World AIDS Day, which falls on 1 December 2019, serves as a yearly reminder of the global HIV and AIDS epidemic. The most recent worldwide report of the United Nations Joint Programme on HIV/AIDS (UNAIDS) estimated that 37.9 million people were living with HIV in 2018. A reversal in recent years of the upward trajectory of the global HIV/AIDS epidemic is evident in a continued reduction in both new infections and AIDS-related deaths, which is a consequence of advances in HIV treatment and the huge scale-up in treatment access. In 2018, an estimated 1.7 million people were newly infected with HIV which represents a 40% decrease compared to the peak in 1997.

In Scotland, according to the latest quarterly data which covers the period up to 30 September 2019, 5,568 individuals are diagnosed and living with HIV. From January to September 2019, 267 new reports of HIV diagnoses were recorded of which 136 were first-ever diagnoses and 131 were newly reported in Scotland, but previously diagnosed elsewhere. Unprotected sexual intercourse among men who have sex with men (MSM) remains the main route through which new HIV infections are acquired in Scotland (33% in the first nine months of 2019 compared with 21% among heterosexuals and 8% among people who inject drugs (PWID)), however since 2015, there has been an outbreak of HIV among PWID in NHS Greater Glasgow & Clyde with over 145 new HIV diagnoses in this risk group compared to a pre-outbreak annual average of 10 diagnoses. Public health interventions to limit further transmission continue, with there being a sustained focus on testing those at risk, providing outreach treatment services, and community prescribing of HIV medication.

In recent years, advances in, and better access to, HIV treatment have continued to save lives. There was a 60% reduction in the global number of AIDS-related deaths to 770,000 in 2018 compared to the peak of 1.9 million in 2004. According to UNAIDS, 1.6 million more people had access to life-saving antiretroviral therapy (ART) in 2018 compared to 2017, resulting in a total of 23.3 million individuals on treatment worldwide. This is a near three-fold expansion in access to HIV treatment from 8 million in 2010. If the increasing rate of access to treatment is sustained, then there is the potential to achieve the UNAIDS target of 30 million on treatment by 2020. 

With the aim of ending the world AIDS epidemic by 2030, the Fast-Track Cities strategy was launched in 2014. This is a global initiative, led by UNAIDS, IAPAC (International Association of Providers of AIDS Care) and the Mayor of Paris, calling on city leaders to sign up to the Paris Declaration and, in so doing, show a commitment to meeting the UNAIDS 90-90-90 targets by 2020 (90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are on treatment, and 90% of people on treatment have a suppressed viral load). To date, over 300 cities globally have signed up to the initiative.

In Scotland, a Fast-Tracking Scotland project was launched by the third sector organisation, HIV Scotland, in October 2018. The ambition is to make Scotland the first Fast-Track country where all cities in a single country sign the Paris Declaration. On World AIDS Day 2018, Glasgow became the first of Scotland’s seven cities to do so, followed by Aberdeen, Dundee and Edinburgh to date. Work is now underway to develop local strategic plans to ensure that the objectives of the Fast-Track initiative are met.

Scotland, as a whole, has now achieved the key UNAIDS 90-90-90 targets ahead of 2020. As of 31 December 2018, it was estimated that there were 5,881 people living with HIV (PLHIV) in Scotland and, of these, 91% (5,352) had been diagnosed. Of those 5,352 diagnosed as PLHIV, 90% (4,799) were receiving ART and, of these, 94% (4,530) had an undetectable viral load. By comparison, 79% of those individuals infected worldwide knew their HIV status at the end of 2018, 78% of whom were accessing treatment and, of those receiving treatment, 86% had achieved viral suppression. While considerable progress has been made, UNAIDS has warned that the current rate of decline in the number of new infections, for example, will be too slow to reach the Fast-Track Target of 500,000 new infections per year by 2020. Therefore, further efforts are required to diagnose and treat those who are infected if these targets are to be met. 

Although access to, and uptake of, treatment in Scotland is very good, there is evidence that public health action is needed to further increase access to, and provide opportunities for, HIV testing. In 2018, more than a quarter (28%) of those newly diagnosed was at a late stage of infection, at which point treatment may be less effective on a weakened immune system. In addition to early and more frequent testing opportunities, prevention efforts are as important as ever. Between January and September 2019, 26% of first ever diagnoses had been acquired in the previous three to four months, indicating that new transmissions are occurring. The prevention toolkit in Scotland was strengthened in July 2017 when HIV pre-exposure prophylaxis (PrEP) became available via the NHS for individuals attending sexual health clinics who are at high risk of acquiring HIV through sexual transmission as assessed using eligibility criteria. During the first year of Scotland’s PrEP programme, almost 2,000 individuals were prescribed PrEP, the majority of those being MSM. The largest proportion (39%) of those prescribed PrEP were aged 20-29 at their first prescription and almost a third (28%) were aged 40 or above. For approximately one-fifth of those prescribed PrEP during the first 12 months, this was the very first time, or the first time in the previous 10 years, that they were attending sexual health services. Uptake data for the first 24 months of the programme are due to be published by Health Protection Scotland (HPS)/Information Services Division (ISD) on 17 December 2019.

Since the discovery of HIV in 1983, and more than twenty years on from the introduction of freely available, highly effective, life-saving, ART in the UK, the associated public health challenges have changed considerably, yet the importance of prevention messages and early testing for those at risk remain. It is hoped that by adopting a multi-agency partnership approach to support wide-ranging improvements in the sexual health of its people, Scotland can maintain, and possibly exceed, the global targets set.

On 26 November 2019, Health Protection Scotland (HPS) published the latest HIV surveillance report, which provides updated diagnoses data to 30 September 2019.

Between January and September 2019, HIV antibody positive test results for 267 individuals were received from NHS Scotland laboratories, of which 136 were first-ever diagnoses and 131 which were newly reported in Scotland, though previously diagnosed elsewhere. As of 30 September 2019, it is estimated that there are 5,568 individuals living with HIV in Scotland, of whom almost three quarters (73%, 4,080) are male and the remaining 27% (1,488) are female.

The next surveillance report, providing annual diagnoses data to 31 December 2019, will be published in March 2020.

In October 2019, NHS Greater Glasgow and Clyde (NHSGG&C) requested that Health Protection Scotland (HPS) provide independent expert support to review the data being used to inform their risk assessment and decision making in relation to wards 6A and 4B at Queen Elizabeth University Hospital (QEUH) and Royal Hospital for Children (RHC). A report published on 26 November 2019 provides a summary of the work undertaken, the findings and the recommendations. The aim of the report was to review NHSGG&C paediatric haemato-oncology data and investigate the suspected increase in environmental gram-negative blood cultures in the paediatric haemato-oncology population.

The report along with a summary is available on the HPS website.

NHS Health Scotland have published Issue 1 of a new Vaccination Transformation Programme (VTP) e-newsletter which will provide quarterly updates on work underway to modernise the delivery of vaccinations across Scotland. The newsletter aims to provide public health, health improvement, primary care, health and social care and third sector colleagues with information regarding how new service delivery models are being developed, tested, implemented and supported to ensure the health of the Scottish public.

To receive VTP e-newsletters directly, please sign up on the VTP subscription page.

Source: NHS Health Scotland, 20 November 2019

The European Centre for Disease Prevention and Control (ECDC) has published an influenza vaccination communication guide which provides advice, guidance and campaign materials to support national influenza vaccination campaigns with the aim of increasing the influenza vaccination uptake in the EU member states.

The guide has been developed as a handbook for national initiatives, with a view to either complementing existing national communication initiatives or providing a basis for the launch of new activities. It contains draft communication materials, which can be adapted to national needs as well as advice on how best to approach different audiences and adapt the toolkit materials for use in national communication activities.

Source: ECDC, 21 November 2019

In April 2019, the Medicines and Healthcare products Regulatory Agency (MHRA) disclosed two reports of fatal adverse reactions to the yellow fever vaccine (Stamaril). In response, a Yellow Fever Vaccine Expert Working Group was convened by the Commission on Human Medicines (CHM), which resulted in strengthened recommendations to minimise vaccine-associated risks.

A joint letter from Health Protection Scotland (HPS), MHRA, National Travel Health Network and Centre (NaTHNaC), and Public Health England (PHE) was sent on 21 November 2019 to UK yellow fever vaccination centres to inform them of the recommendations.

The following measures should be utilised to minimise risk in those with weakened immune systems, in particular those aged 60 years or older or anyone who has had their thymus removed.

• In people aged 60 years or older, due to a higher risk of life-threatening side effects, the vaccine should be given only when there is a significant and unavoidable risk of acquiring yellow fever infection, such as travel to an area where there is a current or periodic risk of yellow fever transmission.
  • Vaccination should not be given for travel to areas in which vaccination is generally not recommended by the World Health Organization (WHO). 
• Only healthcare professionals specifically trained in benefit-risk evaluation of yellow fever vaccine should administer the vaccine, following their individualised assessment of a person’s travel itinerary and suitability to receive the vaccine.
• The manufacturer’s patient information leaflet should be given to everyone receiving a yellow fever vaccine as part of the travel consultation.

The vaccine should not be administered to people:

• who have had their thymus gland removed for any reason 
• who are taking biological drugs that are immunosuppressive or immunomodulating 
• who have a first-degree family history of YEL-AVD or YEL-AND following vaccination that was not related to a known medical risk factor, i.e. in case of an unidentified genetic predisposition

The MHRA advised they are updating the summary of product characteristics and patient information leaflet. This will include information about the early signs and symptoms of these severe side effects, so that vaccinees know to urgently seek medical attention if these side effects are suspected,as this will support rapid identification and referral for treatment of YEL-AND and YEL-AVD.

In addition, MHRA are producing a standardised pre-vaccination screening checklist and a patient group direction (PGD) template.

More information for health professionals can be found on the TRAVAX website.

Source: MHRA, 21 November 2019

In order to assess how communities are involved in the public health response for outbreaks of acute gastroenteritis, the European Centre for Disease Prevention and Control (ECDC) developed a case study project in two EU/EEA countries. The premise for the project is that affected communities are increasingly recognised as key resources that can be utilised during public health emergencies, and that the concerns and experiences of ordinary people should be harnessed as an important part of the response.

ECDC has published a report summarising the findings of the two case studies, one based in Iceland and the other in Ireland. 

The Icelandic case study focused on an outbreak of norovirus that emerged during an international scouting event in August 2017. The Irish case study examined verocytotoxin-producing Escherichia coli (VTEC) as a wider public health issue, but also with a particular focus on a single outbreak that occurred at a childcare facility in mid-2018.

Lessons learned from this project confirm the importance of recognising the community as a key partner in public health emergency preparedness and response.

Source: ECDC, 19 November 2019

According to a new study, conducted by the University of Glasgow and published in Emerging Infectious Diseases, scientists have detected an exotic tick-borne parasite within sheep in the North of Scotland. The study reports that this is the first time that this organism, Babesia venatorum (B. venatorum), has been identified in animals in the UK, and the first time it has been found in sheep anywhere in the world.

The risk of people contracting this infection is believed to be low. The study's authors believe that B. venatorum may have been carried by migratory birds coming to the UK from Scandinavia, where the parasite has previously been found in ticks collected from the environment and migratory birds.

Source: University of Glasgow, 20 November 2019

The European Agency for Safety and Health at Work (EU-OSHA) has been running a campaign during 2018-2019 to help raise awareness of dangerous substances in the workplace and promote ways to manage them. The two-year campaign, which was supported by the Institute of Occupational Safety and Health (IOSH), came to an end at EU-OSHA’s 2019 Healthy Workplaces Summit which took place on 12-13 November 2019. European occupational safety and health stakeholders, campaign partners and media partners gathered to reflect on lessons learned and share good practice for managing dangerous substances in the workplace.

During the campaign, EU-OSHA developed a range of campaign materials, including a database of practical tools and guidance, and a broad variety of approaches to managing dangerous substance effectively. Its interactive e-tool helps businesses to perform risk assessments on their use of dangerous substances and provides tailored advice on good practice and how to apply effective measures in the workplace.

The summit concluded with EU-OSHA sharing details of their 2020-22 ‘Healthy Workplaces Lighten the Load’ campaign, which will aim to raise awareness of work-related musculoskeletal disorders (MSDs), and promote their management and prevention. This new campaign, which will launch in October 2020, will cover several priority areas including an ergonomic work environment, early intervention of MSDs, staying physically active, and how MSDs can be influenced by psychosocial risks. 

Source: IOSH, 22 November 2019