On 5 April 2022, quarterly epidemiological data on Clostridioides difficile infection (CDI), Escherichia coli bacteraemia (ECB), Staphylococcus aureus bacteraemia (SAB), and surgical site infection (SSI) in Scotland, covering October to December (Q4) 2021, was published under the mandatory programmes for surveillance of CDI, ECB, SAB, and SSI in Scotland. Please note, data for SSI are not included due to the pausing of surveillance to support the COVID-19 response.

This report provides data for the fourth 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 for Scotland overall.

On 1 April 2022, Public Health Scotland (PHS) published the latest Needle Exchange Surveillance Initiative (NESI) report. The aim of NESI is to measure and monitor the prevalence of blood-borne viruses, including hepatitis C virus (HCV) and HIV, and injecting risk behaviours among people who inject drugs (PWID) in Scotland. NESI provides information to evaluate and better target interventions aimed at reducing the spread of infection amongst PWID.

This latest report presents the results at:

• Scotland level across seven surveys, from 2008 to 2009 through to 2019 to 2020
• NHS board level for the 2019 to 2020 survey, for eight of the 11 mainland Scottish NHS boards

The initiative was initially funded by the Scottish Government as part of the Hepatitis C Action Plan, which stated that efforts to prevent HCV in Scotland must focus on preventing transmission of the virus among PWID. More recently, the initiative has been funded under the Scottish Government’s Sexual Health and Blood Borne Virus Framework.

Since 1 April 2022, the process to access free travel advice and vaccines in Scotland has changed, with the fitfortravel website now the national entry point for accessing all NHS Scotland travel health services.

Advice for travellers

Travellers should first review the country page for their planned destination(s) to find information on:

• advisable vaccines and malaria risks for that country
• other measures that need to be taken to avoid health risks in that country

A travel health risk assessment is required for travellers requiring vaccines or malaria advice, ideally this should take place at least six to eight weeks before planned travel.

A travel health risk assessment is advisable for some people, even when vaccines or malaria tablets are not required. This includes:

• older people
• those with a weakened immune system
• those with long-term conditions that require medications
• pregnant women
• children

Appointments can be made with travel health professionals via local health boards.

Source: fitfortravel, 1 April 2022

The World Health Organization (WHO) has reported an outbreak of yellow fever in Uganda, with eight cases having been noted from the Masaka and Wakiso districts as of 16 March 2022. Masaka District is on the north-western shore of Lake Victoria, while Wakiso District is on the western boundary of Kampala, the capital city. Yellow fever occurs in Uganda, although large outbreaks are uncommon.

The WHO has also reported a growing outbreak of yellow fever in Kenya, with 56 cases, including six deaths, being noted in Isiolo County, which is located to the north of Nairobi. These figures have been reported from 12 January to 15 March 2022, and a public health alert has been raised in all 47 counties of Kenya, particularly in the high-risk counties of Wajir, Garissa, Marsabit, Meru, Samburu, Baringo, Elgeyo Marakwet, West Pokot and Turkana. While yellow fever is endemic in Kenya, large outbreaks are uncommon.

Yellow fever is an acute viral haemorrhagic disease which is transmitted by the day biting Aedes mosquito, found in tropical areas of Africa and Central and South America. All travellers should be advised to practice mosquito bite avoidance at all times.

Advice for travellers

A traveller's risk of yellow fever is determined by their individual risk assessment, with factors influencing their risk including:

• the country, or countries, being visited
• length of stay
• rate of transmission at destination
• immunisation status
• planned activities

Unvaccinated travellers who visit yellow fever endemic areas are at risk of becoming infected. Unless contraindicated, yellow fever vaccine should be considered for travellers at risk.

Further information for health professionals can be found on the TRAVAX country pages for Uganda and Kenya, and the TRAVAX yellow fever webpage, while the general public can access further information on the fitfortravel country pages for Uganda and Kenya, and the fitfortravel yellow fever webpage.

Sources: TRAVAX, 30 March 2022 and TRAVAX, 29 March 2022

On 25 March 2022, the UK Health Security Agency (UKHSA) confirmed that a case of Crimean-Congo haemorrhagic fever (CCHF) has been identified in England, from a female who had travelled to Central Asia. Prior to this, there have been only two cases of CCHF imported to the UK, in 2012 and 2014. There was no evidence of onward transmission from either of these cases.

CCHF is a viral disease usually transmitted by ticks and livestock animals in countries where the disease is endemic. The disease does not spread easily between people and the overall risk to the public is very low.

The principal carriers of CCHF are Hyalomma ticks, however these are not established in the UK and the virus has never been detected here in a tick.

People living in, or visiting, endemic areas should use personal protective measures to avoid contact with ticks, including:

• avoiding areas where ticks are abundant at times when they are active
• using tick repellents
• checking clothing and skin carefully for ticks

More information on CCHF can be found on the UKHSA website.

Source: UKHSA, 25 March 2022

On 29 March 2022, the European Centre for Disease Prevention and Control (ECDC) and the European Food Safety Authority (EFSA) published their joint annual summary report regarding data on antimicrobial resistance (AMR) in zoonotic and indicator bacteria from humans, animals and food In EU member states.

Monitoring and reporting of AMR in 2019 to 2020 included data regarding Salmonella, Campylobacter and indicator Escherichia coli (E. coli) isolates, as well as data obtained from the specific monitoring of presumptive ESBL-/AmpC-/carbapenemase-producing E. coli isolates. Additionally, some member states reported voluntary data on the occurrence of methicillin-resistant Staphylococcus aureus in animals and food, with some countries also providing data on antimicrobial susceptibility.

The report provides an overview of the main findings of the 2019 to 2020 harmonised AMR monitoring in the main food-producing animal populations monitored, in carcase or meat samples, and in humans. Where available, monitoring data obtained from pigs, calves, broilers, laying hens and turkeys, as well as from carcase or meat samples and humans, were combined and compared at the EU level, with particular emphasis on multidrug resistance, complete susceptibility and combined resistance patterns to critically important antimicrobials, as well as Salmonella and E. coli isolates possessing ESBL-/AmpC-/carbapenemase phenotypes.

The key outcome indicators for AMR in food-producing animals, such as complete susceptibility to the harmonised panel of antimicrobials in E. coli and the prevalence of ESBL-/AmpC-producing E. coli have been specifically analysed over the period 2014 to 2020.

The report found the antibiotic resistance in Salmonella and Campylobacter bacteria is still high, with campylobacteriosis being the most reported zoonosis in the EU in 2020 and the most frequently reported cause of foodborne illness. Campylobacter bacteria from humans and poultry continues to show very high resistance to ciprofloxacin, a fluoroquinolone antibiotic, that is commonly used to treat some types of bacterial human infection.

Increasing trends of resistance against the fluoroquinolone class of antibiotics has been observed in humans and broilers for Campylobacter jejuni (C. jejuni). In Salmonella Enteritidis (S. Enteritidis), the most common type of Salmonella in humans, increasing trends of resistance to the quinolone and fluoroquinolone class of antibiotics were observed. In animals, resistance to these antibiotics in C. jejuni and S. Enteritidis were generally moderate to high.

However, despite the increasing trends of resistance against certain antibiotics, simultaneous resistance to two critically important antibiotics remains low for E. coli, Salmonella and Campylobacter in bacteria from both humans and food-producing animals.

A decline in resistance to tetracyclines and ampicillin in Salmonella from humans was observed in nine and ten countries, respectively, over the period 2016 to 2020, and this was particularly evident in Salmonella Typhimurium. Despite the decline, resistance to these antibiotics still remains high in bacteria from both humans and animals.

Furthermore, in more than half of EU countries, a statistically significant decreasing trend in the prevalence of extended-spectrum β-lactamase (ESBL)-producing E. coli was observed in food-producing animals. This is an important finding as particular strains of ESBL-producing E. coli are responsible for serious infections in humans.

Carbapenem resistance remains extremely rare in E. coli and Salmonella from food-producing animals. Carbapenems are a class of last resort antibiotics and any findings showing resistance to these in zoonotic bacteria are concerning.

Although findings and trends are consistent with data reported in previous years, the COVID-19 pandemic had an impact on the amount of data reported, particularly with regards to public health.

Sources: ECDC, 29 March 2022 and EFSA, 29 March 2022

On 21 March 2022, the World Health Organization (WHO) published new guidelines for the clinical management of severe illness from influenza virus infections, providing recommendations on the use of influenza antivirals, adjunctive therapies and diagnostic strategies.

The new guidelines are intended to guide clinicians in their care of patients with, or at risk, of severe illness from seasonal, zoonotic or pandemic influenza. The guidelines were developed using a robust method that included commissioning systematic reviews and evaluating the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Each guideline was reviewed by an external review group and approved by the WHO’s Guideline Review Committee.

The guidelines provide recommendations on:

• treatment with antivirals, specifically neuraminidase inhibitors
• treatment with adjunctive therapies, specifically corticosteroids, macrolides and passive immune therapy
• the use of diagnostic testing strategies in guiding treatment

The WHO will continue to monitor new evidence for influenza antivirals, adjunctive therapies and diagnostics, and will provide updates as and when relevant.

Source: WHO, 21 March 2022

On 30 March 2022, the World Health Organization (WHO) announced the publication of a ten-year strategy aimed at strengthening and scaling-up genomic surveillance around the world. While the strategy is not specific to a single pathogen or disease threat, it will provide a high-level unifying framework to leverage existing capacities, address barriers and strengthen the use of genomic surveillance worldwide.

Genomic surveillance is the process of constantly monitoring pathogens and analysing their genetic similarities and differences, and helps researchers, epidemiologists and public health officials monitor the evolution of infectious diseases agents, alert on the spread of pathogens, and develop counter measures, such as vaccines. Various public health programmes, from Ebola to cholera, use genomic surveillance to understand a pathogen at its molecular level, but COVID-19 has highlighted the challenges of bringing genomics to scale.

Data collected by the WHO show that in March 2021, 54% of countries had this capacity, and by January 2022, thanks to the major investments made during the COVID-19 pandemic, that number had increased to 68%. Even greater gains were made in the public sharing of sequence data, as by January 2022, 43% more countries published their sequence data compared to the year before.

The WHO report that, despite this fast progress, much remains to be done. Any new technology comes with the risk of increasing inequity, which is one of the gaps this strategy targets. The complexities of genomics and the challenges of sustaining capacities in different settings, including workforce needs, means that most countries cannot develop these capabilities on their own. It is hoped the global strategy will provide a unifying framework for action, and the WHO will work with countries and other partners with this.

Source: WHO, 30 March 2022

On 31 March 2022, the Scottish Environment Protection Agency (SEPA) has published its Scottish Pollutant Release Inventory (SPRI) data for 2020, following a cyber-attack in December 2020.

The SPRI, which is a publicly accessible electronic database providing information to policy makers, academics and the public about the pressure Scottish industry puts on the environment through pollutant emissions, provides a picture on the number of pollutants released in Scotland from SEPA regulated industrial sites. The SPRI does not assess the compliance of the facilities or the health and environmental impact of the releases.

The latest data reveals greenhouse gas emissions fell by 6% between 2019 and 2020, with this reduction continuing the decreasing trend seen over the last 13 years, with an overall drop of around 60% since 2007.

In rounded kilogram (kg) totals, the data show that between 2019 and 2020, emissions of:

• carbon dioxide fell by 6%, from 11,400,000,000 to 10,600,000,000kg
• methane fell by 3%, from 26,700,000 to 26,000,000kg
• nitrous oxide fell by 24%, from 96,500 to 73,500kg
• hydrofluorocarbons (HFCs) rose by 188%, from 1,260 to 3,640kg
• perfluorocarbons (PFCs) rose by 2%, from 3,940 to 4,010kg
• sulphur hexafluoride rose by 3%, from 221 to 227kg

Around a third of the sites that report pollutant emissions to SPRI each year noted a significant difference in their 2020 data compared to 2019, which is in line with previous years. However, unlike past datasets, more than 30 sites from across multiple sectors mentioned the coronavirus pandemic as having an impact on their emissions, with possible reasons including temporary site closures due to restrictions and a change to how data is reported. Production levels also shifted during the pandemic, with a drop in emissions reported at energy sites as a result of fewer people travelling during lockdowns and less demand for transport related fuel, while an increase was recorded at others where there was involvement in manufacturing medical supplies.

SEPA also report that the 188% increase in HFCs between 2019 and 2020 can be linked to multiple factors, with regulatory work to investigate the three sites in the chemicals sector reporting HFCs being ongoing. Two food and beverage sites released HFCs in 2020, with both having accidental releases, and both have taken steps to upgrade their refrigeration to a non-F-gas system since 2020.

Source: SEPA, 31 March 2022

On 29 March 2022, the Scottish Government published the third version of the Fire and Rescue Framework for Scotland, providing the Scottish Fire and Rescue Service (SFRS) with strategic priorities and guidance on how to deliver progress towards improving safety in Scottish communities.

The overriding purpose of the SFRS remains working with communities and partners to improve the safety and well-being of people throughout Scotland, including preventing fires and reducing their impact on society, while maintaining the safety and mental wellbeing of SFRS staff.

The framework also highlights the increasing impact of climate change with greater risks from increased flooding and wildfires, while stressing the importance of the SFRS making a full contribution to the Scottish Government’s Net Zero emissions targets.

Source: Scottish Government, 29 March 2022

On 30 March 2022, the European Food Safety Authority (EFSA) published their latest annual report on pesticide residues in food, covering more than 88,000 food samples collected throughout the EU in 2020. Analysis of the results shows that 94.9% of samples fell within legally permitted levels, while for the subset of 12,077 samples analysed as part of the EU-coordinated control programme (EU MACP), 98.2% were within legal limits.

The EU MACP analyses samples randomly collected from 12 food products, with the same products being sampled every three years, which means upward or downward trends can be identified for specific goods. Of those samples analysed in the coordinated programme:

• 8,278 samples (68.5%) were found to be free of quantifiable levels of residues
• 3,590 samples (29.7%) contained one or more residues in concentrations below or equal to permitted levels
• 209 samples (1.7%) contained residues exceeding the legal maximum, of which 113 samples (0.9%) were non-compliant

The detailed results of the coordinated programme are available on EFSA’s website as browsable charts and graphs, making the data more accessible to non-specialists.

As well as the harmonised and comparable data collected under the coordinated programme, EFSA’s annual report also includes data collected as part of the national control activities carried out by individual EU member states, Norway and Iceland. The national control programmes are risk-based, targeting products that are likely to contain pesticide residues or for which legal infringements have been identified in previous years. These programmes give important information to risk managers but, unlike the data from the EUCP, they do not provide a statistically representative picture of the levels of residues expected in food sold in shops across Europe.

The results from the monitoring programmes are used to estimate dietary exposure of EU consumers to pesticide residues. EFSA carried out a dietary risk assessment as part of its analysis of the results, which suggests that the food commodities analysed in 2020 are unlikely to pose a concern for consumer health. However, EFSA have proposed a number of recommendations aimed at increasing the efficiency of European control systems, aimed at ensuring a high level of consumer protection.

Source: EFSA, 30 March 2022

On 28 March 2022, Food Standards Scotland (FSS) published a situation report which found that, since the COVID-19 pandemic, around one-third (34%) of parents in Scotland reported their own diet has become less healthy, with 17% describing that their child’s diet was also negatively affected. The findings also highlight further evidence linking the impact the pandemic has had on the nation’s health, especially those living in Scotland’s most deprived areas, with 70% of Scottish adults being overweight or obese.

The publication of the report comes as new Scottish Health Survey data revealed nearly 40% of people say their weight has increased since March 2020, with issues such as EU exit and climate change, as well as COVID-19, being linked to eating habits.

The report has revealed that 88% of adults in Scotland understand that an unhealthy diet can lead to poor health. From March 2020, with more time spent at home, snacking increased by over 30%. Trips to takeaways also doubled largely due to the restrictions on the out of home (OOH) market which includes restaurants, cafes and pubs. Additionally the report finds that discretionary products, such as cakes, biscuits, pastries, savoury snacks, sugary drinks and drinks containing alcohol, represent a high proportion of food purchased, particularly within households in the most deprived areas of Scotland.

FSS’s findings echo those of Obesity Action Scotland, which also launched two publications on the state of the nation’s health, who report that people living with overweight and obesity were at greater risk of serious illness from COVID-19, alongside a heightened risk of other health conditions, such as diabetes and cancer

FSS recently launched their Eat Well, Your Way resource and campaign, aimed at encouraging people to make simple changes in helping improve their diet, by offering a variety of straightforward steps and useful advice, as well as helping those shopping on a tight budget, and consumers who are more sustainability conscious.

Source: FSS, 28 March 2022

Following a joint consultation by all four UK nations, it has been announced that producers will be responsible for waste created by their products, and the costs entailed with this packaging. Fees will be weighted, with producers paying more for packaging that is harder to reuse or recycle. It is hoped this will encourage businesses to use less packaging and to ensure what they do use is either recyclable or reusable. Fees charged will help fund improved local recycling collections of packaging waste from households.

Larger coffee shops, fast food chains and others who sell drinks in disposable paper cups will have to provide a dedicated bin to collect and recycle this waste from 2024.

Waste Zero Scotland hope these reforms will help drive the circular economy in Scotland and lead to a more sustainable approach to packaging where it is required, and with a substantial proportion of the 12 million tonnes of packaging waste produced annually in the UK going into landfill, note the importance of taking action to maximise the value of packaging by effective reuse and recycling, and reducing any unnecessary packaging.

Source: Scottish Government, 26 March 2022

On 31 March 2022, the Scottish Government announced the formation of an advisory group that will shape plans for mandatory charges on coffee cups and other single-use disposable beverage containers, work on which had been on hold due to the COVID-19 pandemic. The charge is expected to come into effect during the course of this parliament.

The group will contain representatives from every stage of the supply chain, from manufacturers and distributors through small and large retailers, as well as consumer groups, environmental NGOs, equalities groups and academics.

It is believed charging for single-use cups will help encourage people to make the move to reusable alternatives, as well as supporting the shift towards a more circular economy.

An expert panel on environmental charging and other measures had previously recommended the introduction of a national, mandatory requirement to sell beverages and disposable cups separately, including an initial minimum price of between 20 to 25p per cup.

An estimated 200 million single-use disposable beverage cups are used every year in Scotland, with this figure expected to rise to 310 million by 2025. At present, Zero Waste Scotland estimate that disposable cups generate around 4,000 tonnes of waste each year, with around 40,000 of these cups littered in Scotland every year. Due to their waterproof plastic lining, they can be hard to recycle, resulting in most of them being incinerated or sent to landfill.

As part of recently announced packaging reforms, larger coffee shops, fast food chains and others who sell drinks in disposable paper cups will have to provide a dedicated bin to collect and recycle these from 2024.

Source: Scottish Government, 31 March 2022

On 25 March 2022, the Water Safety Stakeholder Group, which consists of the Scottish Government and a range of key organisations, published an action plan providing extra funding, improved signs and lesson plans for pupils, following a number of water deaths.

The group have committed to further develop partnership working to help prevent drownings, and agreed a number of key actions including:

• new water safety promotions targeted at areas with a higher risk of drowning, improved signage at popular locations including lochs and reservoirs and a risk assessment of beaches
• additional funding of £60,000 for Water Safety Scotland (WSS) to develop its co-ordination role for all organisations with an interest in water safety
• roll-out of a drowning incident review scheme, ensuring lessons are learned from all fatal and non-fatal incidents
• lesson plans on water safety for pupils
• continued development of the National Learn to Swim Framework delivered with local authorities
• development of Scotland's Water Safety Code to ensure consistency of public messages on key issues, including hidden hazards and cold-water shock
• training for businesses and the public on how to use rescue equipment and review of 999 procedures

Source: Scottish Government, 25 March 2022