On 26 February 2019, Health Protection Scotland (HPS) published the ‘Implementation of HIV PrEP in Scotland: First Year Report’ on behalf of the HIV PrEP National Coordination Group. This report describes the implementation, monitoring, uptake and some preliminary data on outcomes from the first year of the HIV PrEP service.

Scotland is one of the first countries worldwide to have successfully established a HIV PrEP (HIV Pre-Exposure Prophylaxis) service which is national, free and, to date, generally accessible to most deemed at highest risk of acquiring HIV.

HIV PrEP is an effective, novel, prophylactic biomedical intervention comprised of two HIV antiretroviral drugs. It is prescribed, as part of a comprehensive approach to HIV prevention, to HIV-negative persons at risk of infection, in particular men who have sex with men (MSM). HIV PrEP became available officially in sexual health clinics throughout the country, following approval of Truvada™ for use within NHS Scotland by the Scottish Medicines Consortium.

Implementation has been very successful with 1,872 individuals, 99% of whom are MSM, being prescribed PrEP at least once in the first year of the Scottish NHS PrEP programme in 11 of the 14 NHS boards. Importantly, around one-fifth of those prescribed PrEP attended sexual health services for the very first time or for the first time in the previous 10 years. While it is too early to draw informed conclusions on the impact of PrEP on HIV and other sexually transmitted infections, the early signs, in relation to HIV, are favourable.

Public Health England (PHE) data suggest that the nasal spray flu vaccine, used for children aged two to seventeen years against influenza A(H1N1)pmd09, is 87% effective. The vaccine given to adults aged 18 to 64 in at-risk groups is estimated to be 39% effective against the same strain. Influenza A(H1N1)pdm09 has been the main strain circulating this season.

More children have been vaccinated than ever before this season, with over five million children in the year five school group being offered the nasal spray. Protecting younger children, who have poorer hand and respiratory hygiene than adults, is necessary in order to protect the rest of the population as they tend to spread flu more easily.

Vaccine uptake in children aged two and three years-old is 43% and 45.2% respectively, while among school-aged children, ranges from 56.2% to 63.9%, depending on year group. 

Source: UK Government, 22 February 2019

The World Health Organisation (WHO) has made recommendations for the composition of the egg-based quadrivalent vaccines for use in the 2019-2020 Northern Hemisphere influenza season.

Source: WHO, 21 February, 2019

The UK Government’s proposed new action plan for antimicrobial resistance (AMR) 2019-2024, is a ‘One Health’ approach across human health, agrifood and environmental sectors.

Resistance to antimicrobials is a natural phenomenon but is exacerbated by inappropriate use in human and animal medicine. AMR becomes a public health concern when disease-causing organisms evolve in ways to survive treatments. Antimicrobial resistant-microbes are found in humans, animals and the environment, so each can be considered as reservoirs of antimicrobial resistance. These resistant-microbes can transfer within and between each of the reservoirs, for example through person-to-person contact, the spreading of manure onto fields and the preparation and consumption of food. Current surveillance data on AMR are not coordinated across reservoirs to the extent needed to inform more targeted interventions, beyond simply reducing antibiotic use.

The new UK Government five-year national action plan to tackle AMR makes a commitment to investigating the coordination and harmonisation of surveillance schemes across the different sectors and it is hoped will provide a more complete picture of antimicrobial use and resistance that will enable analysis of trends over time and across sectors.

Source: UK Parliament, 19 February 2019

The European Centre for Disease Prevention and Control (ECDC) have released annual epidemiological reports for trichinellosis (2016), Rift Valley fever, rabies, and trichinellosis (2017) , which can be downloaded from their website.

Source: ECDC, 21 February 2019

First Minister Nicola Sturgeon told international delegates attending Scotland’s International Marine Conference in Glasgow, that Scotland was leading the way in tackling marine litter. A £175,200 campaign, promoting re-usable sanitary products to reduce the more than 100 billion pieces of sanitary waste disposed of every year, was announced. The funding is made up of Scottish Government money and Zero Waste Scotland’s Resource Efficient Circular Economy Accelerator Programme which is funded by the European Regional Development Fund (ERDF).

In the coming weeks, the Scottish Government will also publish proposals to make it an offence to throw litter overboard from all Scottish fishing vessels while at sea.

The Scottish Government marine litter strategy was published in 2014.

Source: Scottish Government, 19 February 2019

A beach and harbour in Fife have been closed-off as a precaution after a suspected oil spill in the Limekilns - Charlestown area of the Fife coast. The oil spill is reported to be light refined diesel and the source of the contamination appears to be from a drain on the land.

Environmental Health at Fife Council have been working with partners including the Scottish Environmental Protection Agency (SEPA), NHS Fife, Marine Scotland and the Maritime and Coastguard Agency to investigate and clean up the spill.

Environmental Health at Fife Council have erected warning signs at the beach area stating the area has been contaminated by an unknown pollutant and to avoid contact with the beach, not to take anything home from the beach, nor to consume any fish/shellfish from the shore and also to wash hands and foot wear.

Source: Royal Environmental Health Institute of Scotland (REHIS), 21 February 2019

The UK Government has launched consultations to overhaul the waste system, cut plastic pollution, and move towards a more circular economy. Proposals include:

• packaging producers having to pay the full cost of dealing with their waste 
• more consistent household recycling
• a deposit return scheme to be implemented for cans and bottles

On 18 February 2019, a consultation was also launched for a tax on plastic packaging that does not meet a minimum threshold of at least 30% recycled content.

New analysis suggests the net benefit to UK economy of the changes may run into millions of pounds. The consultation will close on 12 May 2019.

Source: UK Government, 18 February 2019

More than 200 people are reported to have suffered food poisoning after eating at a Kentucky Fried Chicken (KFC) restaurant in Ulaanbaatar. In early February 2019, 16 people developed diarrhoea, vomiting and high fever. The Metropolitan Professional Inspection Department say 247 similar cases have also been reported, with 42 people being hospitalised.

Bacterial sampling found Klebsiella and E. coli at the Ulaanbaatar KFC, and a further four people have contracted a Shigella infection following contact with restaurant staff.

Further information and advice on travel to Mongolia is available to view on the Travax (for health professionals) and fitfortravel (for the general public) websites.

Public Health England (PHE) have reported seven cases of Legionnaires’ disease in UK travellers who visited Goa since November 2018, a small increase in cases compared to previous years.

Legionnaires’ disease is more dangerous to people with underlying medical conditions and travellers staying in poorly maintained hotels or apartments. Although the risk to travellers to Goa is considered to be low, anyone who develops an influenza-like illness with fever, cough or shortness of breath during their stay or up to two weeks after returning home, are advised to seek prompt medical advice. They should ask the healthcare professional about Legionnaire’s disease and say where they have been.

Further information and advice on travel to Goa is available to view on the Travax (for health professionals) and fitfortravel (for the general public) websites.

Food Standards Scotland (FSS) has issued a Public Information Statement to alert the public to the presence of a group of harmful Shiga toxin-producing Escherichia coli (STEC) in food. STEC are a group of different types of E. coli bacteria found in the guts of animals such as cattle and sheep, which can make their way into the food chain via the animals’ faeces. Illness caused by STEC can be a very serious for young children and older people in particular, and can cause severe disease, and even death. As few as 10 - 100 cells of STEC can cause infection.

Based on the existing expert scientific evidence, reinforced by a recent report from the World Health Organisation (WHO) and the Food and Agriculture Organization (FAO) of the United Nations, FSS advises that the presence of any STEC in ready-to-eat food is a potential risk to health, and could cause food poisoning.

This advice has been given to local authorities, the food industry and consumers to ensure there is no room for misunderstanding, and is supported by Scotland’s Chief Medical Officer, Scottish and UK health bodies.

Source: FSS, 19 February 2019