NHS boards’ health protection role Aim: ‘through co-operation with its partners, to protect the local population from hazards which endanger their health by preventing, controlling or reducing exposure to these and limiting damage to health when such exposures occur’ Hazards: Communicable diseases, environmental hazards – chemicals & toxins, radiation (e.g. sun, radon, nuclear waste) & physical (e.g. combustion particulates) SEHD/CMO(2007) 2 NHS boards’ health protection remit Health Protection Surveillance Risk assessment, & management Guideline & Protocol Development Emergency Planning Vaccination Programmes Strategic & National Work Expert Advice & Consultation Training, Audit & Evaluation Port Health Function Managing Incidents & Outbreaks

Risk assessment, management & communication  Communicable disease prevention & control: e.g. E. coli O157 cases.  Managing clusters, outbreaks and incidents e.g. Legionella cluster.  Guideline and protocol development: e.g. Public Health management of meningococcal disease.  Emergency Planning and preparedness: e.g. Ebola virus disease, avian flu.

Risk assessment, management & communication Port Health function: – Port Medical Officer – airports and ship ports. – Protect public health from risks (communicable disease / environmental) arising from vehicles arriving or leaving Scottish ports.

Surveillance ‘the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health’

Surveillance Public Health (Scotland) Act 2008: – List of notifiable diseases and infections: E Coli 0157, meningococcal disease, measles, Hep C virus, Varicella, etc. – Notifications received from clinicians & laboratories. Registers for notifiable diseases – monitored by health protection team. Surveillance includes collection of additional information on possible routes of exposure. National enhanced surveillance programmes including: Seasonal flu (severe cases), Invasive meningococcal disease, TB (tuberculosis), Legionella infections, Environmental Health Surveillance System for Scotland.

Expert advice & consultation Infection control advice & training: – Care homes. – Schools and nurseries. Potential health impacts of environmental exposures: – Chemical incidents e.g. ammonia spill. – Risk health assessments e.g. Newton area of Ayr. – Planning applications eg. Hunterston multifuel power station. Immunisation advice: – Advice to health professionals. – 974 immunisation queries in 2013.

Vaccination programmes Public health leadership – Coordination of the implementation and monitoring of immunisation programmes. Childhood immunisations include: Diphtheria, Tetanus, Pertussis, Polio, Hib (Haemophilus influenzae type B). Pneumococcal disease. Rotavirus. Meningitis C. Measles, mumps and rubella (MMR). HPV. If at risk they can also be immunised against Hepatitis B and Tuberculosis.

Childhood Immunisation is constantly evolving In the last two years alone: Rotavirus has been introduced. Flu immunisation has been introduced in schools for all primary school aged children and in GP surgeries for 2-5 year olds. Men C has been introduced into teenage booster programme and for under 25 first time university students, and reduced in infant programme. HPV schedule has been changed for teenage girls.

Rotavirus Rotavirus is the most common cause of gastroenteritis in young children. Most children will experience at least one infection with rotavirus before they are five years old, with some requiring hospitalisation for rehydration. An oral vaccine against Rotavirus was introduced into the infant immunisation programme on 1 July 2013 for babies aged 2 and 3 months. Latest uptake rates in Ayrshire and Arran show 95.1% of infants received first dose and 92.7% received second dose.

Rotavirus Scotland - Number of hospital admissions for rotavirus for infants <1 year by month (pre and post introduction of vaccine):

Scotland – Laboratory reports of rotavirus in children <1 year old (pre and post introduction of vaccine): Rotavirus

Scotland - Percentage of calls to NHS 24 for symptoms of vomiting in children under 1 year (pre and post introduction of vaccine): Rotavirus

Scotland - Percentage of calls to NHS 24 for symptoms of diarrhoea in children under 1 year (pre and post introduction of vaccine): Rotavirus

At-Risk groups - Chronic Resp Disease. - Chronic Heart Disease. - Chronic Renal Disease. - Chronic Liver Disease. - Chronic Neurological Disease. - Diabetes. - Immunosuppression. Other groups - Over 65 years old. - Pregnant women. - Preschool children. - Primary shool aged children. - Unpaid Carers. -Some occupational groups (including NHS staff). Seasonal flu vaccination

Flu Immunisation for Child ren Previously to 2012/13 only children who were “at risk” were offered flu immunisation in GP surgeries. These are children with health conditions. In 2013/14, a new nasal flu immunisation was introduced for children across Scotland. Public Health leads the implementation of this new flu vaccine.

The flu vaccine is offered to: Primary school aged children at schools. Most ‘at risk’ children in this age group can be vaccinated in GP surgeries if preferred. 2013/14: children in P6-P7 classes. 2014/15: all primary school children. Preschool children at GP surgeries. 2013/14: 2-3 years olds. 2014/15: 2-5 year olds. Flu Immunisation for Children

During the first year of the implementation of the flu childhood programme (2012/13): 74% of all eligible primary school (P6-P7) children were immunised against flu. 50.3% of all 2-3 year olds were immunised in GP surgeries. Flu Immunisation for Children

Within Ayrshire and Arran the percentage of immunised “at risk” children was: % of children “at risk” in 2012/2013 (before the new childhood programme). 70% of children “at risk” in primary school 6 and 7 classes in 2013/14 (54.5% at schools; 15.5% GP surgeries). Flu Immunisation for Children

Vaccination number one The US Centers for Disease Control and Prevention (CDC) cites vaccination as the number one public health achievement of that century. The World Health Organisation (WHO) estimates that vaccination saves 2 to 3 million 2 to 3 million lives a year.

Collaborative Working In everything we do Joint Health Protection Plan – Produced in conjunction with North, South and East Ayrshire Environmental Health Services – Provides overview of health protection priorities, provision and preparedness for NHS board area – Covers two-year period – Current plan covers period April 2014 to March 2016 Other partners include: Wider public health workforce Civil Protection Department GPs and hospital clinicians Hospital infection control team Local and national laboratories Health Protection Scotland LA Education Departments Scottish Water SEPA Police, fire, ambulance

Health Protection Surveillance Risk assessment, & management Guideline & Protocol Development Emergency Planning Vaccination Programmes Strategic & National Work Expert Advice & Consultation Training, Audit & Evaluation Port Health Function Managing Incidents & Outbreaks