2019 marks the fiftieth anniversary since the creation of a specialist unit in Scotland designated to conduct surveillance of communicable infections, the pro-genitor of HPS today.

The Communicable Diseases (Scotland) Unit (CD(S)U) was established in 1969 at Ruchill Hospital, Glasgow, and was one of the first specialist national units in the world set up to support the investigation, control and prevention of infectious outbreaks, following high profile incidents such as the 1964 Aberdeen typhoid outbreak, at the time the biggest outbreak in the UK since 1937, where more than 500 cases occurred. Many cases were quarantined in hospital and this outbreak had a major impact on the reputation of the city and Scotland at the time. This event not only demonstrated the need to improve the capacity across the country to manage serious outbreaks that could threaten public health and cause major community and economic disruption, but also highlighted the requirement to improve support for communicable disease control at a national level in Scotland.

CD(S)U was therefore set up in Glasgow as a national centre of expertise to carry out the surveillance of communicable disease across all of Scotland, co-ordinating the collection of information on new cases and outbreaks, as well as sharing intelligence on new sources and causes of infection. This was done to improve knowledge and understanding of how diseases spread and how they could be controlled. In addition, the unit also supported the work of local public health departments, such as that in Glasgow City, providing a resource to help investigate and manage outbreaks of infection in the community.

CD(S)U evolved over the next 50 years, firstly into CDEH(S)U when it absorbed its sister unit for Environmental Health (EH(S)U), also based in Glasgow, and expanded its role in helping protect the public from non-infectious environmental threats to health, e.g. chemical hazards and pollution in drinking water and outdoor air. In 1994, the unit was re-named the Scottish Centre for Infection and Environmental Health (SCIEH), and finally became Health Protection Scotland (HPS) in 2005. By then, the unit had a wider national remit supporting infection prevention and control in NHS health care services (Healthcare Acquired Infection (HAI)) and more broadly in community settings.

The unit has been involved in many of the major milestones of communicable disease surveillance and control, including identifying a mystery respiratory illness among Scottish holidaymakers returning from Spain in the late 1960’s, which went on the be identified as Legionnaires’ Disease after a large outbreak among veterans in the US. SCIEH, then HPS, was involved in supporting research into Cryptosporidium following one of the first ever recognised outbreaks of the infection associated with a contaminated water supply, identified in 1988 in Ayrshire, leading ultimately to investment which improved the quality of the public water supply throughout Scotland using improved filtration technology.

Staff in the unit have led many new developments, especially in the field of HIV and AIDS from its earliest days, and they are now heavily involved in efforts to eliminate hepatitis C infection in Scotland. HPV vaccination has been in the news recently in terms of the dramatic impact it has had on reducing cervical cancer, and this is another programme that HPS staff has been heavily involved with. There are many other developments over the years where the national unit has played a crucial role, the central Scotland E. coli 0157 outbreak investigation and the outbreak of anthrax among drug users due to contaminated heroin being just two examples.

After 50 years as a separate specialist unit, as of 1 April 2020, HPS will be merged into a new organisation, Public Health Scotland (PHS), dedicated to health protection and all other aspects of public health practice in Scotland and still with a base in Glasgow. PHS will continue the proud tradition, started in 1969 with the foundation of CD(S)U, of ensuring a high quality dedicated national level service to support health protection in Scotland.

Although CD(S)U was established in 1969, the weekly report preceded it by two years, and was originally collated and published on behalf of the Scottish Home and Health Department, part of the pre-devolution Scottish Office.

On 17 December 2019, Health Protection Scotland (HPS), in collaboration with Information Services Division (ISD), published the Implementation of HIV PrEP in Scotland: Second Year Report on behalf of the HIV PrEP National Coordination Group. This report describes the uptake of the NHS-funded HIV Pre-Exposure Prophylaxis (PrEP) programme in Scotland during its first two years between 1 July 2017 and 30 June 2019.

Scotland is the first country within the UK, and one of the first worldwide, to have established an HIV PrEP service, freely available via the NHS, for individuals who are at high risk of acquiring HIV though sexual transmission. HIV PrEP, a dual anti-retroviral medication, now forms part of a comprehensive approach to HIV prevention in Scotland.

The successful implementation and uptake of the programme during its first year, as reported in February 2019, has continued to the end of its second year. Between 1 July 2017 and 30 June 2019, over 3,300 individuals received one or more PrEP prescriptions in 11 of the 14 NHS boards. Of those prescribed PrEP, 99% were male, of whom 98% were men who have sex with men (MSM). Furthermore, the availability of PrEP has encouraged individuals who had not previously engaged with sexual health services to come forward as, by the end of the second year, almost 1,000 individuals at high risk of sexual acquisition of HIV, and who had no history of sexual health service attendance, had engaged with the PrEP programme.

On 10 December 2019, Public Health England (PHE) confirmed an outbreak of low pathogenic avian influenza (H5) at a commercial chicken farm in Mid Suffolk. An investigation is underway to determine the most likely source of infection.

A restricted zone of one kilometre is in place around the infected premises as specified in the declaration applying these restrictions. Within this restricted zone, a variety of different controls are in place to prevent the spread of disease, which include restrictions on the movement of poultry, carcases, eggs, used poultry litter and manure, although poultry keepers can apply for movement licences for some specific movements from the zone. Bird gatherings such as fairs, shows, or exhibitions and the release of game birds are not permitted within the restricted zone.

There are two types of avian influenza, of which highly pathogenic avian influenza (HPAI) is the more serious type, as it is often fatal in birds. The main clinical signs of HPAI in birds are: 

• swollen head 
• blue discolouration of neck and throat 
• loss of appetite 
• respiratory distress such as gaping beak, coughing, sneezing, gurgling, rattling 
• diarrhoea 
• fewer eggs laid 
• increased mortality

Clinical signs can vary between species of bird and some species, such as ducks and geese, may show minimal clinical signs.

The second type of avian influenza, low pathogenic avian influenza (LPAI), is usually less serious. LPAI can cause mild breathing problems, but affected birds will not always show clear signs of infection. The severity of LPAI depends on the type of bird and whether it has any other illnesses.

Anyone who keeps poultry must keep a close watch on them for any signs of disease, and must seek prompt advice from their vet if they have any concerns.

Bird flu is a notifiable animal disease. In Scotland, if any type of bird flu is suspected in poultry, it must be reported immediately by calling the local Field Services Office. Failure to do so is an offence.

More information on avian influenza is available on the HPS website.

Source: Department for Environment, Food & Rural Affairs (Defra), 11 December 2019

A fatal case of rabies in a female resident was reported by Latvian health authorities in December 2019. Rabies is not usually present in Latvia and investigations indicated that the patient had previously travelled to Asia where she had suffered an animal bite. Testing showed she was infected with a rabies virus of a type circulating in Asia.

On 11 December 2019, public health authorities in Spain confirmed rabies in a man who was bitten by a cat in Morocco in August. On the same day, hospital staff in Italy reported that a 44 year-old man had died from rabies in Apulia, southern Italy, on 19 November 2019. The victim was bitten by a dog in Zanzibar, Tanzania in September 2019 and was admitted to hospital in Italy a month later.

Advice for travellers 

• Any animal contact in a rabies endemic area poses a potential risk of infection. 
• All travellers to rabies endemic areas should be aware of the risk of rabies and advised to avoid contact with animals, both wild and domestic, particularly dogs and cats. 
• Children are more vulnerable to rabies than adults as they are less likely to comprehend the risk of animal contact, less able to defend themselves from an animal attack and may not report a potential exposure. 
• All travellers to endemic areas should be aware of immediate wound care and advised to seek medical attention immediately if suffering a potential rabies exposure. See the rabies chapter in the Public Health England (PHE) Green Book. 
• An effective rabies vaccination, which can be used pre- and post-exposure, is available and prevents clinical rabies developing. Rabies is invariably fatal once symptoms develop.

Further information on rabies, including vaccination and post-exposure advice, can be accessed on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

The European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) have published the results of zoonoses monitoring activities carried out in 2018 in 36 European countries (28 member states (MS) and eight non-MS).

According to the European Union One Health 2018 Zoonoses Report, the first and second most commonly reported zoonoses in humans were campylobacteriosis and salmonellosis, respectively. The EU trend for confirmed human cases of these two diseases was stable during 2014–2018.

The proportion of human salmonellosis cases due to Salmonella enteritidis was at the same level in 2018 as in 2017. 

Shiga toxin-producing Escherichia coli (STEC) infections in humans were the third most commonly reported zoonosis in the EU and increased from 2014 to 2018. Yersiniosis was the fourth most frequently reported zoonosis in humans in 2018 with a stable trend in 2014–2018. The number of reported confirmed listeriosis cases further increased in 2018, despite Listeria rarely exceeding the EU food safety limit tested in ready-to-eat food.

In total, 5,146 food- and waterborne outbreaks were reported, affecting 48,365 people. Salmonella was the most commonly detected agent with S. enteritidis causing one in five outbreaks. Slovakia, Spain and Poland accounted for 67% of the 1,581 Salmonella outbreaks, which were mainly linked to eggs.

A large increase of human West Nile virus infections was reported in 2018. The report also contains data on bovine tuberculosis, Brucella, Trichinella, Echinococcus, Toxoplasma, rabies, Coxiella burnetii (Q fever) and tularaemia.

Sources: ECDC and EFSA, both 12 December 2019

On 12 December 2019, The European Environment Agency (EEA) published a briefing, which presents an overview of the known and potential risks to human health and the environment in Europe posed by per- and polyfluorinated alkyl substances (PFAS). These are a group of more than 4,700 man-made chemicals, the two most well-known of which are perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS). These are used in a variety of consumer products and industrial applications because of their unique properties, for example, to increase oil and water repellence, reduce surface tension, or resist high temperatures and chemicals. Both people and the environment are exposed to a wide variety of these extremely persistent chemicals, many of which are known to be toxic.

The briefing warns that, due to the large number of PFAS, it is a difficult and time-consuming task to assess and manage risks for these substances individually, which may lead to widespread and irreversible pollution. People are mainly exposed to PFAS through drinking water, food and food packaging, dust, creams and cosmetics, PFAS-coated textiles or other consumer products. The briefing suggests that taking precautionary actions to limit non-essential uses and promoting the use of chemicals that are ‘safe-and-circular-by-design’ could help limit future pollution.

Source: EEA, 12 December 2019

Food Standards Scotland (FSS) is reminding people to reduce the risk of food poisoning over the festive period by ensuring they follow good food safety practices.

Results from the latest FSS Food in Scotland Consumer Tracking Survey reveal that almost three-quarters of Scots (72%) completely fill their fridge at least some of the time, but only 12% always remember to check the temperature when it’s full. This is an essential measure, as a fridge temperature between zero and five degrees centigrade will help slow the growth of food poisoning bacteria, whilst overfilling can raise the fridge temperature.

FSS has created a downloadable food safety checklist which serves as a reminder when carrying out the different stages of preparing, cooking and eating Christmas dinner, as well as storing leftovers.

Source: FSS, 13 December 2019

New EU Official Control regulations came into force across the UK on 14 December 2019. 

The Official Controls  are part of the EU Commission’s Smarter Rules for Safer Food initiative, which aims to modernise, simplify and strengthen official controls across the food chain, including plant and animal production, food manufacturing and supply, and processing and distribution.

The regulations aim to strengthen public health protection and the integrity of the food and feed chain in the UK.

Source: Food Standards Scotland (FSS), 14 December 2019

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

• The Scotsman reported that around sixty firefighters tackled a blaze at a commercial building in Glasgow. Fire crews were called to the premises in Seaward Street in the Kinning Park area of the city just after 3.30am on 16 December 2019. Twelve fire appliances were sent to the scene. Seaward Street was closed to all traffic between Paisley Road West and the M8 eastbound off-slip to Scotland Street.

More detailed information can be found on the SEISS website.