales and two in Northern Ireland.

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.  

Sources: PHS, 5 June 2022 and UKHSA, 6 June 2022

On 24 May 2022, Thai media reported that the Department of Disease Control in the country had identified 70 cases of Plasmodium knowlesi malaria in Ranong, Songkhla and Trat Provinces between 1 October 2021 and 31 March 2022, with nine of these cases being reported from the island of Koh Chang, in the Trat Province, which is a tourist destination.

Plasmodium knowlesi is capable of producing severe illness in those who develop malaria.

Advice for travellers

While higher than expected cases of malaria continue to be reported, travellers to this area should:

• be aware of the risk of malaria, given the current increase in cases
• practise strict mosquito bite avoidance, the mainstay of malaria prevention
• consider antimalarial chemoprophylaxis if they are in groups at higher risk from malaria

Travellers returning from malaria endemic areas should seek prompt medical advice if they develop a fever during travel or on their return, ensuring they highlight potential exposure to malaria. 

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

Sources: TRAVAX, 30 May 2022 and fitfortravel, 30 May 2022

On 28 May 2022, the World Health Organization (WHO) validated Togo as having eliminated trachoma as a public health problem, making it the third country in the WHO African Region, after Ghana and the Gambia, in achieving this milestone. Globally, Togo becomes the thirteenth country in eliminating trachoma as a public health problem.

Trachoma is the leading infectious cause of blindness and is caused by infection with the bacterium Chlamydia trachomatis, which spreads from person-to-person through contaminated fingers, fomites, and flies that come into contact with discharge from the eyes or nose of an infected person. Environmental risk factors for trachoma transmission include poor hygiene, overcrowded households, inadequate access to water and inadequate access to, or use of, proper sanitation facilities.

Trachoma is an endemic disease that mostly affects underserved remote rural communities. Infection mainly affects children, becoming less common with increasing age. Repeated infections in early childhood can result in complications later in life. In adults, women are up to four times more likely than men to be affected by the blinding complications of trachoma, mainly due to close contact with infected children.

Repeated infections in childhood lead to scarring of the inner part of the upper eyelids, which in some individuals leads to one or more eyelashes on the upper eyelids touching the eye, a debilitating condition known as trachomatous trichiasis, or TT, which causes extreme pain with each blink of the eyelids. TT can be managed surgically but, if left untreated, may lead to scarring of the cornea resulting in visual impairment and blindness. Trachoma can be eliminated using the WHO’s SAFE strategy.

Globally, trachoma remains a public health problem in 43 countries, with an estimated 136 million people living in areas endemic for the disease. Trachoma is found mainly in the poorest and most rural areas of Africa, Central and South America, Asia, Australia and the Middle East. The African region is disproportionately affected by trachoma, with 116 million people living in at-risk areas, amounting to around 85% of the global trachoma burden.

Significant progress has been made over the past few years, with the number of people requiring antibiotic treatment for trachoma infection in the WHO African Region falling from 189 million in 2014, to 116 million as of June 2021. Trachoma remains endemic in 26 countries in the region.

Togo and the WHO will continue to closely monitor previously endemic populations, to ensure there is a rapid and proportionate response to any resurgence of disease.

Source: WHO, 28 May 2022

On 30 May 2022, the European Centre for Disease Prevention and Control (ECDC), along with the Centre for Mathematical Modelling of Infectious Diseases (CMMID) at the London School of Hygiene and Tropical Medicine (LSHTM), announced the launch of the European COVID-19 Scenario Hub, which will present modelling projections on how the COVID-19 pandemic may evolve in terms of cases, hospitalisations and deaths. The hub will serve as a resource for member states in their pandemic planning and will inform decisions aimed at minimising the expected burden caused by COVID-19 under different scenarios.

The hub will be updated by collating long-term modelling scenarios for thirty EU and EEA member states, the UK and Switzerland, with each potential scenario composed of one or more plausible and policy-relevant variables, for example, biological parameters, such as the rate of waning immunity, or assumed future changes in contact behaviours. Scenarios cover a period of nine to twelve months, including the coming winter period. Instead of just using single projections, the hub combines and compares different modelling projections from different modelling teams across Europe, hopefully leading to increased confidence and robustness of drawn conclusions and insights.

Scenario modelling combines the best-available epidemiological evidence with realistic assumptions on key uncertainties, in order to create future trajectories of relevant indicators. From this, rational policies can be adopted at an early stage. Comparing results contributed by different modelling teams can highlight important parameters, assumptions and sources and the magnitude of their uncertainty, that would otherwise be difficult to capture.

The scenario hub builds on the current European COVID-19 Forecasting Hub, launched in early 2021, which continues to combine short-term forecasts on the number of COVID-19 cases, hospitalisations and deaths. The scenario hub will complement the forecasting hub with more long-term projections submitted by modelling teams in academic and public health institutes from across Europe and the USA.

Source: ECDC, 30 May 2022

On 27 May 2022, the World Health Assembly (WHA) passed a resolution that aims to help developing countries increase their capacity to run their own clinical trials, helping them to test new drugs, vaccines and other health interventions for the benefit of their populations, while working across countries to respond to future pandemics more rapidly. As well as helping countries to respond faster in a public health emergency, the resolution aims to help countries tackle existing health challenges such as tuberculosis, diabetes and mental health problems.

There will also be closer collaboration between researchers on clinical trials across the world, reducing research waste, while increased transparency will mean the results of trials will be more readily shared between countries.

The resolution aims to strengthen clinical trials of all health interventions, not just drugs and vaccines, but also trials for new diagnostics, surgical procedures or behavioural interventions. The resolution further aims to develop new diagnostics, therapeutics, and vaccines within 100 days of a new pandemic threat being identified.

The resolution urges research funders to invest in developing countries and deliver trials to tackle health problems, which disproportionately affect their populations, while also committing countries to increased international co-ordination to rapidly evaluate drugs and vaccines in any future pandemic.

Source: UK Government, 27 May 2022

On 26 May 2022, Food Standards Scotland (FSS) reported the recall of two Jif peanut butter products due to the risk of Salmonella contamination. Symptoms caused by Salmonella usually include fever, diarrhoea and abdominal cramps.

FSS advise that, if purchased, these products should not be consumed, but returned to their point of purchase for a full refund. Point of sale notices will be displayed in retail stores that are selling these products, explaining why the products are being recalled and informing customers of what action to take if previously purchased.

Source: FSS, 26 May 2022

Food Standards Scotland (FSS) and the Food Standards Agency (FSA) are updating consumers and businesses concerning refined or fully refined food grade vegetable oils that may be used as ingredient substitutions in some food products, despite being labelled as containing sunflower oil.

This update adds fully refined corn (maize) oil to previously issued advice to consumers that refined rapeseed oil, fully refined palm oil, fully refined coconut oil and fully refined soybean oil are temporarily being used in some products without updated labelling.

FSS and FSA have also published the rapid risk assessment underpinning their advice. Their findings show that the risk of allergic reactions from the substitute oils on the list is very low and for fully refined soybean oil it is negligible, which means that allergic reactions to these fully refined vegetable oils are very rare and, if they do occur, are mild.

Source: FSS, 1 June 2022

On 1 June 2022, Scottish Parliament legislation came into force that makes the provision of single-use plastic items by businesses in Scotland an offence. At present, around 700 million of these items are used in Scotland every year.

The regulations come into force following a six-month grace period, during which Zero Waste Scotland ran a business campaign to raise awareness on how to prepare. An exemption is provided for single-use plastic straws, to ensure those who require them for independent living or for a medical purpose can still access them.

The ban applies to the following single-use items:

• plastic cutlery, such as forks, knives, spoons and chopsticks
• plastic plates
• plastic straws
• beverage stirrers and balloon sticks
• food containers made of expanded polystyrene
• cups and other beverage containers made of expanded polystyrene, including covers and lids

Enforcement will be the responsibility of local authorities, with a maximum fine of £5,000 for those who fail to comply with the new regulations.

Source: Scottish Government, 1 June 2022

On 31 May 2022, the World Health Organization (WHO) published a report highlighting the extent tobacco damages both the environment and human health, while calling for the tobacco industry to be held more accountable for the destruction tobacco causes.

Every year, the tobacco industry costs the world more than 8,000,000 human lives, 600,000,000 trees, 200,000 hectares of land, 22 billion tonnes of water and 84,000,000 tonnes of carbon dioxide (CO2). The majority of tobacco is grown in low-and-middle-income countries, where water and farmland are often needed to produce food for the region, however, they are being used to grow tobacco plants, while more and more land is being cleared of forests.

The WHO report highlights that the industry’s carbon footprint from production, processing and transporting tobacco is equivalent to one-fifth of the CO2 produced by the commercial airline industry each year, further contributing to global warming.

The report finds that products such as cigarettes, smokeless tobacco and e-cigarettes also add to the build-up of plastic pollution, with cigarette filters containing microplastics which make up the second-highest form of plastic pollution worldwide. Despite tobacco industry marketing, there is no evidence that filters have any proven health benefits, and the WHO is calling on policymakers to treat cigarette filters as single-use plastics and to consider banning them in order to protect public health and the environment.

The report also states that the cost of cleaning up littered tobacco products falls on taxpayers, rather than the tobacco industry, with a yearly cost to China of around US$2.6 billion, and to India of around US$766 million. The cost for Brazil and Germany comes in at over US$200 million.

The WHO urges other countries and cities to follow the example of France, Spain and San Francisco, California in adopting the polluter pays principle, in making the tobacco industry responsible for clearing the pollution that they create. The WHO further urges countries to give support to tobacco farmers, enabling a switch to sustainable crops, as well as implementing strong tobacco taxes and offering support services to help people stop using tobacco products.

Source: WHO, 31 May 2022

World No Tobacco Day was held on 31 May 2022, and this year's theme was Poisoning our Planet: Tobacco Exposed, which aimed to shed light on the global detrimental impact of tobacco on human health, economies, societies and the environment.

Tobacco use remains a lethal habit, with an estimated 8,000,000 people dying each year due to its use. Tobacco smoking is also an important driver of tuberculosis (TB), accounting for about 730,000 TB episodes in 2020. The risk of developing TB is doubled for people who smoke, as well as for those exposed to second-hand smoke. Furthermore, tobacco smoking slows recovery from TB and is associated with unfavourable treatment outcomes, including recurrence of TB and death. People with TB who smoke tobacco are also more likely to suffer from lung problems, even after successfully completing TB treatment. Efforts to curb the number of people who smoke, and to support people with TB to stop smoking, are seen as crucial in reducing TB-related suffering and deaths.

The World Health Organization (WHO) End TB Strategy emphasises action on TB and comorbidities, including tobacco smoking. At the 2018 UN General Assembly High Level Meeting on the Fight Against Tuberculosis, member states committed to assuring community-based health services that address tobacco use as part of a comprehensive package of TB services, with collaboration between national TB programmes and national tobacco control programmes being critical to scale up WHO-recommended TB and tobacco cessation interventions to meet this commitment. The WHO say integrating smoking cessation interventions within routine TB management is both feasible and effective in reducing smoking rates and for improving treatment outcomes among TB patients.

A people-centred approach, inter-programme and multisectoral collaboration are important to address the detrimental relationship between TB and tobacco, through multipronged strategies, including community health campaigns to reduce the number of people who start smoking and the scale up of efforts to include smoking cessation as part of TB care.

Source: WHO, 31 May 2022

On 31 May 2022, the European Environment Agency (EEA) published its latest official data on greenhouse gas emissions, showing an 11% drop in 2020, compared to the previous year. The data confirms a 30-year downward trend, which has led to the EU achieving its 2020 target to reduce emissions by 20%, compared to 1990 levels.

Collectively, the 2020 reduction was the largest in the EU since 1990, while total greenhouse gas emissions reached their lowest level also since 1990, according to official EU data which the EEA submitted to the United Nations Framework Convention on Climate Change (UNFCCC). The overall reduction in 2020 greenhouse gas emissions was 34% compared to the 1990 base year, or 1.94 billion tonnes of CO2e (carbon dioxide equivalent).

The EU had already reduced its emissions by 26% in 2019 and had achieved its 20% target before the pandemic lockdowns started to impact emission levels.

Key drivers that led to emission reductions over the past three decades include the growing use of renewables, the use of less carbon intensive fossil fuels and improvements in energy efficiency, structural changes in the economy and lower demand for heating due to warmer winters in Europe. The effect of the 2020 economic recession triggered by the COVID-19 lockdowns also had a substantial impact on reducing emissions in 2020.

All sectors reduced emissions except for transport and refrigeration and air conditioning, despite the latter having decreased in the last few years. Reductions were largest for manufacturing industries and construction, electricity and heat production, iron and steel production, and residential combustion.

Several policies, both EU and country-specific, contributed to the overall greenhouse gas emission reductions, including key agricultural and environmental policies in the 1990s and climate and energy policies since 2005.

Almost all EU member states reduced emissions compared to 1990 and contributed to the overall positive EU performance, with the UK and Germany accounting for 47% of the total net reductions over the past 30 years.

Source: EEA, 31 May 2022

On 31 May 2022, Transport Scotland announced the introduction of four new low emission zones (LEZs), following the agreement of plans at local authority level and the approval of Scottish ministers. Following local grace periods, enforcement of the LEZs will cover:

• Glasgow, where the LEZ already applies to buses, from 1 June 2023, or 1 June 2024 for residents within the zone
• Edinburgh from 1 June 2024
• Dundee from 30 May 2024
• Aberdeen from 1 June 2024

LEZs set an emissions limit for certain road spaces, restricting access for the most polluting vehicles to improve air quality, which aims to help protect public health within our towns and cities, making them more attractive places in which to live, work and to visit. LEZs also encourage people to think about leaving the car at home and to consider public transport or active travel, supporting climate action by helping to meet Scotland’s world-leading commitment to reduce 20% car kilometres travelled by 2030.

Vehicles that do not meet the emission standards set for a LEZ will not be able to drive within the zone, with a penalty charge will be payable by the registered keeper of a vehicle when a non-compliant vehicle enters the LEZ.

The minimum emission standards for vehicles permitted within the four LEZs are:

• Euro 4 for petrol cars and vans (generally vehicles registered from January 2006)
• Euro 6 for diesel cars and vans (generally vehicles registered from September 2015)

A number of vehicles are exempt from LEZ requirements, including any vehicle driven by a blue badge holder, the emergency services, military vehicles, historic vehicles, showman's vehicles, motorcycles and mopeds. Funding remains available to help people and businesses comply with LEZs, with information being available on the Low Emissions Zones website.

Source: Low Emissions Zones Scotland, 31 May 2022

On 30 May 2022, the Scottish Government launched consultations on a circular economy bill and a waste route map, which are being proposed in order to help tackle the climate and biodiversity crisis by supporting Scotland’s transition to a zero waste and circular economy.

Key proposals of the measures include:

• banning the destruction of unsold goods to ensure that products never end up landfilled or incinerated when they could be used or recycled
• improving household recycling and reuse services, and consulting on separate kerbside collection of textiles by 2025
• introducing new reporting to show where recycling goes after collection
• reducing the consumption of problematic single-use items and promote re-use of products
• introducing new powers to tackle littering from vehicles
• setting a mandatory requirement for businesses to report surplus and waste figures for goods, such as food and textiles
• introducing powers to set local recycling targets

Scotland’s circular economy targets, outlined in the Scottish Government’s Climate Change Plan, include ending the landfilling of biodegradable municipal waste by 2025, reducing the percentage of all waste sent to landfill to 5% by 2025, and recycling 70% of all waste by 2025.

Source: Scottish Government, 30 May 2022