On 20 December 2017, the Scottish Chief Medical and Pharmaceutical Officers (CMO and CPO) issued a letter noting that recent surveillance information provided by Health Protection Scotland (HPS) was indicating a substantial likelihood that people presenting with an influenza-like illness would be infected with an influenza virus. Accordingly, antiviral drugs can currently be prescribed for the prevention or treatment of influenza in the community where clinically indicated/appropriate and in particular, in those who are presenting with severe infection/symptoms where it is evident their use might help reduce overall symptoms and mortality in hospitalised patients.
Notwithstanding the debate concerning the effectiveness of antivirals (which the letter details), the CMO/CPO’s advice was that:
- Any patient hospitalised with influenza should be given antivirals.
- Antiviral treatment should be considered for all patients in an at-risk category, including pregnant women and those over 65, and those severely immunocompromised. Antivirals should ideally be given within 48 hours of onset of symptoms.
- Normally healthy patients who present with flu like symptoms and who do not at the time require hospitalisation should not require antivirals unless there is a risk that they may develop more severe symptoms as a result of the infection or if the flu strain is particularly severe. Similarly, clinical judgement should be used in deciding whether to administer antiviral treatment to healthy children.
- There is a paucity of evidence from recent studies to inform a single approach for prophylaxis in care homes. These decisions must therefore be made on a case by-case basis using clinical judgement and take account of the severity of the outbreak.
- Should the strain of seasonal flu circulating in the community increase in virulence or show greater risk of complications and/or death, consideration should be given to prescribing antivirals more widely, both prophylactically and for those displaying symptoms.
Weekly information on the incidence and predominant strain of influenza circulating in Scotland can be found on the HPS website.
The report on quarterly epidemiological data on Clostridium difficile infection (CDI), Escherichia coli bacteraemia (ECB), Staphylococcus aureus bacteraemia (SAB), and surgical site infection (SSI) in Scotland, July to September (Q3) 2017, has been published on 9 January 2018 under the mandatory programmes for surveillance of CDI, ECB, SAB, and SSI in Scotland. This report provides data for the third quarter of 2017 in 14 NHS boards and one NHS special health board.
The report on epidemiological data for April to June (Q2) 2017 has been updated due to errors in the data.
On 21 December 2017, Errington Cheese Ltd recalled a batch of their Dunsyre Blue cheese after a wholesaler reported the detection of Listeria monocytogenes in the product. Following further sampling, the company voluntarily recalled all batches of Dunsyre Blue cheese on 22 December 2017.
Symptoms caused by L. monocytogenes can be similar to flu and include high temperature, muscle ache or pains, chills, feeling or being sick and diarrhoea. However, in rare cases, the infection can be more severe, causing serious complications, such as meningitis. Some people are more vulnerable to Listeria infections, including those over 65 years of age, pregnant women and their unborn babies, babies under one month old and people with weakened immune systems.
Anyone who has purchased this product has been advised by Food Standards Scotland (FSS) to avoid eating it and return it for a full refund at the point of purchase.
Source: FSS News Releases, 22-23 December 2017
A final report into the investigation into carbon dioxide (CO2) leaks into homes in the former mining village of Gorebridge in Midlothian was published on 22 December 2017.
The report was completed by the multi-disciplinary Incident Management Team (IMT), which was created to investigate Scotland’s most serious CO2-related incident. This IMT was led by NHS Lothian and comprised partner organisations, including Midlothian Council, Health Protection Scotland and Scottish Environment Protection Agency (SEPA).
The IMT was formed after reports of illness among residents in Gorebridge where CO2 was identified an having seeped into newly-built homes in the former mining area. Between September 2013 and September 2014, 22 residents from a total of 165 in the affected area made contact with healthcare services because of headaches, dry coughs, dizziness and anxiety.
The IMT identified that the seepage of CO2, into the residential houses originated from the old mine workings. This represented a significant ongoing risk to the health of residents and required action. The seepage of CO2 into the houses was thought to have been associated with a number of potential pathways including un-grouted disused mine shafts, natural cracks in the ground and man-made interventions over time.
The IMT has made a total of 26 recommendations to prevent a similar situation from happening again in other areas, by advising Scottish and the UK Government on areas where national level review, research and guidance are required. It has also made recommendations for action by local authorities that are likely to have housing developments on similar sites to prevent a similar threat to public health. On the basis of the investigations and following consideration of the current processes for assessing the need for mine gas mitigation for new build development, the IMT also recommended that mine gas mitigation measures should be made mandatory in all new residential and similar developments, in all areas of Scotland designated as former mining areas.
The report concluded that the seepage of CO2 into the houses in Gorebridge was a rare, complex and costly incident associated with old coal mine workings. This incident is, to date, probably the most serious such CO2 related incident in Scotland.
Source: NHS Lothian News Release, 22 December 2018
Workers’ reproductive health can be put at risk by hazardous chemicals, such as pesticides and pharmaceuticals, as well as biological, physical, organisational and psychosocial factors.
The issue of reproductive occupational health risks has largely been focused on women, particularly pregnant women, but reprotoxic risks can in fact affect both women’s and men’s reproductive health. Reprotoxicants can also affect foetal and human development and effects include miscarriages, malformations and functional deficits.
A summary recently published in multiple languages by the European Agency for Safety and Health at Work (EU-OSHA) presents in short the results of a report that examines the current knowledge on workplace risks to reproduction. It highlights gaps in that knowledge and recommends ways forward to increase awareness and improve prevention.
Source: OSHA News Release, 5 January 2018
Public Health England (PHE) has published a report of the UK National Focal Point (NFP) activity relating to the International Health Regulations (IHR) 2005, marking 10 years since the revised regulations came into force in 2007. Under IHR (2005), countries agree to build their capacities to detect, assess, and report public health events, and are required to designate an IHR NFP to be accessible at all times for communications with the World Health Organization (WHO) IHR Regional Contact Point. The NFP has a duty to both assess any events (infectious, chemical, radiation or biological) that may potentially constitute a Public Health Emergency of International Concern (PHEIC) and to notify them to the WHO. PHE hosts the IHR NFP on behalf of all of UK territory.
The report covers UK IHR NFP activity between 2012 and 2016, during which period WHO declared three PHEICs - the international spread of wild poliovirus, Ebola virus disease in west Africa and Zika virus disease (ZVD). During this period, the UK NFP reported 52 events to WHO. Of these, 50 (96%) were related to infectious diseases, two were chemical-related events, and there were no reported radiological events. A third of these events related to international outbreaks occurring in UK overseas territories (e.g. locally-acquired ZVD cases, chikungunya cases, etc.).
Not all communications of the UK IHR NFP are with the WHO. An analysis of the email communications since 2007, presented in the report, indicated a five-fold increase in email traffic between 2008 and 2016, most of which was direct communication with other countries as part of contact tracing, the report notes. The report concludes that this suggests the implementation of IHR (2005) is successfully achieving its aim to improve global communication about public health events.
For further information, see the UK National Focal Point webpage.
Text adapted from Health Protection Report, 5 January 2018