Health Protection Scotland (HPS) has published the annual surveillance report, on 11 June 2019, describing the overseas outbreaks of infectious intestinal disease in 2018.

This report presents information from the surveillance system that HPS uses to collect and disseminate information on potential outbreaks of infectious intestinal disease believed to have been acquired abroad. A potential outbreak of infectious intestinal disease occurring abroad is defined as two or more confirmed cases of infection, or at least one confirmed case where others are alleged to have been ill.

According to a report from the European Food Safety Authority (EFSA), the use of whole genome sequencing (WGS) can improve the way antimicrobial resistance (AMR) is monitored in food and animals. EFSA suggests that these methods could be introduced into member state monitoring activities ahead of revised legislation on AMR monitoring due to come into force in 2021.

The report highlights the need to monitor AMR in seafood, about which little is known. This is linked to the recent expansion of aquaculture production and the increase in imported products into the EU. The importance of understanding how AMR emerges and spreads in the environment where food is produced or processed is an area that requires more investigation and will be followed up by EFSA.

The report gives recommendations on sample sizes and suggests monitoring of resistance to antibiotics relevant for public health, particularly those that are not currently monitored, in order to allow better detection of possible new mechanisms of resistance. 

Source: EFSA, 5 June 2019

The European Centre for Disease Prevention and Control (ECDC) has released a rapid risk assessment on a large outbreak of New Delhi metallo-beta-lactamase (NDM)-producing, carbapenem-resistant Enterobacteriaceae (CRE), from the Tuscany region in Italy.

Between November 2018 and May 2019, seven Tuscan hospitals notified a total of 350 cases. Due to its size, and the resulting change in the epidemiology of CRE, the reported outbreak is considered a significant event. The change in the type of carbapenemase further reduces treatment options because NDM-producing CRE are not susceptible to some of the new beta-lactam/beta-lactamase inhibitor combinations.

Reported outbreaks and examples of cross-border transmission of NDM-producing CRE in EU/EEA countries demonstrate the transmission potential of NDM-producing CRE in European healthcare systems. Outbreaks, such as the one in Tuscany, present a risk for cross-border transmission and further spread to other EU/EEA countries, especially if the affected area is a major tourist destination.

Source: ECDC, 4 June 2019

According to data released by the World Health Organization (WHO), there are more than one million new cases per day of curable sexually transmitted infections (STIs) among people aged 15-49 years. This amounts to more than 376 million new cases annually of four infections, chlamydia, gonorrhoea, trichomoniasis, and syphilis.

Since the last published data for 2012, there has been no substantive decline in either the rates of new, or existing, infections. According to the latest figures, approximately one in 25 people globally have at least one of these STIs, with some experiencing multiple, simultaneous infections.

These STIs have a profound impact on the health of adults and children worldwide. If untreated, they can lead to serious and chronic health effects that include neurological and cardiovascular disease, infertility, ectopic pregnancy, stillbirths, and increased risk of HIV. STI infection is also associated with significant levels of stigma and domestic violence.

Source: WHO, 6 June 2019

World Food Safety Day has been celebrated for the first time, under the theme ‘Food safety – everyone’s business’. 

In a review published by the World Health Organization (WHO), it is estimated over 23 million people per year fall sick from eating contaminated food, with around 4,700 deaths annually. The review also identifies a variety of bacteria, viruses, parasites and chemical hazards with potentially serious consequences for human health, the economy and environment.

Food Standards Scotland (FSS) highlights food poisoning risk from undercooked chicken. Raw chicken can be contaminated with Campylobacter, which is responsible for an estimated 54,000 cases of illness each year in Scotland. Previous studies have suggested that laboratory reports underestimate the true incidence by a factor of around nine, and there are around 6,000 positive laboratory results in Scotland each year. 

As the summer barbecue season begins, FSS figures show that 14% of people in Scotland would eat chicken that was pink or had red juices, despite this putting them at high risk of food poisoning from Campylobacter which can be killed by thorough cooking.

FSS provide advice on how to store, prepare and cook food safely.

Sources: WHO Europe, 5 June 2019 and FSS, 7 June 2019

The European Centre for Disease Prevention and Control (ECDC) has released a report on a multi-country outbreak of infections due to Listeria monocytogenes clonal complex 8.

Five EU countries are identified in the report (Denmark, Estonia, Finland, France and
Sweden), with a total of 22 cases recorded, which includes five deaths. The first case was reported in July 2014 in Estonia, and the most recent case occurred in Denmark in February 2019. Eight patients confirmed the consumption of cold-smoked fish products. 

L. monocytogenes food isolates, matching the human outbreak strain by whole genome sequencing (WGS), were detected at wholesale and retail outlets in France, Denmark, Italy and Sweden. This was from 13 batches of cold smoked or gravid salmon and from six batches of cold smoked trout products.

The presence of L. monocytogenes matching the outbreak strain suggests the persistence of the microorganism at the Estonian company’s premises, where further investigation is needed to identify points of contamination, and cross-contamination, in the food processing plant. 

Control measures were implemented in Estonia, Denmark, France and Italy following the Rapid Alert System for Food and Feed (RASFF) notifications, but until the source of infection has been identified and controlled, new invasive listeriosis cases associated with this event may still occur.

Source: ECDC, 4 June 2019

In 2010, the US Food and Drug Agency (FDA) published a warning for consumers of Miracle Mineral Solution (MMS). The FDA warned that when used as directed, MMS produces an industrial bleach that can cause serious harm to health. Consumers are instructed to mix the 28 percent sodium chlorite solution with an acid such as citrus juice, which produces chlorine dioxide, a potent bleach used for stripping textiles and in industrial water treatment. High oral doses of MMS, such as those recommended in the labelling, can cause nausea, vomiting, diarrhoea, and symptoms of severe dehydration.

Since 2010, there have been numerous reports in the media of continued use of MMS. The most recent report was published in the Guardian on 18 May 2019, which reports that the product continues to be used in Uganda for cancer, HIV/AIDS and malaria, among other diseases. The newspaper reports that MMS is banned in several countries, including Canada and Ireland, while its use in the UK and US is strictly controlled and has led to fraud prosecutions.

According to the FDA, MMS is distributed on internet websites and online auctions by multiple independent distributors who claim that the product can be used to treat multiple unrelated diseases, including HIV, hepatitis, the H1N1 flu virus, common colds, acne and cancer. The FDA further warns that using MMS for self-treatment, instead of seeking FDA-approved treatments for these conditions, poses a significant health risk to consumers who may choose to use this product.

UK national public health authorities have recently been reminded about the risks associated with this substance by the International Health Regulations National Focal Point (IHRNHP).

The Centre for Environment, Fisheries and Aquatic Science (Cefas) has been designated by the World Organisation for Animal Health (OIE) as the collaborating centre for Emerging Aquatic Animal Disease (EAAD), in recognition of Cefas’ expertise in disease detection and diagnosis, and its links and partnerships with other international expert centres.

The centre will play a central role in aquatic animal disease control in developing countries, where aquaculture is one of the fastest growing food sectors and where it is a significant component of food and income for those nations.

Global aquaculture production has increased rapidly in recent decades, with aquaculture now exceeding wild capture fisheries as a source of aquatic animal protein and is estimated to double production by 2050.

A network of associate laboratories, based in China, Thailand, India, South Africa, North and South America, Denmark and France, will focus on emerging disease surveillance, with a view  to mitigate the negative effects of disease in this rapidly expanding sector.

Source: UK Government, 4 June 2019

The Institute for Public Policy Research (IPPR) has released a report proposing plain packaging for unhealthy food and drinks, as well as advertising restrictions on TV and in public places, in line with the action taken against smoking. 

The research indicates that taking preventative action will not only improve health, but also make the NHS more sustainable, among other social and economic benefits.

Source: IPPR, 4 June 2019

The European Environment Agency (EEA) report, published on 6 June 2019, was compiled using information from more than 21,000 bathing waters, both coastal and inland, in the 28 EU member states. It also covers bathing waters in Albania and Switzerland. The report is a joint production of the EEA and the European Commission (EC).

Europe's bathing water quality has improved following effective monitoring and management, introduced under the EU bathing water directive. Local authorities collect water samples at officially identified bathing sites throughout the bathing season. These samples are analysed for two types of bacteria which indicate pollution from sewage or livestock. Depending on the levels of bacteria detected, the bathing water quality is classified as 'excellent', 'good', 'sufficient' or 'poor'. In the 2018 bathing season, more than 22,000 bathing waters were monitored throughout Europe.

In 2018, 85.1% of bathing water sites met the bathing water directive's most stringent 'excellent' quality standards. The report provides a chart showing the proportion of bathing water sites with excellent water quality in European countries, with the UK reported to have 63.2% of sites classified as ‘excellent’. 

The HPS Weekly Report of 4 June 2019 (53/2208) provides the results of Scottish bathing water quality.

Source: EEA, 6 June 2019