On 7 December 2021, Public Health Scotland (PHS) updated their immunisation and vaccine-preventable diseases web page to reflect the latest quarterly data on:

• Haemophilus influenza 
• invasive pneumococcal disease 
• measles 
• meningococcal disease 
• mumps 
• pertussis 
• rotavirus 
• rubella 
• shingles

International travel continues to be impacted due to COVID-19, and the number of variant strains which have emerged globally. Guidance on international travel is available for people living in Scotland, England, Wales and Northern Ireland. As of 6 December 2021, eleven countries have been added to the UK international travel red list following concerns about cases of the emerging B.1.1.529, or Omicron, variant identified in southern Africa.

As of 30 November 2021, fully vaccinated travellers who are entering Scotland from any destination will have to take a PCR test by the end of the second day after arrival, and will have to self-isolate until they get a negative result. They must also complete a Passenger Locator Form (PLF). Additionally, travellers who are not fully vaccinated must take a second PCR test by the end of the eighth day after arrival, and isolate at home or in the place they are staying for ten days.

Travellers returning to Scotland from countries on the international travel red list will be required to self-isolate in managed quarantine accommodation and take two PCR tests, regardless of their vaccination status. Currently, the countries and territories on the UK red list are: 

• Angola 
• Botswana 
• Eswatini 
• Lesotho 
• Malawi 
• Mozambique 
• Namibia 
• Nigeria
• South Africa 
• Zambia 
• Zimbabwe

It should be noted that the travel lists may be amended at short notice, and do not indicate which destinations are currently allowing UK travellers to enter their country, nor if the Foreign, Commonwealth and Development Office (FCDO) advises against travel to these countries. Information relating to this can be checked on the relevant FCDO foreign travel advice country pages.

Testing and quarantine rules may differ in Scotland, England, Wales and Northern Ireland, therefore travellers must ensure they 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 include a COVID-19 country specific risk-rating, which identifies the risk of exposure to COVID-19 for UK travellers. This information is 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 identifies each country as having either a: 

• high risk of exposure to COVID-19 for UK travellers 
• risk of exposure to COVID-19 for UK travellers

For all countries, travellers should be aware that the risk of COVID-19 may change at short notice. Countries categorised as having a high risk of exposure to COVID-19 either have a high risk of exposure for travellers to COVID-19, or a high risk of emerging or known variants of coronavirus. Travellers should be advised to avoid non-essential travel to high risk countries, even if fully vaccinated against COVID-19.

In addition to the international travel list, as of 1 December 2021, the following countries have a FCDO advisory warning against travel, and are therefore classified as having a high risk of exposure to COVID-19 for UK travellers: 

• Afghanistan 
• Angola
• Botswana
• Burundi 
• Democratic People's Republic of Korea 
• Eswatini (Swaziland)
• Guinea-Bissau 
• Haiti 
• Lesotho
• Malawi
• Mozambique
• Namibia
• Nicaragua 
• Papua New Guinea 
• South Africa
• Timor Leste (East Timor)
• Turkmenistan 
• Venezuela 
• Yemen
• Zambia
• Zimbabwe

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. 

• The FCDO foreign travel advice country pages have up-to-date information on 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 COVID-19 health considerations for travel page.

Source: TRAVAX, November 2021

According to media reports, the Ghana Health Service has reported 39 deaths from yellow fever between mid-October and 26 November 2021, with cases reported in the Savannah, Upper West, Northern, Oti and Bono regions. 

Yellow fever is endemic in Ghana, although these are the first cases reported since 2019. The disease 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, 30 November 2021

The UN Office for the Coordination of Humanitarian Affairs reports that the outbreak of Ebola virus disease (EVD), which began on 10 October 2021 in North Kivu Province, Democratic Republic of the Congo (DRC), remains stable.

The most recent case was reported on 30 October 2021 and discharged five days later. As of 26 November 2021, the total number of cases stands at 11, including nine deaths. Since November 21 2021, 1,045 contacts have left their 21-day follow-up period.

EVD is a type of viral haemorrhagic fever (VHF), which is spread through contact with the blood, body fluids or organs of a person or animal with the infection.

Advice for travellers

The risk to travellers becoming infected or developing EVD is extremely low. 

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

Travellers returning from an Ebola 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 EVD  
• had contact with individuals infected with a VHF

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

Source: TRAVAX, 29 November 2021

The European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe have published a report of the latest surveillance data on HIV and AIDS in the WHO European Region and in the EU and EEA in 2020.

Over the course of the last three decades, over 2.2 million people have been diagnosed and reported with HIV in the WHO European Region, including over 560,000 people in the EU and EEA. In 2020, 104,765 people were newly diagnosed with HIV, and of this number, 81% were in the east of the region, 15% in the west and 4% in the centre. Newly diagnosed infections in the Russian Federation contributed 57% of all cases in the WHO European Region, and the share of cases reported from Ukraine was 15%.

Source: ECDC, 30 November 2021

The European Centre for Disease Prevention and Control (ECDC) has published its tenth external quality assessment (EQA-10) scheme for typing of Shiga toxin-producing Escherichia coli (STEC).

Human STEC infection is a zoonotic disease, which in 2019 had an EU notification rate of 2.2 cases per 100,000 of the population, a similar rate to that reported in 2018. The most commonly reported STEC O group was O157, compromising 26.6% of cases with known serogroup. The EQA-10 contains serotyping, detection of virulence genes and molecular typing-based cluster analysis.

Source: ECDC, 30 November 2021

The European Centre for Disease Prevention and Control (ECDC) has published its 2019 external quality assessment (EQA) scheme for Neisseria gonorrhoeae antimicrobial susceptibility testing.

In July 2019, 28 laboratories in 27 participating countries received 10 gonococcal isolates for antimicrobial susceptibility testing. The highest level of categorical agreement, other than 100% production of betalactamase, was seen with spectinomycin (99.7%) and ceftriaxone (99.1%), while the lowest was with ciprofloxacin (91.1%). In comparison to previous distribution, the largest increase for categorical agreement was observed for azithromycin (92.5% in 2019 compared to 77.6% in 2018) and the largest decrease for ciprofloxacin (91.1% in 2019 compared to 98.1% in 2018).

Source: ECDC, 3 December 2021

Food Standards Scotland (FSS) has launched a campaign urging families to be extra vigilant with food safety over the Christmas season, encouraging people to ensure effective safety practices are used to minimise the risk of illness.

The message is being delivered via advertising on social media, radio and on billboards in busy public places, using a series of images showing the ill effects of food poisoning, under the headline ‘Christmas isn’t so magical with food poisoning’.

FSS has also produced a Christmas food safety checklist, highlighting the best ways of reducing the risks of food poisoning.

Source: FSS, 1 December 2021

The European Food Safety Authority (EFSA) has completed assessments of emergency authorisations granted by 11 EU member states for the use of neonicotinoid-based insecticides on sugar beet in 2020 and 2021.

The assessments cover 17 emergency authorisations for plant protection products containing clothianidin, imidacloprid, thiamethoxam and thiacloprid granted by Belgium, Croatia, Denmark, Finland, France, Germany, Lithuania, Poland, Romania, Slovakia and Spain.

Outdoor use of imidacloprid, thiamethoxam and clothianidin in the EU was banned in 2018 and, in January 2020, the approval of thiacloprid was not renewed. The measures followed assessments by the EFSA which showed that the first three substances posed risks to bee health, while the use of thiacloprid could lead to contamination of groundwater.

In 2020, the European Commission asked the EFSA to assess whether the emergency authorisations granted by the member states were justified, as there was a reported danger to crops which could not be contained by any other reasonable means, in line with the EU Plant Protection Products Regulation.

The EFSA has concluded that in all 17 cases the emergency authorisations were justified, either because no alternative products or methods, chemical or non-chemical, were available, or because there was a risk that the pest could become resistant to available alternative products. 

Source: EFSA, November 2021