On 9 June 2022, Public Health Scotland (PHS) confirmed there have been 12 laboratory-confirmed cases of monkeypox reported since 23 May 2022 in Scotland. As of 12 June 2022, the UK Health Security Agency (UKHSA) reported 452 confirmed cases in England, four 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, 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, 9 June 2022 and UKHSA, 13 June  2022

On 10 June 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 one further case being identified since the previous update on 27 May 2022, bringing the total to 32 reported cases in Scotland since onset in January 2022. The total number of cases identified in the UK is now 240, with all children affected presenting to health services between January and 7 June 2022. The latest technical briefing, issued 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, 10 June 2022  

On 6 June 2022, the Saudi Ministry of Hajj and Umrah announced the opening of an electronic portal for pilgrims from Europe, America and Australia to register for the 1443H/2022 Hajj season. The Saudi Ministry of Health has also issued health requirements and recommendations for travellers to Saudi Arabia for Hajj and Umrah in 1443H (2022), including details of mandatory and recommended vaccinations, COVID-19 testing requirements and disease prevention advice. 

An NHSScotland information leaflet details how Hajj pilgrims can manage travel-associated risks to help protect themselves, their family and the wider community. More information and general advice on Hajj and Umrah are available on the TRAVAX (for health professionals) and the fitfortravel (for the general public) websites. 

Sources: TRAVAX, 7 June 2022 and fitfortravel, 7 June 2022

On 7 June 2022, Italian health services reported that a person had died of rickettsiosis in Lanusei, central-eastern Sardinia, Italy. The patient had been seriously ill in hospital since 2 June 2022 after being bitten by a tick.

Rickettsiosis is a serious bacterial infection transmitted to humans predominantly from the bite of an infected tick. It occurs around the world with most cases in Europe occurring in the Mediterranean region. Symptoms are often non-specific, or may include fever and a rash, and treatment usually includes antibiotics. No vaccine is currently available against rickettsiosis.

Advice for travellers 

Travellers to endemic areas should be aware of the types of activities that increase tick bite exposure, such as walking, hiking, camping, cycling or fishing in woodlands, overgrown fields, parkland, hills and mountainsides. 

Travellers can avoid tick bites by:

• wearing long sleeved tops, trousers tucked into socks, closed footwear to reduce the amount of exposed skin that could be bitten 
• using insect repellents on any areas of exposed skin 
• wearing light coloured clothing so that ticks are more visible if they brush onto clothing 

After participating in outdoor activities, travellers should be advised to inspect their whole body for ticks, and to remove any found as quickly as possible. More information on insect bite avoidance is available on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites. 

Sources: TRAVAX, 8 June 2022 and fitfortravel, 8 June 2022

The European Centre for Disease Prevention and Control (ECDC) has published its annual epidemiological reports on anthrax for 2019 and 2020. 

Anthrax continues to be uncommon in humans in Europe, with only a few cases reported each year. In 2019, one confirmed anthrax case was reported by Hungary, with 29 EU and EEA countries notifying zero confirmed cases. In 2020, three confirmed anthrax cases were reported by Italy, with 28 EU and EEA countries notifying zero confirmed cases. 

Sources: ECDC, 8 June 2022 and ECDC, 8 June 2022

The European Centre for Disease Prevention and Control (ECDC) has published its annual epidemiological report on trichinellosis for 2018. 

In 2018, nine EU and EEA countries reported 85 cases of trichinellosis, 66 of which were confirmed. Bulgaria and Romania accounted for 83% of all confirmed cases. The overall EU and EEA notification rate was 0.01 cases per 100,000 of the population, the lowest rate reported since the beginning of EU-level trichinellosis surveillance in 2007. Consumption of undercooked meat from pigs raised under non-controlled housing conditions, or hunted wild boar, constitutes the highest risk for acquiring trichinellosis in the EU and EEA. 

Source: ECDC, 8 June 2022

On 3 June 2022, the World Health Organization (WHO) published in their consolidated guidelines for malaria, a package of new and updated recommendations across a number of technical areas ranging from malaria chemoprevention and mass drug administration to elimination. The guidelines encourage countries to tailor the recommendations to local disease settings for maximum impact. 

The consolidation of the WHO’s malaria guidelines is one of several actions the organization has undertaken in recent years to make its guidance more accessible to end users in malaria-endemic countries. The overall aim is to deliver timely, high-quality recommendations through processes that are more transparent, consistent, efficient and predictable. 

Source: WHO, 3 June 2022

The European Food Safety Authority (EFSA) has announced its scientists cannot currently establish the safety of cannabidiol (CBD) as a novel food, due to data gaps and uncertainties about potential hazards related to CBD intake. 

Cannabidiol is a substance that can be obtained from Cannabis sativa L. plants and can be synthesised chemically as well. The European Commission considers that CBD qualifies as a novel food provided it meets the conditions of EU legislation on novel foods. Following the submission of numerous applications for CBD under the novel food regulation, the commission asked the EFSA to give its opinion on whether its consumption is safe for humans. 

The EFSA’s expert panel on Nutrition, Novel Foods and Food Allergens (NDA) has received 19 applications for CBD as a novel food, with more expected. They conclude that there is currently insufficient data on the effect of CBD on the liver, gastrointestinal tract, endocrine system, nervous system and on people’s psychological well-being. Studies in animals show significant adverse effects especially in relation to reproduction and the EFSA highlight that it is important to determine if these effects are also seen in humans.

Source: EFSA, 7 June 2022

As of 3 June 2022, the European Centre for Disease Prevention and Control had identified 392 confirmed and probable cases of monophasic Salmonella Typhimurium (S. Typhimurium) in EU and EEA countries and the UK. This outbreak has been characterised by a high proportion of hospitalised cases (around 40%) and some cases having severe clinical symptoms, such as bloody diarrhoea.

Based on epidemiological and microbiological investigations, specific chocolate products from a Belgian chocolate factory have been identified as likely vehicles of infection. Affected cases were identified through advanced molecular typing techniques. As this method of testing is not routinely performed in all countries, some cases may be undetected.

The factory was closed on 8 April 2022 and product recalls were launched globally, with the aim of preventing the consumption of products potentially contaminated with Salmonella. As a result of control measures, the number of cases has started to decline.

Further investigations are being conducted by public health and food safety authorities in countries where cases are reported, to identify the cause and the extent of the contamination, and to ensure contaminated products are not put on the market.

Source: ECDC, 3 June 2022

On 3 June 2022, at the Stockholm+50 conference, the World Health Organization (WHO) launched a new policy brief, reporting that climate change poses serious risks to mental health and wellbeing, and urging countries to include mental health support in their response to the climate crisis, while also citing examples where a few countries have done this effectively. The findings concur with a February 2022 report by the Intergovernmental Panel on Climate Change (IPCC), with the IPPC reporting that rapidly increasing climate change poses a rising threat to mental health and psychosocial well-being, from emotional distress to anxiety, depression, grief, and suicidal behaviour. 

The report finds the mental health impacts of climate change are unequally distributed, with certain groups disproportionately affected depending on factors such as socioeconomic status, gender and age. However, climate change affects many of the social determinants that are already leading to massive mental health burdens globally, with a 2021 WHO survey of 95 countries finding only nine have thus far included mental health and psychosocial support in their national health and climate change plans. A reported total of almost one billion people globally lives with mental health conditions, yet in low- and middle-income countries, three-quarters do not have access to needed services. 

The new WHO policy brief recommends five important approaches for governments to follow, in order to address the mental health impacts of climate change, these being: 

• to integrate climate considerations with mental health programmes 
• to integrate mental health support with climate action 
• to build upon global commitments 
• to develop community-based approaches to reduce vulnerabilities 
• to close the large funding gap that exists for mental health and psychosocial  support 

Examples of how this can be done have been found in the Philippines, which has rebuilt and improved its mental health services after the impact of Typhoon Haiyan in 2013, and in India, where a national project has scaled-up disaster risk reduction in the country, while also preparing cities in responding to climate risks and addressing mental health and psychosocial needs. 

The Stockholm Conference commemorates the fiftieth anniversary of the UN Conference on the Human Environment and recognising the importance of environmental determinants for both physical and mental health. 

Source: WHO, 3 June 2022

On 7 June 2022, the World Health Organization (WHO) European Centre for Environment and Health published a new report, which looked at how cycling and walking can play a crucial role in shaping health, mitigating climate change and improving the environment. 

The report finds that cycling and walking can help fight weight problems and reduce physical inactivity, which reportedly cause one million deaths per year in the European Region, while also helping to reduce air pollution, which reportedly cause more than half a million deaths every year. The report finds that significant shifts toward walking and cycling can address problems resulting from current transport patterns, such as emissions of air pollutants, greenhouse gases and noise, traffic injuries, and limited opportunities for physical activity and use of public space. 

The publication has been developed under the Transport, Health and Environment Pan-European Programme (THE PEP), which is a joint programme between the WHO and the United Nations Economic Commission for Europe (UNECE) and provides policymakers with the latest scientific evidence to promote walking and cycling. While the links between physical activity and health are well-established, the specific effects of both active transport modes on people’s health are also highlighted, with many studies specifically investigating the impacts of walking and cycling. Among these, it was shown that: 

• walking for 30 minutes or cycling for 20 minutes on most days reduces mortality risk by at least 10%
• active commuting is associated with an approximate 10% decrease in risk for cardiovascular disease and a 30% decrease in type 2 diabetes risk
• cancer-related mortality is 30% lower among bike commuters

The WHO European Regional Obesity Report 2022 found that almost two-thirds of adults and one-in-three children are overweight or obese in the region, with physical inactivity and obesity being important risk factors for noncommunicable diseases, accounting for almost 86% of deaths and 77% of the disease burden.

The WHO report that tackling the climate and air pollution crises requires curbing emissions from motorized transport, particularly private cars, as quickly as possible, with the report noting that emerging evidence shows the importance of active mobility in mitigating climate change. For example, a shift from car to active travel is possible for trips up to 16km in length, and those trips are responsible for 40% of carbon emissions from vehicles. Even if not all car trips could be substituted by cycling and walking, the potential for decreasing emissions could be considerable.

However, enabling the necessary shifts towards more active travel requires addressing safety issues, with 84,000 deaths annually from road injuries, including over 20,000 pedestrians and over 3,000 cyclists. Safety improvement measures should follow a systems approach targeting multiple structural levels, from individual education to vehicle safety, infrastructure design, and traffic regulation.

The publication urges countries of the region to implement the following measures to promote safe cycling and walking: 

• Urban spaces should be re-designed to ensure they meet daily needs related to accessing jobs, education, health care, food and goods, recreation, and other amenities within distances that can be safely covered using active mobility means and public transport. 
• Building up an infrastructure for safe walking and cycling, as this plays a central role in promoting active travel. 
• Ensure the provision of trip-end facilities, such as changing rooms at workplaces and secure parking for bikes at destinations and in the proximity of public transport, providing a backup option for active travellers. 
• Green spaces, parks and trails, and forms of urban revitalization should be options used to promote walking and cycling indirectly. 
• Schools should be safely reachable by walking and biking, and children should learn about the importance of regular exercise and the environmental impacts of traffic. 
• Ensuring the reduction of car dependency through better land use and urban planning, efficient public transport and disincentivising driving, which could lead to more walking and cycling. 
• Countries should develop national cycling and walking plans, secure resources and allocate responsibilities to support their implementation. 

The new publication supports the Pan-European Master Plan for Cycling Promotion, which provides a set of recommendations to reallocate space for cycling and walking, improve active mobility infrastructure, increase cyclist and pedestrian safety to reduce fatalities, develop national cycling policies, and integrate cycling into health policies and urban and transport planning. This plan was endorsed last year by 56 countries of the pan-European region, convened under the framework of THE PEP at the fifth high-level meeting on transport, health, and environment.

Source: WHO/Europe, 7 June 2022

On 2 June 2022, through its Small Countries Initiative, World Health Organization Europe (WHO/Europe) launched a new roadmap, a technical document detailing strategic actions for improving health and well-being in small countries by 2025. 

The technical document has reported that the COVID-19 pandemic has tested governments and the resilience of health systems over the past two years, however the impact on smaller countries have been significantly different from those of larger countries, with smaller countries facing a shortage of health workers, inequitable access to medicines and vaccines, and an increase in noncommunicable diseases and mental health problems. Social and economic development has also been delayed through the suspension of tourism and restrictions on movement, putting a significant burden on the domestic resources of smaller countries. 

The roadmap, developed with input from small countries, responds to their need to strengthen their strained health systems and lays out a series of actions to guide them in the years to come, in preparing for, and responding to, future health emergencies and improving overall health and well-being. 

The roadmap aims to support small countries in placing health and well-being high on key political agendas, advocating their needs at the regional and international levels, promoting investment in health and measuring progress towards inform future decisions. The roadmap further stresses that enhanced political, technical and resource-related cooperation is needed to transform primary health care, increase human resources for health, ensure longer-term sustainable health financing, and improve access to medicines, mental health services and innovative digital health. 

The Small Countries Initiative is an active network of 11 small countries across the WHO European Region that provides a forum for innovation, enabling members to jointly address common issues unique to small countries. Most recently, given the impact of COVID-19 on small countries in particular, the focus of the initiative has been on identifying the most immediate areas of need, as well as short-term priorities for action towards a fair recovery, acting on shared priorities concerning national health plans, using the European Programme of Work as an overarching policy framework, and disseminating good practice. 

Source: WHO/Europe, 2 June 2022

On 7 June 2022, the Scottish Government published official statistics, highlighting greenhouse gas emissions in Scotland from 1990 to 2020. The statistics cover two separate measures of greenhouse gases, source emissions and emissions for reporting against targets: 

• Source emissions are a measure of the actual emissions or removals of greenhouse gases in Scotland, including international aviation and shipping. In 2020, source emissions were 40.0 million tonnes of carbon dioxide equivalent (MtCO2e), falling by 51.0 per cent between 1990 and 2020 and falling by 12.0 per cent between 2019 and 2020. In the latest year, emissions from transport fell sharply due to the impact of COVID-19 restrictions in place during 2020. 
• The Climate Change (Emissions Reduction Targets) (Scotland) Act 2019 implements the Climate Change Committee (CCC)’s recommended method of reporting emissions for the purposes of assessing progress against targets. This method, which acts to remove the impact of technical data revisions to the historical time-series, is known as the GHG Account, which reduced by 58.7 per cent between the baseline period and 2020. The Climate Change (Emissions Reduction Targets) (Scotland) Act 2019 specifies a target of a 56.0 per cent reduction over the same period, ensuring the interim target for 2020 was met. 

The baseline period for measuring progress against targets uses 1990 for carbon dioxide, methane and nitrous oxide, and 1995 for hydrofluorocarbons, perfluorocarbons, sulphur hexafluoride and nitrogen trifluoride. 

Source: Scottish Government, 7 June 2022

On 3 June 2022, Scottish Government Net Zero Secretary Michael Matheson pledged to maximise the use of public funding to accelerate the delivery of plans aimed at tackling climate change. The Resource Spending Review, published on 31 May 2022 and covering the period from 2023 to 2024, through to 2026 to 2027, commits to increased spending on heat in buildings, active travel and peatland and woodland restoration.

Capital spending on programmes will also increase by over half a billion pounds over the next three years, aimed at speeding up the reduction in greenhouse gas emissions and build climate resilience across Scotland. Additionally, the Scottish Government has committed to increasing its efforts towards leveraging private sector investment in the just transition to net zero, in order to make better use of limited public funds.

In key commitments of the Resource Spending Review:

• Up to £75 million per year will be provided to deliver the Heat in Building Strategy, enabling £1.8 billion investment towards targets to decarbonise over a million homes and 50,000 non-domestic buildings by 2030.
• Up to £95 million will be provided towards meeting woodland creation targets of 18,000 by 2024 to 2025.
• £46 million will be provided to introduce the community bus fund and an increase in funding for concessionary travel schemes, as well as investing up to £150 million of resource and capital across the spending review period in active travel, as part of a shift of transport funding in walking, wheeling and cycling, supporting the Scottish Government commitment to cut 20% of car kilometres by 2030.
• Investment of over £12 million in peatland restoration will be made, doubling the current rate and helping achieve the target of 20,000 restorations by 2025 to 2026.
• £4 million of resource spending will be provided, alongside £150 million capital and financial investment, for the North-east and Moray Just Transition Fund.
• Rollout of the agriculture National Test Programme to enhance farmers and crofters’ awareness of their climate performance.

Source: Scottish Government, 3 June 2022

Clean Air Day falls on 16 June 2022, with this year's campaign focusing on the health and environmental benefits of walking. The campaign this year encourages people to do three key things around this theme: 

• Talk to people about the harms of air pollution. 
• Walk, cycle or scoot for those short distance trips and leave the car at home, where possible. 
• Ask local and national decision makers for a change in your local community that would make it easier to walk more, leave the car at home and breathe clean air. 

More information on Clean Air Day can be found on the campaign website. 

Source: Royal Environmental Health Institute of Scotland (REHIS), June 2022