International travel continues to be significantly impacted due to COVID-19, and a number of variant strains have emerged globally, with information on such travel available for people living in Scotland, England, Wales and Northern Ireland. To prevent new COVID-19 variants being exported and imported, the Foreign, Commonwealth & Development Office (FCDO) currently advise against travelling to red list countries.

A traffic light system which categorises countries on to a red, amber or green list, based on their COVID-19 risk, is in place for travellers arriving into the UK, although it should be noted that the traffic light system does not indicate which countries are currently allowing UK travellers to enter their country.

Currently, anyone entering Scotland from countries on the international travel green list will not be required to self-isolate on arrival, but will have to complete a passenger locator form, take a COVID-19 test before travelling to Scotland, then another within two days of arriving in Scotland. Isolation is only required if the COVID-19 test taken on day two after arriving back in Scotland is positive or NHS Scotland Test and Protect makes contact to inform of the need to isolate due to travel with someone who has tested positive for COVID-19.

On 30 August 2021, Scotland, England, Wales and Northern Ireland updated their rules for returning to the UK from some red, amber and green list countries.

On return to the UK, travellers should be aware that testing and quarantine rules differ for Scotland, England, Wales and Northern Ireland. Prior to their journey, travellers must ensure they are able to comply with the rules appropriate to the UK nation they will be arriving in and reside in, if different.

Country specific COVID-19 risk

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. This risk-rating is based on a robust public health assessment of the COVID-19 risks for travellers to each country and is regularly reviewed.

In August 2021, there were no countries where the COVID-19 risk for UK travellers was decreased.

Advice for travellers

Prior to booking any international travel, travellers must first check if the country they are travelling to is currently accepting UK travellers.

• Each country or territory on the FCDO foreign travel advice page provides up-to-date information on their entry rules, in response to coronavirus (COVID-19), under the ‘Entry Requirements’ section.
  
  
• Travellers should be aware that some countries or territories may require proof of COVID-19 vaccination status for entry. Guidance for demonstrating COVID-19 vaccination status is available for those living in Scotland, England, Wales and Northern Ireland.

It is advised that travellers are aware of all travel restrictions, self-isolation rules and precautions they should take, in order to reduce their risk of exposure to coronavirus (COVID-19) before, during and after travel, as detailed on the fitfortravel website.

Source: TRAVAX, 10 September 2021

Japanese media have reported a fatal case of severe fever with thrombocytopenia syndrome (SFTS) in Fukuoka, south west Japan. Local public health authorities have stated that the person was admitted to hospital with fever and fatigue on 16 August 2021 and died five days later. It is reported that the person had been bitten recently by ticks.

SFTS is an emerging viral haemorrhagic fever occurring in eastern Asia, and is caused by the zoonotic SFTS virus, transmitted primarily by ticks, although human-to-human transmission in medical settings has occurred.

Advice for travellers

Travellers who may be exposed to ticks during travel should be advised of the risk of infection and the measures needed to avoid tick bites.

In addition, those travelling to work in medical settings should:

• wash hands regularly after caring for or visiting ill people, and use gloves if necessary
• follow appropriate infection control procedures, If working in a healthcare settings

Tick bite prevention measures

Travellers who may be exposed to ticks during travel should:

• avoid unnecessary exposure in infested areas 
• wear lighter, longer clothing and tuck trousers into socks
• impregnate clothing and footwear with insecticide
• use an approved repellent on the skin, for example DEET or Icaridin
• regularly examine clothing and skin for ticks and remove as soon as possible

Detailed guidance about insect bite avoidance can be found on TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

Source: TRAVAX, 3 September 2021

The Madagascar Ministry of Public Health has reported 22 cases of pneumonic plague, including seven deaths. The outbreak is in Miandrandra commune, Arivonimamo district, where the first death was reported in the week of 23 August 2021. The area is now under quarantine and movements of local people within the area are restricted.

Pneumonic plague spreads through coughing and inhalation of droplets containing plague bacteria, and can also develop as a secondary condition following infection through a flea bite.

Advice for travellers

Plague is rare in international travellers. The risk is highest in those visiting endemic regions who come into close contact with local wildlife, particularly rats or other rodents, or those who are in a healthcare environment.

Activities which may increase this risk include:

• camping, or staying in very basic rural accommodation
• walking, hiking or working outdoors
• hunting or participating in activities which involve close contact with wildlife
• caring for a sick person who may be infected with pneumonic plague, which spreads from person-to-person

Travellers should be advised to:

• practice good insect bite avoidance, using insect repellents to help protect against flea bites
• avoid close contact with sick or dead animals
• avoid crowded areas in regions where pneumonic plague has recently been reported
• follow appropriate infection prevention and control guidance in a healthcare environment 
• seek prompt medical attention if they develop symptoms or if there is a risk of having been exposed to plague

No vaccine is available for plague, though progression of the disease may be prevented with appropriate antibiotic treatment.

Further advice and information on plague is available on the TRAVAX (for health professionals) website.

Source: TRAVAX, 6 September 2021

The World Health Organization (WHO) has reported increased transmission of hepatitis E in South Sudan. From January 2019 to August 2021, Bentiu refugee camp has reported 1,001 cases, including nine deaths, with most cases being identified as males between the ages of 15 and 44 years. A significant number of cases have also been reported from outside the camp, indicating widespread transmission in the area. Regional flooding has led to population movement, which may increase regional and cross-border spread of infection.

Advice for travellers

Hepatitis E is a common cause of acute viral hepatitis. Travellers at highest risk of infection are those:

• travelling to regions with poor sanitation and hygiene, such as aid workers and disaster relief volunteers
• planning to consume local dishes of raw or undercooked pork products or shellfish during travel

All travellers should be given advice on:

• maintaining safe food and water precautions
• effective hand hygiene 
• avoid eating raw or undercooked pork and game products and shellfish

This advice must be emphasised to pregnant and immunosuppressed travellers, including those with solid-organ transplants.

There is no vaccine available for use in the UK.

Further advice and information on Hepatitis E is available on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

Source: TRAVAX, 6 September 2021

The World Health Organization (WHO) has reported that Cameroon has recorded 905 suspected yellow fever cases, including 13 deaths, from 1 January to 4 July 2021.

Yellow fever is widespread in tropical Africa and is transmitted by day-biting Aedes mosquitoes.

Advice for travellers

Yellow fever is an acute viral haemorrhagic disease which is transmitted through the bite of an infected mosquito, and is found in tropical areas of Africa and Central and South America. All travellers to these areas are advised to practice mosquito bite avoidance at all times.

A traveller's risk of yellow fever is determined by their individual risk assessment. Factors that will influence their risk includes:

• country or countries to be visited
• length of stay
• rate of transmission at destination
• immunisation status 
• planned activities

Unvaccinated travellers that visit yellow fever endemic areas are at risk of becoming infected, so yellow fever vaccine is recommended, unless contraindicated, for travellers at risk.

Further advice and information on yellow fever is available on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

Source: TRAVAX, 6 September 2021

According to the World Health Organization (WHO), the Democratic Republic of Congo has reported 2,523 cases of monkeypox, including 66 deaths, from 1 January to 8 August 2021. In 2020, a total of 6,257 suspected cases, including 229 deaths, were reported from 17 out of 26 provinces in the country.

Monkeypox occurs mainly in forested areas of Central and West Africa. Most infections result from direct contact with infected animals, primarily primates and rodents, though person-to-person transmission can occur. Symptoms in humans commence with fever and a flu-like illness followed by the development of a skin rash.

Advice for travellers

Monkeypox is an uncommon zoonotic infection that is rarely seen in travellers. However, travellers to Central and West Africa should:

• observe meticulous hand hygiene if visiting or caring for ill friends and relatives
• avoid contact with primates and rodents and avoid consuming undercooked meat from these sources
• wear protective clothing, including gloves, if involved in the slaughter or care of animals in these regions

A vaccine against monkeypox is not widely available. Previous smallpox vaccination is protective.

Further advice and information on monkeypox is available on the TRAVAX (for health professionals) website.

Source: TRAVAX, 7 September 2021

The Centers for Disease Control and Prevention (CDC) has reported 402 cases of cyclosporiasis (not linked to foreign travel) between 29 July and 25 August 2021. This brings the total number of cases for this year to 864 in 34 states and New York City.

Cyclosporiasis is a parasitic diarrhoeal disease and infection occurs by ingesting food or water contaminated by infective oocysts. Fresh raw fruit and vegetables, imported from or consumed in endemic countries, are associated with infection.

Advice for travellers

Travellers should be advised to practice good food and water precautions. In particular, they should be advised that Cyclospora is not killed by most water purification methods such as tablets, portable filtration systems or disinfectants (including standard water chlorination).

In endemic areas, the risk of infection can be reduced by:

• consuming only boiled or bottled water
• avoiding fresh raw fruit and vegetables that cannot be peeled prior to consumption, especially berries, herbs and salad leaves (washing food in potable water is unlikely to remove the oocysts from the surface of the fruit and vegetables)

Further advice and information on cyclosporiasis is available on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

Source: TRAVAX, 7 September 2021

The European Environment Agency (EEA) has published a briefing on innovation and sustainability, reflecting on how social and technological innovation could contribute to more sustainable societies by avoiding technology-sourced, man-made environmental problems, and by shifting emphasis from technology-driven to people-driven solutions. It is believed new governance mechanisms and balancing experimentation with precaution can channel the potential of different types of innovation towards sustainability.

The briefing argues for an innovation governance that enables citizens and societies to participate and engage in positive, transformative change beyond consumer choices.

Source: EEA, 9 September 2021

World Patient Safety Day, on 17 September 2021, 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.

This year’s campaign is dedicated to the need to prioritise and address safety in maternal and new-born care, particularly around the time of childbirth, when most harm occurs. The campaign finds that this is especially important in the context of disruption to health services caused by the COVID-19 pandemic, which has further compounded the situation.

Commenting on some women’s experiences during childbirth are affected by issues of gender equity and violence, the campaign has also highlighted the important notion of respectful care and its linkages with safety.