Public Health Scotland (PHS) is investigating the cause of a small number of cases of hepatitis (liver inflammation) in young children across the central belt of Scotland. PHS are currently aware of 11 cases requiring admission to hospital in children aged between one and five years old in four NHS health board areas, Lanarkshire, Tayside, Greater Glasgow and Clyde and Fife. The hepatitis viruses commonly associated with this condition have been excluded.

Each year around seven or eight cases of non-A to E hepatitis, without other underlying diagnoses, are detected in children in Scotland. The number of cases in such a short period of time, combined with the geographical spread and severity of illness, in some cases, is unusual and requires further investigation.

PHS report that at present there is no clear cause or connection between the cases, although infection is considered to be a more probable source at this time.

All potential causes are currently being explored and work is ongoing with partners and other agencies across the UK to investigate these cases.

Source: PHS, 6 April 2022

The European Centre for Disease Prevention and Control (ECDC) has published 2020 epidemiological reports for:

Chikungunya virus disease - 24 countries reported 59 cases in the EU and EEA, of which 52 (88%) were confirmed. The was the lowest number of cases reported at the EU or EEA level since 2016, with a notification rate of less than 0.1 cases per 100,000 of the population. A total of 49 (83%) of cases were among those aged 25 to 64 years, the majority of cases were likely infected in either Thailand or Brazil. No autochthonous transmission of chikungunya virus occurred within the EU or EEA in 2020.

Dengue - 26 countries reported 1,957 cases of dengue in the EU and EEA, of which 1,820 (92%) were confirmed, with a notification rate of 0.5 cases per 100,000 of the population. From 2016 to 2020, no obvious trend in the number of cases could be identified. Of the cases with known probable country of infection, 79% were imported from the Americas, mostly from Martinique and Guadeloupe. In total, 24 autochthonous dengue cases were reported from the EU or EEA, 13 by France and 11 by Italy.

Sources: ECDC, 5 April 2022 and ECDC, 5 April 2022

The European Centre for Disease Prevention and Control (ECDC) has published an information note providing an overview of public health guidance on testing for tuberculosis (TB) infection, TB preventative treatment and screening for TB disease, in the context of people arriving in European countries from Ukraine.

The ECDC do not recommend universal testing of refugees arriving in European countries from Ukraine for TB infection. Specific groups should be considered for TB testing, such as household contacts of bacteriologically confirmed pulmonary cases or immunocompromised individuals.

Universal screening for TB disease of refugees arriving in European countries from Ukraine is not recommended. In certain groups at risk of TB, such as people living with HIV or those who are contacts of TB patients, screening for TB disease is important, while in those without disease, assessment for TB preventive treatment is recommended.

Source: ECDC, 7 April 2022

The World Health Organization (WHO) has evaluated tuberculosis antigen-based skin tests (TBST), a new class of tests to diagnose tuberculosis (TB) infection, and found them to be accurate, acceptable, feasible and cost-effective. TBST is an alternative to tuberculin skin test (TST) and Interferon-Gamma Release Assays (IGRAs).

The WHO estimates that over a quarter of the world’s population has TB infection, and testing increases the probability that individuals at higher risk benefit from preventive treatment. TBST use Mycobacterium tuberculosis complex specific antigens and represents a significant advancement to TST.

A guideline development group was convened by WHO from 31 January to 3 February 2022, to discuss the findings of the systematic reviews and to make recommendations on the TBST class of diagnostic tests for TB infection. Three products were included in the evaluation, for which details are available in the rapid communication.

The rapid communication is released in advance of updated WHO guidelines expected later in 2022, to inform national TB programmes and other stakeholders about these new developments and to allow for rapid transition and planning at the country level.

Source: WHO, 4 April 2022

Food Standards Scotland (FSS), the Food Standards Agency (FSA) and the UK Health Security Agency (UKHSA) are investigating an outbreak of Listeria monocytogenes linked to smoked fish. This contamination could be particularly unsafe to people who are vulnerable to Listeria infection, including people who are pregnant, people with certain underlying health conditions and those who are taking medications that can weaken the immune system.

Most people do not have any symptoms of the infection, or will only experience mild symptoms such as vomiting and diarrhoea, which usually pass within a few days without the need for treatment. People who are pregnant are at increased risk of developing listeriosis which can lead to miscarriage, stillbirth, or severe illness in their new-born babies. More serious infection, such as severe sepsis and meningitis, can develop in those with weakened immune systems or those over 65 years of age.

Whole genome sequencing analysis has identified an outbreak of 12 linked cases of listeriosis since 2020, with six of these since January 2022. Cases have been identified in England and Scotland, with the majority of these individuals reporting eating smoked fish.

FSS report that given the ongoing outbreak, as a precaution, information for people who are pregnant has been updated to advise that they thoroughly cook smoked fish before eating it. Advice for avoiding listeriosis infection is being updated to include smoked fish as a high-risk product which should be thoroughly cooked before being eaten by anyone in a high-risk group.

Source: FSS, 4 April 2022

Food Standards Scotland (FSS) and the Food Standards Agency (FSA) are advising consumers not to eat certain Kinder products, listed in the product recall information notice (PRIN). This is in connection with a potential link to a salmonella outbreak, including cases in young children. As a result of the continuing investigation into the outbreak, Ferrero has extended its precautionary recall to cover all products produced in its factory in Arlon, Belgium, listed in the PRIN.

Investigations led by the UK Health Security Agency (UKHSA), Public Health Scotland (PHS), Public Health Wales and Public Health Agency Northern Ireland found a link between reported cases of salmonella poisoning across the UK and products produced by the Ferrero company. In response to this, Ferrero has taken the precautionary step to undertake a further product recall with immediate effect whilst investigations continue. The packaging of recalled products may not refer to the Belgium factory where they were produced and may include a different contact address, so it is important that consumers check their products against the additional information in the recall notice, particularly the ‘best-before’ dates. To reduce the risk of any further illness, consumers should not eat the products listed in the recall alert and they and the parent or guardians of children should follow the risk advice within it.

Symptoms of salmonellosis typically resolve themselves within a few days and include diarrhoea, stomach cramps, nausea, vomiting and fever. However, symptoms can be more severe and lead to hospitalisation, especially in the very young and those with weakened immune systems.

Source: FSS, 6 April 2022

The United Nations (UN) Intergovernmental Panel on Climate Change (IPCC) has published the third part of its sixth assessment report (AR6), assessing literature on the scientific, technological, environmental, economic and social aspects of the mitigation of climate change.

The report has several key findings:

• Coal must be effectively phased out if the world is to stay within 1.5C, and currently planned new fossil fuel infrastructure would cause the world to exceed 1.5C.
• Methane emissions must be reduced by one-third.
• Growing forests and preserving soils will be necessary, but tree-planting cannot do enough to compensate for the continued emissions of fossil fuels.
• Investment in the shift to a low-carbon world is approximately six times lower than it needs to be.
• All sectors of the global economy, from energy and transport to buildings and food, must change dramatically and rapidly, and new technologies including hydrogen fuel and carbon capture and storage are needed.

Source: IPCC, 4 April 2022

The World Health Organization (WHO) reports that a record number of over 6000 cities in 117 countries are now monitoring air quality, but the populations living in them are still breathing unhealthy levels of fine particulate matter and nitrogen dioxide (NO2), with people in low and middle-income countries suffering the highest exposures. Overall, almost the entire global population breathes air that exceeds WHO air quality limits, and potentially threatens their health.

The 2022 update of the WHO’s air quality database introduces, for the first time, ground measurements of annual mean concentrations of NO2, a common urban pollutant and precursor of particulate matter and ozone. It also includes measurements of particulate matter with diameters equal or smaller than 10 μm (PM10) or 2.5 μm (PM2.5). Both groups of pollutants originate mainly from human activities related to fossil fuel combustion.

The new air quality database is the most extensive yet in its coverage of air pollution exposure on the ground. An additional 2,000 cities or human settlements are now recording ground monitoring data for particulate matter PM10 and/or PM2.5 compared to the last update. This marks an almost six-fold rise in reporting since the database was launched in 2011.

Source: WHO, 4 April 2022

The European Environment Agency (EEA) has published a briefing on the status of concentrations of pollutants in ambient air in 2020 and 2021 by pollutant, in relation to both EU air quality standards and the World Health Organization (WHO) guidelines updated in 2021. The assessment shows that exceedances of air quality standards are common across the EU, with concentrations above the latest WHO recommendations. Nevertheless, in 2020, lockdown measures adopted to minimise the spread of COVID-19 had a temporary impact on emissions of air pollution from road transport and led to improved air quality.

The briefing has several key findings:

• In 2020, concentrations of nitrogen dioxide (NO2) temporarily fell as a direct result of reductions in road transport during COVID-19 lockdowns. Reductions in NO2 annual mean concentrations of up to 25% were seen in major cities in France, Italy and Spain. During the first lockdown in April 2020, NO2 concentrations monitored at traffic stations fell by up to 70%.
• Despite these reductions and ongoing overall improvements in air quality, air pollution is still a major health concern for Europeans.
• Central-eastern Europe and Italy reported the highest concentrations of particulate matter and benzo[a]pyrene, a carcinogen, due primarily to the burning of solid fuels for domestic heating and their use in industry.
• Ozone levels were lower than in previous years, but still high in central Europe and some Mediterranean countries.
• In the EU, 96% of the urban population was exposed to levels of fine particulate matter above the latest health-based guideline set by the WHO.

In 2021, the Scottish Environment Protection Agency (SEPA) were providing a limited service to local authorities, councils and others for ad-hoc analyses of water samples and identification and quantification of potential cyanobacteria (blue-green algae), responding to nearly 180 reports and dealing with over 70 lab analyses. SEPA now advise they are able to resume analysis capability across their labs.

SEPA continue to follow current Scottish Government guidance on assessment and minimisation of risks to public health from cyanobacteria, following guidance provided by the World Health Organization (WHO). SEPA work in partnership with other organisations to provide advice and assistance in analysis of ad-hoc samples from suspected cyanobacterial blooms in recreational waters.

SEPA have issued the following advice:

• Any potential algal bloom can be recorded using the smartphone app, Bloomin’ Algae, which can be downloaded via Google Play or the app store. The app can be used to send photos and locations of possible blooms, and comments can be received on reported blooms after an account has been registered and authorised. The app also:
  • provides rapid notifications
  • speeds up public and animal health alerts and warnings
  • provides verification of harmful algal blooms to SEPA, local authorities and other agencies
• The SEPA Ecology Assessment Unit can be contacted via email about potential algal and cyanobacteria (blue-green algae), and require the name of the loch, national grid reference (NGR), date of incident and name of the local authority. SEPA can also be contacted directly, and the Pollution Hotline (0800 807060) can be used to report environmental events.
• SEPA should be contacted in order to make appropriate arrangements in advance where potential samples and subsequent analyses may be justified and warranted. When agreed in advance with SEPA, samples should be transported to the relevant SEPA lab, although small samples may also be sent by post.
• Background information and details on sampling procedures are documented in Annex E of the guidance.