On 10 September 2019, the our immunisation web pages were updated to reflect the latest quarterly data on:

• Haemophilus influenzae
• invasive pneumococcal disease
• measles
• meningococcal disease
• mumps
• rotavirus
• rubella
• shingles
• whooping cough

The Health Protection Scotland (HPS) Travel and International Health team have revised the hepatitis B recommendations for medical staff on all TRAVAX individual country pages. 

The hepatitis B virus is found worldwide therefore every country featured on TRAVAX has a hepatitis B recommendation. In addition, there is an indication on each county page as to the estimated risk category based on estimated prevalence for hepatitis B.  High risk is determined as 8% or greater, intermediate risk is between 2–7%, while low risk is less than 2%.

The types of traveller that should be considered for hepatitis B vaccination are: 

• frequent travellers 
• long stay travellers 
• those more likely to be exposed, such as children from cuts and scratches 
• those more at risk of injury and accidents, such as climbers, backpackers, adventure travellers etc 
• individuals with underlying conditions who may need surgical procedures abroad 
• those travelling for medical procedures abroad 
• those at occupational risk, such as healthcare workers

More information on hepatitis can be found on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

On 3 September 2019, Public Health England (PHE) released data that showed new HIV diagnoses in the UK have fallen by almost a third (28%), from 6,271 cases in 2015 to 4,484 cases in 2018, a number also represents the lowest level since 2000.

New HIV diagnoses have been declining in gay, bisexual and heterosexual populations. The steepest falls have been seen among gay and bisexual men, where new diagnoses declined by 39% between 2015 and 2018. The factors associated with the largest decreases among gay and bisexual men are:

• white (46% decrease between 2015 and 2018) 
• born in the UK (46% decrease between 2015 and 2018) 
• aged 15 to 24 (47% decrease between 2015 and 2018) 
• living in London (50% decrease between 2015 and 2018)

During the same period, new diagnoses have also fallen by a quarter among people who acquired HIV through heterosexual contact.

The continued decline of HIV diagnoses is mainly due to the success of combination HIV prevention over the past decade, which includes HIV testing, condom provision, the scale-up of pre-exposure prophylaxis (PrEP) and anti-retroviral therapy (ART) drugs that keep the level of HIV in the body low and prevent the virus being passed on.

Source: PHE, 3 September 2019

World Health Organization (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus, has welcomed plans to direct users searching for vaccine information on Facebook and Instagram to WHO guidance on the subject, which it is hoped will ensure accurate and reliable information on vaccination reaches the people who need it most.

The WHO and Facebook have been in discussions for several months to ensure people can access authoritative information on vaccines and reduce the spread of inaccurate information.

Vaccine misinformation is a major threat to global health which could reverse the years of progress made in tackling preventable diseases. Many serious diseases can be prevented by vaccination including measles, diphtheria, hepatitis, polio, cholera, yellow fever and influenza.

The director-general also called for online efforts to be matched by governments and health sectors taking steps to promote trust in vaccination and to respond to the needs and concerns of parents.

Source: WHO, 4 September 2019

World Sepsis Day is an initiative organised by the Global Sepsis Alliance (GSA) and takes place annually on 13 September.

Sepsis arises when the body’s response to an infection injures its own tissues and organs. This potentially life-threatening condition follows a unique and time-critical clinical course, which in the early stages is highly amenable to treatment through early diagnosis and timely and appropriate clinical management. 

Currently, sepsis causes at least eight million deaths worldwide every year, many of which are preventable.

Depending on country and education, only 7–50 % of people are aware of sepsis. Likewise, many people are unaware that sepsis can be prevented by vaccination and adhering to hygiene rules, and that early recognition and treatment reduces mortality by 50%. This lack of awareness makes sepsis the most preventable cause of death worldwide.

On 3 September 2019, Scotland’s First Minister, Nicola Sturgeon, announced the 2019-2020 ‘Programme for Government’ in the Scottish Parliament. Part of this year’s programme includes further reducing Scotland’s contribution to climate change.

The programme sets out several steps the Scottish Government will take, including an investment of more than £500 million to improve bus infrastructure across the country, in order to encourage more people to use public transport.

Plans also include an aim to decarbonise Scotland’s railways by 2035, and to make the Highlands and Islands the world’s first net zero aviation region by 2040.

Other environmental plans include: 

• A ‘Green New Deal’, creating a £3 billion package of investments to attract green finance to Scotland. 
• Plans to develop regulations, so that from 2024 new homes must use renewable or low carbon heat, targeting a minimum of £30 million of support for renewable heat projects.

Source: Scottish Government, 3 September 2019

The European Environment Agency (EEA) has published a report which investigated the key climate change problems facing agriculture in the EU and the outlook for the years ahead.

The report recommends that adapting to climate change must be made a top priority for the EU’s agriculture sector if it is to improve resilience to extreme events like droughts, heatwaves and floods. The report also states that crop and livestock production is projected to decrease and may even have to be abandoned in parts of Europe’s southern and Mediterranean regions.

Climate impacts have led to poorer harvests and higher production costs, affecting the price, quantity and the quality of farmed products in some parts of Europe. While climate change is projected to improve conditions for growing crops in parts of northern Europe, the opposite is true for crop productivity in the south.

According to projections, yields of non-irrigated crops like wheat, corn and sugar beet will decrease in southern Europe by up to 50% by 2050. This could result in a substantial drop in farm income, with large regional variations. Farmland values are also projected to decrease in parts of southern Europe by more than 80% by 2100. Trade patterns could also be affected, which will reduce agricultural income. 

While food security is not under threat in the EU, increased food demand worldwide could exert pressure on food prices in the coming decades, the report says.

The report also gives an overview of how EU policies and programmes address climate change adaptation and includes examples of feasible and successful adaptation actions. 

Source: EEA, 4 September 2019

On 5 September 2019, a new statutory instrument was laid in the UK Parliament which will tighten rules  to help protect the UK’s food allergy and food intolerance sufferers. 

The law, known as 'Natasha’s Law', will require foods prepared on the premises in which it is sold to be labelled with a full list of ingredients and allergen information. The law will come into effect from October 2021.

The law follows the death of Natasha Ednan-Laperouse, a teenager who died after suffering an allergic reaction to a sandwich bought from a shop. The case led the government to create stronger laws in order to help protect those with allergies and give them greater confidence in the food they buy.

Source: Department for Environment, Food & Rural Affairs (DEFRA), 5 September 2019

According to the Morbidity and Mortality Weekly Report (MMWR), during July and August 2019, five patients were identified at two hospitals in North Carolina with acute lung injury potentially associated with electronic cigarette (e-cigarette) use.

E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine, flavourings, and other chemicals that users inhale, behaviour commonly referred to as vaping. E-cigarettes can also be used to deliver marijuana and other drugs. In recent months, more than 200 possible cases of acute lung injury potentially associated with vaping have been reported from 25 states in the USA.

The five patients were adults aged 18–35 years and all experienced several days of worsening dyspnea, nausea, vomiting, abdominal discomfort and fever. All demonstrated tachypnea with increased work of breathing on examination, hypoxemia and bilateral lung infiltrates on chest x-ray. All five patients shared a history of recent use of marijuana oils or concentrates in e-cigarettes. All were hospitalised for hypoxemic respiratory failure; three required intensive care for acute respiratory distress syndrome, one of whom required intubation and mechanical ventilation. All of the patients survived but these cases highlight the importance of awareness of a potential association between use of marijuana oils or concentrates in e-cigarettes and lipoid pneumonia. 

Source: MMWR, 6 September 2019