On 23 July 2019, Health Protection Scotland (HPS) published the latest report on hepatitis C (HCV) testing and treatment in Scotland. A total of 1,423 people were diagnosed HCV antibody positive in Scotland during the 2018 calendar year, which represents the lowest number of new diagnoses since 1996 and highlights the need for an increased focus on case-finding to reduce the undiagnosed population. 

It is estimated that approximately 21,000 individuals were living with chronic HCV in Scotland by the end of 2018 and approximately 10,500 of these have been diagnosed. Testing for HCV remains high, although the increasing trend observed from 2000 to 2015 has levelled off in the last three years. A total of 2,609 individuals started HCV treatment during financial year 2018/19, which exceeds the Scottish Government target of 2,000 for that period.

World Hepatitis Day, which falls on 28 July 2019, is an annual event organised by the World Hepatitis Alliance (WHA) in collaboration with the World Health Organization (WHO), which raises awareness of the global burden of hepatitis.

Approximately 325 million people worldwide are estimated to be living with viral hepatitis but of these, 290 million are unaware and not receiving care. Unless these ‘missing millions’ are detected and treated, they face the risk of liver disease, liver cancer and passing the infection on to others.

‘Find the Missing Millions’ is a three-year global awareness-raising and advocacy campaign, aimed at tackling the main barriers to diagnosis. A 2018 survey by the WHA identified the main barriers to Hepatitis B and C diagnosis globally as:

• lack of public knowledge of the disease 
• lack of knowledge of the disease among healthcare professionals 
• lack of easily accessible testing 
• stigma and discrimination 
• expense to the patient

For 2019, the WHO is focussing on the need for increased financing for hepatitis prevention, testing, treatment and care services in the context of universal health coverage (UHC) with a slogan ‘Invest in eliminating hepatitis’.

Further advice relating to hepatitis can be found on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

Sources: TRAVAX and fitfortravel (both 28 July 2019)

On 17 July 2019,  the World Health Organization (WHO) declared the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) a Public Health Emergency of International Concern (PHEIC). The declaration was made after a meeting of the International Health Regulations Emergency Committee (IHREC) for EVD in the DRC where recent developments in the outbreak, including the first confirmed case in Goma, a city of almost two million people on the border with Rwanda, and the gateway to the rest of DRC and the world, were reported.

In recommending a PHEIC, the committee made specific recommendations related to this outbreak.

Source: WHO, 17 July 2019

On 18 July 2019, the European Centre for Disease Prevention and Control (ECDC) published the annual epidemiological report on Ebola and Marburg fevers for 2017. Data for 2017 reported no cases of Ebola virus disease (EVD) and Marburg haemorrhagic fever (MHF) in the EU/EEA.

Furthermore, on 19 July 2019, the EDCD published a technical report in order to provide guidance to EU/EEA public health authorities, public health professionals and healthcare practitioners for the management of persons having had contact with cases of EVD after visiting or working in an area that is affected by EVD, as well as occupational exposure to the disease.

Sources: ECDC, 18 July 2019 and 19 July 2019

Public Health England (PHE) has reported 18 cases of Escherichia coli (E. coli) in travellers returning from the Hurghada area of Egypt in 2019. One of the affected people developed a serious condition called Haemolytic Uraemic Syndrome (HUS), which can lead to kidney failure.

Prevention of E. coli and other forms of travellers' diarrhoea depends mainly upon practising good hand hygiene and effective food and water precautions:

• hands should be washed thoroughly before eating or handling food, and always after using the toilet 
• sanitising alcohol hand gel is an alternative when washing facilities are not available 
• E. coli is destroyed if food is cooked thoroughly to internal temperatures of over 70 degrees centigrade

Diarrhoea may occur even in travellers who stick strictly to food and water precautions and in many destinations, the risk is determined by local food hygiene and sanitation practices.

Further advice relating to travellers’ diarrhoea can be found on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

Source: TRAVAX and fitfortravel (both 18 July 2019)

The World Health Organization (WHO) has issued a medical product alert relating to three different falsified rabies vaccines (Verorab, Speeda, and Rabipur) and one falsified anti-rabies serum (Equirab) circulating in the Philippines, where a rabies vaccine shortage is ongoing.

The Philippines are classified as a high-risk country for rabies. Travel health professionals are reminded of the importance of discussing the risk of rabies with travellers and the benefits of receiving pre-exposure vaccination prior to travelling overseas. This is particularly important given this recent alert, and the potential for vaccine failure resulting in death, following exposure to the rabies virus.

No adverse reactions to the products have been reported and investigation and analysis are ongoing to determine their contents and better assess the risk to public health. The extent of potential distribution of falsified vaccines across the Philippines is not yet clear and most patients may have received a genuine rabies vaccine, however, as a precaution, patients who may have initiated rabies post-exposure treatment with any rabies vaccine in the Philippines should have their treatment reviewed. Public Health England (PHE) has produced a guide for management of these patients. 

Anyone assessed for post-exposure treatment should consult with an infectious disease consultant in Scotland and the Rabies and Immunoglobulin Service (RIgS) team in England.

Travellers are advised that any animal contact in a rabies endemic area poses a potential risk of infection and that rabies is the most dangerous of all infectious diseases. There is no recognised treatment once symptoms begin and, with the exception of a tiny number of cases, those who develop symptoms of rabies will die.

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

Sources: TRAVAX and fitfortravel (both 18 July 2019)

BMG Research has been commissioned by Public Health England (PHE) to carry out a survey exploring attitudes to vaccination among children aged 13 to 16 years-old and their parents. The results of the survey will be used to inform planning of the immunisation programme. 

Source: UK Government, 18 July 2019