Enhanced tuberculosis (TB) surveillance was introduced in Scotland in 2000 through the Enhanced Surveillance of Mycobacterial Infections (ESMI) scheme. In 2018, a total of 271 cases of TB were reported to the ESMI scheme, equating to an annual incidence of 5.0 cases per 100,000 of the population. This was a 7.5% decrease in case numbers and a 7.7% decrease in annual incidence when compared with 2017 (293 cases, 5.4 cases per 100,000 of the population). This represents the eighth consecutive annual decrease in TB case numbers and incidence since 2010, with TB case numbers and incidence now both at their lowest levels since ESMI began.

Drug resistance was noted to have increased in 2018, with the proportion of isolates with resistance to at least one first line drug (15.8%) and to isoniazid (8.7%) and pyrazinamide (8.7%) individually all at the highest levels seen since enhanced surveillance began. There were two cases of multidrug-resistant TB and no cases of extensively drug-resistant TB in 2018. This is a concerning finding, as drug-resistant TB is more difficult and expensive to treat and, as a result, patients can remain infectious for longer.

Treatment outcomes at 12 months were recorded for 94.5% of cases initially reported in 2017, of whom 85.8% successfully completed treatment. This is the highest treatment completion rate reported since outcome reporting began in 2001. The number of TB cases with death recorded as an outcome at 12 months decreased from 34 cases in 2016 to 19 in 2017.

The full report, published on 29 October 2019, can be viewed on the Health Protection Scotland (HPS) website.

Public Health England (PHE) has published new guidance for frontline emergency service workers covering prevention and control of exposure to common blood-borne viruses (BBVs). The guidance has been developed to support frontline emergency workers in understanding their potential risk of blood-borne virus (BBV) exposure following injury or assault, and the steps that should be taken to manage and support them by health services, including occupational health. The guidance intends to relieve the stress that such events can bring to staff and dispel the stigma and myths often associated with concerns about transmission of infection. The aim is to provide the highest standard of care to be provided if exposure is thought to have occurred, with care pathways specific to each frontline service.

The guidance, which applies specifically to staff working in the police, fire, ambulance, prison and immigration services, is intended for use at national, regional and local levels, ensuring that staff are effectively supported and educated on the risks of exposure to BBVs.

Source: PHE, 21 October 2019

The European Centre for Disease Prevention and Control (ECDC) has published an operational checklist for health emergency preparedness on imported cases of high-consequence infectious diseases. The checklist aims to support countries in the European Union/European Economic Area (EU/EEA) in their own individual reviews of preparedness system planning.

The content of the ECDC checklist is based on work performed during the Ebola virus disease outbreak in West Africa from 2013 to 2016, and a specific protocol used in the peer-review visits to the health systems of Belgium, Portugal and Romania. The checklist may be seen as complementary to broader preparedness checklists published by other international organisations.

Source: ECDC, 22 October 2019

On 24 October 2019, World Polio Day, the independent Global Commission for the Certification of Poliomyelitis Eradication announced that wild poliovirus type 3 (WPV3) has been eradicated worldwide. Following the eradication of smallpox and wild poliovirus type 2, this news represents a significant historic achievement.

There are three individual and immunologically-distinct wild poliovirus strains, these being wild poliovirus type 1 (WPV1), wild poliovirus type 2 (WPV2) and wild poliovirus type 3 (WPV3). Symptomatically, all three strains are identical, in that they cause irreversible paralysis or even death. But there are genetic and virologic differences which make these three strains separate viruses which must each be eradicated individually.

WPV3 is the second strain of the poliovirus to be wiped out, following the certification of the eradication of WPV2 in 2015. The last case of WPV3 was detected in northern Nigeria in 2012. Investments in skilled workers, innovative tools and a global network of laboratories have helped determine that no WPV3 exists anywhere in the world, apart from specimens locked in secure containment.

At a celebration event at the headquarters of the World Health Organization (WHO) in Geneva, Professor David Salisbury, chair of the independent Global Commission for the Certification of Poliomyelitis Eradication, presented the official certificate of WPV3 eradication to Dr Tedros Adhanom Ghebreyesus, WHO Director-General and Chair of the Global Polio Eradication Initiative (GPEI) Polio Oversight Board. Professor Salisbury welcomed this significant achievement, suggesting that it should reinvigorate the eradication process and provide motivation for the eradication of WPV1 which remains in circulation.

Source: WHO, 24 October 2019

The Department for Environment, Food & Rural Affairs (DEFRA), along with the Scottish and Welsh Governments, have jointly published a strategy setting out a framework on managing an outbreak of equine infectious anaemia (EIA) in Great Britain. EIA, sometimes known as ‘swamp fever’ is a viral disease of equine species, and it should be noted that the disease poses no risk to human health.

The strategy covers general control principles for the most likely scenarios where cases of EIA may occur, and the rationale for such controls. It is not intended to provide detailed operational instructions for how to deal with an outbreak. The Scottish Government’s Exotic diseases of animals: contingency framework plan covers these arrangements and should be referred to for detailed explanation of the systems, structures, roles and responsibilities implemented during an outbreak, which are referenced in this control strategy.

Source: DEFRA, 28 October 2019

The latest Radioactivity in Food and the Environment Report (RIFE 24) was published on 24 October 2019, and shows that doses of radioactivity received by people in Scotland remain within international limits.

The annual RIFE 24 report is a joint publication between all six agencies across the UK with responsibility for ensuring that doses from authorised releases of radioactivity do not pose an unacceptable risk to health, these being the Scottish Environment Protection Agency (SEPA), the Environment Agency (EA), Food Standards Agency (FSA), Food Standards Scotland (FSS), Natural Resources Wales (NRW) and the Northern Ireland Environment Agency (NIEA).

The report looks at the levels and concentrations of radioactivity measured in the environment during 2018 and discharges from all of the nuclear licensed sites in Scotland. It assesses the dose a member of the public could receive, based on a number of factors such as environmental concentrations, diet and activity.  The highest dose for a member of the public reported in Scotland from an authorised discharge was 0.035 millisievert (mSv), around one thirtieth of the legal limit. As a comparison, the UK average exposure from all sources, including background radiation, is 2.7 mSv, of which 0.40 mSv is from patient exposure to radiation from medical treatments.

In Scotland, SEPA is responsible for the radiological monitoring that is carried out and has a duty to ensure that no member of the public receives a dose in excess of the statutory dose limit of one millisievert (1 mSv) per year from authorised discharges. This year’s data shows that doses were within the legal limits and that SEPA’s regulatory processes in relation to radioactive substances are sufficiently robust.

A summary of Radioactivity in Food and the Environment, analysing the public’s exposure to radiation between 2004 and 2016, has also been published.

Source: SEPA, 24 October 2019

Low Emission Zones (LEZs) are intended to protect health by reducing pollution from road traffic. The only vehicles that are allowed to be driven in an LEZ are those which meet certain standards for exhaust emissions. The Scottish Government has committed to introduce LEZs into Scotland's four biggest cities, Dundee, Glasgow, Edinburgh and Aberdeen. Dundee City Council needs to decide the area that its LEZ will cover, and which types of vehicle will be excluded.

Dundee City Council is consulting on plans for LEZs in the city where, although air quality is good in most places, there are places where pollution levels are higher than the legal standards. Road traffic is the biggest single cause of air pollution in Dundee.

Technical work completed to date has considered a wide range of options for the area which Dundee’s LEZ should cover. It concludes that the best option in terms of balancing all of the objectives would be for the LEZ to be the area inside the inner ring road. 

The same work has also considered which types of vehicle should be excluded by the LEZ’s regulations. It suggests two options:

• That the LEZ applies only to non-compliant buses, which may be relatively easy to implement, but will mean that more locations continue to have pollution levels above standards. 
• That the LEZ applies to all non-compliant vehicles, including lorries, vans and private cars, which will impact on the journey choices of more people, but will generate the greatest reduction in pollution. 

In the second option, most diesel vehicles registered before 2015 would be unable to be driven within the LEZ area. 

The council wishes to hear residents’ views about the most appropriate area for the LEZ and on the types of vehicles to which the LEZ regulations should apply.

Scottish Fire and Rescue Service (SFRS) figures show that children are more likely to be injured by fireworks than adults. Over the past five years, more than 350 pre-school children, some as young as one year-old, were treated in hospital for firework injuries.

Fireworks and bonfire safety advice is available on the SFRS website and a list of organised fireworks displays for 2019 can be downloaded. 

SFRS also provide downloadable safety leaflets on Halloween and bonfire and fireworks.

Source: SFRS, 25 October 2019

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

• BBC news reported that firefighters extinguished a major blaze at an industrial estate in Clydebank, close to Yoker station. The Scottish Fire and Rescue Service (SFRS) said seven fire engines were sent to the scene on Hamilton Street at about 17.44 on 23 October 2019. A specialist unit was also sent to the incident due to the risk that hazardous substances could be involved. There were no reports of any injuries. An SFRS spokeswoman said two appliances remained at the premises the following day.

More detailed information can be found on the SEISS website.