Further to current note 52/0902, the latest data from the Nigeria Centre for Disease Control (NCDC) shows that the number of new confirmed and probable cases has been falling for five consecutive weeks, indicating that public health measures are proving effective. However more infections are expected until the end of the dry season. However both NCDC and the World Health Organization (WHO) advised that while the spread of Lassa fever in Nigeria is beginning to slow the epidemic is far from contained.

The current epidemic is Nigeria’s largest on record, with the number of confirmed cases in January and February 2018 alone exceeding the total number reported in the whole of 2017. Between 1 January and 25 March 2018, the NCDC reported 394 laboratory confirmed cases. There were 18 new confirmed cases in the last reporting week (19-25 March 2018), compared to 54 confirmed cases a month earlier (19-25 February 2018).

The cause(s) for the high numbers of infections is not known as yet thought the NCDC is conducting research into the causes of the outbreak in real-time. Researchers at the Irrua Specialist Teaching Hospital, in collaboration with the Bernhard-Nocht Institute for Tropical Medicine, Germany, WHO, NCDC and others, have conducted genome sequencing of the Lassa virus with preliminary results suggesting that the circulating virus is consistent with previous outbreaks and not a new more virulent strain.

WHO recognizes Lassa fever as a priority pathogen which has the potential to cause a public health emergency. The on-going research will provide crucial insights which will help mitigate future Lassa fever outbreaks. WHO has been working with NCDC and other partners to control Lassa fever by deploying teams to hotspots, identifying and treating patients, strengthening infection, prevention and control measures in health facilities, and engaging with communities.

WHO has released US$ 900,000 from its Contingency Fund for Emergencies to quickly scale up operations, and is also supporting preparedness and response capacities in neighbouring countries.

Further information and advice for clinicians advising travellers can be accessed on TRAVAX.

Source: WHO, 26 March 2018

Nearly one billion people will be vaccinated against yellow fever in 27 high-risk African countries by 2026 with support from WHO, Gavi – the Vaccine Alliance, UNICEF and more than 50 health partners.

The commitment is part of the Eliminate Yellow fever Epidemics (EYE) in Africa strategy, which was launched by Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Professor Isaac Folorunso Adewole, Nigeria’s Minister of Health and partners at a regional meeting in Abuja, Nigeria on 10 April 2018.

The objectives of the strategy include protecting at-risk populations through preventive mass vaccination campaigns and routine immunization programmes, preventing international spread, and containing outbreaks rapidly. Developing strong surveillance with robust laboratory networks is key to these efforts.

Source: WHO, 10 April 2018

On 9 April 2018, media reported a suspected outbreak of acute Chagas disease. A total of five people died in the city of Puerto Nuevo in Táchira state, west of Venezuela. The fatalities were an 11 month old baby, a 79 year-old woman and three men of 31, 42 and 51 years old respectively.

Advice for Travellers: Trypanosomiasis is transmitted by the reduvid bugs which inhabit thatched roofs and cracks in the walls of mud huts. The bugs come out and blood feed at night, transmitting infection, into the bite wound as they feed. In addition oral transmission of infection via contaminated fruit juice has been the cause of outbreaks in Brazil and Venezuela.

Further information and advice for clinicians advising travellers can be accessed on TRAVAX.

Source: ProMED Mail, 10 April 2018

A UK case of Neisseria gonorrhoeae with high-level resistance to azithromycin and resistance to ceftriaxone has been acquired abroad.

Public Health England (PHE) is investigating a case where gonorrhoea was acquired abroad which is very resistant to the recommended first line treatment of azithromycin and ceftriaxone. The case is the first in the UK where such a high level of resistance to the two first line treatments and other antibiotics has been found.

Everyone can significantly reduce their risk of getting and/or passing on gonorrhoeae through the consistent and correct use of condoms with new and casual partners.

Source: PHE, 28 March 2018

Following a resubmission, sofosbuvir-velpatasvir has been accepted for restricted use in NHS Scotland.

Sofosbuvir-velpatasvir was associated with high rates of sustained virologic suppression in adults with genotype 1 and 4 chronic HCV infection, including those with decompensated cirrhosis.

This Scottish Medicine Consortium (SMC) advice takes account of the benefits of a Patient Access Scheme (PAS) that improves the cost-effectiveness of sofosbuvir-velpatasvir. This advice is contingent upon the continuing availability of the PAS in NHS Scotland or a list price that is equivalent or lower.

SMC has issued separate advice accepting the use of sofosbuvir-velpatasvir for the treatment of patients with genotype 3 (SMC No.1195/16) and for the treatment of patients with genotypes 2, 5 and 6 chronic HCV infection and for those patients with decompensated cirrhosis, irrespective of chronic HCV genotype (SMC No. 1271/17).

Asbestos claims well over 100,000 lives a year worldwide. It’s estimated that 10 million people across the world will have died as a result of asbestos exposure before it’s been fully controlled.

But there are many other carcinogenic exposures that cause cancer and claim lives – well over 50 substances are listed as known or probable causes of workplace cancer. Across the EU, one in five workers faces an occupational cancer risk. Across the world, it’s estimated that at least 742,000 people die worldwide every year.

IOSH’s ‘No Time to Lose’ campaign aims to get carcinogenic exposure issues more widely understood and help businesses take action. The campaign is working to:

• raise awareness of a significant health issue facing workers in the UK and internationally
• suggest some solutions on a UK scale to tackle the problem – a national model that can be transposed internationally
• offer free practical, original materials to businesses to help them deliver effective prevention programmes

Further information on health and safety issues and asbestos can be found on the Health and Safety Executive (HSE) website.

The REHIS Schools Food Hygiene Initiative is an innovative national initiative, which leads to the award of the REHIS Elementary Food Hygiene Certificate. It has been in place for over twenty years and has proved to be exceptionally popular with Scottish secondary school teachers and students, and with the food industry.

Successful students gain an industry recognised qualification which can fast track them into employment within the food industry and/or seasonal employment while undertaking higher or further education. Some students have found that taking this qualification while at school has supported other areas of their studies, including Home Economics. It also helps Scotland meet the SQA Curriculum for Excellence, Health and Wellbeing (Food and Health) experiences and outcomes.

Royal Environmental Health Institute of Scotland’s (REHIS) funding of £50,000 is being matched by Food Standards Scotland to expand the delivery of the Elementary Food Hygiene Course. This will provide up to 10,000 secondary school pupils with the resources to complete the training in 2018. The funding has been backed by Gary Maclean, Scotland’s first National Chef and Senior Chef Lecturer at City of Glasgow College.

Source: REHIS News, 11 April 2018

Everyone with an interest in Scotland’s environment is being invited to have their say on the Scottish Environment Protection Agency’s (SEPA) sector plans for Scotch whisky, metals and landfill.

The aim of the sector plans is to drive compliance with environmental regulations. Successful future businesses in Scotland will use low amounts of water, materials and carbon-based energy and will create little waste. This sector plans aims to drive this ambition forward with a plan being developed for every sector regulated by SEPA by the end of March 2021. The first sector plans to be consulted on are the Scotch whisky, metals and landfill sectors.

SEPA are consulting on their draft plans and once finalised they will be implemented. Consultees have until 7 May 2018 to respond to the consultation which is available to view on the SEPA consultation hub.

Source: SEPA, 26 March 2018

According to European Environment Agency (EEA) data released on 16 April 2018, emissions of carbon dioxide from new passenger cars have dropped in a number of European countries where a range of taxes, subsidies and other incentives are used to encourage consumers to purchase lower-carbon-dioxide (Co2) emitting vehicles. The number of countries offering incentives for electric vehicles in particular, continues to grow. At the same time, emissions from trucks and buses are expected to increase further if new measures are not taken.

The EEA briefing ‘Appropriate taxes and incentives do affect purchases of new cars’ based on a study done by the EEA’s European Topic Centre on Air Pollution and Climate Change Mitigation (ETC/ACM), examines what financial incentives EU Member States, plus Iceland, Liechtenstein, Norway, and Switzerland are using to steer consumers to drive more eco-friendly cars and what the impact of these incentives has been. The analysis includes seven case studies which explore the different approaches used for taxation and incentives across France, Germany, Greece, Ireland, the Netherlands, Norway and Poland. The study found that consumers more readily purchased lower emitting cars where sufficiently large and targeted taxes and incentives were in place.

The number of countries offering incentives promoting the use of hybrids and battery electric vehicles has jumped considerably from 2010 to 2016. The briefing warns that to foster the uptake of electric vehicles, more charging facilities are needed to reassure people on reliability and range limitation concerns on using battery-powered cars. 

A separate briefing ‘Carbon dioxide emissions from Europe’s heavy-duty vehicles’, also released on 16 April 2018,reports that trucks, buses and coaches are responsible for around one quarter of Co2 emissions from the transport sector and are expected to increase further if new measures to curb emissions are not taken.

Research conducted by the Centre for Environment, Fisheries and Aquaculture Science (Cefas) between 1992-2017 has revealed changes in the composition of marine plastic litter, finding a decrease in the amount of plastic bags found on the UK’s seabed and suggesting that behavioural and legislative changes may be able to tackle the marine litter challenge.

Despite the reduction in the number of plastic bags recorded in an analysis of scientific surveys, the overall amount of litter has been maintained by an increasing amount of other plastic items, including fishing debris.

Widespread distribution of litter items were found on the seabed of the North Sea, English Channel, Celtic Sea and Irish Sea. High variation in the abundance of litter items, ranging from zero to 1835 pieces km−2 of seafloor, was observed.

Plastic items such as bags, bottles and fishing related debris were commonly observed across all areas. Over the entire 25-year period, 63% of the 2,461 trawls contained at least one plastic litter item.

Marine litter is a global challenge, with increasing quantities documented in recent decades. The distribution and abundance of marine litter on the seafloor off the UK’s coasts were quantified during 39 independent scientific surveys conducted between 1992 and 2017.