As the coronavirus (COVID-19) outbreak continues to evolve, the Foreign, Commonwealth & Development Office (FCDO) advises British nationals against all but essential travel, exempting some countries that no longer pose an unacceptably high risk for British travellers. This advice is being kept under constant review and may change at short notice.

The fitfortravel (for the general public) and TRAVAX (for health professionals) country pages have been updated to include a COVID-19 country specific risk-rating, with every country being identified as high, moderate or low risk and each rating accompanied by appropriate travel advice. This information will be listed in the ‘Alerts’ section on each country page of fitfortravel and the 'Emerging Health Risks' section of every TRAVAX country page. The risk-rating is based on a robust public health assessment of the COVID-19 risks for travellers to each country, and will be regularly reviewed. However, as the global spread of COVID-19 can change at any time, travellers are advised to consider the advice below before planning international travel.

It should be noted that the risk ratings for British Virgin Islands, Greece, Hungary, French Polynesia, La Reunion, Portugal, Norway, Guadeloupe, Curacao, Bonaire, St Eustatius and Sabahave recently been upgraded, reflecting an increase of cases in these countries. The risk rating for Sweden has been downgraded.

Advice for travellers

Before planning and/or booking international travel, please check: 

• the UK Border Control website, in order to check current rules regarding self-isolation (quarantine) before your planned return to the UK 
• the Foreign, Commonwealth & Development Office (FCDO) website, for country specific Travel Advisory Notices regarding travel and entry restrictions, and review the local medical care available at your destination 
• the COVID-19 risk-rating at your destination, which will be listed in the ‘Alerts’ section of all fitfortravel country pages and the ‘Emerging Health Risks’ section of all TRAVAX country pages 
• the TRAVAX travel insurance page, as such insurance should be considered essential 
• the fitfortravel COVID-19 health considerations for travel page 
• physical distancing and hygiene measures in the country you are visiting

Information relating to travel and COVID-19 is available on the TRAVAX (for healthcare practitioners) and fitfortravel (for the general public) websites.

Information on COVID-19 for the general public is available on the NHS Inform (Scotland) and the NHS.UK (rest of the UK) websites.

Information and resources on COVID-19 for health professionals is available on the Health Protection Scotland (HPS) (Scotland) and Public Health England (PHE) (rest of the UK) websites.

Source: TRAVAX, 28 August 2020

The European Centre for Disease Prevention and Control (ECDC) has published its annual epidemiological report concerning Haemophilus influenzae (H. influenzae). In 2018, 3,982 confirmed cases of invasive H. influenzae were reported in the EU/EEA. The notification rate was 0.8 cases per 100,000 of the population, an increase compared to 2014 when it stood at 0.6.

In key findings from the report:

• Age-specific rates were highest in infants under one-year-old, with 4.0 cases per 100,000 of the population. This was followed by people aged 65 years and over, with 2.4 cases per 100,000 of the population. 
• Serotyping data were available for 57% of confirmed cases. 
• Non-capsulated strains caused 78% of cases overall, and the majority of cases in all age groups. 
• Serotype f was the most common capsulated serotype observed at 9%. 
• The H. influenzae serotype b (Hib) vaccination has led to a sustained reduction in serotype b infections. In 2018, 7% of cases with known serotype were caused by serotype b.

Source: ECDC, 8 September 2020

The European Centre for Disease Prevention and Control (ECDC) has published its annual epidemiological report concerning invasive pneumococcal disease. In 2018, 24,663 confirmed cases of invasive pneumococcal disease (IPD) were reported in the EU/EEA. The crude notification rate was 6.4 cases per 100,000 of the population, continuing the increasing trend observed since 2014.

In key findings from the report: 

• Age-specific rates were highest in adults aged 65 years or older, with 18.7 confirmed cases per 100,000 of the population. This was followed by infants under one-year-old, with 14.4 confirmed cases per 100,000 of the population. 
• The ten most common serotypes, in order of decreasing frequency, were 8, 3, 19A, 22F, 12F, 9N, 15A, 10A, 23B and 6C, accounting for 70% of typed isolates. 
• Of all the cases in those under five years of age, 75% were caused by a serotype not included in any pneumococcal conjugate vaccine (PCV). 
• Among cases aged 65 years and over, 73% were caused by serotypes included in the 23-valent polysaccharide vaccine, and 29% were caused by serotypes in the 13-valent PCV.

Source: ECDC, 8 September 2020

The European Centre for Disease Prevention and Control (ECDC) has published its annual epidemiological report concerning shigellosis. In 2017, 6,337 confirmed cases of shigellosis were reported in 20 EU/EAA countries. The overall notification rate was 1.7 cases per 100,000 of the population, slightly higher than in 2016. The highest notification rate was observed in children below five years of age, followed by male adults aged 25 to 44 years. Sexual transmission of shigellosis among men who have sex with men (MSM) is thought to have contributed to the gender imbalance in the latter group.

Source: ECDC, 10 September 2020

The World Health Organization (WHO) has published its first global report on sepsis, a preventable, life-threatening condition marked by severe organ dysfunction. Sepsis disproportionately affects vulnerable populations, such as newborns, pregnant women and people living in low-resource settings. Almost half of the 49 million cases of sepsis each year occur among children, resulting in 2.9 million deaths, many of which could be prevented through early diagnosis and appropriate clinical management. The report also finds that sepsis frequently results from infections acquired in health care settings, with around half of patients with sepsis in intensive care units having acquired the infection in hospital.

The WHO states that improved sanitation, water quality and availability, and infection prevention and control measures can prevent sepsis and save lives, but should be coupled with early diagnosis, appropriate clinical management, and access to safe and affordable medicines and vaccines.

The WHO calls for the following measures to improve the prevention, diagnosis and treatment of sepsis: 

• Improve robust study designs and high-quality data collection, especially in low- and middle-income countries. 
• Scale-up global advocacy, funding and the research capacity for epidemiological evidence on the true burden of sepsis. 
• Improve surveillance systems, starting at the primary care level, including the use of standardized and feasible definitions in accordance with the International Classification of Diseases (ICD-11), and leveraging existing programmes and disease networks. 
• Develop rapid, affordable and appropriate diagnostic tools, particularly for primary and secondary levels of care, to improve sepsis identification, surveillance, prevention and treatment.
• Engage and better educate health workers and communities not to underestimate the risk of infections evolving to sepsis, and to seek care promptly in order to avoid clinical complications and the spread of epidemics.

Source: WHO, 8 September 2020

World Patient Day, on 17 September 2020, aims to raise awareness on patient safety as a global health priority. The objectives of World Patient Safety Day are to increase public awareness and engagement, enhance global understanding, and spur global solidarity and action to promote patient safety.

The theme for this year’s campaign is ‘Health worker safety: a priority for patient safety’. The COVID-19 pandemic has unveiled the huge challenges and risks health workers are facing globally, including healthcare-associated infections, violence, stigma, psychological and emotional disturbances, illness and even death. Furthermore, working in stressful environments makes health workers more prone to errors which can lead to patient harm.

The European Environment Agency (EEA) has published a report which finds that a significant proportion of the burden of disease in Europe continues to be attributed to environmental pollution resulting from human activity. The report, which draws extensively on World Health Organization (WHO) data on the causes of death and disease, highlights how the quality of Europe’s environment plays a key role in determining health and well-being outcomes. It shows how social deprivation, unhealthy behaviours and shifting demographics in Europe influence environmental health, with the most vulnerable hardest hit.

In key findings from the report: 

• Air pollution remains Europe’s top environmental threat to health, with more than 400,000 premature deaths driven by air pollution every year in the EU. Noise pollution comes second, contributing to 12,000 premature deaths, followed by the impacts of climate change, notably heatwaves. 
• The burden of pollution and climate change varies across Europe, with clear differences between countries in the east and west of Europe. The highest fraction of national deaths, at 27%, is attributable to the environment in Bosnia and Herzegovina, and the lowest, at 9%, in Iceland and Norway. 
• Socially deprived communities typically struggle under a triple burden of poverty, poor quality environment and ill health. Poorer communities are often exposed to higher levels of pollution and noise and to high temperatures, while pre-existing health conditions increase vulnerability to environmental health hazards. Targeted measures are needed to improve environmental conditions for the most vulnerable in Europe. 
• People are exposed to multiple risks at any time, including air, water and noise pollution, and chemicals, which combine and in some cases act in unison, to impact on health. European cities are particularly vulnerable to these multiple threats, while also having less access to green and blue spaces. 
• Ongoing research is investigating the links between the current COVID-19 pandemic and environmental dimensions.

Source: EEA, 8 September 2020

The Drinking Water Quality Regulator (DWQR) has published its annual report on the quality of private water supplies in Scotland.

According to the report, a total of 48,384 tests were taken from regulated private water supplies in 2019, which are those supplying more than 50 people, or a commercial activity. Of these tests, 89.8% of tests met the required standard, but 14.5% of these supplies had a sample that contained E. coli, an infection which indicates faecal contamination and potentially causes serious illness. Compliance figures have not improved in recent years, and the 2019 results represent a deterioration on 2018 for many types of test.

Private water supplies are those owned and managed by individuals rather than Scottish Water and around 3.3% of the Scottish population receive their water from them. The supplies range from those serving a single house to much larger numbers of houses as well as hotels, tourist accommodation and other businesses.

Many of the very small types of supplies have little or no treatment and where water from these supplies does not meet the standards, there may be a risk to the health of those drinking from them. According to the latest report, a significant number do not meet the required drinking water standards and almost certainly represent a risk to health.

Source: Scottish Government, 7 September 2020

As part of an enhanced Green New Deal, the Scottish Government has announced nearly £1.6 billion in funding to transform the heat and energy efficiency of buildings. This measure aims to accelerate decarbonisation in an area which makes up a quarter of Scotland’s greenhouse gas emissions. To increase climate change resilience, an additional £500 million is being invested in Scotland’s natural economy, including £150 million to support the delivery of a 50% increase in woodland creation by 2024.

The plans, outlined in the Programme for Government 2020 to 2021, are among a number of measures that attempt to protect biodiversity, create green jobs and accelerate a just transition to net-zero in Scotland.

Source: Scottish Government, 4 September 2020