As the coronavirus (COVID-19) outbreak continues to evolve, the Foreign, Commonwealth & Development Office (FCDO) advises British nationals against all but essential travel, exempting some countries that no longer pose an unacceptably high risk for British travellers. This advice is being kept under constant review and may change at short notice.

The fitfortravel (for the general public) and TRAVAX (for health professionals) country pages have been updated to include a COVID-19 country specific risk-rating, with every country being identified as high, moderate or low risk and each rating accompanied by appropriate travel advice. This information will be listed in the ‘Alerts’ section on each country page of fitfortravel and the 'Emerging Health Risks' section of every TRAVAX country page.

This risk-rating is based on a robust public health assessment of the COVID-19 risks for travellers to each country and is regularly reviewed. So far, in September 2020, the risk rating has been increased in 22 countries, which are detailed on the individual country outbreak alerts on the TRAVAX and fitfortravel websites. In the past three months, the COVID-19 risk to UK travellers has been decreased in the following countries:

• Malaysia
• St Vincent and the Grenadines
• East Timor (Timor Leste)
• Lao PDR
• Brunei
• Latvia
• Cuba
• Sweden

The COVID-19 risk rating and travel advice from the FCDO is being kept under constant review and may change at short notice. All travellers are advised to continue following sensible precautions and consider the following sources of information below.

Advice for travellers

Before planning and/or booking international travel, please check:

• the UK Border Control website, in order to check current rules regarding self-isolation (quarantine) before your planned return to the UK
• the Foreign, Commonwealth & Development Office (FCDO) website, for country specific Travel Advisory Notices regarding travel and entry restrictions, and review the local medical care available at your destination 
• the COVID-19 risk-rating at your destination, which will be listed in the ‘Alerts’ section of all fitfortravel country pages and the ‘Emerging Health Risks’ section of all TRAVAX country pages 
• the TRAVAX travel insurance page, as such insurance should be considered essential 
• the fitfortravel COVID-19 health considerations for travel page
• physical distancing and hygiene measures in the country you are visiting.

Information relating to travel and COVID-19 is available on the TRAVAX (for healthcare practitioners) and fitfortravel (for the general public) websites.

Information on COVID-19 for the general public is available on the NHS Inform (Scotland) and the NHS.UK (rest of the UK) websites. 

Information and resources on COVID-19 for health professionals is available on the Health Protection Scotland (HPS) (Scotland) and Public Health England (PHE) (rest of the UK) websites.

Source: TRAVAX, 25 September 2020

New research from Public Health England (PHE) suggests the risk of death more than doubled for people who tested positive for both flu and COVID-19, compared to those with COVID-19 alone. The research, looking at cases between January and April this year, also found that those with co-infection of the two viruses were more at risk of severe illness. Most cases of co-infection were in older people and more than half of them died.

Every year, thousands of people in Scotland are hospitalised with flu and more people than ever will be offered the free flu vaccine this year, with eligibility extending to 55 to 64 year olds, households of those previously shielding and social care workers. The message to all eligible groups this year, especially due to the presence of COVID-19, is that it’s more important than ever to receive the flu vaccine. More information can be found on the NHS Inform website.

Source: PHE, 22 September 2020

On 17 September 2020, the Global Polio Eradication Initiative reported a case of polio (cVDPV2) in Kassala province, Sudan. There have been 22 cVDPV2 cases reported in Sudan in 2020 so far. The initial viruses were linked to the ongoing outbreak in Chad followed by local transmission.

Advice for travellers

The World Health Organization (WHO) recommends that all travellers to polio-affected areas be fully vaccinated against polio. Residents, and visitors for more than four weeks from infected areas, should receive an additional dose of oral polio vaccine (OPV) or inactivated polio vaccine (IPV) within four weeks to 12 months of travel.

For further information see the TRAVAX (for health professionals) or fitfortravel (for the general public) websites.

Source: TRAVAX, 23 September 2020

The European Centre for Disease Prevention and Control (ECDC) has published its annual epidemiological report concerning Variant Creutzfeldt−Jakob disease. In 2017, no cases of variant Creutzfeldt−Jakob disease (vCJD) were identified in the EU/EEA. The disease remains extremely rare, which is consistent with the current understanding of the underlying epidemiology of vCJD and with the positive impact of risk mitigation measures introduced in the EU in the late 1980s to remove potential infectious animal material from the human food chain.

Source: ECDC, 18 September 2020

A demonstration project conducted in Bulgaria has shown that more people get tested for HIV when self-testing is available. In situations where testing is based in health-care institutions, it can be a challenge to encourage some people to come forward. Community-based testing is reported to be a good way to overcome those barriers, but it can be labour intensive. Self-testing can work out less expensive, and a demonstration project conducted last year has shown the role it can play.

Testing for HIV is a critical public health intervention because it is the first step towards treatment and care. With current antiretroviral treatment, people who test positive can expect to live a healthy life with HIV without passing it on to anyone else.

The population groups in Bulgaria who are most vulnerable to HIV infection include gay, bisexual and other men who have sex with men (MSM) and transgender people. Despite progress in recent years, many MSM and transgender people in Bulgaria are not aware of their HIV status and are reluctant to seek testing at health institutions because of the associated stigma.

Source: WHO, 18 September 2020

The European Food Safety Authority (EFSA) has set a new safety threshold for the main perfluoroalkyl substances, or PFAS, that accumulate in the body. The threshold, a group tolerable weekly intake (TWI) of 4.4 nanograms per kilogram of body weight per week, is part of a scientific opinion on the risks to human health arising from the presence of these substances in food.

PFAS are a group of man-made chemicals that are manufactured and used in a variety of industries around the world, such as textiles, household products, fire-fighting, automotive, food processing, construction and electronics. Exposure to PFAS can occur in several ways, including food consumption, where these substances are most often found in drinking water, fish, fruit, eggs and egg products, and such exposure to these chemicals may lead to adverse health effects.

The four PFAS that EFSA’s assessment focused on are perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA), perfluorohexane sulfonic acid (PFHxS).

EFSA scientists report toddlers and other children are the most exposed population groups, with exposure during pregnancy and breastfeeding being the main contributor to PFAS levels in infants.

Source: EFSA, 17 September 2020

Mental health is one of the most neglected areas of public health. The coronavirus (COVID-19) pandemic is further affecting people’s mental health and well-being as well as disrupting health services around the world.

Before the pandemic, relatively few people around the world had access to quality, affordable mental health care. In low- and middle-income countries, more than 75% of people with mental, neurological and substance use disorders receive no treatment for their condition. Furthermore, stigma, discrimination, punitive legislation and human rights abuses are still widespread.

The World Health Organization (WHO) have found that:

• nearly one billion people are living with a mental disorder
• around three million people die annually from the harmful use of alcohol
• one person every 40 seconds dies by suicide

This year the WHO, together with partner organisations, United for Global Mental Health and the World Federation for Mental Health, have initiated a campaign ‘Move for mental health: let’s invest’, which hopes to encourage a massive scale-up in mental health investment and public action around the world. More details can be found on the WHO website.

Several key events are taking place in September and October 2020: 

• On 01 September 2020, the World Federation for Mental Health launched 45 days of awareness-raising activities led by the Federation’s youth section, including a global online discussion forum and art exhibition. 
• On 09 October 2020, United for Global Mental Health will be encouraging people from around the world to participate in a 24-hour livestream virtual march to help increase awareness of mental health issues, break down stigma and bring about policy change. Members of the public will be urged to ‘add their voice’ and join the march using online filters to be released in the lead-up to the event. 
• On 10 October 2020, World Mental Health Day, the WHO will host a global online advocacy event on mental health named The Big Event for Mental Health. World leaders, mental health experts and celebrity guests will join WHO Director-General Dr Tedros Adhanom Ghebreyesus to examine what can be done to improve mental health and how to ensure that quality mental health care is available to everyone.

Further information on travel health advice relating to mental health can be found on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

Source: TRAVAX, 17 September 2020