On 12 December 2018, Health Protection Scotland (HPS) published a series of FAQs for medical and healthcare students that address the following:

• what norovirus is
• how it is spread
• what to do if you have norovirus
• what to do if you are working in a clinical area during a norovirus outbreak

The Scottish Health Protection Network (SHPN) has issued new guidance, replacing the 2013 'Guidance for the Public Health Management of Infection with Verotoxigenic Escherichia coli', which is designed to support the development of those arrangements and assist in response to E. coli cases by health protection teams, environmental health departments and other stakeholders. It is also part of a suite of materials that has been produced in parallel with, and it should be used alongside, the ‘Scottish STEC Enhanced Surveillance Form’.

Over a number of years, there has been a large amount of work to reduce the burden of disease from E. coli O157 through a host of interventions aimed at preventing, or minimising risk of, infection. However, cases still occur, both sporadically and in outbreaks, and rapid response to these situations is necessary for protection of the public health. Additionally, there has been an increase in the number of non-O157 STEC, and increasing evidence of the disease burden of E. coli O157 Shiga-toxin negative organisms.

This document notes the current epidemiology of E. coli in Scotland, including the increase in non-O157 STEC; expands and further details the local diagnostic and reference laboratory testing procedures currently available; and refreshes the advice on public health actions in light of the best available evidence.

The guidance can be accessed on our website.

From 1 January to 2 December 2018, the Nigeria Centre for Disease Control (NCDC) reported a total of 598 confirmed and probable cases of lassa fever, which includes 164 deaths. Lassa fever is a zoonotic viral disease transmitted via the excreta of an infected Mastomys rat.

Twenty-three states have recorded at least one confirmed case in 92 Local Government Areas (Edo, Ondo, Bauchi, Nasarawa, Ebonyi, Anambra, Benue, Kogi, Imo, Plateau, Lagos, Taraba, Delta, Osun, Rivers, FCT, Gombe, Ekiti, Kaduna, Abia, Adamawa, Enugu and Kano). The outbreak remains active in Edo, Ondo, Plateau, Gombe and Kano States.

Travellers are advised there is a very low risk to their health unless they visit a known viral haemorrhagic fever (VHF) outbreak area, and they should be aware of the risk of infection and transmission routes of the particular VHF. This advice is especially true for medical personnel, who must follow strict infection control guidance. Travellers, who have developed symptoms after returning from affected areas, should seek immediate medical advice.

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

A report from the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) presents the results of zoonoses monitoring activities carried out in 2017 in 37 European countries (28 member states (MS) and nine non-MS).

Campylobacteriosis was the most commonly reported zoonosis and the increasing European Union (EU) trend for confirmed human cases since 2008 stabilised during 2013–2017. The decreasing EU trend for confirmed human salmonellosis cases since 2008 ended during 2013–2017, and the proportion of human Salmonella Enteritidis cases increased. The notification rate of human listeriosis further increased in 2017, despite the fact that Listeria seldom exceeds the EU food safety limit in ready-to-eat foods. The decreasing EU trend for confirmed yersiniosis cases since 2008 stabilised during 2013-2017 and the number of confirmed Shiga toxin-producing Escherichia coli (STEC) infections in humans was stable.

Of the 5079 food- and water-borne outbreaks reported, Salmonella was the most common detected agent, with one out of seven outbreaks caused by S. Enteritidis, followed by other bacteria, bacterial toxins and viruses. The agent was unknown in 37.6% of all outbreaks. Salmonella in eggs and Salmonella in meat and meat products were the highest risk agent/food pairs.

The report, 'The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2017', further summarises trends and sources for bovine tuberculosis, Brucella, Trichinella, Echinococcus, Toxoplasma, rabies, Coxiella burnetii (Q fever), West Nile virus and tularaemia.

Source: ECDC, 12 December 2018

The European Centre for Disease Prevention and Control (ECDC) has published three reports in its series of annual epidemiological reports on communicable diseases in Europe.

• Crimean-Congo haemorrhagic fever (CCHF) annual epidemiological report reported a total of six cases for 2016. For the first time, Spain reported two confirmed autochthonous cases. Bulgaria reported the remaining four cases, where CCHF is endemic in the Balkan region.
• Ebola and Marburg fevers - annual epidemiological report reported no cases of Ebola virus disease and Marburg haemorrhagic fever in European Union (EU) or European Economic Area (EEA) countries for 2016.
• Rift Valley fever - annual epidemiological report reported three travel-related cases of Rift Valley fever in EU/EEA countries for 2016. All cases reported by these countries between 2012 and 2016 were travel-related, with probable infection in Comoros, Egypt, Ghana, Mali or Uganda.

Source: ECDC, 12 December 2018

A new report, prepared for Food Standards Scotland (FSS), outlines the scientific evidence on food safety controls, which can be used to reduce the risks of food poisoning bacteria in the production of raw milk cheeses.

The report by Dr Catherine Donnelly, ‘Review of controls for pathogen risks in Scottish artisan cheeses made from unpasteurised milk’, was prepared to supply evidence for Scottish artisan cheesemakers and enforcement officials in managing the microbiological safety of artisan cheeses, particularly those produced from unpasteurised milk. The main pathogens of concern posing a risk to the safety of cheeses made from unpasteurised milk are Listeria monocytogenes, Shiga toxin-producing Escherichia coli, Salmonella and Staphylococcus aureus.

The three-part report covers:

• the categorisation of commonly produced cheese types in Scotland and provides an overview of potential critical control points (CCPs) at each stage of the cheesemaking process, in order to control bacterial pathogens of primary concern
• the analysis of currently available predictive models, challenge testing methods and results of challenge testing, providing evidence of the safety, or lack thereof, attained during cheesemaking
• the analysis of microbiological and physicochemical results obtained from cheesemakers, as well as from the scientific literature and recommendations on testing targets and frequencies to assure process control and production of microbiologically safe products

Source: FSA, 12 December 2018

On 12 December 2018, Scotland’s chief statistician published ‘Scotland’s Carbon Footprint: 1998-2015’. The report provides estimates of Scotland’s greenhouse gas emissions on a consumption basis - emissions that are associated with the spending of Scottish residents on goods and services, wherever in the world these emissions arise, together with emissions directly generated by Scottish households.

The key points that were highlighted were that:

• between 2014 and 2015, the carbon footprint, which is the emissions from all greenhouse gases, remained constant at 76.5 million tonnes of carbon dioxide equivalent (MtCO2e)
• between 1998 and 2015, the carbon footprint fell by 8.0 per cent, from 83.1 MtCO2e in 1998 to 76.5 MtCO2e in 2015
• Scotland’s carbon footprint rose steadily from 1999 to a peak of 97.7 MtCO2e in 2007 before falling sharply in the following years, coinciding with the recession
• Scotland's carbon footprint has generally fallen gradually in more recent years, where the overall reduction between the 2007 peak and 2015 is 21.8 per cent

Source: Scottish Government News, 12 December 2018

Scotland is to become a signatory to the Powering Past Coal Alliance (PPCA), which aims to accelerate clean growth and climate protection through phasing out coal power.

Alliance members commit to cutting unabated coal power generation and to a moratorium on new traditional coal power stations without operational carbon capture and storage. They also commit to support clean power generation and investment.

The PPCA is an alliance of nations, states, cities and organisations committed to moving the world from burning coal to cleaner power sources. Currently there are 47 government and 28 business members of the PPCA. Further information about the PPCA is available on the GOV.UK website. at: https://www.gov.uk/government/publications/powering-past-coal-alliance-decl....

Source: Scottish Government News, 13 December 2018

The latest in a series of horizon-scanning briefing papers has been produced for the European Commission (EC) Directorate-General Environment by the Science Communication Unit at the University of the West of England (UWE). ‘What are the health costs of environmental pollution?’ explores how to assign an economic value to the health impacts of pollution, with a focus on the effects of air, chemical and noise pollution. Costing health impacts has a number of uses in environmental policymaking, from communicating the burden of pollution to informing taxes on polluting activities.

Source: Science for Environment Policy News Alert, December 2018

Health Protection Scotland would like to wish all readers a merry Christmas and a happy and healthy New Year. The next ‘HPS Weekly Report’ will be published on Tuesday 8 January 2019.

We hope you will find these links helpful during the festive season:

• NHS Inform ‘Be Health-Wise This Winter'
• NHS Inform Flu Vaccine
• Scottish Government Ready Scotland
• Food Standards Scotland Turkey Cooking Guide
• Food Standards Agency Season’s Eatings
• Scottish Government Top Tips in Preventing Infection