International travel continues to be impacted due to COVID-19, and the number of variant strains which have emerged globally. Guidance on international travel is available for people living in Scotland, England, Wales and Northern Ireland. As of 28 November 2021, ten countries have been added to the UK international travel red list following concerns about cases of the emerging B.1.1.529, or Omicron, variant identified in southern Africa.

As of 30 November 2021, fully vaccinated travellers who are entering Scotland from any destination will have to take a PCR test by the end of the second day after arrival, and will have to self-isolate until they get a negative result. They must also complete a Passenger Locator Form (PLF). Additionally, travellers who are not fully vaccinated must take a second PCR test by the end of the eighth day after arrival, and isolate at home or in the place they are staying for ten days.

Travellers returning to Scotland from countries on the international travel red list will be required to self-isolate in managed quarantine accommodation and take two PCR tests, regardless of their vaccination status. Currently, the countries and territories on the UK red list are:

• Angola 
• Botswana 
• Eswatini 
• Lesotho 
• Malawi 
• Mozambique 
• Namibia 
• South Africa 
• Zambia 
• Zimbabwe

It should be noted that the travel lists may be amended at short notice, and do not indicate which destinations are currently allowing UK travellers to enter their country, nor if the Foreign, Commonwealth and Development Office (FCDO) advises against travel to these countries. Information relating to this can be checked on the relevant FCDO foreign travel advice country pages.

Testing and quarantine rules may differ in Scotland, England, Wales and Northern Ireland, therefore travellers must ensure they comply with the rules appropriate to the UK nation they will be arriving in and reside in, if different.

Country specific COVID-19 risk

The fitfortravel (for the general public) and TRAVAX (for health professionals) country pages include a COVID-19 country specific risk-rating, which identifies the risk of exposure to COVID-19 for UK travellers. This information is 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 identifies each country as having either a: 

• high risk of exposure to COVID-19 for UK travellers  
• risk of exposure to COVID-19 for UK travellers

For all countries, travellers should be aware that the risk of COVID-19 may change at short notice. Countries categorised as having a high risk of exposure to COVID-19 either have a high risk of exposure for travellers to COVID-19, or a high risk of emerging or known variants of coronavirus. Travellers should be advised to avoid non-essential travel to high risk countries, even if fully vaccinated against COVID-19.

In addition to the international travel list, as of 5 November 2021, the following countries have a FCDO advisory warning against travel, and are therefore classified as having a high risk of exposure to COVID-19 for UK travellers: 

• Afghanistan 
• Burundi 
• Democratic People's Republic of Korea 
• Guinea-Bissau 
• Haiti 
• Nicaragua 
• Papua New Guinea 
• Timor Leste 
• Turkmenistan 
• Venezuela 
• Yemen

Advice for travellers

Prior to booking any international travel, travellers must first check if the country they are travelling to is currently accepting UK travellers. 

• The FCDO foreign travel advice country pages have up-to-date information on entry rules, in response to coronavirus (COVID-19), under the Entry Requirements section. 
• Travellers should be aware that some countries or territories may require proof of COVID-19 vaccination status for entry. Guidance for demonstrating COVID-19 vaccination status is available for those living in Scotland, England, Wales and Northern Ireland.

It is advised that travellers are aware of all travel restrictions, self-isolation rules and precautions they should take, in order to reduce their risk of exposure to coronavirus (COVID-19) before, during and after travel, as detailed on the fitfortravel COVID-19 health considerations for travel page.

Source: TRAVAX, November 2021

Since 15 November 2021, local government in the Netherlands has reported 15 cases, including one death, of Legionnaires’ disease in Schijndel, Noord-Brabant, in the south of the country. An outdoor source of infection is suspected, with cooling towers and fountains being investigated.

Additionally, public health authorities in Barcelona are investigating an outbreak of Legionnaires’ disease in the municipalities of Montmeló and Montornès del Vallès. From 5 to 18 November 2021, 26 cases were detected, with 16 admissions to hospital. The source of the infection is unclear, but the possible involvement of industrial water cooling towers is being investigated.

Legionnaires’ disease is spread by inhalation of legionella bacteria in water spray or aerosols, with outbreaks having being linked to heating or cooling systems, hot tubs, fountains, and swimming pools. The risk of infection is greatest for smokers, the elderly, those with a chronic lung condition or a weakened immune system. There is no vaccine to protect against Legionnaires' disease.

Advice for travellers

Travellers to the Schijndel and Barcelona areas should be made aware of the current outbreak, how the infection is transmitted, and the symptoms of infection. 

• Showers in accommodation that have not been recently used should be flushed through with hot water before first use. 
• Travellers should seek prompt medical advice if they develop an influenza-like illness with fever, cough or shortness of breath during their stay, or for up to two weeks after return. They should inform their healthcare professional of possible exposure to Legionnaires' disease and mention the area visited.

Information and advice for travellers on legionellosis is available on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

Sources: TRAVAX, 23 November 2021 and TRAVAX, 19 November 2021

On 3 November 2021, the thirtieth meeting of the Emergency Committee under the International Health Regulations (IHR) (2005) regarding the international spread of wild poliovirus, was convened by the World Health Organization (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus. The committee agreed that the situation still constitutes a Public Health Emergency of International Concern (PHEIC), and recommended the extension of the temporary recommendations.

Under IHR (2005), proof of polio vaccination recorded on an International Certificate of Vaccination or Prophylaxis (ICVP), given between four weeks to 12 months before departure, may be required on exit from the following countries: 

• Afghanistan 
• Pakistan 
• Madagascar 
• Yemen

As the global situation with polio virus is ongoing, vaccination recommendations and documentation requirements should be checked on the TRAVAX individual country pages (for health professionals) or fitfortravel destination pages (for the general public).

Advice for travellers

Travellers should be encouraged to take strict precautions with food, water and personal hygiene, with further information provided on the TRAVAX and fitfortravel poliomyelitis pages.

In order to comply with the latest WHO temporary recommendations, and also to avoid travellers receiving live oral polio vaccine unnecessarily when departing polio-infected countries, authorities in the UK have made a number of vaccination recommendations.

• If visiting a polio-infected or potentially exporting country for longer than four weeks, travellers should consider receiving a booster dose of a polio-containing vaccine if they have not had one in the past 12 months. This advice supersedes current advice in the Public Health England (PHE) Green Book. 
• Travellers should acquire this booster dose within 12 months of the date they plan to leave the polio-infected country. 
• Travellers visiting one of these countries for less than four weeks should ensure they are up-to-date with routine polio vaccination, including ten yearly boosters. 
• Travellers should carry proof of vaccination. For the countries listed above, proof of vaccination should be documented on the standard ICVP.

International Certificate of Vaccination or Prophylaxis

The ICVP is the yellow booklet normally used for yellow fever vaccination. Failure to produce an ICVP when departing a polio-endemic country may result in the traveller being vaccinated on their departure, often using live oral polio vaccine (OPV), which may cause problems for individuals with weakened immune systems, including pregnancy, who should not receive the live OPV.

In Scotland, paper ICVPs can be obtained from Public Health Scotland (PHS) by contacting the TRAVAX administration team and providing them with your full name and postal address. In the rest of UK, paper ICVP’s should be obtained from the National Travel Health Network and Centre (NaTHNaC).

Source: TRAVAX, 25 November 2021

The European Centre for Disease Prevention and Control (ECDC) has published its annual epidemiological report on trichinellosis for 2019.

In 2019, 12 EU and EEA countries reported 96 confirmed cases of trichinellosis, with Bulgaria, Italy and Spain accounting for 79.2% of all confirmed cases. The overall EU and EEA notification rate was 0.02 cases per 100,000 of the population. Consumption of undercooked meat from pigs raised under non-controlled housing conditions, or hunted wild boar, constitutes the highest risk for acquiring trichinellosis in the EU and EEA.

Source: ECDC, 25 November 2021

World AIDS Day, which falls on 1 December every year, serves as an annual reminder of the global HIV and AIDS epidemic, with this year marking 40 years since the first reported cases of HIV-related illnesses and deaths. The most recent worldwide report of the UN Joint Programme on HIV/AIDS (UNAIDS) estimated that 37.7 million people were living with HIV at the end of 2020. Around 27.5 million people were accessing antiretroviral therapy, up from 6.4 million in 2009. Approximately 1.5 million people were newly infected with HIV in 2020 and there were around 680,000 AIDS-related deaths worldwide last year.

People living with HIV can experience more severe outcomes and have higher comorbidities from COVID-19 than people not living with HIV. In mid-2021, many people living with HIV, particularly in sub-Saharan Africa, did not have access to COVID-19 vaccines.

More information about the campaign is available on the World AIDS Day website.

The World Health Organization (WHO) has published its latest HIV drug resistance (HIVDR) report, giving an in-depth picture of the extent to which drug resistance is growing, and the steps that countries are taking to ensure people will receive effective medicine to treat and prevent HIV.

The WHO recommends that countries routinely implement nationally representative HIVDR surveys, and this report shows substantial progress in the implementation of surveillance. Between 2014 and 2021, 56 countries implemented HIVDR surveys using WHO-recommended methods. The report summarises the findings from the 38 countries, all of which had finalised their surveys by the time of publication and shared the data with the WHO.

Source: WHO, 24 November 2021

The World Health Organization (WHO) estimates that 82.4 million people were newly infected with gonorrhoea in 2020, the second most common bacterial sexually transmitted infection (STI). While gonorrhoea is curable when treated with antibiotics, antimicrobial resistance (AMR) to gonorrhoea has increased over the past 50 years, rendering ineffective many classes of antibiotics, including quinolones and early-generation cephalosporins. Resistance to many older antibiotics has made gonorrhoea a multidrug-resistant pathogen.

In September 2021, The Lancet Microbe published the latest results from a retrospective observational study of the WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae isolates from 2017 to 2018. In total, 73 countries contributed data to the biennial report on the status of AMR in gonorrhoea, which confirmed that resistant gonococcal strains are globally widespread. 

Key data from the report notes that the number of countries reporting gonococcal AMR have substantially increased compared with the previous global reports. Data on at least one or more drugs were provided by the 73 countries reporting. The WHO European Region had the highest number of reporting countries at 30, followed by the Western Pacific Region with 14 countries. Surveillance remains scarce in central America and the Caribbean and eastern Europe, and in the WHO African, Eastern Mediterranean, and South-East Asia Regions. The total number of gonorrhoea isolates examined for susceptibility to different antimicrobials varied from 12,895 for cefixime to 25,505 for ciprofloxacin in 2017, and from 15,876 for cefixime to 27,251 for ciprofloxacin in 2018.

Furthermore, the study reported decreased susceptibility or resistance to ceftriaxone in 21 out of 68 reporting countries, and to cefixime in 24 of 51 reporting countries. Resistance to azithromycin was reported by 51 of 61 reporting countries and to ciprofloxacin by all 70 reporting countries. In many countries, ciprofloxacin resistance is extremely high, azithromycin resistance is rapidly increasing, and resistance or decreased susceptibility to ceftriaxone and cefixime continue to emerge. Without new gonorrhoea treatments, it is believed there will be people with gonorrhoea infections that will be difficult to treat and cure.

Source: WHO, 22 November 2021

The World Health Organization (WHO) has published updated guidance on validation of elimination of mother-to-child transmission (EMTCT) of HIV, syphilis and hepatitis B virus (HBV). This third version of global guidance incorporates EMTCT of HBV towards validation of triple elimination and provides standardized processes and criteria to both validate EMTCT of HIV, syphilis and HBV, and to recognize high burden countries that have made significant progress toward elimination.

The guidance strongly emphasizes country-led accountability, rigorous analysis, intensive programme assessment and multilevel collaboration, including the involvement of communities of women living with HIV or HBV, or affected by syphilis. A harmonised approach to triple elimination is encouraged within a public health, rights-based and person-centred approach but depending on readiness, countries may choose to pursue validation of single, dual or triple EMTCT. Mother-to-child transmission, or vertical transmission, is a significant contributor to the HIV pandemic, accounting for 9% of new infections globally in 2017.

Source: WHO, 26 November 2021

The Chief Veterinary Officers for Scotland, England, Wales and Northern Ireland have agreed to bring in new housing measures to protect poultry and captive birds from avian influenza, following a number of confirmed cases across Great Britain in recent weeks.

The new housing measures, which came into force on 29 November 2021, mean that it will be a legal requirement for all bird keepers across the UK to keep their birds indoors and to follow strict biosecurity measures in order to limit the spread of and eradicate the disease.

Wild birds migrating to the UK from mainland Europe during the winter months can carry the disease and this can lead to cases in poultry and other captive birds.

The Scottish Government has advised that the risk to public health from the virus is very low, and the UK food standards agencies inform that avian influenzas poses a very low food safety risk to UK consumers, as it does not affect the consumption of poultry products, including eggs.

Source: Scottish Government, 24 November 2021