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For many sports-minded individuals, the fall season turns all weekend thoughts toward football.

Friday high school games. Saturday college games. Sunday pro games.

It’s also a season that brings concussion injuries sharply into focus, given football’s reputation for high-impact injuries.

But Matthew Axtman, DO, with orthopedic sports medicine at Spectrum Health, wants to set the record straight: Football isn’t the only contact sport with concussion risk.

Soccer, lacrosse, hockey, cheerleading and other sports carry a high risk, too.

In fact, the potential for concussion is ever-present, whether in sports or in daily living. Simply avoiding contact sports doesn’t guarantee injury prevention.

“You can’t live your life being worried about getting injured in sports, specifically a concussion,” Dr. Axtman said. “You could stay away from sports your whole life, but you could fall on the sidewalk, fall down the stairs or stand up and hit your head on a cabinet and get a concussion.”

Act quickly, but cautiously

A concussion is a brain injury. The brain sits inside the skull. And normally, the communication pathways are very regulated.

When a person gets hit in the head, however, it causes mass confusion with how the brain functions. The pathways become chaotic, Dr. Axtman said.

It’s critical to know how to identify a concussion early, recognizing the signs and symptoms after an injury.

Some symptoms include headaches, blurry vision, feeling sick to your stomach and dizziness, Dr. Axtman said. When those symptoms arise, the individual should meet with an athletic trainer or physician to undergo further evaluation.

If the injury appears to be a concussion, trainers and physicians need to act quickly to minimize brain damage.

Once a health team member examines an injured person for obvious injuries—cuts, bruises, etc.—they’ll ask simple questions to test the individual’s thought process and memory.

Questions may include: What day is it? What activity is being conducted? What’s the score of the game?

“If there is a concussion or any suspicion that the player sustained a concussion, they cannot go back into the game,” Dr. Axtman said. “If there is any doubt, you must err on the side of caution. When in doubt, sit them out.”

As much as an athlete may want to get back in the game, that would be dangerous, Dr. Axtman said.

“You only have one brain and you don’t want to do anything that will expose it to continued hits that could end up causing long-term neurological damage and problems,” he said. “This can include chronic headaches and memory loss issues.”

Careful participation

While people shouldn’t take unwarranted chances, Dr. Axtman noted that a common myth—that you’re done with sports after three concussions—is not true.

“It all depends upon the individual and on a case-by-case basis that is made by a physician knowledgeable in concussion treatment,” he said.

There is really no way to prevent all concussions in sports, Dr. Axtman said.

In football, for example, modern helmets and rule changes concerning tackling techniques may help reduce concussions—but there are no guarantees.

“There are better helmets than others that can help, but it’s not going to be the be-all-and-end-all (solution),” he said. “There will never be 100 percent resolution of concussions in sports.”

So, should people participate in sports?

“Absolutely,” Dr. Axtman said. “Anyone that can participate in a sport or exercise activity should participate. With exercise comes significant health benefits that outweigh the risks of injury and, specifically, concussion.”

He stressed that anyone concerned about sports participation should have a discussion with a physician.

Navigating the milk aisle has never been more challenging. The options are endless, and the health advice is sometimes controversial.

So how do you choose the best option? The most important thing you can do is develop a rich understanding of the types of milks and milk ingredients and how they affect your body.

Facts to digest

Many folks may notice some unpleasantries when consuming cow’s milk or products made with cow’s milk. This can include bloating, gas or diarrhea. These symptoms are often a result of the body’s inability to digest the natural lactose sugar in milk.

We need specific enzymes to digest the nutrients we eat. For lactose, we need the lactase enzyme.

The body tends to produce less of this enzyme as we age, however, because humans weren’t meant to continue drinking milk after weaning as youngsters.

This is known as lactose intolerance.

One option to alleviate this: Consume lactose-free cow’s milk—it’s treated with the lactase enzyme—or switch to a plant-based alternative that’s naturally lactose-free.

Items such as yogurt and cheeses are also low in lactose, as the activity of the added bacteria and fermentation eat up much of the lactose sugar in the milk.

Keep in mind that even lactose-free dairy options can still bother sensitive stomachs. In this case, plant-based milks are your best bet.

Calcium and bone health

The first thing that comes to mind for most of us when we think about drinking cow’s milk is bone health.

Cow’s milk is a great source of calcium and, since our bones are made of about 65% calcium, one would assume cow’s milk is essential for bone health.

So, is it? The answer is yes and no.

We certainly need calcium for bone health. But some research studies have found no association between milk intake and bone health.

In fact, one observational study found that people who drink more milk may experience more bone fractures than those who drink less. Some studies have shown a possible higher risk for bone fracture in men.

If you’re concerned about bone health, you can certainly do without milk—or less milk—and still have healthy bones.

Many plants are great sources of calcium. They can supply what you body needs to support bone health, as well as providing other essential bone-building nutrients, such as vitamin K.

You can get what you need from soybeans, white beans, mustard greens, turnip greens, collard greens, dandelion greens and molasses.

Many plant-based alternative milks are also fortified with calcium for an additional boost.

What’s best for you?

There have been some possible associations between milk consumption and cancer risk, especially prostate cancer.

Researchers have found that men who consume higher amounts of cow’s milk have a greater risk of prostate cancer. This is thought to be related to the natural hormones found in milk.

However, there also seems to be some protective effect from milk as it relates to colon cancer.

To help you determine if milk is appropriate for your diet, talk to your primary care provider.

Nutritional profile

Cow’s milk has advantages in the protein and potassium category. The downside of many plant-based milks is the low protein profile.

Nutritionally, the substitution is not always 1:1. Soy milk tends to be the most comparable. It’s recommended as the best substitute if you’re using milk for a protein boost.

Most Americans are not deficient in protein, however, and they can easily meet their protein needs with other high-protein foods.

For those trying to trim calories for weight loss, some plant-based alternatives can offer benefits in this area while still providing that milky flavor.

Whole fat vs. low fat

If we look just at cow’s milk, there are a variety of options—fat-free, 2%, whole milk and more. Whole milk, or vitamin D milk, is left in its original form, with about 3.25% fat content.

Milk labeled as 1% or 2% has had the fat removed to its respective percentage, while skim milk has all fat removed.

Whole milk provides a more flavorful option that may help people feel fuller and more satisfied. You’ll also find lower rates of diabetes and fewer weight issues in children drinking whole milk, as the milk fat may protect from blood sugar spikes.

In adults, there’s no association of weight gain with full-fat milk. There are mixed results as it relates to coronary heart disease or stroke, with some benefit in swapping milk fat with fish or nuts.

Keeping things as close as possible to what nature gave us is usually a safe bet.

While it does provide more calories if you choose to drink cow’s milk, whole milk may be a good option, especially for youngsters.

This may be left to your own personal preference—and as always, moderation is key.

Additives

In the creation of plant-based milks, the milk base—almonds, oats, soy—is typically soaked in water and then blended. The solids are then strained out, so what you have left is your plant milk.

This is great, but to keep it from spoiling—and to ensure the best flavor and texture—many plant-based milks have several additives we’d be better off without.

Here’s what to look for:

• Added sugars: Unless a product is labeled unsweetened, watch out for added sugars in most milks.
• Gums: These are used to thicken products for creamier texture. They are soluble fibers extracted from plants. Some can benefit gut health. Other emulsifiers, such as carrageenan, may be detrimental to gut health.
• Ascorbic acid: This is vitamin C, used to preserve food.
• Oils: Oils are added for a better mouthfeel, but these are usually highly processed oils. It’s best to limit intake.
• Phosphates: People with kidney disease need to watch phosphate intake to avoid high phosphate levels in their blood. For others, high intake of phosphates may be associated with higher risk of heart disease.
• Natural flavors: The term natural is used very loosely. This is an umbrella term that covers a lot of options. Manufacturers often use synthetic chemicals to create the flavoring, which ends up in your food. People with food allergies should keep an eye on these ingredients.
• Vitamins and minerals: There are typically no problems here.

Your best bet? Make your own milk, or look for brands with minimal additives.

Flavor and versatility

What about the taste of your milk? This comes down to personal preference.

Try different kinds of milks until you find your favorite.

In cooking, plant-based milks can substitute in most recipes without noticing a difference. Just buy plain milk instead of vanilla-flavored for savory dishes.

My personal choice: Given the mixed evidence with cow’s milk, I choose to use unsweetened almond milk. This is based on my flavor preference, but it also has less sugar and fewer additives. It’s also a lower-cost option.

I also enjoy some fermented dairy, such as aged cheeses and yogurt—and always in moderation.

Jeffrey Conzelmann, 56, has been a pharmacist at Spectrum Health for 31 years.

Not until he became a patient himself, however, did he truly understand what it meant to be on the receiving side of health care.

“Being diagnosed with T-cell leukemia has been an eye-opening experience,” Conzelmann, of Spring Lake, Michigan, said. “I gained a new appreciation for what patients go through. I thought of myself as compassionate, but this experience has given me a new level of understanding.”

Conzelmann’s story begins on the run.

Training alongside his brother, Tom, the two were preparing for a 50-kilometer trail run in spring 2020.

“I had been a runner for a long time,” he said. “But I noticed that it was getting harder to keep up my usual pace. Tom and I had this conversation about aging—maybe I was just getting older and slowing down.”

Just to be sure, Conzelmann scheduled a physical with his doctor.

He appeared healthy. His doctor encouraged him to add weight training to his exercise regimen to improve his core strength.

“He asked me to come in for bloodwork, though,” Conzelmann said.

He scheduled those tests in October 2020. When the results came in from the bloodwork, Conzelmann’s doctor gave him a call.

The white blood cells in his sample were elevated. His doctor asked him to come in for a second test.

“This time we did a blood test differential,” Conzelmann said.

A blood differential test measures the amount of each type of white blood cell in a person’s body. In that test, Conzelmann’s lymphocytes—two main types of white blood cells that include B- and T-cells—showed an elevation in T-cells.

T-cells help the body detect and fight off infection or illness. When elevated, it can indicate that the body is locked in a battle.

“I was on vacation in Gatlinburg with my wife, Janet, and my parents when I got the call from my doctor,” Conzelmann said. “‘I think you have something brewing,’ he said. And he wanted to do more tests.”

The diagnosis came in December 2020. He had T-cell prolymphocytic leukemia.

His doctor sent him to Spectrum Health Lemmon-Holton Cancer Pavilion.

Sobering diagnosis

Sami Brake, MD, program director of the adult bone marrow transplant program at Spectrum Health, met with Conzelmann for more tests. He gathered a team of specialists.

“T-cell prolymphocytic leukemia, or T-PLL, is an extremely rare and typically aggressive malignancy,” Dr. Brake said. “Because of that fact, it is important that patients are evaluated at a highly experienced cancer center.

“This is particularly important because the treatment of T-PLL is very specific and not used for other T-cell malignancies, and an incorrect diagnosis may result in a poor outcome.”

T-cell leukemia can be hard to diagnose, Dr. Brake said.

“Many of these diagnoses get missed, because it is hard to detect. But Jeff was correctly diagnosed,” he said.

Despite the diagnosis, Conzelmann said he felt fine.

“I didn’t feel sick,” he said. “But we did more tests, including a CT scan and a pulmonary evaluation. I had an infiltration in the right lower lobe of my lung.”

In December 2020, he underwent bone marrow biopsy.

“Right away, I was doing all kinds of research in medical journals,” Conzelmann said. “As a pharmacist, I had the advantage of having access to all that.”

“We found nodules on Jeff’s lungs,” Dr. Brake said. “Biopsies confirmed that his lungs were involved with T-cell leukemia, indicating a very aggressive disease.”

“I was still feeling positive,” Conzelmann said. “I didn’t have any major involvement in liver or spleen, none of that. I was calm. I knew we could control this.”

Conzelmann began immunotherapy using Campath, a drug specifically used for this type of cancer. The thrice-weekly infusions worked within a matter of a few weeks—the nodules in his lungs cleared.

He continued the infusions for 12 weeks.

Even as he progressed, Conzelmann and his care team began to discuss a stem cell bone marrow transplant to eliminate the leukemia.

It was his best option.

“My brother Tom was a 100% match,” Conzelmann said. “You generally should be under age 40 for a marrow donation, and Tom is four years older than me. But he’s healthy, and a match with a brother gives me my best chance.”

Perfect match

While doctors extracted Tom’s bone marrow, Conzelmann underwent more chemotherapy treatments with the goal of adjusting his immune system to the point it would not reject the donor marrow.

Doctors admitted Conzelmann to Spectrum Health Butterworth Hospital on June 2, 2021, and began ablative chemotherapy treatments.

On June 8, he received the bone marrow transplant.

“It was comfortable, much like a blood transfusion,” Conzelmann said. “It took about an hour. I was discharged on June 21 with daily home fluid and electrolyte infusions.”

He encountered some additional challenges, and he required a week-long hospitalization, but with some adjustments to his treatment he was back on the road to healing.

“It really has been quite a journey, but I have had lots of support along the way,” Conzelmann said. “Janet was my rock and coordinated most of my care initially.

“Family and friends were so supportive and made it less taxing. I also can’t say enough about my care teams at all levels. From the staff at the bone marrow transplant clinic, to hospital staff and all my providers, they all created a positive environment for me to heal.”

Conzelmann’s one-year anniversary of good health came in June 2022.

He and his wife planned a cross-country trip in an RV to celebrate.

“I went on disability when this happened, but I plan to return to my work at Spectrum Health eventually,” he said. “I always tell people how fortunate we are in this community with the excellent health care and the dedicated providers we have.”

Today, the two Conzelmann brothers are running again, side by side.

“You know what they say,” Conzelmann said. “It’s not a sprint, but a marathon. We’re running it together. Tom likes to remind me now: I have his good genes.”

Since January 2022, we have detected an increase in the number of acute (sudden onset) hepatitis cases in the UK in children aged 10 and under.

Hepatitis is a condition that affects the liver and can be caused by infection with a virus. The viruses that normally cause hepatitis (hepatitis viruses A to E) have not been found in the children affected recently. Other possible causes of acute hepatitis, including some medications and toxins are also being investigated, however so far a link has not been found. The UK Health Security Agency is working with the NHS, a wide range of experts and with public health colleagues across the UK to find the cause as soon as possible.

Hepatitis symptoms include:

• yellowing of the white part of the eyes or skin (jaundice)
• dark urine
• pale, grey-coloured faeces (poo)
• itchy skin
• muscle and joint pain
• a high temperature
• feeling and being sick
• feeling unusually tired all the time
• loss of appetite
• tummy pain

Watch our video below for more information on symptoms.

What is causing the increase in cases?

The viruses that normally cause hepatitis (hepatitis viruses A- E) have not been found in the children affected by the recent increase in acute hepatitis, therefore public health teams are looking at all other possible causes. One area being explored is whether the hepatitis cases are linked to an increase in infections caused by adenovirus, a common cause of childhood illness. Over the last two years children have been mixing less because of the COVID-19 pandemic, and because of this the number of common infections seen in children was reduced.

Now that children are mixing more we are seeing an increase in some infections, including adenovirus. We are also investigating other possible causes such as another infection (including COVID-19) or something in the environment.

Some of the children with acute hepatitis have recently had a COVID-19 infection, but there has been a high number of COVID-19 infections in this age group so this is not unexpected. There is no link between these hepatitis cases and the COVID-19 vaccine. None of the current cases aged under 10 years old in the UK is known to have been vaccinated.

What do I need to do if my child is unwell with symptoms of a viral illness?

Viral infections, including adenovirus, are common in children and cause a range of mild illnesses including colds, vomiting and diarrhoea. Adenovirus or other infections don’t normally cause hepatitis, but it can be a very rare complication of some types of viral infection.

If your child develops the common mild symptoms that could be due to a viral infection, such as symptoms of a cold, vomiting or diarrhoea, the chance of them developing hepatitis is extremely low. Most children will soon recover following rest and plenty of fluids.

You do not need to contact the NHS unless your child is very unwell (for example, has breathing difficulties or is not eating or drinking) or if they develop jaundice (yellowing of the eyes or skin). If your child is getting rapidly worse or you are worried, trust your instincts and contact your GP or call the NHS on 111. Children who are unwell should be kept at home and not be sent to school or nursery.

Children who have experienced symptoms of a gastrointestinal infection including vomiting and diarrhoea should not return to school or nursery until 48 hours after the symptoms have stopped.

How do I prevent the spread of common childhood infections?

Childhood infections are commonly passed from person to person through close contact, coughing and sneezing or by touching contaminated surfaces. The most effective way to reduce the spread of infections is to practice good hand and respiratory hygiene.

Cover your nose and mouth when you cough and sneeze, wash your hands regularly. Supervise thorough handwashing in younger children and make sure they cover their nose and mouth when they cough or sneeze.

Who is at risk of hepatitis?

Almost all of the cases have been seen in children under 10, with most cases aged between 3 and 5 years. Most of the children affected were previously healthy, and only a very small number of cases are linked to another case of hepatitis. This means that even if there has been a case in your family or friends, or if a case has occurred at your child’s nursery or school, your child is still at low risk of developing hepatitis.

Could the cases be linked to COVID-19 infection or vaccine?

Only a few of the cases have had recent COVID-19 infection, in line with what we would expect given the current trends in the UK. However, we are investigating whether there could be a link to previous COVID-19 infection.

There is no link between these hepatitis cases and the COVID-19 vaccine. The COVID-19 vaccines do not contain viruses that can grow in the human body. There were no COVID-19 vaccinations recorded in cases under 5, the age group which makes up over 75% of hepatitis cases. There are fewer than five older case-patients recorded as having had a COVID-19 vaccination prior to hepatitis onset.

More information on can be found on the NHS website.

Each year, on 12 May, I take great pride in celebrating and showing my appreciation for nursing colleagues working across the health and care system on International Nurses Day.  This date marks the birth date of Florence Nightingale in 1820.

Many of us immediately think of Nightingale holding a lamp.  In your mind’s eye, if you know a little more about her history, you may place her in Crimea, helping the injured British soldiers. Few people – or fewer than she deserves – know to credit her for the immensely important public health leadership role which she played.  She recognised that too many people were dying from poor sanitation and the lack of effective infection prevention control interventions.

It was not until I started working in public health that I fully appreciated how Nightingale had used statistics to achieve major health reform. Having collected hospital mortality data for 2 years, while out in Crimea, Nightingale used a then pioneering way to present her findings. Using her rose diagrams, she was able to illustrate that most people were dying from poor sanitation and infection, which was considered largely preventable.

I also think about the bravery and leadership of Mary Jane Seacole, a nurse whose work and impact were lost in time because of her colour.  Seacole, born 23 November 1805, showed immense courage in setting up the British Hotel and in visiting the front line to provide care to injured soldiers during the Crimean war.

Her story has finally come to light and she rightly deserves to be remembered for her bravery, tenacity and inclusivity.  This is something which has never been more important to our nursing profession, as we recognise the huge inequalities which exist across our communities.

Celebrating nursing heritage

So, in 2022, we should celebrate both Seacole and Nightingale, who demonstrated that our nursing profession could be a voice to lead. They were courageous leaders, statisticians and public health pioneers who challenged the world to do things differently to save and improve lives.

Our access to data has certainly improved since the 1800s and so has our understanding of the major causes of premature morbidity and mortality. We have also advanced our knowledge of the evidenced based interventions which can be used to reduce preventable death and ill health across the life course, from preconception to older age. However, there is still a tendency for our profession to focus on the management and treatment of disease and ill health, rather than us placing an equal focus on preventing, protecting and promoting the public’s health.

As the world starts to recover from the COVID-19 pandemic, it will be important for the nursing profession to consider the lessons learnt and what needs to change to allow us to truly build back better and fairer.

The pandemic has provided us all with an opportunity to see with greater clarity that all nurses play an important public health role, regardless of their speciality or setting. It is now essential that we build on this knowledge and consider the ways in which we can take a greater role in preventing illness, protecting health and promoting wellbeing. The nursing profession will also play an important role in addressing the widening health inequalities which has been made ever clearer by the COVID-19 pandemic.

This International Nurses Day I will celebrate nursing colleagues from the past – a heritage we can be proud of.  I will also take pleasure in thanking all the colleagues in the present and future who are building on our strong track record as a profession and who are, collectively, a voice to lead.

Nursing is an amazing occupation and I am proud to be part of the most trusted profession.  We nurses will play an important role in driving a decade of transformation and change in the 2020s, which will result in more people living longer and healthier lives, regardless of where you live and how your life started. Centre to this achievement is for all nurses to see themselves as public health professionals who, like Mary and Florence, can act with bravery and candour to improve health outcomes for everyone.

Happy International Nurses Day!

 

UKHSA is urgently investigating a number of monkeypox cases recently identified in the UK. You can find our updates on this GOV.UK page.

Monkeypox is a viral infection usually associated with travel to West Africa. This is the first time that there has been suspected community transmission in the UK without known links to countries where it is endemic, so the current situation is unusual and we are acting with urgency to learn more.

Monkeypox is usually a mild illness that does not spread easily between people and gets better by itself, with most people recovering within a few weeks. The risk to the UK population remains low, but this is being kept under review as we continue to investigate and learn more about transmission patterns and risks.

This blog contains information about monkeypox, its symptoms, how it spreads, how we treat it and what to do if you’re concerned.

What are the symptoms and how does it spread?

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, and can look like chickenpox or syphilis, before finally forming a scab, which later falls off.

The virus enters the body through broken skin (even if not visible), the respiratory tract, or the mucous membranes (eyes, nose, or mouth) and doesn’t usually spread easily between people.

Spread can occur when a person comes into close contact with someone or something contaminated with the virus.

Anyone with concerns that they could be infected is advised to contact NHS 111 in the first instance, or a sexual health clinic. People should notify clinics ahead of their visit. Calls or discussions at clinics will be treated sensitively and confidentially.  Confirmed cases will be contacted by UKHSA local Health Protection Teams to help identify and trace contacts so that the appropriate public health action can be taken to prevent the spread of infection.

What happens if I’ve been in close contact with someone with monkeypox?

We are contacting any identified close contacts of the cases to provide health information and advice.

How is it treated?

Most of those with monkeypox will recover within a few weeks without treatment.

Treatment for monkeypox is sometimes offered to help people avoid more severe consequences of the virus.

Is there a vaccine?

There isn’t a specific vaccine for monkeypox, but the vaccinia (smallpox) vaccine does offer some protection. Giving the vaccine to contacts after they have been exposed to the virus can prevent infection developing or reduce the severity of illness depending on how quickly this can be given.

Some healthcare workers caring for individuals and those with higher level of exposures may be offered this smallpox vaccine following an assessment.

Is monkeypox an STI and why are gay and bisexual men being told to be particularly alert?

Recent cases in UK and Europe have been found predominantly in gay and bisexual men, so we are particularly urging these communities to be alert to the symptoms and seek help if they are concerned.

Monkeypox has not previously been described as a sexually transmitted infection, though it can be passed on by direct contact during sex. It can also be passed on through other close contact with a person who has monkeypox or contact with clothing or linens used by a person who has monkeypox.

UKHSA is recommending anyone who has changed sex partners regularly, or who has had close contact with individuals that they don’t know, to come forward if they develop a rash.

What is UKHSA doing to find the cause?

UKHSA has quickly identified cases and we are carrying out extensive contact tracing of anyone who has come into contact with confirmed cases to stop the spread. We are continuing to rapidly investigate the source of these infections and are liaising with public health bodies in all four UK nations to raise awareness among healthcare professionals of what to look out for.

Anyone who thinks they might have monkeypox symptoms should call NHS 111 or phone their local sexual health centre as appropriate.

You can read guidance on epidemiology, symptoms, diagnosis and management of monkeypox virus infections on gov.uk here.

Breathing in polluted air affects our health, reduces our life expectancy, and costs our society billions of pounds each year. It is estimated that two million healthy life years are lost in Europe due to the impacts of poor air quality, making the need to improve air we breathe in and reduce the pollution we produce a clear priority.

Despite improvements in air quality over previous decades, air pollution remains a significant environmental risk factor, which is why the UK Health Security Agency (UKHSA) through its Cleaner Air Programme is aiming to reduce people’s exposure, therefore tackling existing health inequalities, and improving outcomes for all.

Increasing the evidence base

UKHSA’s programme is organised around three core outcomes: Increasing the evidence base, influencing, and supporting stakeholders and improving awareness and understanding.

We build this evidence base by publishing journals, reports and policy briefs on a range of topics and review the effectiveness of interventions. Key to the research we carry out are our Health Protection Research Units (HPRUs), which are existing partnerships between academia and UKHSA, funded by the National Institute of Health Research (NIHR).

Between 2014 and 2020 one such HPRU, ‘Health impacts of Environmental Hazards’ focussed its research on air quality, spanning from in vitro laboratory studies through to epidemiology studies. From 2020, four new HPRUs – which include partnerships with the University of Leicester, Imperial College London and the London School of Hygiene and Tropical Medicine – will continue to research and answer the key questions on air pollution, namely:

• How does air pollution affect our health?
• How does exposure to air pollution vary in different environments?
• How can we improve our understanding of indoor air quality?
• What can we do to reduce exposure?

Influencing and supporting stakeholders

It is vitally important that in order to support our stakeholders, UKHSA Air Quality representatives offer their expertise on air pollution in order to improve understanding of the issue across the country.

In preparation for Clean Air day, Amanda Craswell from Environmental Hazards and Emergencies (EHE) department joined the Leeds City Council’s public health and environmental health team to encourage actions for reducing emissions improve better health, whilst Charlotte Landeg-Cox will be leading discussions on public consultation and engagement at the Transition Clean Air network event ‘Beyond the Clean Air Zone’ in Birmingham.

To mark National Clean Air Day, the London Air Quality and Health Programme Office, hosted by UKHSA, has presented a paper to the London Clinical Executive Group asking that they:

• Commit to amplifying messaging on the need to improve air quality and tackle health inequalities across Integrated Care Systems and Trusts; and
• note the detrimental impact of air quality on health and factor air quality into discussions about local healthcare delivery and drive accelerated action.

Improving awareness and understanding

Continuing on from Public Health England, the UKHSA continues to conduct environmental public health tracking and surveillance of air pollution.

A new pilot surveillance system aims to consider both ambient and indoor aspects of exposure to air pollution and is a tool that will be usable to stakeholders for evaluation of interventions that aim to reduce this exposure at population level. In time, the system should have the potential to incorporate linkages to health behaviours and outcomes.

What can you do?

Air pollution is a problem that affects all of us, but it is almost always the most socioeconomically disadvantaged that suffer the most from its effects, as well as the most vulnerable in our society such as children and people with underlying conditions.

We can all do our bit to improve air quality. By walking or cycling to work and school we can improve our health through exercise and subsequently help to limit air pollution – where you can, walk those short distance trips and leave your car at home.

Talking is also vital – ask local and national decision makers what would make it easier for you to walk more in your local community, and speak to friends, family and colleagues about the harms of air pollution.

According to the Global Action Plan, 82% of people think that air pollution should be a priority for the UK, an increase of 11% over the last three years, while 90% now report doing at least one thing to help reduce outdoor air pollution.

The consensus around the need for clean air is clear, and each individual step combined with the impact of actions taken by local and national government will see the air we breathe in improve immeasurably in the future.

You can read more about what the UKHSA is doing to tackle air pollution in the latest edition of our Chemical hazards and Poisons report, published on 16 June.

The Global Action Plan team have collected everything you need to know about air pollution in one place, published here.

Two years ago, we launched the SARS-CoV2- Immunity and Reinfection Evaluation Study, known as SIREN, the largest of its kind globally. The study set out to find answers to some of the most important questions about COVID-19.

The SIREN study monitors infections in a large group of healthcare workers who provide samples for regular PCR and antibody testing.  Analysis of these samples helps the UK to evaluate the immune response to COVID-19, provides insight into COVID-19 reinfections and has helped us to build an understanding of the level of protection offered by vaccines.

The scale of the SIREN study has been staggering. In two years, it has carried out over a million PCR tests, over 400,000 blood tests and engaged with almost 45,000 participants from 135 NHS sites across the UK.

The number of tests, sites, participants and nations involved in the SIREN study. Data correct as of June 2022.

We have helped answer some of the most pressing questions about COVID-19, enabling decision-makers – both national and locally – to control the spread of the disease. Two years into our research, here are the main things we have learnt:

How effective is previous infection and vaccination against COVID-19?

In our first year we found that previous infection with COVID-19 offered high protection against reinfection for several months, during wild-type and Alpha-variant dominant periods. We also found that COVID-19 vaccination was highly effective in reducing infections (both symptomatic and asymptomatic) in the immediate months after vaccination.

In our second year we investigated the durability of protection following vaccination and among those vaccinated after a previous infection, during the Delta-variant dominant period.

We found evidence of waning protection six months after two vaccine doses in those without previous infection, and this informed advice on deploying booster doses. We also demonstrated the value of vaccination on those with previous infection, with those subsequently vaccinated having protection consistently higher than 90% for a longer period of time compared to those with previous infection who remained unvaccinated.

When the Omicron variant emerged in December 2021, we found protection from either two doses of the vaccine or previous infection to wane, while a booster dose helped to restore some of this waning immunity. This research helped to inform the widening of the booster vaccination campaign.

We have built collaborations with immunologists in multiple academic organisations to understand why some individuals get reinfections and breakthrough infections – this will be critical to understanding future vaccine targets.

How do we keep the study going?

The SIREN study would not be possible without the efforts and dedication of participants from around the UK, and we would like to say a huge thank you to these individuals. These participants have volunteered to undergo fortnightly testing and provide quarterly blood samples all while carrying out their day jobs in the NHS under some of the most challenging conditions the workforce has ever seen.

We would also like to thank the 135 NHS sites who have encouraged their staff to participate in the study, including the all-important laboratory and research teams.

Our approach to maintaining participant interest in the study included newsletters, webinars, video messages and celebration events. We also recruited a Participant Involvement Panel:

The SIREN participant panel is comprised of seven SIREN study participants recruited from a diverse range of professional backgrounds and locations. As a panel we have met regularly to contribute to the aims of the SIREN study, including providing open and honest feedback on its research aims and outputs, helping with engagement activities and ensuring participant concerns are heard. We have valued the opportunity to contribute to a study which has helped inform key decisions being made about the COVID-19 response in the UK.

SIREN Participant Involvement Panel, June 2022

We have also built strong multidisciplinary collaborations with academics from leading UK research institutions, enabling us to combine epidemiological, viral, immunological, genomic and clinical expertise.

What next?

We are really pleased that the SIREN study has been funded to continue participant follow-up in all four nations through to 31 March 2023. This is testament to how well SIREN is valued by those leading the COVID-19 response.

As community testing has reduced, the surveillance role of SIREN in monitoring infection trends and emerging variants has become increasingly important to inform the national COVID-19 response.  SIREN will have an important function throughout the coming Winter while the NHS deals with seasonal pressures, with influenza, seasonal viruses and resulting staff absence.

Going forward we will maintain our commitment to addressing vital research questions. What is the impact of new variants? What effect does reinfection have post vaccination? What is the impact of COVID-19 vaccine booster programmes?

This research would not be possible without the efforts and dedication of so many people, including participants, NHS sites, laboratory teams and more.

A webpage to share more information about the SIREN study can now be found here.

As Summer approaches, we look forward to  travelling, taking holidays, attending events and enjoying more time outdoors. There are some simple things we can all do to stay safe throughout summer and to keep illness at bay as we enjoy the longer days and better weather.

COVID-19

COVID-19 has not gone away, we are all learning to live with it. Thankfully the vaccine continues to be highly effective in preventing severe illness and antiviral treatments are now available for those who need them. However in recent weeks we have seen a small, but steady increase in cases. We can all follow simple steps to help protect ourselves, family and friends.

The best thing we can all do is make sure we are up to date with our vaccinations. These remain our best form of defence against the virus. It’s not too late to catch up if you’ve missed boosters or even first doses.

If you have any symptoms of a respiratory infection and a high temperature or feel unwell, try to stay at home or away from others – especially those who are elderly or vulnerable.

If you are meeting others indoors you should let lots of fresh air in. Open some windows to help with ventilation and in the sunny weather you could also plan to meet outside.

We should all continue to practice good hand hygiene, frequently washing our hands for 20 seconds with hot water and soap. It might also be a good idea to wear a face covering in a crowded space such as public transport.

We should all continue to follow the most up-to date guidance which can be found here.

Heatwaves

The weather can affect our health, particularly in those who are more vulnerable or have long-term health conditions. If hot weather hits this summer, you can help protect yourself and others by:

• Looking out for those who may struggle to keep themselves cool and hydrated – older people, those with underlying health conditions and those who live alone are particularly at risk
• Staying cool indoors – closing curtains on rooms that face the sun can keep the temperature lower in indoor spaces
• Drinking plenty of fluids and avoiding excess alcohol
• Never leave anyone in a closed, parked vehicle, especially infants, young children or animals
• Try to keep out of the sun between 11am to 3pm, when its strongest
• Walking in the shade, applying sunscreen regularly can protect your skin, and it’s helpful to wear a wide brimmed hat while outside on sunny days

Travelling abroad this year?

If you’re planning to travel outside the UK, check health information for your destination before you go. You may need vaccines to protect you from serious diseases found in some parts of the world and may also need medication, for example to protect you against malaria.

Check the advice for your destination on TravelHealthPro and speak to your practice nurse, GP, pharmacist or a travel clinic ideally 4-6 weeks before travel to get appropriate advice for your trip. They can give you information about vaccinations and any extra precautions or medication you might need to take.

Be sure to check the COVID-19 rules and entry requirements for the country you are travelling to.

• Vaccines can prevent a number of different infections including some of the illnesses spread through food and water and some of the diseases spread by insects, such as yellow fever or Japanese encephalitis. However, there are a number of diseases which are not vaccine preventable. Take basic precautions with food and water and insect bite avoidance, carry a basic first aid kit to manage common problems and know when to see medical help

 

• Rabies is found throughout the world and all animals can catch rabies and pass it on. Avoid contact with wild and domestic animals where possible. If you are bitten, scratched or licked on broken skin, immediately wash the area thoroughly with soap and water, and seek medical attention locally. You may be advised to start rabies post-exposure treatment, but always contact your GP on return to the UK to complete any treatment required. Further information about rabies is available in this leaflet for travellers. Check whether you’re visiting a place where rabies is present in animals and consider having a course of pre-exposure rabies vaccines if you are undertaking activities that might put you at greater risk of contact with animals or if you are visiting remote areas where medical care may not be readily available.

Read more about travel illnesses, vaccinations and travel health advice.

Immunisations

Checking you’re up to date on your routine vaccinations including MMR and MenACWY is important and helps to keep illnesses from spreading. If you are not sure which vaccines you’ve had, contact your GP surgery and if you are a parent or carer, you can look in your child’s red book (their health record). For some vaccines it’s never too late to catch up. The list of routine NHS vaccines can be seen on the NHS website here.

It’s also not too late to have the COVID vaccine. It doesn’t matter which dose you are due. Visit the NHS website to find your nearest vaccination centre or phone 119

For more advice on staying safe during the summer, visit the NHS website.

Monkeypox

The outbreak of Monkeypox, largely affecting men who are gay or bisexual, is growing in the UK and elsewhere in Europe. The infection can spread through close physical contact like skin-to-skin contact, kissing, sex or sharing things like bedding and towels.

Some examples of the symptoms of Monkeypox includes recent unusual spots, ulcers or blisters on your body, fever, headaches, muscle aches, chills and exhaustion as well as swollen glands.

Anyone can get Monkeypox, particularly if you have had close contact, including sexual contact, with an individual with symptoms. During a time when more people are mixing and spending time together, it’s important to be aware of the symptoms, particularly if you have recently had a new sexual partner.

Contact a sexual health clinic if you have a rash with blisters and you’ve been either:

• in close contact, including sexual contact, with someone who has or might have Monkeypox (even if they’ve not been tested yet) in the past 3 weeks
• to West or Central Africa in the past 3 weeks

Avoid close contact with others until you have received medical advice.

Insect Bites    

There are some simple precautions you can take to reduce your risk of being bitten or stung by insects. It’s particularly important to follow this advice if you’ve had a bad reaction to an insect bite or sting in the past or you’re travelling to an area where there’s a risk of picking up a serious illness.

The following measures can help you avoid insect bites and stings:

• Cover exposed skin – if you’re outside at a time of day when insects are particularly active, such as sunrise or sunset, wearing loose clothing and keeping shoes on can help you avoid bites. Apply insect repellent to exposed skin – repellents that contain 50% DEET (diethyltoluamide) are most effective.

• Be mindful that mosquitoes and horseflies are commonly found near water.

Ticks

Ticks are small spider-like creatures that are mainly found in woodland, heathland and areas with long grass, including in urban parks. They attach to your skin, and bite to suck blood. Bacteria in the ticks can lead to Lyme disease in some cases. Our blog has more detail.

You can reduce your risk of being bitten by a tick if you:

• Keep to footpaths and avoid areas of long grass when out walking
• Wear appropriate clothing in tick-infested areas (a long-sleeved shirt and trousers)
• Check yourself for ticks when you have walked in these habitats, and check again at the end of the day to remove any ticks
• Wear light-coloured fabrics that may help you spot a tick on your clothes
• Use insect repellent on exposed skin
• Inspect your skin for ticks, particularly at the end of the day, including on your legs, arms and groin area, and particularly for children, check around the head, neck and skin folds (armpits, groin, and waistband) and check your children and any pets. It’s important you remove ticks as soon as possible if you find them on your skin.

Watch our video on Lyme disease for more information:

Food

Summer is a great time to enjoy a BBQ with family and friends. Ensuring meat is not left outside of the fridge for long periods and is cooked thoroughly can help prevent food poisoning. Handwashing before preparing food and after handing raw meat can help prevent bacteria spreading too.

Learn more about BBQ food safety here.

The Government’s Living with COVID-19 plan set out how the UK would transition from managing COVID-19 as an emergency response to living with the virus, whilst ensuring we retain the resilience and contingency capabilities to deal with the uncertainty around the future path of the pandemic.

This transition is underpinned by the success of the UK’s vaccination programme, and a suite of available pharmaceutical tools for treating people who are most vulnerable or severely ill with COVID-19. Vaccination derived protection and treatments have changed the risks of COVID-19 and led a pathway to greater stability.

As we move from pandemic to endemic, management of COVID-19 no longer requires the rapid deployment of specific interventions which respond to changing daily data, and wider public health measures and guidance provide an effective and proportionate approach.

This makes it possible to manage COVID-19 in a similar way to other respiratory illnesses. COVID-19 will be managed through ongoing surveillance, vaccination programmes and strong public health messaging.

In line with this approach, data on the COVID-19 Dashboard will move from daily to weekly reporting from 1st July 2022. This follows the typical reporting schedules for other respiratory infections and also aligns COVID-19 reporting for England with Scotland and Wales – which already report COVID-19 data on a weekly basis.

The COVID-19 Dashboard will continue to update every Wednesday at 4pm with the most up to date available daily data on testing, cases, vaccinations, healthcare, and deaths within 28 days of a positive COVID-19 test from the nations of the UK.

This change represents a further evolution of the COVID-19 Dashboard which has continued to develop in step with the needs of the health and care sector, policy makers, the media and the public alike, providing a powerful and popular tool for timely and reliable COVID-19 statistics.

The Dashboard will continue to be a key source of COVID-19 data and we remain committed to providing open-source data that can be rapidly and frequently used by international, national, regional and local users including major media outlets that analyse and report COVID-19 statistics and trends to audiences within the UK and around the world.

Rob England, Senior Journalist in the BBC News Data and Analysis team, said:

From its first launch, the dashboard has been a vital tool in monitoring and reporting both local and national trends in the Covid-19 pandemic. 

In bringing together all the relevant data from across nations in one place, it made it easier to do thorough analysis at speed to keep our audiences up to date.

It also provided the much needed context of having various different metrics alongside one another, such as cases, hospital admissions and deaths by various measures – giving us a more complete picture of the situation in the country.

The API provided also made the process of accessing the data more streamlined, and the visualisations allowed us to better brainstorm ideas for how best to communicate the figures to audiences.

Overall, the dashboard is the most intuitive government data hub I have ever experienced working with, and has a hard working and helpful team behind it who are dedicated to providing an excellent public service.

The Dashboard will also continue seeking to enhance equitable access to official public health data directly to the public.  A recent report titled ‘What Counts’ published by Sense about Science, illustrated the Dashboard’s success in proving equitable access by illustrating that the level of Dashboard followers varied less between groups categorised by age, qualification and economic activity when compared with followers of other government information sites.

A large contributing factor to reaching high levels of public engagement can be attributed to the quality of engineering, statistics and the user interface which have been developed and designed in response to regular user feedback.

Public health advice and government decisions will continue to be informed through the COVID-19 Dashboard and we will also maintain our other critical surveillance capabilities to monitor the virus, including the weekly COVID-19 surveillance report and the COVID-19 Infection Survey (CIS).

Genomic sequencing will be maintained to help us understand the evolution of the virus and identify new variants. The Government also retains core infrastructure and capabilities to scale up testing if needed. As we move forward and continue to monitor COVID-19 closely, the frequency of reporting data on the COVID-19 Dashboard will be kept under review.