Zika virus is no longer a global health emergency, UN health agency says

The United Nations health agency has declared that the Zika virus and related neurological complications no longer constitute an international emergency and said it is preparing a longer-term response to the mosquito-borne virus that can result in severe neurological defects in newborns whose mothers were infected.

World Health Organization officials were quick to note that the move does not mean the agency is downgrading the threat of the virus that has spread across Latin America, the Caribbean and elsewhere. Nearly 30 countries have reported birth defects linked to Zika, with 2,100 cases of nervous-system malformations reported in Brazil alone.

The officials also emphasized that the now-lifted “public health emergency of international concern” was declared in February, when Zika clusters were appearing and a sharp increase in research was needed and with the looming Rio Olympics in mind.

WHO said the emergency measures had led the world to an “urgent and coordinated response”, but the virus had continued to spread. It acknowledged that “many aspects of this disease and associated consequences still remain to be understood, but this can best be done through sustained research”.

“It is a significant and enduring public health challenge, but it no longer represents an emergency,” Dr David Heymann, who heads the WHO emergency committee on Zika, said after the panel met for the fifth time this year. “There was no downgrading of this.”

Heymann said recommendations made in recent months were now being “internalized” at the Geneva-based agency.

“If anything, this has been escalated in importance by becoming activities that will be continued in the long-term in the World Health Organization,” he said.

Zika is mainly spread by mosquitoes but also can be spread through sex. Most infected people don’t get sick. It can cause a mild illness, with fever, rash and joint pain.

It also causes microcephaly, or shrunken heads, in newborn children whose mothers were infected, leading to severe developmental problems and sowing grave concerns of would-be parents in countries hit by the virus.

Responding to the WHO announcement, the US Centers for Disease Control and Prevention reiterated its position that pregnant women should avoid traveling to areas with local transmission of Zika.

Dr Peter Salama, WHO’s director of emergencies, said the new phase of fighting the virus requires development donors “to step up to the plate and see this for what it is, which is a long-term problem that the world will have to deal with for many years to come”.

“We are sending the message that Zika is here to stay, and WHO’s response is here to stay in a very robust manner,” Salama said.

Zika virus is no longer a global health emergency, UN health agency says

NHS saves £600m in crackdown on agency fees

The NHS has slashed more than £600m from the billions it pays every year for temporary doctors and nurses by cracking down on fees paid to “rip-off” staffing agencies, new figures reveal.

Gaps in hospital rotas sent the bill for temporary staff soaring from £2.2bn in 2009-10 to £3.6bn last year. But hospitals have halted the relentless increase in recent years of the rates for stand-in personnel needed to ease chronic understaffing and ensure patient safety on wards.

Data compiled by NHS Improvement, which regulates the health service in England, shows that hospitals spent £613m less since the blitz on agency staff began on 15 October last year, compared to the 12 months before caps on hourly rates were brought in.

In August, for example, NHS trusts spent £252m on agency staff – £61m (19.5%) less than the £313m they paid out in the same month the year before. Similarly, in July they spent £256m compared to their £331m outlay in July 2015.

If maintained, the NHS stands to meet its target of spending £1bn less a year on temporary staff, which would be key to its ambition to reduce hospitals’ collective overspend of £2.5bn last year to £580m. Hospitals are now paying 18% less on average for nurses whom they hire through agencies which NHS England boss Simon Stevens last year criticised for “ripping off the NHS”. The limits on fees for stand-ins have also succeeded in reducing the cost of locum doctors, but only by 13%.

Jim Mackey, NHS Improvement’s chief executive, will cite the figures as proof that the NHS is making progress at controlling its costs when he, Stevens and health secretary Jeremy Hunt give evidence to MPs on the Commons health select committee on Tuesday.

Simon Stevens, chief executive of NHS England, has accused staffing agencies of ripping off the NHS. Photograph: Felix Clay for the Observer

Medical organisations reacted with alarm to disclosures that Theresa May, the prime minister, has told Stevens that, despite mounting concern that the NHS is under dangerous strain, it would not receive any extra funding when Philip Hammond, the chancellor, presents his autumn statement on 23 November. “If these reports are true, the prime minister needs to explain how exactly the NHS will keep up with rising demand without the necessary investment.

“Theresa May talks about injecting £10bn into the NHS, yet in reality the increase in health spending is less than half that,” said Dr Anthea Mowat, a spokeswoman for the British Medical Association.

“The NHS is already the most efficient healthcare system in the world. The notion that the funding crisis can be solved with further efficiency savings is a myth, and these are not savings, they are year-on-year cuts that have driven almost every acute trust in England into deficit, led to a crisis in general practice and a community and social care system on the brink of collapse,” added Mowat.

Two-thirds of the acute, mental health, community services and ambulance trusts covered by the new rules on agency staff had cut the amount of money they spend on them, NHS Improvement said. Since April trusts have only been allowed to pay 55% more than the usual rate for the job for temporary workers, though they are allowed to breach that supposed ceiling “on exceptional safety grounds” in order to ensure that patients do not come to harm because of staff shortages.

However, Mackey recently told trusts that, despite the progress on agency fees, “across the sector we are falling short of what is needed and must do more to reduce over-reliance on agencies”. The regulator will soon start to publish quarterly updates on how much each trust has spent on such staff in what some in the NHS see as a crude “naming and shaming” exercise designed to embarrass trusts into spending less and do not take account of high vacancy rates which force them to turn to agencies in the first place. It also plans to phase out altogether hospitals’ use of expensive interim senior executives, whose temporary costs can see them being paid over £1,000 a day. “Reducing spending on the agency bill is fundamentally important for NHS finances. But it’s not a panacea,” said Anita Charlesworth, chief economist at the Health Foundation thinktank, Hospitals are still heading for an overspend of £580m this year despite receiving £1.8bn of “sustainability and transformation” funding, and NS England has made only “slow progress” at finding its promised £22bn of efficiency savings, she warned.

“Reducing the agency bill will help but it’s not the solution. The NHS needs a comprehensive plan to improve efficiency,” she added.

“The NHS has saved over £600m since we introduced our agency price cap system. Most NHS trusts have responded well to the caps, using them to significantly reduce their agency spending and improve their workforce management,” said Dr Kathy McLean, NHS Improvement’s executive medical director.

NHS saves £600m in crackdown on agency fees

Fluoride in water doesn"t lower IQ or cause cancer, says health agency

Australia’s chief health and medical research agency says fluoride in drinking water does not lower a person’s IQ, cause cancer or cause any other negative health effects.

The National Health and Medical Research Council (NHMRC) analysis of more than 60 years of scientific research and 3,000 studies has backed adding fluoride to public drinking supplies as a safe and effective measure for preventing tooth decay.

The review shows there are no health effects or harm under the levels used in Australia, the NHMRC chief executive, Prof Anne Kelso, said.

“It shows that community water fluoridation, as it’s used in Australia today, is effective at reducing tooth decay and is not associated with any general negative health effects,” Prof Kelso said.

The evidence consistently showed no link between water fluoridation at Australian levels and cancer overall, including two forms of bone cancer, the NHMRC’s draft information paper released on Wednesday said.

There was also no link with the IQ or cognitive function of children or adults, it said. The study also found:

• Fluoridation reduces tooth decay by 26% to 44% in children, teenagers and adults

• There was no association with: cancer; Down’s syndrome; IQ; mortality; hip fractures; bone cancers osteosarcoma and Ewing sarcoma

• Insufficient evidence about any association with: chronic kidney disease; heart disease and high blood pressure; kidney stones; low birth weight; osteoporosis and musculoskeletal pain; thyroid function; gastric discomfort, headache, insomnia

NHMRC fluoride reference group member Prof Clive Wright said reports about water fluoridation affecting children’s IQ were based on studies undertaken in China that used poor methodology and areas with up to five times as much fluoride in the water as Australia.

He said a New Zealand study found no difference in the IQ scores of school-aged children or adults between those exposed to community water fluoridation and those who were not.

Wright said if Australia stopped putting fluoride into public water supplies, it would come at the cost of higher rates of tooth decay in children and adults.

“By preventing tooth decay and all of its associated pain and suffering, community water fluoridation saves money both for individuals, including dental treatments and time off work or school, and the healthcare system,” he said.

Fluoride occurs naturally in the water supply in many countries, and some have naturally higher levels than that in Australia, which is between 0.6-1.1 micrograms per litre.

Fluoride in water doesn"t lower IQ or cause cancer, says health agency

Scottish food standards agency criticised over E coli poisoning case

Scotland’s food standards agency has come under attack after it confirmed it had no samples or test evidence linking a cheese-maker with a food poisoning outbreak that killed a three-year-old girl.

Prof Sir Hugh Pennington, a world authority on the bug blamed for the outbreak, E coli O157, said the information issued by Food Standards Scotland on its investigation had been “a mess”, and had failed to answer basis questions about the case.

“The whole thing is a mess in terms of the public information coming out; from my point of view, I just don’t understand what’s going on,” said Pennington, emeritus professor for bacteriology at Aberdeen university and a former adviser to the UK Food Standards Agency.

He said he was puzzled by the agency’s delay in releasing its report in the outbreak, which ended several weeks ago. “The sooner we see all the data which has been collated which allows the FSS to point the finger, the better it will be for everybody,” he said.

The agency issued an alert in July after it linked an E coli outbreak that had affected 20 people with two batches of Dunsyre Blue, one of the best known brands from an artisan cheese firm in Lanarkshire, Errington Cheese, which has pioneered the use of unpasteurised milk.

The firm withdrew the cheeses from sale in July, but the scare escalated last week after the FSS revealed that a three-year-old girl in Dunbartonshire had died and 11 people were hospitalised after contracting the E coli O157 bug. Prosecutors at the Crown Office are studying a file on the case.

Errington Cheese insisted its repeated testing had found no traces of E coli in any of the cheeses involved, but Food Standards Scotland said last week two batches of Dunsyre cheese “were implicated based on epidemiological evidence”.

Two days later, the company said that withdrawing the cheeses from sale was in “the best interests of consumers to protect them from potential risks to public health”.

However, the agency told the Sunday Herald at the weekend it had no direct proof the cheeses it had named and had banned from sale were to blame. “Tests carried out to date from samples taken by South Lanarkshire council as part of this investigation have not detected the same strain linked to the outbreak,” it said.

It is understood the FSS did not test any samples of the cheese eaten, had no swabs from any restaurant or home or supplier, and was relying instead on a questionnaire of those affected by the outbreak. The FSS would not comment on those elements of its investigation.

The agency said on Saturday its testing of Errington’s cheeses led to a positive finding of E coli O157 on a different product, the firm’s Lanark White brand; although it had not yet established that that cheese had the shiga toxin that makes the bug so dangerous.

The company withdrew its Lanark White from sale, too, on the agency’s instructions but again tried to defend its food hygiene and production standards. In a statement on its website, Errington Cheese said its advisers were unhappy about the testing used by the FSS: those batches of Lanark White had been on sale for three weeks with no reports of ill-health.

The company said in August there had been no E coli detected at all at its factory or in its cheeses since 21 March, either by its own laboratory, the local council or by its customers.

Its six samples of the Dunsyre Blue that was targeted by the FSS had all been clear. From the limited information given to it by the FSS, all the cases occurred in the first two weeks of July, even though the cheese had been on sale for up to nine weeks.

The FSS said on Monday: “Public health is and will continue to be FSS’s priority and any actions will continue to be determined by what is necessary to protect public health and the interests of consumers. As there is an ongoing food safety investigation, we will publish more information when this is necessary to protect public health and provide information to consumers.”

Pennington said it was often directly to directly link a suspect batch of cheese to a poisoning outbreak because an E coli bug may only affect part of each block, and consumers could literally eat the only evidence available.

In some cases, people could pick up the bug from an infected knife without eating the cheese involved. However, without very detailed analysis, such as DNA testing, of each bug detected in every patient to prove a direct link, there could more than one source of the outbreak.

Pennington has not been contacted by the Errington family in this case but gave expert evidence in the company’s defence in 1994 when it was unsuccessfully prosecuted after traces of listeria were found it its Lanark Blue cheese. He said in this case, the Erringtons had a right to see the FSS’s report as soon as possible, so it could understand why its brands had been identified as the source of this outbreak.

But he said the FSS attitude in this case underlined long-standing hostility in Scotland’s public health and food safety sectors towards cheeses made by unpasteurised milk, including the Errington brands. English regulators were more relaxed about unpasteurised milk; Scottish agencies became far more hardline after two major salmonella outbreaks in the 1970s caused a number of fatalities.

Scottish food standards agency criticised over E coli poisoning case

Ireland calls for EU drug agency to be moved from London to Dublin

Ireland is set for a post-Brexit battle with five other EU countries to be the site of the new headquarters of the London-based European Medicines Agency (EMA).

The Irish health minister, Simon Harris, has said he will be pressing the case in Brussels for the relocation of the EMA, one of two key EU agencies that will move once Britain leaves the union.

“The minister has asked his officials to prepare for a bid to bring the EMA to Dublin. We will be making the case that Dublin offers significant advantages as a location, not least the advantage of the English language, a strong pharmaceutical and R&D sector presence,” said a spokeswoman for Harris.

Related: Brexit could lead to longer waiting times for new medicines, warn experts

Spain has already staked its claim to either the EMA or the European Banking Authority as part of a land grab in the aftermath of June’s EU referendum. Sweden, Denmark, Italy and Germany have also expressed interest in hosting the EMA.

Harris’s spokeswoman said officials in Dublin had “already begun laying the groundwork” and in September will seek a formal inter-departmental working group to flesh out Ireland’s bid.

The EMA, with a staff of 890, is the largest EU body in Britain and has overseen pan-European drug approvals since 1995 from its headquarters tucked away among global banks in London’s Canary Wharf.

Spain, which joined the EU in 1986, will argue that it is time it was considered for one of the more important EU institutions, and the EMA and European Banking Authority are two of the largest.

The EMA works with individual regulatory authorities from all 31 European Economic Area member countries.

Ireland calls for EU drug agency to be moved from London to Dublin

Fifty-three cases of Zika virus confirmed in UK, says health agency

Fifty-three people have been confirmed with Zika virus in the UK, Public Health England has said.

In the most recent cases, a hospital trust said three people had been treated for the virus in Yorkshire.

The Calderdale and Huddersfield NHS Trust said the three had returned from overseas have tested positive for the Zika virus. The condition of the patients is unknown, but the infection itself is mild – some people do not even know they have it – and does not require hospital treatment.

Two cases have been confirmed in Ireland.

An infection control report submitted to the Calderdale and Huddersfield hospitals’ trust board on Thursday said: “Three patients have tested positive for Zika virus following return from foreign travel.”

Dr Gavin Boyd, infection control lead at the trust, said: “There is no specific treatment for Zika and it usually wears off naturally after two to seven days.

“There is extremely low risk of contracting Zika virus in the UK as the mosquito that transmits the infection is not present in the UK, however it can be spread by sexual transmission.”

Zika virus is widespread across Latin America and particularly in Brazil, which is about to host the Olympics. However, the mosquito-breeding season is now over and the danger of transmission of the virus is low.

On Friday, four patients in Florida became the first of 1,650 to be infected by the virus in the United States whose illness is not linked to foreign travel. Florida’s governor said the state had concluded that the infections probably came from mosquitoes in the Miami area.

The virus has caused Guillain-Barre syndrome in a small number of people in Latin America. The syndrome can be triggered by viral attacks on the immune system and results in muscle weakness and sometimes patients are unable to stand without support. Most get better over time, however.

But the biggest concern is the link between zika infection in pregnant women and brain damage in their babies, which is now known to take forms other than just microcephaly (an under-developed head). Fourteen countries have reported microcephaly cases. The first baby born in Europe with microcephaly was reported in Spain this week. The mother had contracted both dengue fever and Zika virus while travelling in Latin America.

Zika virus is predominantly transmitted by the Aedes Egypti mosquito which cannot live in the cooler climate of the UK. There is a very small risk, however, of sexual infection.

The World Health Organisation and PHE are warning those intending to take part in the Olympics or go to Rio to protect themselves against bites while there and take precautions when they return. Some competitors, including golfer Rory McIlroy, have pulled out, even though the WHO says the risk of contracting Zika at the Olympics is very low.

PHE says men and women should use condoms for eight weeks after returning from an area where there is Zika virus and for six months if they experience any symptoms themselves.

Prof Paul Cosford, medical director of PHE, said in a statement: “We expect to see small numbers of Zika virus infections in travellers returning to the UK, but the risk to the wider population is very low as the mosquito that spreads the Zika virus is not found in the UK. As of 27 July 2016, over 50 cases have been diagnosed in UK travellers since January 2016. Public Health England is monitoring the international situation closely and the risk to the UK remains unchanged.

“If you have recently returned from an area where Zika virus transmissions are currently reported and have a fever or flu-like illness, seek medical attention without delay to exclude malaria and mention your recent travel.”

Fifty-three cases of Zika virus confirmed in UK, says health agency

Public well being agency backs e-cigarettes as safer than smoking

Vaping is safer than smoking and could lead to demise of the standard cigarette, Public Wellness England (PHE) has said in the very first official recognition that e-cigarettes are much less damaging to overall health than smoking tobacco.

The well being physique concluded that, on “the best estimate so far”, e-cigarettes are about 95% significantly less harmful than tobacco cigarettes and could one day be dispensed as a licensed medicine in an different to anti-smoking merchandise this kind of as patches.

Even though stressing that e-cigarettes are not free from threat, PHE now believes that e-cigarettes “have the potential to make a significant contribution to the endgame for tobacco”.

The message was backed by the government’s chief healthcare officer, Dame Sally Davies, who however cautioned that “there continues to be a lack of evidence on the lengthy-phrase use of e-cigarettes”. She mentioned they ought to only be used as a signifies to assist smokers quit.

“I want to see these products coming to the market place as licensed medicines. This would give assurance on the security, quality and efficacy to consumers who want to use these products as quitting aids, specially in relation to the flavourings employed, which is exactly where we know least about any inhalation risks.”

The 111-web page evaluation raises considerations about the length and expense of the the government’s licensing process, which is a essential portion of the revised technique to minimize tobacco use.

No e-cigarettes have however been licensed, unlike other nicotine-substitute therapies such as gums, lozenges and patches. Pilot schemes in Leicester and the City of London allow stop-smoking experts to provide totally free e-cigarette starter kits, but smokers elsewhere can’t be presented e-cigarettes on prescription.

The Medicines and Healthcare Products Regulatory Company began its perform in this location more than two years ago, and makers have complained that it expenses them hundreds of thousands to go by way of the process.

Jane Ellison, the public wellness minister in England, reminded smokers that the best point they could do to avoid falling victim to the country’s variety one killer was to quit entirely.

“Although we recognise the e-cigarettes may possibly help adults to quit, we even now want to safeguard children from the dangers of nicotine, which is why we have made it unlawful for under-18s to buy them,” she said.

The evaluation found that almost all of the 2.six million grownups in the Uk now thought to be employing e-cigarettes are existing or former standard smokers, most using them to help them quit tobacco or to avert them going back to smoking.

There was no suggestion that the goods were a gateway into tobacco smoking, with less than 1% of adults or younger men and women who had never smoked becoming regular cigarette customers.

The PHE decision comes right after cautiously choreographed moves by anti-tobacco campaigners and public wellness experts to aid move the NHS towards providing better smoking cessation help and to be less damaging about e-cigarettes.

Providers are getting urged to adhere to people in the north-east of England in providing behavioural support to individuals wanting to quit tobacco and utilizing e-cigarettes to try out to do so.

Smoking kills about one hundred,000 men and women a 12 months in the United kingdom, most of these in England in which there are thought to be eight million tobacco users. But official figures recommend smoking is now at its lowest prevalence because information started out in the 1940s.

Costs are highest in several of the most deprived places of England, and acquiring smokers off tobacco is increasingly noticed as a single of the ideal ways of minimizing overall health inequalities.

Worryingly for numerous of these behind the policy modify, rising numbers of individuals – up to 22%, compared with eight% two many years ago – believe e-cigarettes are equally or a lot more dangerous than tobacco. This is top some smokers to avoid switching, studies have advised.

Tobacco reduction campaigners say the public requirements to be educated to recognise that although e-cigarettes, like tobacco cigarettes, have addictive nicotine, they do not have much more hazardous chemicals such as tar and arsenic.

PHE is also advocating careful monitoring of the e-cigarette industry, notably of organizations closely concerned with or portion of huge tobacco companies. It says the government have to meet its obligations “to defend public overall health policy from commercial and other vested interests of the tobacco industry”.

Kevin Fenton, director of overall health and wellbeing at PHE, mentioned: “E-cigarettes are not fully risk-totally free but when in contrast to smoking, evidence shows they carry just a fraction of the harm.

Associated: Vaping is ever more common, but is it a smoking remedy or a new hazard?

“The issue is folks more and more consider they are at least as damaging and this might be keeping millions of smokers from quitting. Nearby quit-smoking companies ought to look to assistance e-cigarette end users in their journey to quitting completely.”

Peter Hajek, of Queen Mary University, London, one of the independent authors of the review, stated: “My reading of the proof is that smokers who switch to vaping remove virtually all the risks smoking poses to their health. Smokers vary in their demands and I would advise them not to give up on e-cigarettes if they do not like the very first a single they try out. It may get some experimentation with various merchandise and e-liquids to discover the right a single.”

Ecita, a trade association of e-cigarette makers, explained: “There could be large long-phrase advantages to taxpayers and the NHS as properly as to former smokers and their households. The proposed ban in public areas across Wales is really worrying, as are a lot of of the bans in pubs and eating places across the United kingdom. This appears to be driving a increasing number of people to feel the harm is the very same, deterring smokers from moving to e-cigarettes, and damaging public overall health.”

The smokers group Forest questioned whether prescribing e-cigarettes on the NHS would be a justifiable use of taxpayers’ money. Simon Clark, its director, said promoting them “as a state-accepted smoking cessation assist ignores the fact that many individuals take pleasure in vaping in its personal correct and use e-cigs as a recreational not a medicinal item.”

He said e-cigarettes had been successful because the consumer, not the state, was in charge. “If they want much more smokers to switch to e-cigarettes, public wellness campaigners should embrace consumer selection and oppose needless restrictions on the sale, marketing and advertising and promotion of this potentially game-changing merchandise.”

The switch in policy towards e-cigarettes coincided with publication in the Journal of the American Health care Association of study from Los Angeles suggesting that high college students who had use e-cigarettes are more probably to go on to try out tobacco.

But Hajek stated this did not demonstrate that vaping prospects to smoking. “It just exhibits that men and women who are attracted to e-cigarettes are the exact same people who are attracted to smoking. Men and women who drink white wine are more very likely to try out red wine than people who do not drink alcohol.”

Public well being agency backs e-cigarettes as safer than smoking