The report on quarterly epidemiological data for Clostridioides difficile infection (CDI), Escherichia coli bacteraemia (ECB), Staphylococcus aureus bacteraemia (SAB), and surgical site infection (SSI) in Scotland, April to June (Q2) 2021, was published on 5 October 2021, under the mandatory programmes for surveillance of CDI, ECB, SAB, and SSI in Scotland. Please note that data for SSI are not included due to the pausing of surveillance to support the COVID-19 response.

This report provides data for the second quarter of 2021 in 14 NHS boards and one NHS special health board. In addition, an appendix can also be accessed which details all cases and denominator data for each NHS board and overall for Scotland.

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.

On 4 October 2021, the traffic light system for travel to the UK was 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 the lists do not 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 updated 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.

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

The Nigeria Centre for Disease Control continues to report transmission of cholera in the country, with 1,182 suspected cases recorded by 13 Nigerian states in the week ending 12 September 2021. Since the beginning of 2021, 72,910 suspected cholera cases, including 2,404 deaths, have been reported from 27 states and the Federal Capital Territory.

Travellers to the region are advised to only consume safe food and water. Food and drink to be wary of include untreated water, ice, shellfish, salads, unwashed fruit and vegetables. Travellers are also advised that good personal hygiene is essential, particularly frequent hand washing.

A vaccine is available to protect against cholera, but as the risk to most travellers is very low, it is only recommended for: 

• volunteers, aid workers and medical personnel in disaster relief situations where cholera outbreaks are likely  
• those travelling to work in slums or refugee camps, areas affected by natural disasters, or countries experiencing cholera outbreaks and where care with food and water is difficult or not possible

Further information relating to cholera can be found on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

Source: TRAVAX, 24 September 2021

The European Centre for Disease Prevention and Control (ECDC) has published an overview of avian influenza for the period May to September 2021. Between 15 May and 15 September 2021, 162 highly pathogenic avian influenza (HPAI) virus detections were reported in 17 EU and EEA countries, and the UK, in poultry, wild and captive birds. The most affected countries were Kosovo with 20 cases, Poland with 17 cases and Albania with six cases.

The data presented in this report indicates that the HPAI virus is still circulating in domestic and wild bird populations in some European countries, and that the epidemic is not over yet. Based on these observations, it appears that the persistence of HPAI A(H5) in Europe continues to pose a risk of further virus incursions in domestic bird populations. Furthermore, during the summer, HPAI viruses were detected in poultry and several wild bird species in areas in Russia that are linked to key migration areas of wild waterbirds. The ECDC report that this is of concern due to the possible introduction and spread of novel virus strains via wild birds migrating to EU countries during the autumn from eastern breeding areas to the overwintering sites. In total, 19 different virus genotypes have been identified so far in Europe and Central Asia since July 2020, confirming a high propensity for this virus to undergo reassortment events.

Since the last ECDC avian influenza summary report in May 2021, 15 human infections due to A(H5N6) HPAI and five human cases due to A(H9N2) low pathogenic avian influenza (LPAI) virus have been reported from China.

Source: ECDC, 30 September 2021

On 28 September 2021, the World Health Organization (WHO) and partners launched the first global strategy to defeat meningitis, a debilitating disease that kills hundreds of thousands of people each year. By 2030, the goals are to eliminate epidemics of bacterial meningitis, halve the number of overall cases, and reduce deaths by 70%. The WHO estimate that this could save more than 200,000 lives annually, and significantly reduce disability caused by the disease.

The strategy was launched by a broad coalition of partners involved in meningitis prevention and control, and it has a focus on preventing infections and improving care and diagnosis for those affected. The new roadmap highlights several priorities for meningitis response and prevention.

• Achievement of high immunisation coverage, development of new affordable vaccines, and improved prevention strategies and outbreak response. 
• The speedy diagnosis and optimal treatment for patients. 
• Production of good data to guide prevention and control efforts. 
• Care and support for those affected, focusing on early recognition and improved access for those suffering with meningitis after-effects. 
• Advocacy and engagement, to ensure high awareness of meningitis, accountability for national plans, and affirmation of the right to prevention, care and after-care services.

Source: WHO, 28 September 2021

The European Environment Agency (EEA) has published a briefing describing the effects of industrial pollution, based on emission data from the European Pollutant Release and Transfer Register (E-PRTR). The analysis is part of EEA’s ongoing activities to assess the impacts of air pollution in Europe, and shows that, despite significant progress in reducing its environment and climate impacts, the societal costs of industrial air pollution remain high.

The briefing contains several key messages. 

• Europe’s industry has made significant progress in reducing its environment and climate impacts. However, the societal costs or externalities caused by air pollution from the sector remain high and include damage to human health, ecosystems, infrastructure and the climate. 
• A small number of industrial facilities are responsible for 50% of the damage caused by air pollution, mostly emitted from within Germany, the UK, Poland, Spain and Italy. When these costs are compared to GDP as an indicator of relative environmental performance per unit of national economic output, the top five comprises Estonia, Bulgaria, Czech Republic, Poland and Slovakia. 
• Europe’s Green Deal and zero-pollution targets are an opportunity for change, with industry engaged in the conversation.

Source: EEA, 29 September 2021

The European Environment Agency (EEA) has published a report focusing on the state of European nature and its habitats and species, examining conservation, data collection and strategies to restore biodiversity and ecosystems.

The report emphasises that European ecosystems are under serious threat, stating centuries of exploitation have left their mark on Europe’s natural world and that most protected habitats and species are not in good conservation status.

Source: EEA, 30 September 2021

The Scottish Government has launched a consultation on the future role of the Scottish Fire and Rescue Service (SFRS), as it adapts to meet new challenges. The overriding purpose of SFRS will remain the protection of communities, preventing fires and reducing their impact on society while maintaining the safety and mental wellbeing of staff. However, the consultation is also asking the public about the increasing impact of climate change and the need for SFRS to take account of greater risks from flooding and wildfires.

Other key issues in the consultation on an updated Fire and Rescue Framework for Scotland include: 

• use of new technology and modernisation of facilities and equipment 
• effective use of resources 
• keeping rural communities safe

The consultation paper is available from the Scottish Government website, and participants can fill in the online form to give their views. The consultation closes on 22 December 2021.

Source: Scottish Government, 29 September 2021