Immunisation and vaccine-preventable diseases quarterly report
April to June 2022 (Q2)

Diphtheria

Background information

Diphtheria is an acute bacterial infection affecting the upper respiratory tract or the skin.

It is caused by the diphtheria toxin produced by toxigenic strains of:

• Corynebacterium diphtheriae (C. diphtheria)
• Corynebacterium ulcerans (C. ulcerans)
• Corynebacterium pseudotuberculosis (C. pseudotuberculosis) – this is less common

The most common symptoms of diphtheria affecting the upper respiratory tract are membranous pharyngitis with fever, lymphadenopathy and upper respiratory tract soft tissue swelling ‘bull neck’ potentially leading to life-threatening airway obstruction.

Cutaneous diphtheria may cause pus-filled blisters on legs, hands and feet and ulceration of the skin.

In unvaccinated or partially vaccinated individuals, systemic absorption of the toxin can lead to late complications such as cardiac and neurological conditions and sometimes death.

Immunisation against diphtheria is offered to babies and children as part of the routine childhood immunisation schedule.

They receive:

• three doses of the 6-in-1 vaccine at 8, 12 and 16 weeks of age
• a 4-in-1 pre-school booster from 3 years 4 months old.
• a 3-in-1 teenage booster at around 14 years of age (S3)

Guidance on diphtheria immunisation is available in chapter 15 of the UKHSA’s green book.

Surveillance

Diphtheria is now rare in the UK because babies and children have been vaccinated against it since the 1940s.

Prior to the introduction of a vaccine there were up to 70,000 cases a year, causing around 5,000 deaths.

There have been no toxigenic strains of diphtheria reported in 2022.

Vaccine uptake statistics

Vaccine uptake statistics for children are published in our childhood immunisation statistics quarterly report.

Haemophilus influenzae

Background information

In 1992, following introduction of the Hib vaccine for young children, the number of H. influenzae type b cases fell dramatically, not only in the vaccinated group but also in older age groups. 

Due to reduced carriage of the organism within the respiratory tract of vaccinated children, transmission to the wider community was effectively suppressed.

The addition of the Hib booster vaccine in 2006 to the childhood immunisation schedule, reduced case numbers further.

In Scotland, typing is conducted on cases with positive laboratory reports for H. influenzae in order that national trends in disease subtypes can be monitored.

Further enhanced surveillance is carried out for all H. influenzae cases identified in children under the age of 5 and type b strains across all age groups.

Surveillance update for April to June 2022

There were 21 invasive H. influenzae cases reported in the second quarter of 2022, bringing the total number of cases for the first half of the year to 36.

This is higher than the number of cases reported for the same period in 2021 (n=10) and 2020 (n=34), but slightly lower than the number of cases reported for the same period in 2019 (n=40) and 2018 (n=42).

This may indicate a return to pre-pandemic case levels.

Figure 1 is a series of line graphs showing the cumulative number of Haemophilus influenzae cases reported to Health Protection Scotland per week by year. Each line represents a different year from 2017 to the end of the second quarter of 2022. All years show a steady increase in cumulative number of cases per week. The number of cases in the first quarter of 2022 is higher than the number of cases reported for the same period in 2021 and 2020, but slightly lower than for 2019 and 2018.

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Figure 1: Cumulative number of Haemophilus influenzae cases reported to PHS, 2017 to 2022 (week 26)

Of the 36 cases reported in the first half of 2022:

• 19 were people aged over 40 years
• seven were people aged between 21 to 40 years
• three were in people aged between 5 and 20 years
• seven were children aged under 5 years old – three of whom were infants aged under one year

There were no deaths associated with H. influenzae reported in the first half of 2022.

Figure 2 demonstrates the epidemiological impact of the Hib vaccine, for those aged under five (routinely vaccinated group) and for all ages (including under-fives).

There was a marked decrease in cases from 1992 in all age groups, followed by a rise in case numbers in the early 2000s.

Case numbers decreased again following the introduction of the Hib booster vaccine, and figures have remained relatively stable since 2011.

Figure 2 is a line graph showing the number of invasive Haemophilus influenzae type b disease cases reported to Health Protection Scotland from 1988 to the end of the second quarter of 2022. There are two lines on the graph, one representing the under 5 age group and the other, total number of cases (including under 5 years). Following introduction of the Hib vaccine in 1992, cases rapidly decreased to single figures. However, in 2001 a sharp increase was observed and total number of cases peaked at 31 in 2002, prompting introduction of the Hib booster campaign in June 2003. Cases across all ages subsequently decreased and following introduction of a routine Hib booster in 2006, reached low numbers by 2009. Only one case has been observed in the under 5 age group between 2011 and the end of the second quarter of 2022.

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Figure 2: Laboratory reports of invasive Haemophilus influenzae type b disease in Scotland, 1988 to 2022 (week 26)

Figure 3 presents laboratory reports by serotype, since the introduction of the Hib booster campaign in 2003.

Of the 36 isolates in the first half of 2022:

• 19 were non-typable
• two were identified as type f
• one was identified as type a
• typing was not carried out for the remaining 14 isolates

Figure 3 is a bar chart showing the laboratory reports of Haemophilus influenzae by type from 2003 to the end of the second quarter of 2022. The chart shows a steady decline in type b infection since introduction of the Hib vaccine in 2003, with a corresponding increase in non-typeable strains. Non-typeable strains are now the most commonly reported type followed by type f, with very few reports of types a, b, d, and e.

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Figure 3: Laboratory reports of Haemophilus influenzae by serogroup, 2003 to 2022 (week 26)

Vaccine uptake statistics

Vaccine uptake statistics are published in our childhood immunisation statistics quarterly report.

Measles

Background Information

Before vaccination, measles was a very common childhood disease in Scotland and deaths attributable to measles were substantial.

Following the introduction of measles vaccine in 1968 and the subsequent introduction of the MMR vaccine in 1988, the incidence of the disease has decreased dramatically.

However, as Figure 4 shows, outbreaks have occurred in recent years. These outbreaks have largely occurred in under-immunised populations.

Figure 4 is a line chart showing the number of laboratory-confirmed cases of measles reported in Scotland by year from 1988 to the end of June 2022. The figure shows a sharp increase in the number of measles cases in 1994, when 536 cases were reported. The number of cases decreased to 23 in 1995 and has generally remained low since, with the exception of 2008 (when 54 cases were reported) and 2013 (when 51 cases were reported). There were no cases reported in 2015, 26 cases reported in 2016, 5 cases reported in 2017, and 2 cases reported in 2018. 18 cases were reported in 2019 and no cases were reported in 2020 or 2021. One case has been reported thus far in 2022, in February. The graph is also annotated with important measles vaccination time points, with the MMR vaccine introduced in 1988, the measles/rubella campaign initiated in 1994, and the second dose of MMR added to the vaccine schedule in 1996.

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Figure 4: Number of laboratory-confirmed cases of measles in Scotland by year, 1988 to 2022 (week 26)

Surveillance update for April to June 2022

One case of laboratory-confirmed measles has been reported in 2022, between January and March. This is the first case reported in Scotland since 2019.

As shown in Figure 5, the number of cases each year has been variable, in:

• 2020 and 2021 there were no cases
• 2019 there were 18 cases
• 2018 there were 2 cases
• 2017 there were 5 cases
• 2016 there were 26 cases

Most cases in Scotland over this time were imported or linked to imported cases within or outwith the UK.

In 2019, there were 18 laboratory-confirmed cases of measles reported.

Of these:

• one case was acquired elsewhere within the UK, outwith Scotland – from which two further
• seven cases were imported from outwith the UK, and resulted in two import-related cases in Scotland
• the remaining six laboratory-confirmed cases of measles in Scotland were of unknown origin – typing indicated that the majority of these cases were strains identified elsewhere in the UK and Europe, which demonstrates transmission within the UK and across the continent prior to the onset of the COVID-19 pandemic

In highly vaccinated populations such as Scotland, it is rare but possible for individuals who have received two doses of MMR vaccine to develop symptoms following exposure to a measles case. However, symptoms are usually attenuated, and individuals are unlikely to be as infectious.

No sustained further transmission occurred in Scotland, highlighting the success of the MMR vaccination programme and the importance of maintaining high vaccine uptake in Scotland.

Figure 5 is a bar chart showing the number of laboratory-confirmed cases of measles reported in Scotland by month and year between 2015 to the end of June 2022. The graph shows that the number of measles cases fluctuates each year. In 2016, measles cases were reported throughout the year, with a peak in October. In 2017 and 2018, cases were reported during the spring and summer months. In 2019, cases were reported in February, in May through to August and October. No cases were reported in 2020 or in 2021. One case has been reported in 2022, in February 2022.

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Figure 5: Number of laboratory-confirmed cases of measles in Scotland by month and year, 2015 to 2022 (week 26)

Of cases reported in 2019, the median age of the 18 laboratory-confirmed cases measles cases was 24 years.

This is similar to the median age of cases in 2016 – which was 22 years – and 2017 – which was 27 years.

Of the two laboratory-confirmed cases reported in 2018 one case was in the under one year age group and the other case reported was in the 30 to 39 year age group. The age distribution of measles cases has varied over recent years, but the majority of cases are observed in children and young adults.

Measles outbreaks occurred across Europe throughout 2018 and continued into 2019.

There has been a notable reduction in cases from March 2020 with this trend likely to be a result of social distancing measures and travel restrictions implemented to limit the spread of COVID-19.

Between June 2021 and June 2022 there were 105 cases of measles reported to the European Centre for Disease Prevention and Control.

The EU/EEA countries with highest reported rate of cases between this time period  were Belgium and Cyprus with a rate of 1.82 and 1.13 cases per million of population, respectively.

Ongoing measles activity in Europe and globally poses a threat to international travellers and Scotland will continue to face an elevated risk of imported cases from other counties and other regions of the UK.

Vaccine uptake statistics

Vaccine uptake statistics are published in our childhood immunisation statistics quarterly report.

Meningococcal Disease

Background information

In 1999, the Meningococcal Invasive Disease Augmented Surveillance (MIDAS) system was introduced.

The surveillance scheme is managed jointly by Public Health Scotland and the Scottish Haemophilus Legionella Meningococcus and Pneumococcus Reference Laboratory (SHLMPRL).

Surveillance data from MIDAS informs the epidemiology of meningococcal disease in Scotland, as analyses can be conducted according to:

• age
• serogroup
• molecular typing
• clinical presentation
• outcome

Surveillance update for April to June 2022

There were six cases of meningococcal disease reported in the second quarter of 2022, bringing the total for the year so far to 15.

This is higher than the number of cases reported for the same period in 2021 (n=5), but lower than the number of cases reported in the second quarter for the previous three years (range 24 to 50) as shown in Figure 6.

Figure 6 is a series of line graphs showing the cumulative number of meningococcal cases reported to MIDAS per week, by year. Each line represents a different year from 2017 to the end of the second quarter of 2022. The number of cases reported in the second quarter of 2022 is higher than the number of cases reported for the same period in 2021, but fewer than half the average number of cases reported for the same period in the previous three years.

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Figure 6: Cumulative number of meningococcal disease cases reported to MIDAS, 2017 to 2022 (week 26)

Figure 7 shows the number of meningococcal disease cases, according to age group and by quarter from 2001 to the end of the second quarter of 2022.

In the first half of 2022 there were:  

• three cases aged under one year
• seven cases in the five to 24 years age group
• five cases in those aged 25 years or over

Figure 7 is a series of line graphs showing the number of meningococcal cases reported to MIDAS per quarter, by year. The data ranges from 2001 to the end of the second quarter of 2022 and each line on the graph represents number of cases for a specific age group, and there is a line for the total number of cases. Historically, cases were more frequent in the under five age group. However, since 2016 those aged above 25 years have overtaken the under fives as the group with highest number of cases overall.

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Figure 7: Meningococcal disease cases reported to MIDAS by age group and quarter, 2001 to 2022 (week 26)

Of the 15 cases of meningococcal disease reported in the first half of 2022:

• twelve were serogroup B
• three cases were based on clinical diagnosis, as shown in Figure 8

Figure 8 is a bar chart showing the number of meningococcal cases reported to MIDAS by serogroup, from 1999 to the end of the second quarter of 2022. Until 2001, predominant serogroups were B and C (in addition to clinically diagnosed infections). However, the number of group C infections decreased rapidly after 2001 and since 2012, serogroup B infections comprise the majority of laboratory confirmed cases. In 2016, laboratory reports of serogroup C infection increased, alongside serogroup W infections.

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Figure 8: Meningococcal disease cases reported to MIDAS by serogroup, 1999 to 2022 (week 26)

Serogroup W cases continue to be reported separately following introduction of the MenACWY immunisation programme in summer 2015. Figure 9 demonstrates a positive impact of the MenACWY vaccine for the eligible population.

There were no serogroup W cases reported in the first half of 2022. 

Figure 9 is a series of line graphs showing the number of serogroup W cases reported from 2009 to the end of the second quarter of 2022, by age group. From 2014 to 2016 there was an increase in serogroup W amongst all age groups with exception of those aged 5 to 14 years. Since 2017, serogroup W case numbers have decreased in those aged under 25 years.

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Figure 9: Meningococcal serogroup W by age group reported to PHS 2009 to 2022 (week 26)

The number of deaths between 2002 and the end of the second quarter of 2022, reported by serogroup is shown in Figure 10, and case fatality ratio is shown in Figure 11.

There were two deaths from meningococcal disease reported in the first half of 2022.

Figure 10 is a bar chart showing the number of deaths from meningococcal cases reported to MIDAS by serogroup, from 2002 to the end of the second quarter of 2022. The overall trend is varied, with the highest number of deaths in 2004 (15 deaths).

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Figure 10: Meningococcal deaths by serotype reported to PHS 2002 to 2022 (week 26)

Figure 11 is a line graph showing meningococcal disease case fatality ratio from 2002 to the end of the second quarter of 2022.

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Figure 11: Meningococcal disease case fatality ratio, 2002 to 2022 (week 26)

Vaccination information

MenB vaccine

The MenB vaccine was introduced into the routine childhood vaccination programme on 1 September 2015.

All children born from 1 July 2015 were offered the Men B vaccine at eight weeks, 16 weeks and 12 months of age, alongside other routine childhood vaccinations.

A catch-up programme was rolled out for children born after 1 May 2015.

Children born before 1 May 2015 are not eligible to receive the MenB vaccine.

MenC vaccine

The combined Hib and MenC vaccine given in the UK is called Menitorix® and it is included in the UK childhood immunisation schedule, with routine vaccination recommended between 12 and 13 months of age.

Visit NHS Inform for further information about MenC vaccination.

MenACWY vaccine

MenACWY vaccine was recommended by the Joint Committee on Vaccination and Immunisation (JCVI) and offered to 14 to 18-year-olds as a measure to address an increasing number of meningococcal serogroup W cases in this age group.

A phased catch-up programme also ran in Scotland between August 2015 and March 2016.

The vaccine was also offered to students under the age of 25 attending university for the first time from Autumn 2015. MenACWY vaccine continues to be offered routinely to those in secondary school year 3 (S3).

Visit NHS Inform for further information about MenACWY vaccine.

Further information

Find out more on the addition of MenB to routine vaccinations and their impact (external website).

Read a letter from the Chief Medical Officer letter on the changes to the MenC vaccine.

Vaccine uptake statistics

Vaccine uptake statistics are published in our childhood immunisation statistics quarterly report.

Vaccine uptake statistics for the teenage MenACWY vaccine can be found in our teenage booster immunisation statistics Scotland report.

Mumps

Background information

Mumps is a disease resulting from infection by the mumps virus.

It was a common childhood disease prior to the introduction of the MMR vaccine in 1988, with more than 85% of adults having evidence of previous infection.

Following the introduction of vaccination in 1988, the incidence of mumps has substantially decreased. However, from 2004 to 2020, there was a widespread increased incidence of mumps throughout the UK, with the number of laboratory-confirmed cases peaking in 2005.

Cases of mumps are commonly identified by laboratory testing based on positive PCR or IgM serology and reported to PHS. However, many cases of mumps may be diagnosed clinically or go undiagnosed and the reliance on laboratory reports may represent a considerable underestimate of the true rate of disease in the community.

Surveillance update for April to June 2022

There has been one case of mumps reported in 2022 between April and June.

Since April 2020, there has been a substantial reduction in number of cases of mumps reported with only one laboratory-confirmed case of mumps reported in 2021.

As shown in Figure 12, small outbreaks occurred in:

• 2009
• 2012
• 2014 to 2015

At these points in time, most of the individuals affected were adolescents and young adults and had not received two doses of MMR.

Figure 12 is a line chart showing the number of laboratory-confirmed cases of mumps by year from 2000 to the end of June 2022. The figure shows the outbreak which started in 2004 and peaked in 2005 with 1,892 and 2,586 cases, respectively. While the number of cases has decreased since 2005, smaller outbreaks have occurred in 2009, 2012, and 2014 to 2015. The graph shows cases increasing again after 2016 with a total of 784 laboratory-confirmed cases of mumps reported in 2019, 864 from January to December 2020 and only one laboratory confirmed case in 2021. There has been one case reported thus far in 2022.

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Figure 12: Number of laboratory-confirmed cases of mumps in Scotland by year, 2000 to 2022 (week 26)

As shown in figure 13, there were:

• 385 cases reported in 2017
• 281 cases reported in 2018
• 784 cases reported in 2019
• 864 cases reported in 2020
• One reported case in 2021
• One case reported in 2022 to end of June

In 2020, the majority of reported cases occurred in the first three months, as shown in figure 13. The decrease in reported cases since April 2020 is likely to be a result of social distancing measures and restrictions implemented in response to the COVID-19 pandemic, which will also have interrupted the transmission of mumps. These measures have also reduced attendance to the primary care setting, resulting in reduced opportunity to diagnose cases.

NHS boards experienced clusters of mumps into the first quarter of 2020, occurring mainly in adolescents and young adults. The observed increase in cases in 2019 and early 2020, prior to the implementation of COVID-19 social restriction measures, may have represented poorer initial immune response to the mumps component of the MMR vaccine, waning immunity, or a combination of both within fully and partially vaccinated individuals.

Figure 13 is a bar chart showing the number of laboratory-confirmed cases of mumps by month and year from 2015 to the end of June 2022. The graph shows recurring peaks in the number of mumps cases reported by month, with the highest peaks occurring in June 2015 (142 cases), November 2017 (122 cases), April 2019 (119 cases) and December 2019 (109). The chart shows a sharp rise in cases at the start of 2020; 316 cases in January, 343 in February and 194 in March, however in the most recent three months, the number of cases can be seen to have dropped to 0 cases from June to November 2020, a single case in December 2020, and only one case reported to the end of 2021. One case has been reported so far in 2022.

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Figure 13: Number of laboratory-confirmed cases of mumps in Scotland by month and year, 2015 to 2022 (week 26)

Age distribution of cases

Figure 14 shows that the majority of mumps cases in recent years have been in those aged 17 to 34 years.

Although the vaccination status of cases is not routinely collected, this is consistent with the age groups that are likely to be under-immunised with a mumps-containing vaccine, or for whom there is waning immunity.

Figure 14 is a bar chart showing the number of laboratory-confirmed cases of mumps by age group and year from 2015 to 2020. Data from 2021 and 2022 are not presented due to the low number of cases. While the overall number of cases varies by year, the majority of mumps cases in all years have occurred in individuals aged 17 to 34 years.

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Figure 14: Number of laboratory-confirmed cases of mumps in Scotland by age group and year, 2015 to 2020 (week 52)

The incidence of mumps by age group in 2020, shown in Figure 15, reflects a higher incidence among individuals aged 17 to 20 years compared to other ages (137 cases per 100,000 population).

This was followed by those aged 21 to 24 years (88 cases per 100,000 population).

Figure 15 is a bar chart and shows the incidence per 100,000 population of laboratory-confirmed cases of mumps by age group between 1st January and 30th December 2020. the incidence of mumps was highest among individuals aged 17 to 20 years, at 137 cases per 100,000 population. This was followed by those aged 21 to 24 years, at 88 cases per 100,000 population. Data from 2021 and 2022 are not presented due to the low number/absence of cases.

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Figure 15: Number of laboratory-confirmed cases of mumps by age group, 2020 (week 52)*

*Only one laboratory-confirmed case of mumps was reported in 2021 and one case thus far in 2022, therefore only 2020 data has been presented.

Figure 16 shows the variability in the incidence of mumps between NHS Boards in 2020.

The highest incidence in 2020 was observed in:

• NHS Forth Valley – 48 cases per 100,000 population
• NHS Borders – 34 cases per 100,000 population
• NHS Lothian – 25 cases per 100,000 population

Figure 16 shows the incidence per 100,000 population cases of mumps by NHS Board between 1st January and 30th December 2020 as a bar chart. During this period, the incidence of mumps was highest NHS Forth Valley (48 cases per 100,000 population), followed by NHS Borders and Lothian (34 and 25 cases per 100,000 population, respectively). Data from 2021 and 2022 is not presented due to the low number/absence of cases.

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Figure 16: Incidence of mumps cases per 100,000 population by NHS board, 2020 (to week 52)*

*Only one laboratory-confirmed case of mumps was reported in 2021 and only one case thus far in 2022, therefore only 2020 data has been presented.

Limitations

Relying on laboratory reports will represent an underestimate of mumps since there will be cases that are clinically and not laboratory-confirmation and other cases that may not attend healthcare settings for diagnosis.

It should also be noted that differences in sampling and testing practices may account for variation across the NHS boards.

Vaccine uptake statistics

Vaccine uptake statistics are published in our childhood immunisation statistics quarterly report.

Pertussis

Background information

Pertussis (or whooping cough) is an acute bacterial disease of the respiratory tract, resulting from infection with Bordetella pertussis.

It can affect people of all ages. Adolescents and adults tend to suffer with a prolonged cough. Unimmunised infants are more likely to develop complications from pertussis infection which can require hospital treatment and, in severe cases, can be fatal.

As pertussis continues to circulate in Scotland, immunisation of pregnant women is vital. The immunity that young infants will receive from their mother, although very important in the first few weeks of life, offers only short-term protection. Therefore, it is important that infants are vaccinated as part of the routine childhood schedule on time in order to provide longer-term protection.

Surveillance update April to June 2022

There were two cases of pertussis reported from April to June 2022.

Four cases of laboratory-confirmed pertussis disease were reported in 2021.

In 2020, there were 198 laboratory reports of B. pertussis, the majority of which occurred in the first quarter of the year. This reduction is likely to be attributable to social distancing measures implemented to mitigate the transmission of COVID-19.

Figure 17 shows the number of positive laboratory reports of B. pertussis in Scotland from 2012 to the end of June 2022.

In 2012 and 2013, an outbreak occurred in Scotland, with 1,896 and 1,188 laboratory reports of pertussis, respectively.

Since then, the number of reports annually has been lower than those years:

• 533 in 2017
• 443 in 2018
• 746 in 2019

Figure 17 is a bar chart showing the number of laboratory reports of Bordetella pertussis by month from 2012 through to the end of June 2022. The figure shows the outbreak that occurred in 2012 into 2013 with 1,896 and 1,188 reports, respectively, as well as an increase in activity that occurred in 2016 (1,075 reports). The number of laboratory reports has declined since 2016 but remains elevated when compared with pre-outbreak levels. From the first quarter of 2020, cases can be seen to drop to nearly zero with only four cases reported in 2021 and two cases have been reported thus far in 2022.

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Figure 17: Number of laboratory reports of Bordetella pertussis in Scotland by month, 2012 to 2022 (week 26)*

Age breakdown of cases

Figure 18 presents the percentage of laboratory reports for pertussis by age group and year from 2012 to the end of December 2021.

The data for 2020 indicate that adults aged 50 to 59 years accounted for a comparatively higher percentage of laboratory reports than individuals in other age groups.

Of the four reported cases in 2021:

• one case was aged between 15 and 19 years
• one case was between 50 to 59 years
• two cases were older than 70 years

Figure 19 presents the number of laboratory reports for pertussis by age group from January to December of 2020.

The graph shows that the 50 to 59 age group accounted for the highest number of cases, however incidence was highest among children under one year of age at 9.8 per 100,000 population as shown in Figure 20.

This was followed by children aged 1 to 4 years, with an incidence of 7.2 per 100,000 population.

Figure 18 is a stacked bar chart that shows the percentage of laboratory reports of pertussis by age group and year from 2012 through the end of 2021. The data for 2020 indicate that adults aged 50 to 59 years accounted for a comparatively higher percentage of laboratory reports than did individuals in other age groups. It is worth noting that there have only been four cases reported in 2021.

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Figure 18: Percentage of Bordetella pertussis laboratory reports in Scotland by age group and year, 2012 to 2021 (week 52)*

Figure 19 is a bar chart showing the number of laboratory reports for Bordetella pertussis by age group during 2020. The graph shows that the 50-59 age group accounted for the highest number of cases.

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Figure 19: Number of laboratory reports of Bordetella pertussis in Scotland by age group, 2020 (to week 52)*

*The low number or absence of cases in 2021 and 2022 means that only data until 2020 is presented.

Figure 20 is a bar chart showing the incidence of Bordetella pertussis per 100,000 population by age group during 2020. During this period, incidence was highest among children under one year of age at 9.8 per 100,000 population.

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Figure 20: Incidence of Bordetella pertussis per 100,000 population in Scotland by age group, 2020 (to week 52)*

*The low number or absence of cases in 2021 and 2022 means that only data until 2020 is presented.

Laboratory reports by NHS board

NHS Tayside and NHS Greater Glasgow and Clyde each reported one laboratory-confirmed case of pertussis to the end of 2021, with NHS Lothian reporting two cases.

Figure 21 demonstrates the number of pertussis laboratory reports by NHS board from January to December 2020, while Figure 22 presents incidence per 100,000 population.

There is variation between NHS boards, with the highest incidence in 2020 in:

• NHS Highland – 8.1 reports per 100,000 population
• NHS Dumfries – 6.7 reports per 100,000
• NHS Galloway – 6.7 reports per 100,000

No positive laboratory reports were received in 2020 from NHS Orkney, NHS Shetland, and NHS Western Isles.

Figure 21 is a bar chart showing the number of laboratory reports of Bordetella pertussis by NHS Board during 2020. NHS Greater Glasgow and Clyde had the highest number of cases during this period (50 reports), followed by NHS Lothian (43 reports). NHS Orkney, NHS Shetland, and NHS Western Isles had no positive laboratory reports during 2020.

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Figure 21: Number of laboratory reports of Bordetella pertussis in Scotland by NHS board, 2020 (to week 52)*

*The low number/absence of cases in 2021 and 2022 means that only data until 2020 is presented.

Figure 22 is a bar chart showing the incidence of Bordetella pertussis per 100,000 population by NHS Board during 2020. There is variation between NHS Boards, with NHS Highland having the highest incidence (8.1 reports per 100,000 population), followed by NHS Dumfries and Galloway (6.7 reports per 100,000 population).

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Figure 22: Incidence of Bordetella pertussis per 100,000 population in Scotland by NHS board, 2020 (to week 52)**

*The low number or absence of cases in 2021 and 2022 means that only data until 2020 is presented.

Vaccination information

In response to the increase in cases and to protect young infants in the first few weeks of life until starting the routine childhood immunisation programme at eight weeks, a programme was introduced in October 2012 to offer pertussis vaccination to all pregnant women.

The vaccine is offered to pregnant women between gestational weeks 16 and 32 to maximise protection of the baby from birth.

Women may still be immunised after week 32 of pregnancy but this may not offer as high a level of passive immunological protection to the baby.

Vaccination late in pregnancy may, however, directly protect the mother against disease and thereby reduce the risk of exposure to her infant.

Vaccine uptake statistics

Vaccine uptake statistics are published in our our childhood immunisation statistics quarterly report.

Pneumococcal disease

Background information

Invasive Pneumococcal Disease (IPD) surveillance is based on local and reference laboratory reports confirming isolation of Streptococcus pneumoniae from sterile body sites, mainly blood and cerebrospinal fluid (CSF).

In 1999, the Scottish Pneumococcal Invasive Disease Enhanced Reporting (SPIDER) scheme was introduced. The enhanced surveillance scheme is jointly managed by Public Health Scotland and the Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory (SHLMPRL).

Data from SPIDER informs understanding of the epidemiology of IPD in Scotland.

Surveillance update April to June 2022

There were 95 cases of IPD reported in the second quarter of 2022, bringing the total for the first half of the year to 178.

This is higher than the number of cases reported for the same period in 2021 (n=113), but lower than for the first half of the previous three years (range 188 to 340) as shown in Figure 23.

The lower number of cases of IPD observed since early 2020 is likely due to the impact of social distancing measures and other restrictions implemented in response to the COVID-19 pandemic over that period.

Figure 23 is a series of line graphs showing the cumulative number of invasive pneumococcal disease cases reported to SPIDER per week by year. Each line represents a different year from 2017 to the end of the second quarter of 2022. Across all years there is a steady increase in the cumulative number of cases per week. The graphs show that case numbers for the second quarter of 2022 are higher than those reported for the same period in 2021, but lower than in the previous three years.

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Figure 23: Cumulative number of invasive pneumococcal disease cases reported to SPIDER, 2016 to 2022 (week 26)

Figure 24 presents data on cases by age group, and indicates that the burden of IPD is in adults over 35 years:

• 82 were aged 65 years or older (46.1%)
• 62 were aged 35 to 64 years (34.8%)
• five were aged 15 to 34 years (2.8%)
• three were aged 5 to 14 years (1.7%)
• 26 were aged under five years (14.6%), of whom five were infants aged under one year

Figure 24 is a series of line graphs showing the number of invasive pneumococcal disease cases reported to SPIDER per quarter by year from 1999 to the end of the second quarter of 2022. Each line represents number of cases for each age group. The graphs show that the majority of cases were observed in those aged 35 years and over.

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Figure 24: Cases of IPD reported to SPIDER by quarter and by age group, 1999 to 2022 (week 26)

IPD in children under five years old

Of the 178 IPD cases reported in the first quarter of 2022, 26 were children under five years of age, 25 of whom were old enough to have been eligible for at least a first dose of PCV13 vaccination.

This is higher than the number of cases reported in children under five for the same period in each of the previous four years, which ranged from 12 to 21.

Serotypes detected in children aged under five years in the first half of 2022 are shown in Table 1.

Septicaemia and pneumonia were the most common clinical presentations in children aged under five years old.

Five of the 26 children aged under five years who had IPD in the first half of 2022 were known to have an underlying condition.

Circulating serotypes of Streptococcus pneumoniae

All IPD isolates and specimens should be sent to the reference laboratory for further typing and antimicrobial sensitivities.

Typing results were available for 132 of the 178 cases reported in the first half of 2022. This accounts for 74.2% of the cases reported.

The three most common serotypes reported were:

• Serotype 8 (22 cases)
• Serotype 3 (18 cases)
• Serotype 9N (12 cases)

A total of 33 cases, or 18.5%, were caused by serotypes covered by the PCV13 vaccine.

For the most recent information on antimicrobial resistance in Streptococcus pneumoniae, see Scottish One Health Antimicrobial Use and Antimicrobial Resistance in 2020.

Vaccination information

Two pneumococcal vaccines are available that provide protection against pneumococcal disease.

Pneumococcal polysaccharide vaccine (PPV23)

The pneumococcal polysaccharide vaccine, PPV23, is recommended for many of the same people who receive an annual flu vaccination. Unlike the flu vaccine, which is given every year, the pneumococcal vaccine is usually only given once.

In 2003, the pneumococcal vaccination for all people aged 65 years and over was introduced, in addition to those aged under 65, with certain underlying conditions. This vaccine offers protection against 23 serotypes of IPD.

Pneumococcal conjugate vaccine (PCV7)

In September 2006, the pneumococcal conjugate vaccine PCV7 was introduced into the routine childhood immunisation schedule.

Pneumococcal conjugate vaccine (PCV13)

In spring 2010, PCV7 was replaced with PCV13 to provide broader protection against more serotypes of S. pneumoniae.

PCV13 was initially offered as three doses:

• primary doses at eight weeks
• primary dose at 16 weeks
• booster at 12 to 13 months

From April 2020, the PCV13 schedule changed to:

• primary dose at 12 weeks
• booster dose at between 12 and 13 months.

PCV13 offers protection against the following 13 serotypes of S. pneumoniae:

• 1
• 3
• 4
• 5
• 14
• 6A
• 6B
• 7F
• 9V
• 18C
• 19A
• 19F
• 23F

To coincide with the introduction of PCV7, enhanced surveillance was established for children under five years of age.

A very limited number of high-risk older children and adults are also indicated for PCV13 – see Pneumococcal: the green book, chapter 25 and CMO(2020)02: changes to the childhood pneumococcal conjugate vaccine (PCV13) schedule from 6 April 2020.

Vaccine uptake statistics

Vaccine uptake statistics for children are published in our childhood immunisation statistics quarterly report.

Vaccine uptake statistics for adults are published by our Clinical and Protecting Health Directorate.

Poliomyelitis

Background information

Poliomyelitis (polio) is an acute viral illness caused by one of the three serotypes of poliovirus.

Most infections cause no symptoms, but in a small number of people can result in a potentially life-threatening infection that can cause temporary or permanent paralysis.

People may become infected with the polio virus through contact with infected faecal matter or respiratory secretions.

Immunisation against polio is offered to babies and children as part of the routine childhood immunisation schedule.

They receive:

• three doses of the 6-in-1 vaccine at 8, 12 and 16 weeks of age
• a 4-in-1 pre-school booster at 3 years 4 months old
• a 3-in-1 teenage booster at around 14 years of age (S3)

Guidance on polio immunisation is available in chapter 26 of the UKHSA’s green book.

Surveillance

Following the introduction of the vaccine in the 1950s, the number of cases fell rapidly.

• The last UK case of poliomyelitis caused by wild polio virus was in 1984.
• The last imported case of polio in the UK was 1993.

Poliovirus is targeted by the World Health Organization (WHO) for eradication and, due to the efforts of countries worldwide, polio is now eliminated from four of the six WHO regions.

Pakistan and Afghanistan are considered the countries with the highest risk.

However, polio outbreaks do occur in other countries when the disease is spread amongst people who may not be fully vaccinated.

Visit fitfortravel for more information on those who may be at risk of exposure through travel.

Vaccine uptake statistics

Vaccine uptake statistics for children are published in our childhood immunisation statistics quarterly report.

Rotavirus

Background information

Rotavirus is highly infectious and a leading cause of gastroenteritis in children worldwide. In Scotland, most children will have had at least one rotavirus infection by five years old.

Prior to the implementation of the rotavirus vaccination programme, rotavirus reports peaked between February and April. This caused considerable additional pressure on the NHS, particularly in primary care and paediatric healthcare facilities.

In July 2013, Rotarix®, a live attenuated vaccine was introduced into the routine infant vaccination schedule in the UK, with doses given at 8 and 12 weeks.

Surveillance update April to June 2022

Figure 25 shows the number of rotavirus laboratory reports in Scotland from 2011 to the end of June 2022.

Following the introduction of the immunisation programme, there has been a marked reduction in the number of laboratory reports, which clearly demonstrates the impact of the vaccine.

A reduction of laboratory-confirmed rotavirus samples has also been seen in unvaccinated children suggestive of indirect population protection due to the vaccine.

Figure 25 is a line graph which presents the number of rotavirus laboratory reports in Scotland by month and year from 2011 to the end of June 2022. There has been a marked reduction in the number of laboratory reports following introduction of the rotavirus vaccine.

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Figure 25: Laboratory reports of rotavirus in Scotland from 2011 to end of June 2022

Hospitalisations

Scottish Morbidity Record 01 (SMR01) is a national dataset held by Public Health Scotland that provides data on admissions to General Acute Inpatient and Day Case Units.

Surveillance of hospital admissions attributable to rotavirus is undertaken using defined International Classification of Disease 10 (ICD-10) codes for rotavirus and viral enteritis (possible rotavirus).

Figure 26 shows the number of admissions for rotavirus for children aged less than five years by month in the three-year period 2014 to 2017 compared to an average of the years 2010 to 2013.

This figure shows the impact of the vaccine on rotavirus related hospital admissions of young children.

The increase in hospital admissions observed in November and December of 2016, was prior to the rotavirus season and therefore most likely associated with increased circulation of norovirus at that time.

Figure 26 is a line graph which presents the number of admissions for rotavirus for children aged less than 5 years by month in 2014 to 2017 compared to an average of the years 2010 to 2013. This figure shows the impact of the vaccine on rotavirus related hospital admissions of young children.

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Figure 26: Number of admissions for rotavirus and viral enteritis (including rotavirus) of children < 5 years, 2014 to 2017 compared to 2010 to 2013 pre-vaccine average

GP consultations

Infections resulting in hospitalisation represent a fraction of cases that occur in the community which, while less severe, cause substantial illness.

Methods to monitor the impact of the vaccine programme in community settings have also been established to obtain a more complete representation of the impact of the vaccine on the burden of disease.

Figure 27 presents the consultation rate per 100,000 of the population for infants less than one year of age for gastrointestinal illness and compares 2014 to 2018 to an average of 2010 to 2013 before the vaccine was introduced.

The impact of the vaccine is clear with an absence of a seasonal peak of consultations corresponding to the rotavirus season in the years 2014 to 2018.

Figure 27 is a bar chart which presents the consultation rate per 100,000 of the population for infants less than 1 year of age for gastrointestinal illness in 2014 to 2018 as a line graph compared to the average for 2011 to 2013, before the vaccine was introduced. The impact of the vaccine is clear with an absence of a seasonal peak of consultations corresponding to the rotavirus season in 2010 to 2018.

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Figure 27: GP consultation rate for all gastrointestinal illness in infants under 1 year, 2014 to 2017 compared to 2011 to 2013 pre-vaccine average

Vaccination information

A national rotavirus vaccination programme using the vaccine Rotarix® was introduced into the routine infant vaccination schedule in Scotland in July 2013, with approximately 93% uptake rate.

The vaccine provides protection against the most common strains of rotavirus, but not other enteric viruses such as norovirus.

Infants are offered two doses of the oral vaccine Rotarix®, which is a weakened form of virus which can't cause disease but that protects against rotavirus at an interval of at least four weeks between doses - at eight weeks and again at 12 weeks.

Vaccine uptake statistics

Vaccine uptake statistics are published in our childhood immunisation statistics quarterly report.

Rubella

Background information

Before the introduction of rubella vaccination, more than 80% of adults had evidence of previous exposure to rubella.

A vaccination programme targeting girls and non-immune women of childbearing age was introduced in the UK in 1970 and reduced the number of congenital rubella syndrome (CRS)-related births and terminations.

In 1988, the Measles, Mumps and Rubella (MMR) vaccine was introduced for both boys and girls and further decreased cases of rubella to near elimination levels (Figure 28).

Surveillance update April to May 2022

No laboratory-confirmed cases of rubella were reported between January and June 2022.

The last reported case of laboratory-confirmed rubella in Scotland was in 2017.

Figure 28 is a line chart showing the number of laboratory-confirmed cases of rubella reported in Scotland by year from 1988 through to the end of June 2022. The figure shows that the number of cases of rubella fluctuated each year between 1988 and 1995. The number of cases peaked in 1996 at 766 but decreased dramatically in 1997 before rising slightly to 47 cases in 1999. Since 1999, the number of cases has been low and stable. No laboratory-confirmed cases of rubella have been reported in Scotland since 2017, when one case was reported. The graph is also annotated with relevant time points in rubella vaccination, with the MMR vaccine introduced in 1988, the measles/rubella campaign initiated in 1994, and the second dose of MMR added to the vaccine schedule in 1996.

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Figure 28: Number of laboratory-confirmed cases of rubella in Scotland by year, 1988 to 2022 (week 26)

Congenital rubella surveillance

Congenital rubella surveillance can be viewed on the Royal College of Paediatrics and Child Health (RCPCH) website.

Vaccine uptake statistics

Vaccine uptake statistics are published in the childhood immunisation statistics quarterly report.

Shingles

Background information

Shingles, also known as herpes zoster, is caused by reactivation of latent varicella zoster virus. Varicella zoster is the same virus that causes chickenpox.

Shingles is characterised by a painful skin rash. The main complication from shingles is post-herpetic neuralgia (PHN), a long-lasting neuropathic pain after the rash has disappeared.

PHN can persist for months or years and the risk and severity increases with age. Its effect can be very debilitating.

The Scottish Morbidity Record 01 (SMR01) is a national dataset held by the NHS Information Services Division and provides data on inpatient and day case admissions. It is used to investigate the burden of disease on hospital inpatient and day-case discharges from acute specialties from hospitals in Scotland.

Shingles surveillance data

Figure 29 shows the rate of admissions per 100,000 population for shingles and related complications by age group between 2010 and 2021.

This graph shows that the rate of admissions is higher among the older age groups.

Figure 29 is a line graph which shows the rate of admissions per 100,000 population for shingles and related complications by age group between 2010 and 2021. This graph shows that the rate of admissions increases with increasing age.

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Figure 29: Rate of admissions per 100,000 population for shingles and related complications by age group and year, 2010 to 2021*

*Rates are calculated using an updated methodology, which differs from that previously used to estimate burden of disease. This is therefore not comparable to graphs in previous reports.

GP consultations

An aggregated dataset is received quarterly from approximately 50% of GP practices in Scotland on consultations for shingles and related complications.

Figure 30 presents the number of consultations for shingles by age group between 2011 and 2017.

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Figure 30: Number of GP consultations for shingles and related complications by age band and year

Figure 31 shows the rate of GP consultations for shingles per 1,000 population by age group between 2011 and 2017.

As with the data in Figure 29, this chart suggests that the burden of shingles is higher among the older age groups with this data demonstrating a decline in the number of consultations after 2014 observed in those over 70 years.

This is consistent with the cohort who were eligible to receive shingles vaccination from September 2013. 

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Figure 31: Rate of GP consultations for shingles per 1,000 population by year and age group, 2011 to 2017

Vaccination information

The vaccine is offered routinely to those aged 70 years.

Opportunistic vaccination is offered to eligible individuals aged 71 to 79 years who have not previously been vaccinated.

Read more in Shingles (herpes zoster): the green book, chapter 28a.

Zostavax®

In September 2013, a national shingles vaccination programme was introduced using Zostavax®.

As Zostavax® is a live attenuated vaccine, it cannot be given to patients who are severely immunosuppressed.

Download the screening tool to identify when the Zostavax® vaccine is contraindicated.

Shingrix®

From September 2021 a non-live vaccine was introduced following recommendation from the JCVI.

This vaccine, Shingrix®, should be offered to those people for whom Zostavax® is contraindicated due to severe immunosuppression but who are eligible for vaccination under the current programme. This means that they can gain a similar level of protection to those with no contraindications.

Vaccine uptake statistics

Tables 2 and 3 present shingles vaccine coverage among the eligible routine and catch-up cohort of the Zostavax® vaccine in Scotland for the current programme to the end of May 2022.

• Vaccine coverage among the routine cohort – those aged 70 between 1 September 2021 and 31 August 2022 – was 24.4%.
• Within the catch-up cohort – those aged between 71 and 79 in the same time period – nearly two thirds, or 57.9%, of those eligible have ever received their vaccination against shingles.

The uptake for the 2020 to 2021 season is lower than anticipated.

This trend is likely attributable to the social restriction measures and reduced physical consultation time between patients and clinicians that was implemented to mitigate the spread of COVID-19 infection.