Health Protection Scotland (HPS) has published the latest Needle Exchange Surveillance Initiative (NESI) report.

NESI measures and monitors the prevalence of blood-borne viruses and injecting risk behaviours among people who inject drugs (PWID) in Scotland and is funded by Scottish Government via the Sexual Health and Blood-Borne Virus Framework.     

This latest report presents the results, at the NHS board level, for the data collection period from July 2017 until October 2018, during which data were collected across the 11 mainland Scottish NHS Boards. This report also presents the findings of the NESI survey, at Scotland-wide level, from 2008-09 until the most recent survey, 2017-18.

Four cases of wound botulism have recently been notified to Health Protection Scotland (HPS). The first case, in NHS Fife, presented in early February 2019 and has been confirmed microbiologically. Two further cases presented in mid-late March in NHS Lanarkshire and NHS Greater Glasgow and Clyde (GGC) respectively, and have also been confirmed microbiologically.

In the past few days, a further probable case from NHS Lanarkshire presented. In total, there have been 3 confirmed and 1 probable case of wound botulism investigated since February 2019. All cases presented with clinical features consistent with wound botulism, and all involve people who inject drugs (PWID). There have been no deaths among the identified cases.

Samples were obtained and sent to the reference lab for microbiological confirmation. The source of the infection is believed to be heroin contaminated with Clostridium botulinum spores. The last confirmed case of wound botulism among PWID in Scotland was in 2017.

Information and guidance about botulism and information on the public health management of botulism are available on the HPS website.

New research has shown that the Human Papillomavirus (HPV) vaccine has reduced the highest grade of cervical pre-cancer by almost 90%.

The study involved a collaboration of researchers from Health Protection Scotland (HPS), Information Services Division (ISD) and the Scottish Human Papillomavirus Reference Laboratory all within NHS Scotland, and the universities of Aberdeen, Edinburgh, Glasgow Caledonian and Strathclyde. This follows a recent study which showed large reductions in HPV infection in girls eligible for vaccination.

Cervical cancer is the second most common cancer in women aged under 35 in the UK and caused the deaths of more than 800 women in 2016. Infection with HPV types 16 and 18 is known to be the cause of at least 80 per cent of cases in Scotland. Recent population-based studies suggest that HPV also plays a part in causing other cancers, particularly head-and-neck, vulvo-vaginal and anal cancers.

Since the start of the Scottish HPV immunisation programme in 2008, uptake of the vaccine has exceeded 85% every year and these results are welcomed as they highlight the success of the programme in protecting girls against cervical pre-cancer.

The research also highlights the success of the work of the Scottish Immunisation Programme which set up the HPV immunisation programme and continues to co-ordinate the delivery of the programme. The results will also be welcomed by the many healthcare workers that are involved at all levels in the delivery of the vaccination programme in schools.

In future years, the massive reduction in cervical pre-cancer should translate to reductions in cervical cancer which will be closely monitored by Health Protection Scotland as part of the work of the Scottish Immunisation Programme. These results are promising for the potential future impact of the upcoming extension of the programme to boys on other HPV driven cancers.

Source: HPS, 4 April 2019

Public Health England (PHE) has updated its guidance on managing Avian influenza in humans. The guidance has been developed to assist with the management of possible or confirmed cases of Avian influenza, in particular, H5N6, H5N1 and H7N9.

Further information on Avian influenza is available on the Health Protection Scotland website.

Source: PHE, 5 April 2019

An oral cholera vaccination campaign to protect survivors of Cyclone Idai has begun in Beira, Mozambique. Funded by Gavi, the Vaccine Alliance, the campaign will be carried out by the Mozambique Ministry of Health with support from the World Health Organization (WHO) and other partners including UNICEF, the International Federation of the Red Cross and Red Crescent Societies (IFRC), Médecins Sans Frontières (MSF) and Save the Children.

There has already been one reported cholera death and almost 1,500 reported cases following the cyclone, which caused severe flooding in Mozambique, Zimbabwe, Malawi and Madagascar after making landfall in March. Nine cholera treatment centres, with 500-bed capacity, are already admitting patients.

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

Information about current cholera outbreaks in Africa, including Mozambique, is also available on TRAVAX.

Source: WHO, 3 April 2019

The European Centre for Disease Prevention and Control (ECDC) has published a report that summarises the progress made in the areas of EU-wide enhanced molecular typing for disease surveillance, genomic surveillance, and multi-country outbreak support. The report also documents how member states use Whole Genome Sequencing (WGS) in public health operations and reviews the current evidence for the effectiveness of WGS.

The proposed strategic framework sets out a revised list of priority pathogens/diseases for medium-term integration in 2019–2021. Over this period, ECDC proposes to prepare for and/or implement support to multi-country outbreak investigations, continuous EU surveillance, and sentinel surveillance. Depending on preparedness for reporting of high-quality sequence data, the following applications and pathogens are particularly relevant:

• Support to multi-country outbreak investigations through sequence-based typing: Campylobacter, Clostridium difficile, Hepatitis A virus, Legionella spp., Listeria monocytogenes, multidrug-resistant Mycobacterium tuberculosis (MDR TB), Neisseria meningitidis, Salmonella enterica, Shiga-toxin producing E. coli, West Nile virus and emerging multi- or extensively drug-resistant (MDR or XDR) bacteria, new pathogens or new modes of transmission of healthcare-associated or community pathogens.

• EU-wide sequence-based continuous surveillance: influenza virus, Listeria monocytogenes, MDR TB, Neisseria meningitidis, Salmonella enterica and Shiga-toxin producing E. coli.

• Sentinel surveillance or surveys: antibiotic-resistant Neisseria gonorrhoeae, Bordetella pertussis, carbapenem- or colistin-resistant Enterobacteriaceae, carbapenem-resistant Acinetobacter baumannii, HIV-transmitted drug resistance, and Streptococcus pneumoniae.

The report further outlines the technological steps that are necessary to develop an integrated analytical framework and operational platform that combine sequence-based typing data with epidemiological data at the European level.

Source: ECDC, 4 April 2019

Radon is a colourless, odourless radioactive gas. It’s formed by the radioactive decay of small amounts of uranium that occur naturally in all rocks and soils.

The main danger from high radon exposure is the increased risk of lung cancer. For most people, radon is the single largest source of radiation exposure whether they are at home or at work.

A new report published by Public Health England (PHE) investigates the performance of preventive measures in reducing radon levels in new homes built in areas of elevated radon risk by comparing radon levels in new properties built with basic radon prevention measures with levels observed in properties, in the same areas, that were built without preventive measures, prior to this building regulations requirement.

The results show that ‘basic’ preventive measures reduce radon levels in new properties by around 40% when compared with properties built without these measures in areas of elevated radon risk.

Radon levels in some properties were high despite having these basic measures in place. This supports existing advice that these properties should be tested for radon.

This evidence will be useful to those involved in designing and reviewing radon prevention measures in new properties.

Source: PHE, 5 April 2019