Since Public Health Scotland formed over two years ago, we have been reviewing all our publications and how they support the organisation’s strategic plans. The HPS Weekly Report is now to be reviewed to evaluate its purpose and aims and during this process we have decided to pause publication of the report. 

This current week will be the last issue before we pause this publication. 

We are establishing how we will undertake the review, in the meantime if you have any points you wish to feed into the review, please email them to us via HPS Weekly Report Editor mailbox. 

Thank you for your support over the years.

On 5 July 2022, quarterly epidemiological data on Clostridioides difficile infection (CDI), Escherichia coli bacteraemia (ECB), Staphylococcus aureus bacteraemia (SAB), and surgical site infection (SSI) in Scotland, covering January to March (Q1) 2022, was published under the mandatory programmes for surveillance of CDI, ECB, SAB, and SSI in Scotland. Please note, data for SSI are not included due to the pausing of surveillance to support the COVID-19 response. 

This report provides data for the first quarter of 2022 in 14 NHS boards and one NHS special health board. In addition, an appendix can also be accessed which details all cases and denominator data for each NHS board, and for Scotland overall.

As of 1 July 2022, Public Health Scotland (PHS) confirmed there have been 34 laboratory-confirmed cases of monkeypox reported since 23 May 2022 in Scotland. On the same date, the UK Health Security Agency (UKHSA) reported 1,185 confirmed cases in England, ten in Wales and six in Northern Ireland.  

PHS and UKHSA are advising people to be alert to any new rashes or lesions, which appear like spots, ulcers or blisters, on any part of their body. Although this advice applies to everyone, most cases identified to date have been among men who are gay, bisexual and men who have sex with men (MSM), so people in these groups are advised to be aware of the symptoms, particularly if they have recently had a new sexual partner. Anyone with unusual rashes or lesions is advised to contact NHS 24 (Scotland), NHS 111 (England or Wales) or a sexual health service, contacting clinics ahead of visiting and avoiding close contact with others until seen by a clinician. 

Vaccinations are being offered to close contacts of those who have monkeypox, however, on 21 June 2022, the UK Health Security Agency (UKHSA) published a strategy, endorsed by the Joint Committee on Vaccination and Immunisation (JCVI), recommending that some gay and bisexual men at higher risk of exposure to monkeypox should be offered pre-exposure vaccinations to help control the recent outbreak of the virus. The Scottish Government has subsequently confirmed Scotland will also adopt this approach, with full details on how eligible people can get vaccinated provided in due course. 

Monkeypox is a viral infection usually associated with travel to West Africa and has only rarely been reported outwith this region. Monkeypox can be transmitted through close contact with a person who already has the infection, including direct contact during sex, and can also be passed on by contact with clothing or linens used by a person who has the disease. Initial symptoms of monkeypox include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. A rash can develop, often beginning on the face, then spreading to other parts of the body, including the genitals. The rash changes and goes through different stages before finally forming a scab, which later falls off. 

PHS and the UKHSA are working closely with the NHS and other stakeholders, in order to urgently investigate where and how recent confirmed monkeypox cases were acquired, including how they may be linked to each other. Clinicians should be alert to individuals presenting with rashes without a clear alternative diagnosis and should contact local specialist services for advice, if monkeypox infection is suspected. 

Sources: PHS, 1 July 2022 and UKHSA, 1 July 2022  

On 29 June 2022, Public Health Scotland (PHS) published three interim reports, evaluating various aspects of the flu and COVID-19 vaccination programmes. 

• The first report focuses on learning to date about factors which affect vaccine uptake, including booking methods and delivery models. Although there has been a high uptake of COVID-19 vaccinations in Scotland overall, uptake levels have not been equal across all population groups. This publication includes recommendations to support maximal and equitable access to vaccinations, both for the COVID-19 and other vaccination programmes. 
• The second report details interim findings on delivery models used for vaccine rollout, methods for maximising uptake in different population groups, factors affecting vaccine uptake, lessons learned about programme implementation and recommendations for the programme. 
• The third report features interviews with health board vaccination leads about their experience of the COVID-19 vaccination programme. Findings include learning on delivery models, engagement and communication, inclusion and outreach activity, what helped and hindered vaccine roll out, and recommendations for the programme. 

Many of the evaluation findings in these reports have already been shared with key stakeholders and have led to real-time improvements in the roll out of the flu and COVID-19 vaccination programmes. 

The final evaluation report from PHS on the flu and COVID-19 vaccination programme, which is due to be published in September 2022, will synthesise the learning from all evaluation activity and make recommendations to inform future vaccination programmes. 

Source: PHS, 29 June 2022  

On 30 June 2022, the European Centre for Disease Prevention and Control (ECDC) published their annual epidemiological report for invasive meningococcal disease (IMD) in 2018. This report is based on data for 2018 retrieved from The European Surveillance System (TESSy) on 11 March 2020. TESSy is a system for the collection, analysis and dissemination of data on communicable diseases. 

The report finds that in 2018, there were 3,233 confirmed cases of IMD, including 324 deaths, which were reported from 30 EU and EEA member states. 

Source: ECDC, 30 June 2022

On 28 July 2022, the European Centre for Disease Prevention and Control (ECDC) published a technical report, offering contact tracing guidance to public health authorities in EU and EEA countries which can be utilised during the 2022 monkeypox outbreak. 

The ECDC note that although monkeypox is not a traditional sexually transmitted infection (STI), the virus takes the opportunities for close-contact transmission wherever they arise. The priority for public health authorities in EU and EEA countries is the early identification and isolation of cases and prompt tracing of their contacts to break the chains of transmission. 

The collaboration between public health and sexual health professionals, who are already experienced and have established procedures for partner notification for STIs, is critical to ensure that as many close contacts as possible are identified and informed about their exposure. Close collaboration with civil society and community-based organisations is also recommended to build trust in contact tracing strategies and to ensure these strategies and accompanying risk communication is adapted to the affected groups, while minimising stigmatization, as this outbreak is currently circulating largely among men who have sex with men (MSM) with multiple partners. 

On 2 June 2022, the ECDC and the World Health Organization (WHO) jointly published interim guidance, aimed at providing advice to health authorities on the communication of risks and engagement of groups most affected by the outbreak. The joint report highlighted the need to build trust between authorities and at-risk groups, ensuring timely and consistent health information and advice to broader populations, while using more direct channels to, and engagement with, those at increased risk through two-way communication. 

With COVID-19 restrictions ending, the number of large gatherings has increased, as has international travel, and in response the ECDC and the WHO jointly published interim advice for public health authorities on summer events during the monkeypox outbreak. Although the focus of the report is monkeypox, much of the advice addresses good public health practices in general, which may help prevent the transmission of several infectious diseases. The guidance includes sections which can be used to formulate advice to business and venue owners and event organisers, as well as participants themselves before, during and after events. 

In order to raise awareness directly with the group that has been most affected by the current outbreak, that is gay and bisexual men and other MSM, the ECDC partnered with community organisations and public health experts from The Love Tank, Prepster, and MPact, to produce guidance, explaining what precautions people should take and providing useful links with additional information. 

Source: ECDC, 28 July 2022

On 23 June 2022, at the Kigali Summit on Malaria and Neglected Tropical Diseases (NTDs), heads of state and government of commonwealth countries have reaffirmed their commitment to end malaria and reduce NTDs by 2030, following the signing of the Kigali Declaration on NTDs. This follows previous commitments made, such as the 2018 pledge to halve malaria across the commonwealth by 2023, to eliminate blinding trachoma by 2020, and to combat other mosquito-borne diseases. 

In recent years, an estimated 10.6 million malaria deaths and 1.7 billion malaria cases were averted from 2000 to 2020, with 26 countries reporting fewer than 100 indigenous cases of malaria in 2020, up from six countries in 2000. Since 2015, nine countries have been certified as malaria-free by the World Health Organization (WHO). 

Additionally, 46 countries have eliminated at least one NTD and, between 2015 and 2019, more than one billion people were treated every year for one or more NTDs. In the period 2010 to 2020, the number of people requiring an NTD intervention was reduced by 600 million. Cases of African trypanosomiasis have fallen by 90% over the last 10 years, and only 15 cases of Guinea worm disease were reported in 2021 globally, compared to 3.5 million cases in the mid-1980s. 

However, in 2020, an estimated 627,000 people died of malaria, and there were 241 million new cases of the disease, and despite several important NTD milestones in many countries, such as the elimination of transmission of dracunculiasis, onchocerciasis and yaws, and the elimination of human African trypanosomiasis, lymphatic filariasis, rabies and trachoma as public health problems, more than 1.7 billion people required treatment and care for NTDs in 2020. 

Progress towards the 2023 malaria target for Commonwealth countries, as well as the 2030 targets of the WHO global malaria strategy, remains off track, with around half of the world’s population still missing out on the services they need to prevent, detect and treat the disease. Similarly, the targets set out in the WHO NTD road map for 2021 to 2030 also face severe risk due, in part, to disruptions caused by the COVID-19 pandemic, which saw most malaria-endemic countries experience moderate disruptions to malaria services, and some countries saw delays in the delivery of insecticide-treated net (ITN) campaigns. During the first year of the pandemic, disruptions to malaria services contributed to an increase of 14 million malaria cases, with at least two-thirds of the additional 69,000 deaths recorded in 2020, compared to 2019. 

NTD programmes, especially community-based interventions such as preventive chemotherapy campaigns, were among the most severely and frequently affected across the spectrum of health services, while the number of people receiving treatment for an NTD fell by one-third in 2020, due to health service disruptions caused by the pandemic. 

The WHO have highlighted the importance of strengthening primary health care as the foundation for universal health coverage and global health security, with increased domestic financing being critical, complemented by the engagement of new partners and donors, more international funding and the successful replenishment of the Global Fund. 

Africa and Asia carry the highest burden of both malaria and NTDs and, as such, a continent-wide response will be required to galvanize political and societal commitment and facilitate greater regional coordination and cross-border collaboration between countries. Youth engagement and empowerment are also key to ensuring that the next generation of health practitioners and global health leaders can take the lead in ending long-standing disease burdens. 

Participants in the Kigali Summit also emphasized the need for innovative tools and strategies to tackle malaria and NTDs. Innovation is needed, for example, to stay ahead of emerging biological threats, such as drug and insecticide resistance, and to address the growing inequalities and barriers in access to health services. 

The Kigali Summit also acknowledged a pledge from Novartis to invest US$100 million in research and development towards combating several NTDs, including Chagas disease, leishmaniasis and dengue fever in addition to cryptosporidiosis, and an additional US$150 million in next generation antimalarials and in an optimized drug formulation for infants. These commitments were complemented by pledges of US$1 billion from Pfizer to the International Trachoma Initiative and US$80 million from the Wellcome Trust for research and development into snakebite treatments and additional NTD research. 

Source: WHO, 23 June 2022

On 27 June 2022, Food Standards Scotland (FSS) and the Food Standards Agency (FSA) launched an inaugural annual review of food standards across the UK. The report comes after the UK food system has faced two years of major upheaval following the UK’s departure from the EU, the significant effects of the COVID-19 pandemic, and more recently the disruption caused by the war in Ukraine. 

Despite these significant pressures, the report concludes that food standards in the UK have largely been maintained, while warning of significant challenges ahead. 

Two main concerns have been highlighted in the report. First, the fall in the level of local authority inspections of food businesses, which are being hampered by resourcing pressures faced by local authorities, despite some progress in getting inspections back on track. Secondly, the delay in establishing full UK import controls for high-risk food and feed from the EU, continues to reduce the ability to prevent the entry of unsafe food into the UK market. 

The review was presented to all four UK parliaments or assemblies and is intended to be the first annual report looking at how food standards change over time, so that consumers and parliamentarians remain sighted on the changes and challenges to the food system and the evidence being shared with government decision makers. 

Sources: FSS, 27 June 2022 and FSA, 27 June 2022

On 29 June 2022, the European Environment Agency (EEA) published a report, which found that exposure to pollution causes over 10% of all cancer cases in Europe. With nearly three million new patients and 1.3 million deaths each year across the EU, cancer takes a huge toll on society, with the economic costs at around 178 billion euros in 2018 alone. 

The EEA study suggests that most of these environmental and occupational cancer risks can be reduced by preventing pollution and changing behaviours, with reducing to these risks offering an effective and cost-effective way of reducing cancer cases and associated deaths. 

In main findings of the report: 

• Air pollution, both indoor and outdoor, is linked to around 1% of all cancer cases in Europe, and causes around 2% of all cancer deaths, though in the case of lung cancers alone, this rises to 9% of deaths. Recent studies have detected associations between long-term exposure to particulate matter, a key air pollutant, and leukaemia in adults and children. 
• Indoor exposure to radon is linked to up to 2% of all cancer cases and one-in-ten lung cancer cases in Europe. Natural ultraviolet radiation may be responsible for up to 4% of all cancer cases in Europe. In particular, the incidence of melanoma, a serious form of skin cancer, has increased across Europe over the last few decades. 
• Exposure to second-hand smoke may increase the overall risk for all cancers by up to 16% in people who have themselves never been smokers. Around 31% of Europeans are exposed to second-hand tobacco smoke at home, work, during leisure, in educational institutions or in public settings. 
• Certain chemicals used in European workplaces and released into the environment are carcinogenic and contribute to causing cancer. Moreover, several of these chemicals are known or suspected to induce cancer in multiple organs, including lead, arsenic, chromium, cadmium, acrylamide, pesticides, Bisphenol A and per- and polyfluorinated alkyl substances (PFAS). 
• All forms of asbestos are well-known carcinogens, associated with mesothelioma and lung cancers, as well as laryngeal and ovarian cancers. While the EU banned asbestos in 2005, it remains present in buildings and infrastructure, leading to the exposure of workers involved in renovation and demolition work. In addition, cancers continue to manifest many years after exposure, with asbestos estimated to account for 55-88% of occupational lung cancers. 

Source: EEA, 29 June 2022

On 28 June 2022, the UK Government published details of the carbon footprint of the UK, and England separately, for 2019. 

In key points from the UK report: 

• The UK carbon footprint was estimated to have fallen by 2% between 2018 and 2019, reflecting a decrease in emissions associated with imports, goods and services produced in the UK and emissions generated directly by UK residents. 
• The UK carbon footprint in 2019 was 30% lower than its peak of 1,111 million tonnes (mt) carbon dioxide equivalents in 2004. 
• GHG emissions relating to imports rose by 61% per cent from 1996 to a peak in 2007, and in 2019 were 8% higher than in 1996. Emissions associated with imports from China also showed a peak in 2007, while in 2019, they were 67% higher than in 1996. 
• In 2019, emissions relating to the consumption of goods and services produced in the UK were 35% lower than in 1996. 
• The findings indicate that the UK’s carbon dioxide footprint fell by 3% between 2018 and 2019. 

Source: UK Government, 28 June 2022

On 27 June 2022, the Scottish Government announced the launch of a £10 million Hydrogen Innovation scheme, a four-year plan aimed at driving innovation within the hydrogen sector and accelerate production and storage. The scheme will provide capital support over the next four years and hopes to unlock additional private investment in the technology, while enabling new companies to enter the sector. 

The first round of funding will target projects which support: 

• the low-cost, efficient and sustainable production of renewable hydrogen 
• efficient hydrogen storage and distribution, both within Scotland and for export 
• the efficient integration of hydrogen into our energy system 

The scheme is part of a Scottish Government commitment to invest £100 million in hydrogen over the course of this parliament, as part of a £180 million package of investment in emerging energy technologies, which will be delivered as set out in the Scottish Government's updated climate change plan. 

Source: Scottish Government, 27 June 2022

On 29 June 2022, following a Scottish Parliament debate, the Fireworks and Pyrotechnic Articles (Scotland) Bill was passed, introducing a fireworks licensing system, with mandatory safety training, for people wishing to purchase and use fireworks. The bill further allows local authorities to designate firework control zones, restrictions on the supply and use of fireworks, and a new offence to criminalise the supply of fireworks and pyrotechnics to under-18s. Being in possession of a firework or other pyrotechnic in a public place, or at certain places or events, without reasonable excuse also becomes an offence. 

The passage of the bill saw extensive consultation and stakeholder engagement, with the legislation receiving strong backing from a coalition of professional medical bodies including the BMA, The Royal College of Ophthalmology, and The British Society for Surgery of the Hand, along with support from emergency services and animal charities. 

The bill is the final legislative part of work towards improvements in firework safety which began in 2019, following a consultation on the use of fireworks which gathered 16,000 responses, leading to the creation of the Fireworks Action Plan and the establishment of the Firework Review Group, who made a series of recommendations for legislative and non-legislative changes to reduce the harm and the disturbance from firework use. 

A further consultation was held last year, ahead of the bill’s introduction, with an analysis of the responses showing that 84% of respondents agreed that a fireworks licensing system should be introduced in Scotland. 

Source: Scottish Government, 29 June 2022