On 27 August 2019, Health Protection Scotland (HPS) published the surveillance report ‘HIV infection and AIDS, HIV infection in Scotland: summary report of treatment and care to 31 December 2018’. 

The report shows that as at the end of December 2018, it is estimated that there are 5,881 individuals living with HIV in Scotland and, of these, 91% (5,352) have been diagnosed, of whom almost three quarters (73%, 3,916) are male and 1,436 are female. Of 5,352 diagnosed individuals, 92% (4,913) are attending specialist HIV services for treatment and care and, of these, 4,799 (98%) are receiving ART, of whom 94% (4,530) have achieved an undetectable viral load.

These figures highlight that Scotland has maintained the global UNAIDS ‘Fast Track’ HIV 90-90-90 targets set for 2020 first met in September 2018 (90% of HIV infected individuals will be diagnosed and, of these, 90% will be receiving antiretroviral therapy (ART) and, of these, 90% will achieve an undetectable viral load).

While it is welcome news that the numbers of diagnosed individuals attending for care, receiving ART and achieving viral suppression in Scotland are high, there is evidence that an appreciable proportion of first ever diagnoses are being made at a late, or very late, stage of infection each year (approximately one quarter (27%) of first ever diagnoses recorded in 2018 were made at a late stage of infection). Those individuals diagnosed late have an eight-fold higher risk of dying within one year of diagnosis.¹

Thus, while HIV treatment and care in Scotland is optimal, the main areas for public health action are:

• to reduce the number of HIV transmissions taking place (with HIV pre-exposure prophylaxis being a primary strategy among those at highest risk of sexual acquisition) and, where prevention fails, to diagnose these infections early (particularly focusing on key groups identified such as heterosexuals of White Scottish and Black African ethnicity), and
  
  
• to diagnose (or re-diagnose) early those infected individuals who come to Scotland already infected through earlier and more frequent testing with a view to improving their health outcomes.

1. Delpech, V., Brown, A.E., Croxford, S., Chau, C., Polavarapu, V., Cooper, N., et al. Quality of HIV care in the United Kingdom: key indicators for the first 12 months from HIV diagnosis. HIV Med 2019; 14(3): 19-24.

The UK has lost its ‘measles-free’ status with the World Health Organization (WHO) three years after the measles virus was eliminated from the country.

The UK initially achieved WHO measles elimination status in 2017, but in 2018 there was a marked increase in the number of confirmed measles cases with 991 confirmed cases in England and Wales, compared with 284 cases in 2017.

The same strain of measles virus, B3 Dublin, was detected for more than 12 months across 2017 and 2018. Based on this, the WHO determined that the UK could no longer be considered ‘measles-free’ and that transmission of the virus had been re-established.

Measles can be prevented through two doses of the MMR vaccine, which is offered free by the NHS to all young children in the UK. While coverage of the first dose in the UK has reached the WHO target of 95% for children aged five, coverage of the second dose is at 87.4%.

On 19 August 2019, Public Health England (PHE) reviewed the reasons for the change in the UK’s status, and the ongoing efforts being made to protect the British population from the measles virus.

Source: Royal Environmental Health Institute of Scotland (REHIS), 20 August 2019

Public Health England (PHE) has warned that one-in-seven children aged five years-old in England may not be fully up-to-date with routine immunisations, with the figure rising to around one-in-four children in London.

The estimates were released as part of PHE’s Value of Vaccines campaign, which shows some four- and five-year-olds are starting school at unnecessary risk of serious diseases, prompting a call for parents to check their child’s immunisation schedule is up-to-date.

In the UK, the first dose of the Measles, Mumps and Rubella (MMR) vaccine, is usually given to infants at around twelve months of age. A second dose is given before school, usually at three years and four months of age, to ensure best protection.
Two doses of MMR in a lifetime are needed for a person to be considered fully protected. The 4-in-1 pre-school booster is also usually offered at three years and four months of age and protects against diphtheria, whooping cough, tetanus and polio.

Around 680,000 five-year-olds start school in England each year, according to Department for Education figures. Based on percentage uptake from latest vaccination coverage figures, PHE estimates that:

• Over 30,000 five-year-olds may still need to receive their first dose of MMR, leaving them significantly more at risk compared to pupils who are fully vaccinated.
• Around 90,000 five-year-olds in England may still need to receive their second dose of MMR vaccine. Almost 30,000 of these children are in London, meaning that around one-in-four primary school starters in the capital don’t have the full protection that the MMR vaccine offers.
• Around 100,000 five-year-olds in England may still need their 4-in-1 pre-school booster.

Source: PHE, 19 August 2019

World Rabies Day is held each year on 28 September, the anniversary of Louis Pasteur’s death.

Created and co-ordinated annually by Global Alliance for Rabies Control (GARC), World Rabies Day aims to increase awareness of the disease and its prevention.

The theme this year is ‘Rabies – Vaccinate to Eliminate’, which highlights the importance of vaccination in the goal of ending rabies deaths. The key messages for health care practitioners and members of the public are:

• to make individuals aware of when and how to obtain pre- and post-exposure rabies vaccinations
• to ensure that dogs are vaccinated
• to commit to the 2030 goal of eliminating human deaths from dog mediated rabies
• rabies is 99.9% fatal and 100% preventable.

World Rabies Day is a reminder to health care practitioners in the UK that rabies risks should be discussed in all relevant travel consultations.

The Travax rabies and rabies FAQ pages give information to health professionals on the disease and pre-exposure vaccination. The post-exposure rabies guidance page gives information on where to seek advice when rabies post-exposure management is required. Information for the general public is available on the fitfortravel website (https://www.fitfortravel.nhs.uk/advice/disease-prevention-advice/rabies)

Consult the relevant country pages for local specific risks.

Source: Travax, 19 August 2019

The World Health Organization’s (WHO) Strategic Advisory Group on Malaria Eradication (SAGme) has published a report commenting on the prospects of malaria eradication, and suggesting action that needs to be taken in the future.

The report says that accelerated research and development (R&D) in new tools for malaria prevention and treatment is the key to eradicating the virus in the foreseeable future. Currently, less than 1% of funding for health R&D investment goes towards developing tools to tackle malaria.

The report also outlines the urgent need for progress to advance universal health coverage and improve access to services and better surveillance to guide a more targeted malaria response.

The group has published an executive summary of its report ahead of a WHO-hosted forum to be held in Geneva on 9 September 2019.

Global malaria infection and death rates have remained virtually unchanged since 2015. The WHO’s world malaria report in 2018 revealed that the world is currently off-track in achieving a 90% reduction of malaria incidence and mortality by 2030, goals set out in the WHO Global Technical Strategy for malaria 2016-2030.

Source: WHO, 23 August 2019

The Centers for Disease Control and Prevention (CDC) is investigating 94 possible cases of severe lung illness associated with “vaping” in the United States. The cases have been reported in 14 states as of 17 August 2019, according to a statement from the agency.

CDC is providing consultation to the departments of health in Wisconsin, Illinois, California, Indiana and Minnesota. The cases have been primarily reported among young adults. Additional states have alerted CDC to possible (not confirmed) cases and investigations into these cases are ongoing.

It is unclear what is causing the illnesses, or if there is a link between patients' symptoms and the kind of products they have used.

On Friday 23 August 2019, one death relating to the outbreak was confirmed.

Source: CDC, 17 August 2019

On 22 August 2019, the UK Government’s Science and Technology Select Committee published a report which recommended bringing forward the ban on sales of new petrol and diesel vehicles in the UK from 2040 to 2035.

The report also recommends government action to support the development and deployment of technologies that can reduce the UK’s emissions.

The recommendations cover the following areas:

• The clean growth strategy
• UK greenhouse gas emissions
• decarbonising power generation
• decarbonising transport
• decarbonising heating
• the UK energy system
• carbon capture and storage

In addition, the report also highlighted the lack of government policies in place to deliver the net zero carbon target by 2050 and recommends ten steps the government should take to meet this legally binding target.

Source: Science and Technology Select Committee, 22 August 2019

On 22 August 2019, the World Health Organization (WHO) issued a call for a further assessment of microplastics in the environment and their potential impacts on human health, following the release of analysis of current research related to microplastics in drinking-water.

The WHO also called for a reduction in plastic pollution to benefit the environment and reduce human exposure.

According to the analysis, microplastics larger than 150 micrometres are not likely to be absorbed in the human body and uptake of smaller particles is expected to be limited. Absorption and distribution of very small microplastic particles including in the nano size range may be higher, although the data is extremely limited.

Further research is needed to obtain a more accurate assessment of exposure to microplastics and their potential impacts on human health. These include:

• developing standard methods for measuring microplastic particles in water
• more studies on the sources and occurrence of microplastics in fresh water
• reviewing the efficacy of different treatment processes

The WHO recommends drinking-water suppliers and regulators prioritize the removal of microbial pathogens and chemicals that are known risks to human health, such as those causing deadly diarrhoeal diseases.

Wastewater treatment can remove more than 90% of microplastics from waste water, with the highest removal coming from tertiary treatment such as filtration. Conventional drinking-water treatment can remove particles smaller than a micrometre.

A significant proportion of the global population currently does not benefit from adequate water and sewage treatment. By addressing the problem of human exposure to faecally contaminated water, communities can simultaneously address the concern related to microplastics.

Source: WHO, 22 August 2019

The plumbing approval register, Watersafe, has urged owners of Scottish homes built before 1970 to check if their water pipes are made of lead.

The installation of lead plumbing has been banned in the UK for more than 25 years. Lead dissolving into drinking water can be harmful if it builds up in the body, especially for babies and children, whose development can be affected.

Research by WaterSafe shows nearly two-thirds of homeowners in Scotland have never checked to see if they have lead water pipes.

The annual drinking water quality report, published by the Drinking Water Quality Regulator for Scotland (DWQR) earlier this month, shows drinking water in Scotland is of high quality, with 99.90% of samples meeting the required standards, though it also shows that drinking water in some homes is still being affected by lead pipes, which are mostly found in properties built before 1970.

Nine lead failures were picked up during Scottish Water’s routine tests at customers’ taps in 2018, with lead pipes in the home’s plumbing being found in all cases.

Replacing lead plumbing inside homes, and to the property boundary, is the responsibility of the homeowner. WaterSafe’s research shows only half of households are aware of this.

Source: Scottish Water, 22 August 2019

World Water Week will take place between 25-30 August 2019. World Water Week is organized by the Stockholm International Water Institute (SIWI) and takes place in Stockholm, Sweden on an annual basis. Its aim is to transform global water challenges.

World Water Week is a collaborative learning experience, providing a forum and opportunity to facilitate the exchange of views, experiences, and practices between the scientific, business, policy and civil society.

This year, the theme will focus on ‘Water for society – Including all’ with the seminars driven by the Scientific Programme Committee and many other sessions focused on aspects of this theme.

Source: SIWI, 2019

The Scottish Environmental Incident Surveillance System (SEISS) recorded the following incidents in the past week:

• Parents and pet owners have been warned to keep their children and animals out of the water at Clatto reservoir near Dundee because of the presence of toxic blue-green algae. Despite the presence of the algae, there have been reports of dogs and children in the water. Blue green algae (BGA) blooms may appear as green or greenish-brown scum on the surface of water and can contain toxins that can be harmful for animals if ingested. This was reported by the Dundee Evening Telegraph.
• On Sunday 25 August 2019, more than 80 firefighters worked through the night to tackle a "complex" blaze at a Woodmill High School, in Dunfermline, Fife. The fire was fought by 15 fire appliances for several hours, after the alarm was raised at about 17:05 BST on Sunday. There are no reports of injuries but Fife Council said the school would be closed and pupils should stay at home. The Scottish Fire and Rescue Service asked people to avoid the area to allow access by the emergency services. This was reported by the BBC.

For more detailed information, visit the SEISS website.