On 21 September 2021, the Healthcare Associated Infection (HAI) annual report 2020 was published by Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Scotland. The report reflects the work undertaken on healthcare associated infection (HCAI) prevention and reducing antimicrobial resistance (AMR) during 2020. Data are provided for common HCAIs, which are an important cause of severe illness, death, and higher treatment costs.

This year the report also includes analysis of hospital onset COVID-19 and its impact on other Scottish national surveillance systems. The global pandemic brought unique challenges during 2020, and ARHAI Scotland within NHS National Services Scotland has been a key part of the national COVID-19 response to the pandemic.

This report details the progress made by ARHAI Scotland to support the reduction of HCAIs in NHS Scotland, as well as providing data to inform local and national HCAI prevention activities.

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.

From 4 October 2021, the current traffic light system for travel to the UK is set to be simplified, with the green and amber lists merging, and a red list remaining for countries with high case numbers and variants of concern. It should be noted that neither the current traffic light system, nor the list changes that will come into effect in October 2021, indicate which destinations allow 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 22 September 2021, Scotland, England, Wales and Northern Ireland will update their rules regarding return travel to the UK from eight current red 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.

Since 15 September 2021, the COVID-19 risk to UK travellers has been increased for the following countries and territories: 

• Anguilla 
• Antigua and Barbuda 
• Brunei Darussalam 
• Grenada 
• Republic of North Macedonia 
• Saint Kitts and Nevis

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

Since the start of the 2021 West Nile virus (WNV) transmission season, up to 9 September 2021, the European Centre for Disease Prevention and Control (ECDC) has reported 87 cases of West Nile fever in EU and EEA countries, comprising of 43 cases in Greece (including three deaths), 27 in Italy, 12 in Serbia (including two deaths), five in Spain (including one death), four in Romania (including one death), three in Austria, three in Hungary and two in Germany.

West Nile fever is caused by West Nile virus (WNV) and occurs annually in southern and central Europe. The virus is spread by mosquito bites and can cause a flu-like illness and, on rare occasions, severe disease.

Advice for travellers

Travellers should be advised to: 

• practice mosquito bite avoidance measures at all times, especially at dusk and dawn during peak transmission times and when outbreaks are known to be occurring 
• seek medical advice if they develop a sudden onset of flu-like symptoms with fever following travel to a risk area

Blood donors should note that if they have travelled to an area where WNV has been detected in the past four months, they may need to be tested for the virus before donating blood. All travel must be mentioned to the blood transfusion service so that they can determine whether a test is required. The Scottish National Blood Transfusion Service (SNBTS) has produced a leaflet which details information about blood donation after travel.

It should be noted there is no vaccine which protects against WNV.

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

Source: TRAVAX, 14 September 2021

As of 10 September 2021, public health authorities have reported approximately ten cases of leptospirosis in the Ariege department of France, a mountainous area near the border with Spain. All people infected were involved in water activities in the River Argensou at Auzat, and anyone who becomes unwell after fishing, swimming or canyoning in the area have been advised to seek medical attention.

Advice for travellers 

• Leptospirosis is a bacterial infection transmitted to humans from the urine of infected animals, often rodents. Infection often occurs from water contaminated by infected animal urine. 
• Travellers participating in adventure or ecotourism, water-based sports activities, athletic endurance events, mountain biking, and military exercises have an increased chance of exposure, especially if travelling to high-risk destinations.

No licensed vaccine is available in the UK for leptospirosis.

Travellers at increased risk of leptospirosis are advised: 

• to be aware of the risk of infection and to seek medical help if they become symptomatic 
• to avoid exposure to potentially contaminated water especially of mucosa (swallowing or inhaling water) and abraded skin, including excoriated insect bites 
• to wear protective clothing if exposure is unavoidable 
• to cover open skin lesions with waterproof plasters and wash and disinfect any injuries sustained during possible exposure 
• to wash or shower thoroughly after possible exposure

Information and advice for travellers on leptospirosis is available from the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

Source: TRAVAX, 10 September 2021

The World Health Organization (WHO) reports that Guinea declared the end of the recent Marburg virus disease outbreak on 15 September 2021. There had been no new cases since the first was diagnosed on 9 August 2021.

Advice for travellers

Marburg virus disease is a type of viral haemorrhagic fever (VHF). Humans may become infected from direct contact with the reservoir host, African fruit bats or from direct contact or droplet spread from infected humans or non-human primates. The risk to travellers becoming infected or developing Marburg virus disease is extremely low.

• Travellers to known Marburg outbreak areas must be made aware of the risk of infection and transmission routes of Marburg virus. 
• Medical personnel travelling to work in an outbreak region must follow strict infection prevention control guidance.

Travellers returning from a Marburg outbreak area should seek rapid medical attention by contacting NHS 24 (Scotland) or NHS 111 (rest of UK) for advice prior to attending UK medical facilities if they develop fever and have: 

• returned to the UK within 21 days from a region or area with a known outbreak of Marburg virus disease 
• had contact with individuals infected with a VHF

Information and advice for travellers on VHFs are available from the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

Source: TRAVAX, 17 September 2021

On 14 September 2021, the European Centre for Disease Prevention and Control (ECDC) published the poliomyelitis annual epidemiological report for 2018.

The World Health Organization (WHO) European Region was declared polio-free in 2002. Neither wild-type nor vaccine-type viruses were notified in 2019, however the risk of importation and subsequent transmission remain high in some countries.

Source: ECDC, 14 September 2021

On 13 September 2021, the European Centre for Disease Prevention and Control (ECDC) published the tuberculosis (TB) annual epidemiological report for 2019.

In 2019, 29 countries in the EU and EEA reported a total of 49,752 TB cases, a notification rate of 9.6 cases per 100,000 of the population. Despite a decline in the overall TB notification rate, the EU and EEA are not on track to reach the goal of ending the TB epidemic by 2030.

Multidrug resistance (MDR) was reported for 3.4% of TB cases with drug susceptibility testing results reported. Extensive drug resistance (XDR) was reported for 22.4% of MDR TB cases that underwent second-line drug susceptibility testing.

In total, 19 countries reported HIV status for 16,088, or 78%, of 20,620 TB cases in 2019. Of cases with known HIV status, 502, or 3.1%, were reported as HIV positive. Among the 16 countries with at least 50% reporting completeness for HIV status, co-infection cases were highest in Belgium (8.7%), Estonia (11.3%), Hungary (9.4%), Ireland (9.4%), and Portugal (11.0%). Compared with 2018, there was a decrease in the number of countries that reported the HIV status of TB cases, and only 32.3% of all TB cases notified in 2019 had known HIV status.

Source: ECDC, 14 September 2021

The Scottish Government has published its first quarterly statistics on the number of suspected drug deaths during the first half of 2021. This first report covers January to June 2021, after which they will show statistics for each subsequent three-month period.

The new statistics show that in the first six months of 2021: 

• there were 722 suspected drug deaths, 1% fewer than during the first six months of 2020 
• males accounted for 72% of suspected drug deaths, compared to 76% during the same period last year 
• just over two-thirds of suspected drug deaths were in people aged between 35 and 54 
• there were 35 suspected drug deaths in the under 25 age group, 29% fewer than during the first six months of 2020 
• the police divisions with the highest numbers of suspected drug deaths were Greater Glasgow (187), Lanarkshire (67), Edinburgh City (64) and Tayside (64)

Source: Scottish Government, 14 September 2021

The UK will host the 26th UN Climate Change Conference of the Parties (COP26) in Glasgow, from 31 October to 12 November 2021. The Scottish Government has announced details of Scotland’s community climate change engagement programme ahead of the summit, with the aim of engaging communities in the journey to net-zero.

The programme, led by Keep Scotland Beautiful and the Glasgow Science Centre, aspires to include communities that have not previously been involved in climate action, as well as engaging young people through schools and youth groups. 

Source: Scottish Government, 9 September 2021

Every year since 2011, World Environmental Health Day has been celebrated on 26 September.

This year’s theme, ‘Prioritising environmental health for healthier communities in global recovery’, focuses on the integral connection between the environment, health and the economy, promoting investment in healthy and green recovery from the COVID-19 pandemic.

More information on World Environment Day 2021 can be found on the International Federation of Environmental Health (IFEH) website.