28 June 2022
Volume: 56 Issue: 25
- Twenty-six cases of monkeypox reported in Scotland
- Update on the ongoing investigation into hepatitis in children
- PHS encourages uptake of COVID-19 spring booster vaccination
- HFMD in Malaysia
- Dengue in Vietnam and Sri Lanka
- Yellow fever in Cameroon
- Cholera in Pakistan
- Polio in London
- ECDC report on leishmaniases in the EU and neighbouring countries
- Survey on the implementation of integrated surveillance of respiratory viruses with pandemic potential
- Gambiense form of HAT eliminated as a public health problem in Equatorial Guinea
- WHO quality toolkit launched
- New consortium launched to tackle bird flu
- Scottish Government launches coal extraction consultation
- Multi-agency calls to prevent wildfire damage
- Figures released on woodland creation
HPS Weekly Report
28 Jun 2022
Volume 56 No. 25
Twenty-six cases of monkeypox reported in Scotland
As of 23 June 2022, Public Health Scotland (PHS) confirmed there have been 26 laboratory-confirmed cases of monkeypox reported since 23 May 2022 in Scotland. On the same date, the UK Health Security Agency (UKHSA) reported 873 confirmed cases in England, eight in Wales and three in Northern Ireland.
PHS and UKHSA are advising people to be alert to any new rashes or lesions, which appear like spots, ulcers or blisters, on any part of their body. Although this advice applies to everyone, the majority of cases identified to date have been among men who are gay, bisexual and men who have sex with men (MSM), so people in these groups are advised to be aware of the symptoms, particularly if they have recently had a new sexual partner. Anyone with unusual rashes or lesions is advised to contact NHS 24 (Scotland), NHS 111 (England or Wales) or a sexual health service, contacting clinics ahead of visiting and avoiding close contact with others until seen by a clinician.
Vaccinations are being offered to close contacts of those who have monkeypox, however, on 21 June 2022, the UK Health Security Agency (UKHSA) published a strategy, endorsed by the Joint Committee on Vaccination and Immunisation (JCVI), recommending that some gay and bisexual men at higher risk of exposure to monkeypox should be offered pre-exposure vaccinations to help control the recent outbreak of the virus. The Scottish Government has subsequently confirmed Scotland will also adopt this approach, with full details on how eligible people can get vaccinated provided in due course.
Monkeypox is a viral infection usually associated with travel to West Africa and has only rarely been reported outwith this region. Monkeypox can be transmitted through close contact with a person who already has the infection, including direct contact during sex, and can also be passed on by contact with clothing or linens used by a person who has the disease. 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, including the genitals. The rash changes and goes through different stages before finally forming a scab, which later falls off.
PHS and the UKHSA are working closely with the NHS and other stakeholders, in order to urgently investigate where and how recent confirmed monkeypox cases were acquired, including how they may be linked to each other. Clinicians should be alert to individuals presenting with rashes without a clear alternative diagnosis and should contact local specialist services for advice, if monkeypox infection is suspected.
Sources: PHS, 24 June 2022 and UKHSA, 24 June 2022
Update on the ongoing investigation into hepatitis in children
On 23 June 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 three further cases being identified since the previous update on 10 June 2022, bringing the total to 35 reported cases in Scotland since onset in January 2022. The total number of cases identified in the UK is now 258, with all children affected presenting to health services between January and 21 June 2022. A technical briefing, issued on 19 May 2022, suggests adenovirus is one of the leading causes of the higher than usual rates of hepatitis in children. An additional update on aetiology was published on 19 June 2022.
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.
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, 23 June 2022
PHS encourages uptake of COVID-19 spring booster vaccination
Public Health Scotland (PHS) has called for eligible people, such as the elderly or those with a weakened immune system, to receive the spring booster vaccination, in order to help reduce the risk of serious illness, or admission to hospital, due to COVID-19 infection.
The call for those eligible to take up the spring booster vaccine follows a recent increase in COVID-19 cases in Scotland, with 11,922 confirmed cases reported as of 15 June 2022, which represents a 44.5% increase from the previous week. Furthermore, those in vulnerable groups may find COVID-19 infection is more serious, while evidence suggests vaccine prevention may wear off more quickly than it does for the general population.
The Joint Committee on Vaccination and Immunisation (JCVI) recommends a spring booster dose for people:
- aged 75 years and over, or those aged 75 years by 30 June 2022
- with a weakened immune system
The spring booster dose will usually be offered around six months since the previous dose of COVID-19 vaccine, though some people may be invited sooner than this, at least three months following their last dose, to help protect them against any increase in COVID-19 infections. NHS Scotland will contact people to arrange their appointment at the right time for them. People in eligible groups can have their spring booster dose if they have received all their primary doses, and at least three months has passed since their last dose.
Another booster dose, as well as the usual flu vaccine, may be required for some people in the autumn.
More information on booster doses can be found on the NHS Inform website.
Source: PHS, 20 June 2022
HFMD in Malaysia
On 4 June 2022, media quoting public health authorities reported that, as of 3 June 2022, there have been 1,174 cases of hand, foot and mouth disease (HFMD) recorded this year in Perlis state, on the northwest coast of Peninsular Malaysia, with nurseries and children's day-care centres being affected.
HFMD is a mild viral infection most common in children, but can also affect adults, causing a fever, a blistering rash on the hands and feet, sore throat and sores in the mouth. The infection spreads easily between people through coughs and sneezes, contact with saliva, poo, or fluid in blisters of an infected person, or with surfaces contaminated by the virus.
Symptoms are usually mild, and most people recover within a week to ten days, with serious illness being unusual. There is no specific treatment for HFMD, with no vaccine being available.
Advice for travellers
To reduce the risk of spreading HFMD, travellers to an outbreak area should be encouraged to:
- wash their hands often, especially after changing nappies, while children should also be encouraged or assisted to wash their hands
- avoid touching their eyes, nose and mouth with unwashed hands
- avoid close contact, such as kissing and hugging, with someone infected with HFMD
- avoid sharing towels, bedding or household items like cups, plates and cutlery with someone infected with HFMD
- regularly disinfect frequently touched surfaces and personal items, such as mobile phones, where someone has HFMD
Further information on HFMD can be found on NHS Inform and NHS UK websites.
Sources: TRAVAX, 21 June 2022 and fitfortravel, 21 June 2022
Dengue in Vietnam and Sri Lanka
Up to 16 June 2022, the Vietnamese Ministry of Health official newspaper reported 60,000 cases of dengue fever in the country this year. There have also been 36 deaths from dengue fever, which is more common in the south of Vietnam.
Also, on 10 June 2022, media quoting the Sri Lanka Ministry of Health reported continuing transmission of dengue fever across the country, with 2,416 cases in the first of week of June 2022 across several districts.
Dengue is an infection found in tropical and sub-tropical climates worldwide. Dengue is spread by Aedes mosquito bites and can cause a severe flu-like illness.
There is no vaccine against dengue fever licensed in the UK, with treatment being supportive only.
Advice for travellers
All travellers to endemic regions are potentially at risk of dengue fever and should be aware of this infection. Aedes mosquitoes are particularly persistent and aggressive, and bite between dawn and dusk. Prevention relies on avoiding mosquito bites at all times.
Travellers developing a fever during or on return from travel are advised to seek medical attention as soon as possible.
Information and advice for travellers on dengue fever is available on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.
Sources: TRAVAX, 21 June 2022 and TRAVAX, 21 June 2022
Yellow fever in Cameroon
On 12 June 2022, the World Health Organization (WHO) reported 555 suspected cases of yellow fever, including 14 deaths, in Cameroon from 1 January to 22 May 2022.
Yellow fever is an acute viral disease which is transmitted by the day biting Aedes mosquito, which is found in tropical areas of Africa and Central and South America.
Advice for travellers
All travellers should be advised to always practice mosquito bite avoidance.
A traveller's risk of yellow fever is determined by their individual risk assessment, with factors influencing that risk including:
- country or countries to be 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. Yellow fever vaccine should be considered, unless contraindicated, for travellers at risk.
More information for health professionals can be found on the TRAVAX Kenya and yellow fever webpages, while the general public can access information on the fitfortravel yellow fever webpage.
Sources: TRAVAX, 21 June 2022 and fitfortravel, 21 June 2022
Cholera in Pakistan
On 17 June 2022, the World Health Organization (WHO) issued an update on the continuing cholera outbreak in Pakistan, with 290 cases reported as of 27 May 2022. A total of 234 cases have been reported in Sindh province, Balochistan province reported 31 cases, including nine deaths, while 25 cases were reported in the Panjab province.
Cholera is an acute diarrhoeal infection caused by ingestion of faecally contaminated food or water, and occasionally from foodstuffs such as shellfish.
Advice for travellers
Severe cholera is rare in travellers, with mild cases may present as travellers' diarrhoea.
Travellers should be given advice on:
- maintaining safe food and water precautions
- effective hand hygiene
- basic steps in self-treating diarrhoea, particularly remaining adequately hydrated
Vaccination against cholera is dependent on the individual risk assessment, but may be considered for:
- volunteers, humanitarian workers and medical personnel travelling to disaster relief situations where cholera outbreaks are likely
- travellers with remote itineraries in areas where cholera outbreaks are occurring and there is limited access to medical care
More information on cholera can be found on the TRAVAX (for health professionals) and fitfortravel (for the general public) webpages.
Sources: TRAVAX, 21 June 2022 and fitfortravel, 21 June 2022
Polio in London
On 22 June 2022, the UK Heath Security Agency (UKHSA), working with the Medicines and Healthcare products Regulatory Agency (MHRA), found poliovirus in sewage samples collected from the London Beckton Sewage Treatment Works.
As part of routine surveillance, it is normal for one to three vaccine-like polioviruses to be detected each year in UK sewage samples, but these have always been one-off findings that were not detected again. These previous detections occurred when an individual vaccinated overseas with the live oral polio vaccine (OPV) returned or travelled to the UK and briefly shed traces of the vaccine-like poliovirus in their faeces.
Investigations were launched after several closely related viruses were found in sewage samples taken between February and May. The virus has continued to evolve and is now classified as a vaccine-derived poliovirus type 2 (VDPV2), which on rare occasions can cause serious illness, such as paralysis, in people who are not fully vaccinated.
The detection of a VDPV2 suggests it is likely there has been some spread between closely linked individuals in north and east London and that they are now shedding the type 2 poliovirus strain in their faeces. The virus has only been detected in sewage samples and no associated cases of paralysis have been reported, though investigations are underway to establish if any community transmission is occurring. Vaccine-derived poliovirus is rare and the risk to the public overall is extremely low.
The last case of wild polio contracted in the UK was confirmed in 1984. The UK was declared polio-free in 2003, with low-risk for polio transmission due to the high level of vaccine coverage across the population. However, vaccine coverage for childhood vaccines has decreased nationally and especially in parts of London over the past few years, so the UKHSA is urging people to check they are up to date with their vaccines.
Wastewater surveillance is being expanded to assess the extent of transmission and identify local areas for targeted action. Healthcare professionals have been alerted to these findings so they can promptly investigate and report anyone presenting with symptoms that could be polio, such as paralysis.
Source: UKHSA, 22 June 2022
ECDC report on leishmaniases in the EU and neighbouring countries
On 20 June 2022, the European Centre for Disease Prevention and Control (ECDC) published a technical report, presenting the epidemiology of human and animal leishmaniases in the EU and its neighbouring countries. The report concluded that the disease remains widespread and underreported in many countries of southern Europe, northern Africa, and the Middle East, and a need exists to improve leishmaniasis prevention and control based on robust surveillance in humans, animals, and vectors, and to increase public awareness following a one health approach.
The report suggests current leishmaniasis prevention and control measures and access to valid diagnostic methods and effective treatments are insufficient, which could have important disease implications, including an increase in incidence in the EU and its neighbouring countries, the spread of Leishmania spp. into new areas going unnoticed, increases in treatment failure and the development of resistance to treatments.
The report also describes the surveillance, prevention, and control measures implemented in 40 countries in Europe, northern Africa, the Middle East, Turkey, and the Caucasus, where leishmaniases are endemic, or where sand fly vectors of Leishmania parasites have been reported.
Information was gathered through an extensive, non-systematic review of the scientific and grey literature published between 2009 and 2020, and through questionnaires addressing the public health and veterinary national authorities in the targeted countries.
- a description and analysis of the spatial and temporal dynamics, including presence maps and evidence for emergence
- a description of statutory notification, surveillance, and control arrangements
- a description of levels of access to diagnostic techniques and medicines
This information was collated to provide the basis for recommendations on potential future action to strengthen surveillance, prevention, and control of leishmaniases, in order to reduce the impact of the disease in the EU and its neighbouring countries.
Source: ECDC, 20 June 2022
Survey on the implementation of integrated surveillance of respiratory viruses with pandemic potential
On 17 June 2022, the European Centre for Disease Prevention and Control (ECDC) published the results of a response from 29 EU and EEA countries, following a survey on the implementation of integrated surveillance of respiratory viruses with pandemic potential.
In brief findings from the survey:
- Member states were in unanimous agreement that common objectives should be established for sentinel surveillance of respiratory viruses.
- Overall, countries agree with the proposed ECDC and World Health Organization (WHO) core objectives for an integrated surveillance of respiratory viruses with pandemic potential.
- Most countries are in the process of discussing, planning, or implementing integrated surveillance at national level.
- Hurdles to the implementation of integrated surveillance are anticipated, particularly regarding the availability of necessary infrastructure and resources.
- Changes in testing strategies for community testing have been implemented, or are expected to be implemented, in the majority of the countries.
- Most countries have implemented or are planning to implement integrated sentinel surveillance (primary care (ILI/ARI) and SARI) and non-sentinel surveillance for influenza, SARS-CoV-2 and RSV.
- In contrast to the primary care sentinel surveillance, for SARI, 42% countries are still in the process of implementing surveillance systems.
- Genomic surveillance has been implemented in 93% countries for SARS-CoV-2, 79% countries for influenza and 28% countries for respiratory syncytial virus (RSV).
- Only a selected number of countries are currently monitoring vaccine effectiveness in primary and secondary care.
- IHR/EWRS/EpiPulse notifications and the monitoring of human-animal interface are being actively used by the majority of countries for SARS-CoV-2 and influenza.
- Approximately 40% of countries have implemented special studies for SARS-CoV-2 and influenza.
Source: ECDC, 17 June 2022
Gambiense form of HAT eliminated as a public health problem in Equatorial Guinea
On 20 June 2022, the World Health Organization (WHO) reported that Equatorial Guinea has become the latest country to eliminate the gambiense form of human African trypanosomiasis (HAT), also known as sleeping sickness, as a public health problem within its borders. HAT has two principal forms, referred to as gambiense and rhodesiense, and is generally transmitted through contact with infected tsetse flies.
The general incidence of the gambiense form of HAT has reduced sharply this century. In 2021, 750 cases were reported in 11 endemic countries representing a 95% reduction from the 26,095 cases reported in 2001. Equatorial Guinea now joins the list of countries which have seen elimination of the disease as a public health problem validated by WHO recently, these being Benin, Côte d’Ivoire, Togo and Uganda.
Longstanding work and commitment by the Ministry of Health of Equatorial Guinea, through its HAT National Control Program (PNCTHA), has allowed the country to reach the threshold established for validating elimination, which is defined as fewer than one case per 10,000 inhabitants on average, over the last five years, in all the country’s health districts. Validation of elimination requires countries to submit extensive dossiers to WHO, which are assessed by an independent group of experts, who determine if the criteria for elimination as a public health problem have been met.
The WHO say elimination of gambiense HAT as a public health problem is an important step on the road to achieving the more ambitious goal of elimination of transmission. Equatorial Guinea has committed to maintaining its surveillance capacity, ensuring that screening and diagnosis continues in populations at risk of contracting the disease, while maintaining adequate treatment for any new cases detected, and to controlling tsetse fly populations.
Source: WHO, 20 June 2022
WHO quality toolkit launched
On 20 June 2022, the World Health Organization (WHO) announced the release of a new WHO quality toolkit, providing tools to improve the quality of health services, gathered for the first time, from across different programmes at WHO. This new online resource is a user-friendly toolkit aimed at supporting action on improving the quality of health services at every level of the health system, from national and district to facility and community levels.
The quality toolkit accompanies the WHO quality planning guide, which provides a roadmap for action across the health system to improve the quality of health services at the point of care, while the quality toolkit offers practical tools and approaches that can support implementation of the necessary actions.
The toolkit can be used to gain a good basic understanding on quality of care, but also access practical tools that can be used to enhance quality of care. This WHO toolkit will be updated regularly to ensure new resources available are included.
Source: WHO, 20 June 2022
New consortium launched to tackle bird flu
On 20 June 2022, eight of the UK's scientific organisations have formed a new research consortium to tackle bird flu, having received £1.5 million funding from the Biotechnology and Biosciences Research Council (BBSRC) and the Department for Environment, Food and Rural Affairs (Defra). The consortium, headed by the research team at the Animal and Plant Health Agency (APHA), has been tasked with developing new strategies to tackle future bird flu outbreaks.
This year’s bird flu outbreak has been the largest and longest ever experienced in the UK and in many parts of Europe, starting earlier than in previous years after the virus continued to circulate in Europe over summer 2021 and leading to over 100 cases in the UK.
The aim of the consortium is to find new ways to contain future outbreaks, and it is hoped will provide a significant boost to the UK’s poultry sector and rural economy, which has experienced significant disruption from this year’s outbreak, with compulsory indoor housing measures put in place to protect poultry.
The consortium will focus on building understanding of bird flu in several key areas, including:
- what it is about the current virus strains that helps them to form larger and longer outbreaks
- understanding transmission and infection in different bird populations, including how the virus transmits from wild birds to farmed poultry, the gaps in biosecurity that allow the virus to penetrate premises, and how this could be addressed
- mapping and modelling the spread of infection over time and across species
- why some birds, such as ducks, are more resistant to bird flu strains
- developing models to predict how the viruses will evolve and spread in the future
- inform risk mitigation measures in birds to reduce disease burden thereby protecting against zoonotic transmission occurring from animals to humans, to prevent future spillovers of influenza with pandemic potential into humans
Source: Defra, 20 June 2022
Scottish Government launches coal extraction consultation
On 21 June 2022, the Scottish Government launched a consultation, aimed at gathering evidence towards establishing their finalised policy position on coal extraction in Scotland. This policy will form part of the Scottish Government's energy strategy, to be refreshed during 2022 and including a comprehensive range of policy positions for related areas.
This consultation does not set out or advocate a preferred Scottish Government position or policy but looks for interested parties to contribute views and evidence on the development of coal extraction policy in Scotland in order to ensure that the government delivers a robust and fully evidenced policy position in line with Scottish energy needs, statutory requirements and climate change ambitions.
The consultation document includes a respondent information form, which can be filled in and sent back to the Scottish Government.
Multi-agency calls to prevent wildfire damage
On 17 June 2022, Scottish Water, along with Forestry and Land Scotland and the Scottish Fire and Rescue Service (SFRS), called for a raising of awareness to the risks of wildfires in order to prevent damage and to help protect the environment and water supplies.
There have been at least 12 wildfires in the past five years on land owned and managed as water catchments, covering thousands of hectares in different parts of the country, including South Ayrshire and the Isle of Skye. Around 70% of Scotland’s public drinking water supply has its source in approximately 525,000 hectares of peatland and moorland.
Wildfires can be very damaging to the natural environment, ecology and wildlife, such as nesting birds, voles, frogs and insects. As well as the potential impact on wildlife habitats, wildfires can burn valuable carbon stores, such as trees and peatland, releasing greenhouse gases back into the atmosphere and losing their ability to capture carbon. The damage to peatland is of particular concern given the long timeframes it takes to recover. In addition, the de-stabilisation of peatlands near watercourses and ashes from wildfires which get into water sources such as reservoirs, can lead to changes in raw water quality.
Fire ashes cause high phenols, which pass through the water treatment process and react with chlorine to create taste and odour issues for customers.
Fires can also expose soil, increasing the risk of run-off into source waters, which can put pressure on the treatment process at water treatment works.
Source: Scottish Water, 17 June 2022
Figures released on woodland creation
On 16 June 2022, Forest Research figures found that Scotland has achieved nearly 80% of the yearly woodland creation target, despite the main planting season being badly affected by a run of winter storms. A total of 10,480 hectares (ha) of new woodland was created in Scotland, with 42% being native species, meaning the Bute House Agreement, which set a target to create over 4,000 ha of native woodland, was met with 4,360 ha being achieved.
The overall woodland creation target, part of Scotland’s climate change plans, was increased to 13,500 ha for 2021 to 2022. Scottish Forestry had approved enough woodland creation schemes to hit the new target, however parts of the forestry sector had to divert resources from planting to recovering the millions of trees brought down in the storms.
Storm Arwen damaged 8,000 ha of woodland this winter, the equivalent of around 16 million trees, requiring millions of tonnes of timber to be recovered.
Scottish Forestry supported the forestry sector throughout the winter storms by reallocating staff resources and fast tracking the paperwork needed to manage the aftermath of the storms. Their data shows that most of the shortfall from the yearly target located in the Grampian, South Scotland and Perthshire areas, which were most badly affected by the storms.
Across other parts of the UK, England created 2,260 ha of new woodland, Wales 580 ha and Northern Ireland 540 ha.
Source: Scottish Forestry, 16 June 2022