On 12 May 2022, Public Health Scotland (PHS) issued an update on the active investigation into cases of sudden onset hepatitis (liver inflammation) in children aged ten years and under, with 26 identified cases reported in Scotland since onset in January 2022. The total number of cases identified in the UK, as of 10 May 2022, was 176, with no reported fatalities to date. Also on 10 May 2022, the European Centre for Disease Prevention and Control (ECDC) reported between 102 and 106 cases in the EU and EEA, and at least a further 181 cases worldwide, outside the UK, EU and EEA. 

Jaundice and vomiting are the most common symptoms experienced by the children affected. If a child shows signs of jaundice, where there is a yellow tinge in the whites of the eyes or on the skin, then parents should contact their GP or other healthcare professional. Other symptoms can include dark urine, pale grey coloured poo, itchy skin, muscle and joint pains, tiredness, feeling sick, a high temperature, loss of appetite and stomach pain. 

The usual viruses that cause infectious hepatitis, hepatitis A to E, have not been detected, while there is no evidence of any link to the COVID-19 vaccine. The majority of cases are in children under five years old, who are too young to have received the vaccine. 

As the latest UKHSA Technical Briefing suggests, one of the leading potential causes of the severe disease is adenovirus, which are commonly passed from person to person and by touching contaminated surfaces, as well as through the respiratory system. 

PHS advise that the current risk to children of severe hepatitis remains low. Furthermore, parents and caregivers are encouraged to ensure children practice good hand and respiratory hygiene, in order to help reduce the spread of common infections. 

Source: PHS, 12 May 2022

On 7 May 2022, the UK Health Security Agency (UKHSA) confirmed the diagnosis of monkeypox in an individual who had travelled from Nigeria, before arriving in the UK, while on 14 May 2022, the UKHSA further confirmed two additional diagnoses of monkeypox in London, unrelated to the case reported the week before. Both new cases are in people who live in the same household. 

Monkeypox, a rare viral infection, does not spread easily between people and is usually a mild self-limiting illness with most people recovering within a few weeks, though severe illness can occur in some individuals. The infection can be spread when someone is in close contact with an infected person, however, the risk of transmission to the general population is very low. 

Initial symptoms of monkeypox include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. A rash can develop, often beginning on the face, then spreading to other parts of the body. The rash changes and goes through different stages before finally forming a scab, which later falls off. 

As a precautionary measure, UKHSA experts are working closely with NHS colleagues and will contact people who might have been in close contact with all three individuals to provide information and health advice. For the first case, this will include contacting several passengers who travelled in close proximity to the individual on the same flight to the UK. People without symptoms are not considered infectious but, as a precaution, those who have been in close proximity are being contacted to ensure that if they do become unwell, they can be treated quickly. If passengers are not contacted, then there is no action they should take. 

Source: UKHSA, 14 May 2022

As of 11 May 2022, the Australian Department of Health has reported 41 cases, including four deaths, of Japanese encephalitis virus (JEV) across four states, these being New South Wales, Queensland, South Australia and Victoria. People in these areas are advised to avoid mosquito bites at all times. 

JEV is a mosquito-borne virus which affects the central nervous system and is most common around areas of rice and pig farming. JEV is transmitted from animals, mainly pigs and birds, to humans through the bite of an infected Culex mosquito which feeds in the hours around dusk. No human-to-human transmission occurs.

Advice for travellers

All travellers to endemic countries or outbreak areas are potentially at risk of infection, with the risk increasing for those who:

• travel to rural areas during transmission seasons
• participate in outdoor activities during twilight hours
• travel for a prolonged period of time

All travellers should be advised on:

• the risks and potentially severe consequences of JEV
• practicing strict mosquito bite avoidance, including the correct use of insect repellents
• minimising outdoor activities during twilight hours when Culex mosquitoes bite

Travellers at an increased risk of developing severe clinical disease are those:

• with pre-existing chronic medical conditions
• younger than 10 years of age
• older than 50 years of age

For most travellers, the risk of acquiring infection will be very small, but vaccination should be considered by those:

• frequently exposed to bites in rural infected areas, such as backpackers, agricultural workers and volunteers
• at ongoing risk or repeatedly visiting high risk areas, such as flood plains, rice paddies, marshlands and pig farms
• staying for short periods during outbreaks
• staying for more than one month in infected areas
• going to live in an endemic area

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

Sources: TRAVAX, 12 May 2022 and fitfortravel, 12 May 2022

China has reported a recent increase in the number of cases and emerging or known variants of coronavirus (COVID-19) in Shanghai municipality and Jilin province.

While there is a risk of exposure to COVID-19 throughout mainland China, following a review of the public health risk assessment process, Shanghai municipality and Jilin province now carry a high risk of exposure to the disease.

The China country page on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites can be checked for regular updates or any changes to the risk of exposure to COVID-19 in China. 

Advice for travellers 

All travellers are advised to avoid non-essential travel to Shanghai municipality and Jilin province, even if fully vaccinated.

Travellers should be aware that the risk of COVID-19 in China may change at short notice and must also consider the risk of exposure in transit countries and during their journey.

Prior to travel, all travellers should be advised to:

• check the latest government guidance on the Foreign, Commonwealth and Development Office (FCDO) foreign travel advice and country specific webpages for travel to China, and the rules on entering the UK on return
• ensure they are up to date with UK recommendations on COVID-19 vaccination
• consider their risk of severe COVID-19 and availability of medical facilities at the destination and travellers at increased risk of severe COVID-19 should carefully consider their travel plans
• consider their ability to comply with COVID-19 prevention advice during travel and at their destination
• consult the fitfortravel COVID-19: health considerations for travel webpage

Further information and advice on COVID-19 is available on the TRAVAX and fitfortravel websites.

Sources: TRAVAX, 11 May 2022 and fitfortravel, 11 May 2022

The Victoria Department of Health has reported the spread of Buruli ulcer in the city of Melbourne, with media reporting 39 cases through the state, as of 4 May 2022. The disease has occurred in north Melbourne and coastal areas of the State of Victoria in previous years.

Buruli ulcer occurs due to a bacterial infection, beginning as a raised, painless spot and developing into a deep ulcer over a period of weeks, with contaminated water and insect bites being possible routes of transmission. Buruli ulcer is not transmitted between people, and there is no vaccine, however the infection can be treated with antibiotics. 

Advice for travellers 

Longer term travellers to endemic regions, including Melbourne, should be advised of the risk of Buruli ulcer disease. They should be encouraged to have any new skin lesions medically assessed, ensuring they mention their travel history if back in the UK. 

The precise mode of transmission is unknown, but travellers should be advised to:

• avoid insect bites
• ensure wounds are treated quickly and appropriately, and covered by dressings when working outside, especially with stagnant water bodies
• wear protective clothing during water contact and when working outside 

Health professionals can access further information on Buruli ulcer on the TRAVAX website. 

Sources: TRAVAX, 6 May 2022 and fitfortravel, 6 May 2022

On 11 May 2022, the European Union Aviation Safety Agency (EASA) and European Centre for Disease Prevention and Control (ECDC) issued a joint update to the health safety measures for air travel, dropping the mandatory wearing of medical masks on board a flight, but noting that a face mask is still one of the best protections against transmission of COVID-19. 

The update takes account of the latest developments in the pandemic, in particular the levels of vaccination and naturally acquired immunity, and the accompanying lifting of restrictions in a growing number of European countries. In addition to the changes with respect to masks, its recommendations include a relaxation of the more stringent measures on airline operations, which will help relieve the burden on the industry whilst keeping appropriate measures in place. 

The new recommendations on the wearing of face masks are set to come into effect from 16 May 2022. However, rules for masks will continue to vary by airline beyond that date. For example, flights to or from a destination where mask-wearing is still required on public transport should continue to encourage mask wearing, according to the recommendations. Vulnerable passengers should continue to wear a face mask regardless of the rules, ideally an FFP2/N95/KN95 type mask, which offers a higher level of protection than a standard surgical mask.

Passengers are also encouraged to observe distancing measures in indoor areas, including at the airport, wherever possible. But airport operators should adopt a pragmatic approach to this, such as avoiding the imposition of distancing requirements if these will very likely lead to a bottleneck in another location in the passenger journey, especially if they are not required at national or regional level in other similar settings.

While many states no longer require passengers to submit data through a passenger locator form, airlines should keep their data collection systems on standby so they could make this information available to public health authorities if needed, for example, in the case where a new variant of concern (VOC) emerged which was identified as potentially more dangerous.

Sources: EASA, 11 May 2022 and ECDC, 11 May 2022

On 10 May 2022, the European Centre for Disease Prevention and Control (ECDC) published its annual epidemiological report on Legionnaires' disease for 2020 in Europe.

In a summary of the report's major points:

• The overall notification report decreased from 2.2 to 1.9 cases per 100,000 of the population from 2019.
• Notification rates remained heterogenous across the EU and EEA, varying from fewer than 0.5 up to 5.7 cases per 100,000 of the population, with the highest rate reported by Slovenia.
• France, Germany, Italy and Spain accounted for 72% of all notified cases.
• Males aged 65 years and older were most affected, with 7.1 cases per 100,000 of the population.
• The number of reported cases to the travel-associated surveillance scheme decreased by 67% compared with 2019.
• Only 10% of cases were culture confirmed, possibly leading to underestimation of disease caused by Legionella species other than Legionella pneumophila. 

Source: ECDC, 10 May 2022

On 5 May 2022, the UK Health Security Agency (UKHSA) issued an update on their investigation into an outbreak of Salmonella linked to some Kinder products made in one of Ferrero’s factories, in Arlon, Belgium. 

The UKHSA, working in partnership on this investigation with the Food Standards Agency (FSA), Food Standards Scotland (FSS), Public Health Scotland (PHS), Public Health Wales (PHW) and Public Health Agency Northern Ireland, as well as international public health and food safety authorities, report that 101 cases are now linked to this outbreak in the UK, with most of the cases being in children under five years of age. Further information on case numbers in all affected countries can be found on the European Centre for Disease Prevention and Control (ECDC) website. 

On 7 May 2022, the FSA issued a new update of recalled items by Ferrero, which should be accessed along with the previously reported update, as both updates are valid. 

Source: UKHSA, 6 May 2022

On 9 May 2022, the Scottish Government launched a consultation, aimed at gathering views on specific proposals for tuberculosis (TB) diagnostic testing, cattle movements, isolation requirements and unclean cattle. 

Bovine TB is a notifiable disease of cattle, which can also affect other mammals, and continues to present a significant challenge to the farming sector across the UK. 

Scotland achieved Officially Tuberculosis Free Status (OTF) in September 2009, in recognition of the relatively low and stable incidence of TB found in Scottish herds, and this pattern is consistent with sporadic introductions of disease, which are eradicated through testing and removal of infected cattle. 

The current Tuberculosis (Scotland) Order came into force in 2007 and has been amended a number of times since, most recently to make amendments arising from the withdrawal of the UK from the EU. The Scottish Government are proposing to consolidate all the bovine TB legislation in one updated TB Order, as well as considering amendments to the legislation. 

The following amendments have been proposed:

• An amendment to the provisions for the application of diagnostic tests, to include a requirement for the prior written permission of Scottish Ministers where non-statutory and private samples are taken with the intention of applying a diagnostic test for TB.
• An end to the practice of accepting a clear final short interval test (SIT) at the end of all TB breakdowns as a valid pre-movement test. Cattle to be moved out of such herds will need to have a further (bespoke) pre-movement skin test with negative results.
• A shortening of the period during which a pre-movement test with negative results remains valid, from the current 60 days to 30 days after tuberculin injection, to bring domestic pre-movement testing into line with the testing of cattle intended for export, and further reduce the risk of cattle contracting TB between the dates of the test and the movement.
• A reduction of compensation for unclean cattle at slaughter.
• A tightening of measures relating to the isolation of reactors and inconclusive reactors (IRs). 

While anyone may respond to this consultation, the Scottish Government would particularly like to hear from keepers of cattle or livestock, cattle or livestock associations, veterinary surgeons or associations, agricultural markets and valuers, animal welfare advocates and anyone else with an interest in the eradication and control of bovine TB in Scotland. 

The consultation will run until 1 August 2022 and responses can be made on the Scottish Government website. 

Source: Scottish Government, 9 May 2022

On 10 May 2022, the Scottish Government published an independent report on incineration in Scotland. The report, with supporting documents, was authored by waste sector expert Dr Colin Church, and reviewed the role of incineration in the waste hierarchy, with a focus on aligning national capacity with Scotland’s waste reduction targets and has recommended a cap on future incineration capacity. 

The report has provided 12 policy recommendations for the Scottish Government, local authorities and the wider waste industry, including:

• no further planning permission be granted to incineration infrastructure within the scope of this review, unless balanced by an equal or greater closure of capacity
• the development of an indicative cap, which declines over time for the amount of residual waste treatment needed as Scotland transitions towards a fully circular economy
• community engagement and trust be strengthened before, during and after development 

The Scottish Government will set out its initial response to the review in June, while public consultations on a Circular Economy Bill and a Waste Route Map will launch this month. 

Source: Scottish Government, 10 May 2022

On 11 May 2022, the Department for Environmental, Food and Rural Affairs (DEFRA) published the latest statistics on waste at a UK level. This report coincided with the COVID-19 pandemic and national lockdowns, during which there were disruptions and cancellations to kerbside waste collections and widespread closures of Household Waste Recycling Centres (HWRCs). 

In key points from the report:

• The UK recycling rate for Waste from Households (WfH), including Incinerator Bottom Ash metal (IBAm) was 44.4% in 2020, decreasing from 46.0% in 2019.
• The recycling rate for WfH decreased in all UK countries in 2020, except for Wales. The recycling rate for England was 44.0%, compared with 49.1% in Northern Ireland, 41.0% in Scotland, and 56.5% in Wales.
• UK biodegradable municipal waste (BMW) sent to landfill has fallen from approximately 6.6 million tonnes in 2019 to around 6.1 million tonnes in 2020.
• Provisional figures for 2021 show that 63.2% of UK packaging waste was recycled, similar to 2020.
• It is estimated that the UK generated 43.9 million tonnes of commercial and industrial (C&I) waste in 2018, of which 37.2 million tonnes (85%) was generated in England. The latest estimates for England only, indicate that C&I waste generation was around 33.8 million tonnes in 2020.
• The UK generated 222.2 million tonnes of total waste in 2018, with England responsible for 84% of this total. 

Source: DEFRA, 11 May 2022

On 6 May 2022, Scottish Forestry announced that new measures would be introduced to the Woodland Carbon Code on 1 October 2022, aimed at maintaining the code's gold standard for verifying carbon credits associated with woodland planting schemes. 

There has been rapid growth in the carbon market, with a fourfold increase of projects having registered with the Woodland Carbon Code, and for increased scrutiny, Scottish Forestry will strengthen the code with revised additionality tests. It is hoped these tests will foster trust in the opportunities that forestry has to deliver high quality carbon credits. 

Demand for carbon credits has been cited as one of the reasons for the current high prices being paid for plantable land and it is hoped that the new tests will cool this trend by reducing the risk of over-bidding by those buying land, who might otherwise expect part of the cost to be recouped from carbon credits. 

The key changes to the additionality tests are:

• simplification to make it easier for project developers and validators to use them
• some standardisations to ensure they are applied consistently
• changes to ensure that high land values do not skew the calculations 

The changes to the rules are also in line with the Scottish Government’s recent announcement on new Interim Principles for Responsible Investment in Natural Capital, which ensures woodland projects deliver social, environmental and economic benefit. 

The additionality tests were reviewed by a stakeholder group of forestry and land interests. This included two independent assessments by a senior economist and an international carbon markets expert. 

Source: Scottish Forestry, 6 May 2022