Avian influenza (bird flu) is an infectious disease that affects birds, caused by the influenza A virus. Birds are the hosts for a variety of influenza A virus subtypes, particularly waterfowl and shore birds. All birds are susceptible to avian influenza A and the virus can rapidly cause significant mortality in flocks but some species of bird show more severe clinical signs than others. The influenza A viruses found in birds are not well adapted to infect humans, and human infections with avian influenza viruses are rare. However, some subtypes, such as A(H5N1) or A(H7N9), have been associated with human disease, usually in people directly exposed to infected birds or animals. Over the past few years, a particular virus has come to dominate infections in birds internationally; influenza A(H5N1). Globally it has also caused animal outbreaks among mink and marine mammals and has now spread among dairy cows in the United States. There have been a number of human cases in those working on farms with affected cattle in the US. Both A(H5N1) and A(H5N5) were detected in wild and kept birds in Great Britain last year. There are many different types of influenza A(H5N1) and the genotype in the UK is different from that circulating in the US. ## **What are the symptoms of bird flu?** The symptoms of avian influenza in humans vary. Most of the infections in humans that have occurred in the US have been mild, with symptoms of conjunctivitis (red, sore and discharging eyes) being common. However, the infection can be serious, and a number of individuals in the US and beyond - for instance in Cambodia - have experienced severe illness. Almost all cases of A(H5N1) virus infection in people have been associated with close contact with infected live or dead birds and mammals or contaminated environments. Influenza A(H5N1) continues to infect new mammal hosts (ranging from foxes, otters and seals to cattle), increasing the opportunities the virus has to evolve. The concern is that the virus may at some point evolve further, allowing it to adapt better to infecting people and spreading between them. We therefore remain vigilant for any evidence of changing levels of risk and keep this under constant review, although based on the latest evidence the current risk to the UK human population from avian influenza remains very low. ## **How are we protecting****humans from bird flu?** UKHSA works with the Animal and Plant Health Agency (APHA), the Department for Environment, Food and Rural Affairs (Defra), Food Standards Agency (FSA), and the public health agencies of Scotland, Wales and Northern Ireland to monitor the risk to human health from emerging influenza viruses. We also work closely with partners across the world to learn more about international cases to inform UK preparedness plans. Our surveillance and diagnostic expertise coupled with our genomic sequencing abilities are crucial to the early detection, assessment and response to emerging health and biosecurity threats such as avian influenza. We work with the APHA to monitor circulating avian viruses, and aim to detect potential human avian influenza cases early, assess the risk to human health and scale up the public health response at pace if required. Our work contributes to initiatives such as the WHO Global Influenza Surveillance and Response System, helping the world detect and respond to emerging influenza viruses with pandemic potential. We typically see more detections of avian influenza in wild birds over autumn and winter and an increased risk to poultry and other captive birds, associated with the migratory pattern of waterfowl and environmental conditions becoming more favourable for virus survival. ## **How is bird flu being monitored in the UK?** We are working with the NHS to ensure patients admitted to intensive care with severe acute respiratory infections, or influenza-like-illnesses are tested for respiratory viruses, including influenza. UKHSA public health labs and the influenza reference laboratory undertake additional testing of samples that are positive for influenza A but where normal seasonal influenza is not found, to confirm that the detection is not due to avian influenza. Monitoring of these samples is an important mechanism for the early detection of avian influenza and novel influenza viruses. For example, in November 2023 a novel human case of influenza A(H1N2)v was identified in this way. As people developing avian influenza infections may become severely ill, intensive care units are a good place to target disease surveillance; this work fits within wider surveillance programmes alongside the existing standard public health processes, where people who are exposed to birds with avian influenza are monitored and followed up by UKHSA Health Protection Teams. ## **Vaccination** The standard seasonal flu vaccination is not expected to protect against avian influenza, although it remains important for those eligible to take up the seasonal flu vaccine to protect them from severe illness caused by the flu that circulates every winter in people. As part of long-standing preparedness plans, the government has purchased over 5 million H5 influenza vaccines in case these are ever needed in a pandemic scenario. ## **What should I do if I find a sick or dead bird?** Keep your distance from wild birds as much as possible. There are many reasons why wild birds die or appear to be sick and not every dead or sick wild bird will be infected with avian influenza. Some birds will not show signs of avian influenza infection, so it is not always possible to know if birds are infected with, or have died from, avian influenza. Avian influenza is not often found in small garden birds. If you cannot avoid touching a dead or sick garden bird at your home or other residential property, you should check UKHSA’s guidance on reducing the risk of catching avian influenza  and Defra’s guidance on how to dispose of dead wild birds not required for surveillance. If you want to take the bird to a vet or animal welfare organisation, phone ahead and follow their instructions. This protects other birds and animals at the practice or rehabilitation centre. In some cases, humane euthanasia by a veterinary professional may be the best option for the bird's welfare. In Great Britain, members of the public are encouraged to report findings of dead wild birds using the online reporting system or by calling the Defra helpline (03459 33 55 77). Reporting dead wild birds helps Defra and APHA understand the risk of avian influenza and other diseases to different species groups of wild birds, and supports UKHSA’s understanding of the risk to humans. Further information on APHA’s surveillance for avian influenza in wild birds can be found in their guidance. More information on how Defra and APHA monitor avian influenza virus infection in wild birds and wild mammals can be found in their guidance on GOV.UK. ## **What should I do if I think I may have been exposed to bird flu?­­­** If you are exposed to avian influenza then your regional health protection team will assess and monitor you, and provide advice on any necessary testing or treatment

Meningitis is a serious condition where the protective layers (meninges) around the brain and spinal cord become inflamed. It has many causes, such as different germs, including bacteria, viruses, and fungi. In the UK, most cases are due to bacteria or viruses. Some of the bacteria that cause meningitis can also lead to septicaemia (blood poisoning), and both conditions can result in sepsis, which is life-threatening. Although anyone can get meningitis, it’s most common in babies, young children, teenagers, and young adults. It needs to be treated quickly so it is important to know the signs and symptoms which can happen in any order and may not all be present. ## **What is the difference between bacterial and viral meningitis?** Bacterial meningitis is less common but more serious than viral meningitis. It is often accompanied by life-threatening sepsis and can result in permanent damage to the brain or nerves. Around one in every 10 cases of bacterial meningitis is fatal and some cases will have long-term health problems. However, most people with bacterial meningitis who receive prompt treatment make a full recovery. Viral meningitis is generally less serious and usually gets better on its own within 7 to 10 days, rarely causing long-term problems. Mumps was the most common cause of viral meningitis before the MMR vaccine was introduced. Now a number of other viruses may be responsible. ## **What are the symptoms of meningitis?** Early symptoms – such as vomiting, fever, aches, muscle pain, cold hands and feet and headaches – can look similar to common illnesses like colds or flu. But someone with meningitis or septicaemia will usually become seriously ill in a matter of hours. That’s why it’s crucial to keep checking on anyone who is unwell. Symptoms can appear in any order and some may not happen at all. For meningitis, common signs and symptoms include: * fever * a very bad headache (this alone is not a reason to get medical help) * vomiting * stiff neck * dislike of bright lights * rash * confusion, delirium * severe sleepiness, losing consciousness * fits ## **How do you recognise septicaemia?** It’s important to be aware of how to recognise septicaemia as well as meningitis. The most important signs to look out for are: * fever and shivering * severe pains and aches in limbs and joints * vomiting * very cold hands and feet * pale or blotchy skin * rapid breathing * diarrhoea and stomach cramps * red or purple ‘bruised’ or blotchy rash on skin that does not fade under pressure - do the glass test. On dark skin, check inside the eyelids or roof of the mouth where the spots may be more visible * difficulty walking or standing * severe sleepiness, losing consciousness The NHS (Meningitis - Symptoms - NHS) and meningitis charities have very good information on signs and symptoms (see Meningitis - Symptoms, Causes and Treatments | Meningitis Now or Symptoms of Meningitis | Meningitis Research Foundation). ## **How does meningitis affect babies?** The symptoms and signs of meningitis and septicaemia in babies can include: * refusing feeds, vomiting * feeling drowsy and not responding to you, or being difficult to wake * being floppy and having no energy, or being stiff with jerky movements * being irritable when picked up * a high-pitched moaning cry * grunting * rapid or unusual patterns of breathing * fever (high temperature) * cold hands and/or feet * skin that is pale, blotchy or turning blue * shivering * spots or a rash that does not fade under pressure Find out more details about meningitis in babies and the MenB vaccine here. ## **What does the meningitis rash look like?** Although the meningitis rash doesn't always appear and can vary greatly in appearance, it is one of the most recognisable signs of meningococcal meningitis and septicaemia. DO NOT wait for a rash to appear before seeking medical advice. The rash often starts with a few small, isolated spots and typically develops into a non-blanching rash (one that doesn't disappear when pressed). It is important to spot this early as a rapidly evolving rash indicates very severe disease. The rash can be harder to see on darker skin but may be visible on paler areas such as the soles of feet, palms of hands, abdomen, or inside the eyelid or roof of the mouth. Check the whole body, particularly where clothing creates pressure (underwear elastic, nappies, stockings). Find out more about the meningitis rash on the website of the Meningitis Research Foundation. ## **When should I seek medical help?** Call 999 immediately or go to your nearest A&E if you think you or someone in your care could have meningitis, septicaemia or sepsis. Trust your instincts and do not wait for all symptoms or for a rash to develop. People with meningitis, septicaemia or sepsis can become seriously unwell very quickly. Call NHS 111 if you're unsure whether it's serious. If you've already had medical advice but remain worried or symptoms worsen, seek medical help again. ## **Is meningitis also known as 'freshers' flu'?** No, meningitis and freshers' flu are very different things. While the signs and symptoms may be quite similar at first, people with meningitis are likely to become much more unwell very quickly. Freshers' flu may not be flu at all. It's a collection of common cold viruses that spread rapidly when students arrive at university. While freshers' flu is unpleasant, it's rarely serious. Sometimes it may be genuine flu, and will need a few days in bed. Make sure you, your family and your friends look out for each other and that someone knows if you are unwell so they can keep an eye on you. This could be life-saving. ## **How is meningitis spread?** Meningitis spreads in a similar way to a cold - through close contact or lengthy contact with someone carrying the infection who may not show any signs of infection themselves. Most cases occur in individuals but outbreaks sometimes happen in schools or places where people share living space, such as university halls. ## **Can meningitis be prevented?** Several vaccines offered free of charge by the NHS can help protect against certain causes of meningitis and septicaemia: * MenB vaccine: For babies given at 8 weeks, 12 weeks, and 1 year * 6-in-1 vaccine: For babies given at 8, 12 and 16 weeks * Pneumococcal vaccine: Two doses for babies given at 16 weeks and 1 year; single dose for adults aged 65+ * Hib/MenC vaccine: For babies given at 1 year (if born on or before 30 June 2024) * MMR vaccine: For babies given at 1 year, with a second dose at 18 months * MenACWY vaccine: For teenagers aged 13 to 14 ## **What should I do if I’ve missed my meningitis vaccine?** To get the most benefit, it is important for you or your child to have your vaccines when they are offered or as close to that time as possible.  Young children who have missed one or more dose of the MenB vaccine can have this free of charge before their second birthday and missed MMR vaccine doses can be given at any age. Teenagers can arrange to have vaccines they have missed. This is especially important before starting university or college. If that’s not possible, they should make arrangements with their new GP as soon as they can after term begins. All GP practices should be able to offer free missed MenACWY to students who are under 25 years as well as MMR vaccines to eligible students. International students in the same age group are also eligible for these routine vaccines. ## **How is meningitis treated?** People with suspected meningitis usually have tests in hospital to confirm the diagnosis and determine whether it's viral or bacterial. Bacterial meningitis typically requires hospital treatment for at least a week, including: * antibiotics given directly into a vein * fluids given directly into a vein * oxygen through a face mask Viral meningitis often doesn't require hospital treatment and tends to improve on its own within 7 to 10 days. Treatment focuses on rest, painkillers and anti-sickness medication to relieve symptoms. ## **What is the long-term outlook?** Viral meningitis usually resolves completely without long-term problems.  While most people with bacterial meningitis and septicaemia who receive prompt treatment make a full recovery, some experience serious long-term complications including: * hearing loss or vision loss (partial or total) * problems with memory and concentration * recurrent fits (epilepsy) * co-ordination, movement and balance problems * loss of digits or limbs (amputation is sometimes necessary) Early diagnosis and treatment significantly improve chances of recovery.

Norovirus, commonly known as the winter vomiting bug (although you can catch it throughout the year, including during summer), is a stomach bug that causes vomiting and diarrhoea. It spreads easily through communities, making outbreaks common in settings where individuals have close contact such as hospitals, care homes, schools and nurseries. The virus infects the stomach and intestines, and is also known as a gastrointestinal virus. You can catch norovirus more than once in a short time period because multiple types (or genotypes) of norovirus circulate at any given time. You may develop limited immunity to one strain but can still be infected by a different one soon after. ## What are the symptoms of norovirus infection? Symptoms include sudden onset of feeling sick and wanting to vomit, projectile vomiting and diarrhoea, but can also include a high temperature, pain in the stomach area and aching limbs. ## How long do norovirus symptoms take to develop? The incubation period of norovirus is usually 12 to 48 hours. This is the time between catching the virus and developing symptoms. ## How long are you contagious for with norovirus? Individuals are most infectious when showing symptoms, but it's possible to pass on norovirus both before developing symptoms and after symptoms have stopped. You should stay at home and avoid preparing food for others until 48 hours after symptoms have completely stopped, as you may still be shedding the virus during this time. ## How long do norovirus symptoms last? For most people, norovirus is an unpleasant but short-lived illness, with full recovery within 2 to 3 days without needing any medicine. However, some groups - including young children, the elderly or those with weakened immunity - are at risk of suffering more serious and prolonged illness, which may require medical treatment. ## How long does norovirus last on surfaces? Norovirus can survive on surfaces for days or weeks, this is one of the key reasons why the virus spreads so easily through communities. It is important to properly clean and disinfect contaminated surfaces using a bleach-based solution (chlorine), wearing disposable gloves where possible. The typical recommendation is to use a 0.1% sodium hypochlorite solution (i.e. 1,000 parts per million (ppm)) for surfaces. ## What treatment is there for norovirus? There is no specific treatment for norovirus and it cannot be treated with antibiotics because antibiotics work to fight bacteria, not viruses. The focus of treatment is preventing dehydration by drinking plenty of fluids, as vomiting and diarrhoea cause your body to lose water and salts. Elderly people, young children and those with weakened immune systems are most at risk of becoming dehydrated and may need medical treatment. ## How can I avoid catching norovirus? Good hand hygiene is crucial to stop norovirus spreading. Wash your hands frequently and thoroughly with soap and warm water, particularly after using the toilet, before eating or preparing food, and after cleaning up vomit or diarrhoea. Alcohol-based hand sanitisers don’t kill norovirus. ## What should I do if I have norovirus? If you've got norovirus: * stay at home and rest * do not return to work or send children to school until 48 hours after the symptoms have stopped * don't visit your GP or hospital while symptomatic - if you're concerned about your symptoms, talk to your GP by phone, contact NHS 111 or visit the NHS norovirus webpage * drink plenty of fluids to prevent dehydration from vomiting and diarrhoea * avoid cooking and helping to prepare meals for others until 48 hours after symptoms have stopped, as norovirus can be spread through contaminated food * it is important to wash hands regularly and clean, wash or disinfect thoroughly any contaminated items or surfaces such as clothes, bedding, toilets, taps and door handles ## How can we stop norovirus spreading? Practising good hygiene and avoiding contact with others while infectious are the best ways of preventing the virus from spreading. The virus is easily transmitted through contact with infected people and any surfaces or objects contaminated with the virus, so thorough cleaning and proper hand hygiene are essential. Wash any contaminated clothing or bedding using normal washing powder at 60°C, and if possible, wear disposable gloves to handle contaminated items. Disinfect contaminated surfaces using bleach-based cleaning products where possible, as norovirus can survive on surfaces for days or weeks otherwise. ## Is norovirus called stomach flu because it is related to the flu virus? No, norovirus is not related to the flu virus at all. The term ‘stomach flu’ is misleading - it's simply a common nickname for inflammation of the stomach and intestines. The seasonal flu is caused by influenza viruses, which are completely different from norovirus and primarily affect the nose, mouth, lungs and airways rather than the digestive system. Norovirus is a gastrointestinal virus. ## What is Kawasaki norovirus? One of the norovirus genotypes (GII.17) has been incorrectly covered in the media as Kawasaki norovirus, which is a historic GII.17 variant, not another name for the current GII.17. The distinction is important because the incorrect use of ‘Kawasaki virus’ has caused confusion with ‘Kawasaki disease,’ which is an unrelated, very serious condition.

Our scientists are tracking flu and other respiratory viruses and they need your help. Join our FluSurvey UK-wide citizen science programme and contribute directly to protecting the nation’s health this winter. When you register, you'll be invited to report any respiratory symptoms on our website on a weekly basis. It’s quick and easy to submit the information, and you’ll be playing a part in protecting the health of all of us across the country. From this season, you’ll also be able to track your symptoms on your profile each week. We’d also encourage you to share the link with your friends and family – the more of us participate, the better the data will be. At UKHSA, our purpose is to protect the public from threats to health - everything from infectious diseases to nuclear incidents. To achieve this, we monitor health hazards and develop ways of dealing with them, which makes science a huge part of what we do. We are ramping up our comprehensive surveillance systems to monitor flu and other seasonal respiratory viruses over the winter season. FluSurvey is one of the key methods we use to understand how these viruses are spreading in our communities. This is valuable information for us because not everyone who feels unwell will call 111, visit their GP, or go to hospital, so their symptoms may not be captured. Community-based systems like FluSurvey include data from those who manage their symptoms at home, giving us an early understanding of respiratory illness activity across the whole population. When added to our existing sources of information, the value of real-time data on respiratory illnesses, provided directly by households countrywide, is immense. It's like having thousands of health detectives scattered across the country, all working together to build a comprehensive picture of flu-like illnesses. By taking part in FluSurvey, you would be contributing a vital piece to a larger puzzle. The data you submit will also form part of our award-winning UKHSA data dashboard, which shares public health data in a simple, inclusive and accessible way. If you’re interested in taking part, sign up for FluSurvey today.

Andi Biotic reminds us to Keep Antibiotics Working Imagine a world where common infections became life-threatening, because our medicines no longer worked. It might sound like the plot for a dystopian film, but this scenario is real and it's happening now. Antimicrobial resistance, known as AMR, is stopping antibiotics from being as effective as they used to be. There were an estimated 66,730 serious antibiotic-resistant infections in 2023, a rise compared to 62,314 that we saw in 2019, before the pandemic. This blog post explains why we all need to be more aware of AMR and what it means, and introduces the new campaign to Keep Antibiotics Working, fronted by our mascot Andi Biotic. ## **What exactly is AMR?** AMR occurs when bacteria and other microorganisms evolve to survive the medicines we use to fight them. Just as we adapt to challenges, bacteria can adapt to survive antibiotics. When this happens, these vital medicines stop working when we need them most. Find out more about AMR on the NHS website. ## The global impact The numbers tell a stark story: * in 2021 alone, AMR directly caused 1.14 million deaths worldwide: that's more than 1 million families losing someone they love * if we don’t act now, by 2050, AMR could claim an additional 39 million lives globally * without effective antibiotics, routine medical procedures like your appendix or tonsils being removed, hip replacements, caesarean sections, dental work and chemotherapy could become extremely risky due to the threat of untreatable infections While AMR affects everyone, Black British and Asian British communities face a higher risk of developing infections that don't respond well to antibiotics, which makes it crucial that we focus our activities to address this issue. ## **Our campaign** We have created a new campaign, fronted by our mascot Andi Biotic, who is on a mission to make people aware of the correct ways to use antibiotics. These are simple things everyone can do, to help make sure antibiotics work for you and for future generations. ## How you can help Here are 3 simple but powerful actions: 1. Don't take antibiotics for colds and flu - they won't help because these illnesses are caused by viruses, not bacteria. If in doubt, go to your local pharmacy for advice. 2. Never save antibiotics for later use - they won’t work properly and could make the problem worse. 3. When prescribed antibiotics, take them exactly as directed by your GP, nurse or pharmacist, to make sure they are effective. ## UKHSA’s role in tackling AMR The UK Health Security Agency (UKHSA) plays a pivotal role in the UK's 20-year strategy to tackle AMR, recently publishing a new National Action Plan (2024-2029). Our aim is to contain and control AMR by 2040. Here are 3 ways we are working towards that goal: 1. We are developing cutting-edge surveillance and innovation at facilities including our Porton Down replica hospital ward, which enables us to study the exact conditions found in a hospital ward without putting anyone at risk. The agency's publication of surveillance reports such as the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report provides crucial data for scientists and policy makers. 2. Our Incidents, Outbreaks & Stewardship team responds to multidrug-resistant outbreaks and develops resources to be used by healthcare practitioners. 3. We raise awareness about appropriate antibiotic use through campaigns just like this one. ## Want to do more? We hope this information encourages you to join us in fighting back against AMR. There are ways to get involved: * visit the NHS website to learn more about antibiotic resistance * share what you've learned with friends and family * you can sign up to find out more information about the campaign here, and access lots of videos, graphics and assets to share with others Together, we can help keep these vital medicines working for generations to come.

As we move into spring, protection from any earlier COVID-19 vaccination you may have had will be starting to wane. COVID-19 can still be very dangerous and even life threatening, particularly for older people and those with a weakened immune system. Thankfully, for those who are more likely to become seriously ill from COVID-19, the NHS offers a free vaccine in the spring to top up their protection. This was previously known as the ‘Spring Booster’. The vaccine has saved countless lives, prevented thousands from needing to go to hospital and helped us to live with the virus without fear or restrictions. UKHSA surveillance data relating to last spring’s programme shows that those who received a vaccine were around 45% less likely to be admitted to hospital with COVID-19 from 2 weeks following vaccination, compared to those who remained unvaccinated. ## Eligibility for the COVID-19 vaccination this spring  The eligibility criteria is the same as for spring 2024, and similar to spring 2022 and spring 2023, with the addition of immunocompromised people in younger age groups: * adults aged 75 years and over * residents in a care home for older adults * individuals aged 6 months and over who have a weakened immune system The eligibility is the same across the 4 nations of the UK (England, Scotland, Wales and Northern Ireland). ## Age-based criteria Those who are aged 75 and over can come forward to top up their protection this spring. If you are 74 but turn 75 years old by 17 June 2025, you don’t have to wait for your birthday to come forward. ## Eligibility for residents and staff in care homes Those who are resident in care homes for older adults are also eligible. Carers and staff in care homes are not eligible, this is because the vaccination programme this spring is targeted towards providing protection to those most vulnerable to severe disease. ## Those with a weakened immune system We understand that having a weakened immune system (immunosuppression) is a lot less straightforward than the other criteria. Looking online can cause even more confusion, as people might see themselves (and be considered by others) as immunosuppressed but might not fit the immunosuppression criteria for vaccination. So, what are the immunosuppression criteria? Eligibility is outlined in Chapter 14a of the Green Book, a document published by UKHSA specifically for public health professionals. It can be a complicated document for non-experts, so we've listed some of the groups here: * organ, bone marrow or stem cell transplant patients * those being treated with systemic steroids for more than a month * those living with HIV * those receiving immunosuppressive or immunomodulating biological therapy, including children who are about to receive therapy * those undergoing chemotherapy or radiotherapy * those who require long-term treatment for immunosuppression * those with a history of haematological malignancy including chronic leukaemia, lymphomas, and leukaemia * those with genetic disorders affecting the immune system While this list summarises some major groups, it does not cover everything. Please check online at nhs.uk/get-vaccine to see if you are eligible. ## Booking the spring COVID-19 vaccine You should come forward rather than waiting for the NHS to contact you this year. The National Booking System opens on 25 March to book appointments from 1 April: nhs.uk/bookcovid. If you or someone you know can’t get online, book by calling 119 free of charge, where a translator is available if needed. Getting your COVID-19 vaccine is very convenient, with thousands of appointments available across the country every day, usually at pharmacies and GP practices. While having your spring vaccine around 6 months after your last dose is the usual timeframe, you can have it as soon as 3 months after a previous COVID-19 vaccine dose. If you are eligible, you can get protection from a spring COVID-19 vaccination even if you have not taken up a COVID-19 vaccine offer in the past. Most people do not need extra vaccinations to make up for any they have missed, but your doctor may advise a further dose if you have a severely weakened immune system. It is important that everyone who is eligible takes up the offer this spring before the vaccination programme closes on 17 June 2025.

UKHSA’s most recent data on tuberculosis (TB) revealed a rise in reported numbers in England by 13% in 2024 (5,480) compared to 2023 (4,850). This signals a rebound to above the pre-COVID-19 numbers, despite significant progress towards a decline in TB over the last few decades. In this blog post, we outline the trends and patterns healthcare professionals should remain alert for, to help prevent the disease spreading further. ## Causes and symptoms of TB Tuberculosis is an infection caused by bacteria. It mainly affects the lungs, but it can affect any part of the body, including lymph nodes (glands), bones and the brain, causing meningitis. The infection is spread when a person with TB in their lungs or throat coughs or sneezes. Symptoms include a cough that lasts more than 3 weeks, high temperatures, drenching night sweats, loss of appetite and unexplained weight loss. It is a potentially fatal condition but can be cured if it's diagnosed early and treated promptly with the right combination of specific antibiotics. Early diagnosis is essential for the most successful outcome. ## Rates of TB in England The incidence of TB has remained low in England for a long period of time. However, data for 2023 and 2024 shows that a previous downward trend has been reversed and rates now sit above pre-COVID-19 numbers. TB remains most common in urban areas, including London. However, we have recently seen increases in parts of the country where TB incidence has historically been lower, such as the South West and North East. This latest data set confirms England is moving further away from the trajectory required to meet World Health Organization (WHO) 2035 elimination targets. These targets include reaching 90% of people with TB treatment, providing access to healthcare services and using a WHO-recommended rapid test as the first method of diagnosing TB. ## Groups at highest risk In England, we know the highest incidence is among people born outside the UK (81.5%). In instances where the person was born in the UK (18.5%), research has shown a clear link between TB and deprivation, including those who experience homelessness, drug and alcohol dependence, and have had contact with the criminal justice system. ## How frontline healthcare professionals can help reduce TB It is essential that at risk groups and healthcare workers know the signs and symptoms of TB and seek out a timely diagnosis – treating TB early reduces the risk of transmission to others and improves outcome for individuals. It’s not uncommon for early symptoms of TB, such as a persistent cough and high temperature, to be confused with flu or COVID-19. For this reason, it’s important healthcare professionals keep local communities aware of TB symptoms, especially that a persistent cough with mucus and lasting longer than 3 weeks could be signs of the infection. Timely notification of a positive diagnosis must also be a priority, as it will inform subsequent public health action. ## Breaking down barriers to treatment We know that many people diagnosed with TB face barriers to accessing the interventions required to limit onward transmission. An array of factors such as awareness and geographical access to healthcare services, language and cultural barriers, and lack of support to attend screening appointments can all play a part. They also experience difficulties self-administering treatment and attending follow-up appointments. Consequently, 25% of individuals with TB and social risk factors do not complete treatment within the expected duration. UKHSA recently published a toolkit for tackling TB in inclusion health groups (IHGs). This toolkit provides local systems with support to lead the development, improvement, and delivery of services to tackle TB using an integrated approach across IHGs with healthcare services. The toolkit is evidence-based and showcases best practice and learning from across the country, demonstrating the impact of outreach, providing patient-centered care and using accessible communication. Its recommendations include: * Targeting screening and programmes to local need * Addressing stigma and misinformation concerning TB to inclusion health groups * Providing staff with training on inclusion health groups and local TB pathways * Involving people with lived experience in service design and commissioning * And using incentives and enablers to support individuals’ engagement to treatment completion among many others ## Genomic surveillance UKHSA’s world-leading genomic sequencing capabilities are tailoring the antibiotics used to treat and cure an individual with TB. As a result, the time from TB detection to understanding the effective drugs has halved from 6 to 12 weeks to approximately 2 to 4 weeks in the vast majority of treated infections – helping reduce onward transmission in the community. With TB cases rising, we need to maintain collective action and vigilance. UKHSA is working with partners across the healthcare system to understand how we can best refocus efforts to eliminate this preventable and treatable infection.

The UK Health Security Agency (UKHSA) is harnessing the power of artificial intelligence (AI) to address health security challenges. Here are 3 examples of projects that demonstrate how we're using cutting-edge AI technology to protect and improve public health. ### Using AI to understand patient experiences Understanding patients' lived experiences is crucial for improving healthcare services. Traditionally, analysing qualitative survey data has been time-consuming and resource-intensive. We're now using Large Language Models (LLMs) to accelerate this process. In a recent project analysing responses from the Positive Voices 2022 survey of people living with HIV, our AI system successfully identified key themes from over 1,600 responses about the U=U (Undetectable = Untransmissible) concept. The AI-driven approach is currently undergoing human validation, but demonstrates the potential for AI to dramatically speed up the use of qualitative analysis in public health research. ### Using AI to detect food-borne illness outbreaks Food-borne gastrointestinal illness represents a significant health burden in the UK, affecting millions annually, yet most cases remain undiagnosed through traditional surveillance. Our tech experts and scientists evaluated various LLMs for their ability to analyse thousands of online reviews, screening for key terms related to gastrointestinal symptoms - such as diarrhoea, vomiting and abdominal pain - alongside mentions of specific food types like meat and fish. While previous research has explored similar approaches, UKHSA's study is more comprehensive, examining a much more detailed list of terms and language patterns that could help identify illness outbreaks. The research has highlighted important challenges that must be addressed before widespread implementation, particularly regarding data access and quality. With further work, this approach could potentially become a routine part of public health surveillance, capturing cases that currently slip through existing monitoring systems while providing critical insights into possible sources of outbreaks. ### Making public health guidance more consistent Clear, consistent guidance is essential during health emergencies. UKHSA maintains hundreds of guidance documents for members of the public and professionals, and consistency is important to reduce the risk from health hazards. Manual reviews of guidance documents are time consuming and challenging. A recent project uses secure LLMs on UKHSA’s computing clusters to automatically detect potential conflicts between public health guidance recommendations. The system lets users upload a piece of guidance in development and automatically retrieves existing, relevant sections of UKHSA guidance, then flags any potential conflicts between them. This is currently being user-tested internally, and is showing promising early results, with over 90% accuracy rates in both retrieving relevant text and identifying discrepancies in recommendations. This tool could help ensure public health messaging remains clear and consistent, particularly during fast-moving health emergencies. ### Looking ahead With AI still in its infancy, we can only imagine the potential advantages it could bring to public health provision in the future. Dr Nick Watkins, Deputy Director Data Science & Geospatial and Chief Data Scientist at UKHSA said: > ‘These projects demonstrate how, alongside human expertise, AI can enhance public health protection. As we continue to develop and refine these systems, we maintain a careful balance between embracing innovation and ensuring robust validation of AI outputs. This approach helps us harness AI's potential while maintaining the high standards expected of a national public health agency.’

Solar flare Space weather occurs when explosive events near the Sun’s surface project strong radiation fields towards the Earth. These events typically peak during solar maximum – a cycle that occurs approximately every 11 years – but serious events can also happen during solar minimum. Currently, we are experiencing a maximum, with solar activity at its highest level in more than 2 decades. As the Sun reaches its most active period in 22 years, we’re increasingly aware of the risks we face from severe space weather events. An example of this was seen in the ‘Mothers’ Day Storm’ in May 2024, which produced aurora visible across southern England. This was the strongest solar storm since 2003 to hit the Earth’s upper atmosphere. There were stunning images to be seen, but UKHSA scientists were also studying these events to work out whether they posed a risk to people. May 2024 Aurora Borealis over Oxford, caused by the most powerful solar storm in two decades. Image courtesy Rick Tanner These solar phenomena may seem distant, but their potential impacts on public health and national infrastructure are significant enough to be included on the National Risk Register. For this reason, the UK government takes this risk very seriously. ## **Understanding the threat** The consequences of severe space weather could be far-reaching, potentially disrupting electrical power grids, transport and satellite operations: satellite disruptions can cause the loss of GPS, which has navigational impacts. However, a particularly concerning aspect for the Radiation, Chemical, Climate and Environmental Hazards Directorate within UKHSA is the radiation exposure risk to both workers and the general public. Those at greatest risk include individuals in high-altitude aviation and space environments, where the magnetic and atmospheric protection offered by the Earth is reduced. A large Coronal Mass Ejection (CME) being emitted from a large, unstable region of sunspots An unstable region of sunspots (top left) which is emitting the CME The threat related to the aurora is chiefly from the magnetic fields that cause them, which can induce currents in conductors at sea level. These magnetic fields caused a major electricity grid failure in Ottawa in 1989 and less significant grid failures in South Africa and Sweden more recently. But none of the events that caused those impacts were close to being as powerful as the 1859 Carrington Event, which caused geomagnetic storms and disruption to telegraph communications. It is often taken as a benchmark for a worst-case scenario, but historic records show that events in the one-in-a-thousand-year category could be much worse even than the Carrington Event. An event that emits very high energy protons would be the most significant in terms of radiation experienced by people. In this regard the May 2024 event was not major, but radiation was still detectable at sea level from a relatively small peak in radiation dose rates. **Government response** Recognising the potential severity of this ‘low frequency, high impact’ threat, the Department for Energy Security and Net Zero (DESNZ) is leading cross-government response planning. UKHSA has been contributing expertise specifically related to radiation exposure during commercial flights. Arrangements for a severe space weather event are regularly exercised to test preparedness, including the advice we feed into the Scientific Advisory Group for Emergencies (SAGE). ## Advancing our monitoring capabilities Until recently, the UK lacked the capability to estimate radiation doses in real time during severe space weather events. This crucial gap is now being addressed through the Space Weather Instrumentation, Measurement, Modelling and Risk project (SWIMMR), which has developed improved measurement capabilities that enable rapid assessment of radiation exposure. Key advances include: * Deployment of on-board monitors to measure live dose rates on commercial aircraft. The first batch of these are already in action on some long-haul flights, with a focus of flights to and from the West Coast of the US. * Development of a UK-based ground level neutron monitor to provide the Met Office with real-time data: this should be operational very soon with a second instrument planned for the Shetland Isles. * Enhancement of the MAIRE-S Nowcast system for more accurate estimates of cosmic ray dose rates in the atmosphere: this will be used in real time during a severe space weather event. ## **Practical applications and future planning** Working with the Space Environment Impacts Expert Group (SEIEG), UKHSA is developing forecasting capabilities to identify high-risk periods when commercial flight patterns might need adjustment. These recommendations would only be implemented during the most extreme solar conditions. On-board flight monitors are already operational, with efforts underway to extend their use on long-haul flights to improve nowcasting accuracy. These practical applications represent significant progress in the UK's ability to respond to severe space weather events. ## **Looking ahead** The next 2 to 3 years will provide a critical test of these new capabilities and response frameworks, before we face the next solar maximum expected in the mid-2030s. However, major space weather events can happen at any stage in the solar cycle, so even during the solar minimum there is no room for complacency. This period will be crucial for refining our understanding and responses to space weather threats, ensuring the UK remains resilient to these cosmic challenges that, while invisible to most, could have profound impacts on our technologically dependent society. Rick Tanner, Radiation Metrology Group Leader, UKHSA said: > "While the threat of severe space weather events may seem alarming, the day-to-day risk to the public is very low. The government continuously monitors solar activity through sophisticated detection networks, and we've recently enhanced our capabilities to estimate radiation doses during severe events. > > We're also gaining valuable knowledge about long-term radiation exposure risks, particularly for those in aviation, and we’re developing forecasting tools that could help adjust commercial flight patterns during high-risk periods. This is a risk we understand and are actively prepared for."

Nanoplastics are plastic particles smaller than 1,000 nanometers in diameter, or 100 times smaller than the diameter of a human hair, and they are polluting our environment and our food, to the extent that they are now being found in human blood, lungs, placenta, and even breast milk. The study of microplastics is still a relatively new field. In this blog post we’ll explore how scientists are investigating the effects nanoparticles are having on the human brain and its defences. It's estimated that microwaving food in plastic containers for 3 minutes could release as much as 4 billion nanoplastic particles from one square centimetre of plastic. ## **The blood brain barrier: our brain's defence system** The blood brain barrier (BBB) is the thin shield around the brain that protects against threats like bacteria, toxins and chemicals. At the same time, the barrier allows oxygen and nutrients to pass through tiny holes guarded by specialist cells. Nanoplastics are so incredibly small that they can slip past these defensive cells, known as pericytes, or hitch a ride on nutrients making their way to the brain. These pericyte cells primarily help to maintain the barrier and clear toxins that threaten the brain. ## **Potential links to neurodegenerative diseases** Diseases such as Alzheimer’s and Parkinson’s disease are associated with dysfunction in pericyte cells, which raises the question as to whether miniscule pieces of plastic, or a build-up of them in these cells, could bring about similar diseases. A question scientists are investigating. ## **Nanoplastic research project** To study potential effects of plastic particle exposure on pericytes, scientists made their own particles, similar to those widely used for food containers and drink bottles. Human brain pericytes grown in the lab were exposed to chronic levels of nanoplastic particles, concentrations 31.25 times higher than normally detected in the blood, for 3, 6 and 10 days. These high levels were used to replicate the potential exposure and accumulation of nanoplastics at the BBB over time. As nano particles are so incredibly small, we worked with scientists at Arts et Metiers, Institute of Technology, Paris, and Glasgow University who used 3 cutting-edge techniques to monitor the concentration and molecular make-up of plastic particles in the pericytes. Fourier-transform infrared spectroscopy, thermogravimetric analysis, and differential scanning calorimetry (DSC) help scientists take precise measurements of microscopic light levels and temperature changes. These measurements were then used to assess whether PET particles can lead to oxidative stress - a build-up of waste in the cell; and whether this build-up of waste damages the mechanism in each cell which generates energy. Damage to the powerhouse of the cell - the mitochondria - and a lack of energy means the eventual the death of the cells and a deterioration in brain function. ## **Research findings and future directions** The study demonstrated that human pericytes grown in the lab exposed to high levels of PET nanoplastics over 3 days, slowed down mitochondrial functions. Interestingly, it also showed a recovery of the mitochondrial functions from 6 days until the 10-day exposure timeline tested. More research is needed to understand the full extent of chronic exposure to PET nanoplastic particles and the mitochondrial function recovery in human pericytes cells.

Scientist using a blow torch to seal an ampule with a bacterial sample inside Within the UK Health Security Agency lies a scientific treasure trove, known as the Culture Collections. Its 4 repositories house thousands of meticulously preserved microorganisms, with some specimens dating back to World War 1 and the late 19th Century. At their heart is the National Collection of Type Cultures (NCTC), which was established in 1920, making it one of the oldest collections of its kind in the world and the oldest constituent part of the UKHSA. Far from being museum pieces, the irreplaceable scientific resources held within this collection have proven instrumental in tackling the most pressing public health challenges of the past 100 years. From identifying emerging pathogens to tackling antimicrobial resistance, read on to find out how these century-old samples are helping us to safeguard health today and to strengthen our defences against future threats. ## Frozen in time Samples being cryopreserved using liquid nitrogen at -196c Why are these strains useful to scientists, even after 100 years? The stories behind NCTC 86 Escherichia coli and NCTC 6571 Staphylococcus aureus _,_  just two of the many thousands of bacterial strains that can be found within the collection, illustrate how microbial strains isolated decades ago can still be used today for a multiplicity of applications in science and industry. ## E. coli – the NCTC 86 story Inside the intestines and colons of every human lives a bacterial species called Escherichia coli, or E. coli for short. While many people associate it with food poisoning, most strains of E. coli are actually harmless to humans. The bacterium takes its name from Theodor Escherich, a Bavarian paediatrician who first isolated it in 1885. The name combines Escherichia (after its discoverer) with coli (meaning ‘‘of the ’,colon’, indicating where it naturally resides). Escherich published his discovery in a scientific monograph the following year. The strain was maintained in Escherich’s laboratory throughout his scientific career. Then, from 1900 onwards, it was distributed among several UK institutions, including the Pathological Laboratory of the University of Cambridge, the Royal Commission on Sewage Disposal and the Lister Institute of Preventative Medicine – before being received by the NCTC collection in 1920. Now operated by the UK Health Security Agency, NCTC has maintained Escherich’s original strain throughout the 20th and early 21st Century, where it still exists 140 years after its original isolation, under the identifier ’NCTC 86’. But why do scientists keep bacteria in collections like the NCTC? And given that Escherichia coli can be found in the intestines of numerous mammals, not just humans, what makes a specific strain of E. coli worth keeping around? ### The many lives of a microbe 1. **A laboratory helper  ** Scientists can use it as a quality control strain - essentially a ‘known quantity’ that helps ensure their tests are working correctly. It also played a crucial role in the development of MacConkey agar, a growth medium used in labs worldwide to tell the difference between E. coli (which is often harmless) and Salmonella (which can cause serious food poisoning). Early in the 20th Century it was also used as a disinfectant test strain, helping to ensure that industrial disinfectants and household cleaning products worked effectively. Bacterial samples in petri dishes 2. **A window to human health  ** Escherich first described this bacterium while investigating how gut bacteria affect human health. By preserving his original strain, we've kept a valuable reference point for modern research. Today, scientists study how different strains of E. coli in our intestines might influence our health in what are called ’microbiome studies’. 3. **A digital pioneer  ** In the modern era of whole genome sequencing, NCTC 86 has found yet another new purpose: it was one of about 3,000 bacterial strains from our collection to have its complete genetic code mapped in a project known as NCTC3000. Its genetic blueprint is now freely available online for researchers to study and examine – what was once a physical archive of microbes is now transforming into a digital genetic library as well. Currently, a PhD student working with NCTC and the University of East Anglia is comparing the genetic makeup of NCTC 86 with 280 other E. coli strains collected over a century, helping us to understand how this important bacterium has evolved over time. ## S. aureus – the NCTC 6571 story Bacterium S. aureus, NCTC 6571 Staphylococcus aureus (S. aureus)is a bacterium that can harmlessly inhabit the human body, with as many as 30% of humans being long-term carriers in their skin, nostrils or reproductive tract. However, it can also cause serious illness including soft tissue infection, toxic shock syndrome and sepsis. In 1943, Sir Alexander Fleming - whose discovery of penicillin revolutionised medicine - deposited a S. aureus strain into the NCTC collection. This strain, affectionately known as ’Oxford Staph’ or ‘the Oxford Staphylococcus’, had been used in the penicillin trials at Oxford University. Eight decades later, this same historic microbe (under the identifier NCTC 6571) continues to play a crucial role in research. Another notable early adopter of NCTC 6571 was English biologist and biochemist Norman Heatley, also a member of the Oxford team that developed penicillin. Heatley used it to measure how strong each batch of the medicine was, which was crucial at a time when penicillin was new and difficult to produce consistently. The use of NCTC 6571 in this context continued long after World War 2; since 1949, the NCTC has produced and supplied more than 8,000 samples of this same bacteria to researchers worldwide. Letter sent by Sir Alexander Fleming depositing the Oxford Straph. Image courtesy The Archives of the National Collection of Type Cultures What made NCTC 6571 so special that it was used for this purpose? Interestingly, no one knows exactly why this particular strain was adopted. In his letter to the NCTC (pictured above), Fleming simply wrote, ‘I am sending you a culture of the staphylococcus I have used for testing penicillin. I got it from [Howard] Florey, and all of us on the Penicillin Trials are using it.’ The origins of NCTC 6571 and why it was selected otherwise appear lost to time. ## New discoveries in old samples With genome sequences becoming more readily available, we can now read the complete genetic code of bacteria, providing additional insights into samples that have been preserved for decades. For example, NCTC scientists recently sequenced 133 strains of S. aureus as part of the NCTC3000 project, including Fleming's NCTC 6571. The scientists were interested in genes that make some of these strains harmful to humans, known as enterotoxin genes. While examining the genetic data, the researchers discovered 2 previously unknown enterotoxin genes. Surprisingly, at least 1 of these genes still exists in strains circulating today. This shows how preserved bacteria from the past can help us understand present-day health threats. Furthermore, a second NCTC/UEA PhD student is currently conducting a significantly expanded study analysing thousands of globally isolated S. aureus strains, using data science and machine learning techniques to gain insights into enterotoxin gene evolution. ## Nature's living tools Freeze-dried samples held by the collection Unlocking the potential of microbes isn’t an activity confined to Oxford in the 1940s. Microbes are valuable resources driving scientific innovation, and they perform remarkable functions that scientists continue to harness for developing new technologies. For example, some microbes can: * ‘eat’ man-made plastics (Ideonella sakaiensis NCTC 14201) * produce natural antibiotics (Streptomyces griseus NCTC 13033) * demonstrate how rapidly some bacteria can evolve antibiotic resistance (AMR) (Escherichia coli NCTC 13846) * serve as models for studying how and why some bacteria cause human disease (Streptococcus pneumoniae NCTC 14077). ## Supporting scientific progress The NCTC collection also plays a crucial role in: #### **Testing new antimicrobials** Researchers are using our strains to evaluate novel antimicrobials (Neisseria gonorrhoeae NCTC 14208) and evaluate new diagnostic techniques (Staphylococcus aureus NCTC 14245). #### Expanding Scientific Knowledge When scientists discover bacteria previously unknown to science, they can compare them to reference strains from the collection like Campylobacter jejuni (NCTC 11168) and Campylobacter lanienae etc (NCTC 13004). #### Practical Applications Microbes from the collection are used to evaluate everyday infection prevention practices, such as the difference between handwashing with warm water versus cold water (Escherichia coli NCTC 10538) and in the surveillance of antimicrobial resistance (Klebsiella pneumoniae NCTC 13368). Others may be used in years to come in ways in which we can only imagine today. ## The future The foresight of those who preserved these microscopic organisms throughout the past century has given us an invaluable resource, and as modern techniques like whole genome sequencing become more advanced and accessible, the full value of their legacy is only beginning to be realised.

From 6 April 2025, we’re expanding the list of pathogens that Registered Medical Professionals and laboratories in England must notify us about. The changes will strengthen local and national surveillance and support a prompt response to outbreaks of infectious diseases. In this blog post, we will provide more information on the changes and important links. ## **The health protection notification regulations** Under the Health Protection (Notification) Regulations 2010 (HPNR), all doctors (registered medical practitioners) are required to report notifiable diseases to the Proper Officer of the local authority (usually a UK Health Security Agency regional team). There is also a legal requirement for diagnostic laboratories that process human samples in England to report certain pathogens to UKHSA. Reporting of notifiable disease is a critical public health tool which informs local and national surveillance of serious infectious diseases. Notification allows us to take prompt public health action to prevent and control Infections. You can learn about the full list of notifiable diseases here. ## **Changes for Registered Medical Professionals in England** In addition to the existing infections, from 6 April 2025, medical professionals must notify us if they suspect a patient has any of the following: * Middle East respiratory syndrome (MERS) * influenza of zoonotic origin * chickenpox (varicella) * congenital syphilis * neonatal herpes * acute flaccid paralysis or acute flaccid myelitis (AFP or AFM) * disseminated gonococcal infection (DGI) * Creutzfeldt-Jakob disease (CJD) As previously, RMPs can notify us here, via Report a Notifiable Disease. **Changes for laboratories** Laboratories that test human samples in England will be required to report an additional 10 causative agents from 6 April 2025. These are: * Middle East respiratory syndrome coronavirus (MERS-CoV) * non-human influenza A subtypes * norovirus * Echinococcus spp * tick-borne encephalitis virus (TBEV) * Toxoplasma (congenital toxoplasmosis) * Trichinella spp * Yersinia spp * respiratory syncytial virus (RSV) * Candidozyma auris Diagnostic labs can still notify us here. Last year, an electronic NOIDs system was rolled out, allowing medical professionals to notify suspected cases via an online form - Report a Notifiable Disease. Pilot data has shown that this has reduced notification time by 50%. ## **Expanding the list of notifiable diseases** Together with the Department of Health and Social Care, we assessed surveillance capabilities for current and emerging infectious diseases and made recommendations for updating the regulations, to strengthen local and national surveillance. These changes follow a public consultation on updating the legislation. ## Using the data Some notifications require immediate public health action from our Health Protection Teams – for instance to provide antibiotics, vaccination or isolation advice to contacts. Other notifications strengthen our surveillance at local and national level and allow us to assess the impact of different public health interventions, such as vaccine programmes. ## **The impact on patients** Information shared with our teams for this purpose is confidential and protected by General Data Protection Regulations (GDPR). The information is to inform public health response, and understanding of how diseases spread and how we can prevent them. A full guide to what should be notified and when can be found on GOV.UK.

In this blog post we take a behind-the-scenes look at the Rare and Imported Pathogens Laboratory (RIPL), where our scientists work to safeguard public health from rare and deadly diseases. ## Our laboratories RIPL is the UK’s frontline clinical diagnostic laboratory for unusual, rare, and hazardous infections, particularly those imported from abroad. Every day, our scientists receive clinical samples from healthcare providers across the UK. Using diagnostic techniques like serology and polymerase chain reaction (PCR) assays, our teams work to quickly identify diseases that might be difficult to diagnose in hospital laboratories. Our specialist laboratories are equipped to detect and contain high-risk viruses such as Marburg, Ebola, and Lassa fever. These infections may be imported into the UK by returning travellers and, although extremely rare it is important to provide 24/7 access to testing to make sure proper infection control and public health measures are put in place. We receive about one sample per week for testing for possible imported viral haemorrhagic fevers. And our rigorous containment and safety measures ensure that no pathogen slips through the cracks. ## Specialised services for complex cases Our scientists and clinicians have developed tailored diagnostic panels based on patient travel history and symptoms. These panels cover 10 world regions, allowing us to look for a number of infections in a single sample as quickly as possible, rather than ruling out possibilities one by one. From imported viruses to bacterial diseases like anthrax and Q fever, our expertise spans a wide range of infectious threats. Beyond testing hospital samples, RIPL is involved in other public health protection and surveillance work. For example, we provide testing for anthrax for samples from potentially contaminated old buildings or suspected animal infections. We are also involved in a wide range of surveillance work, including testing samples from blood donors and healthy volunteers to assess the risk of vector-borne disease in the UK. ## The Imported Fever Service The Imported Fever Service (IFS) is the clinical face of RIPL. Our doctors support frontline NHS clinicians by providing an around-the-clock service for: * 24/7 access to clinical, microbiological and infection control expertise. * Rapid molecular diagnostics for viral haemorrhagic fevers like Ebola. * Next-working-day PCR results for acute imported fevers. We aim to deliver fast answers and support in the diagnosis and management of patients with a fever, ensuring appropriate infection prevention and control measures, and activating public health interventions if needed. ## Our role in global public health We live in a global world, and when people travel frequently across borders, it means disease can too. Early detection is crucial to responding quickly with the appropriate public health interventions, preventing or mitigating outbreaks and saving lives. Every sample we handle represents a potential threat which means our team’s expertise and unique capability to handle dangerous diseases in our high containment laboratories and cutting-edge diagnostic facilities ensures we are timely and accurate in delivering test results. While we don’t work directly with patients, our impact is felt nationwide, from hospitals to public health responses carried out locally, and our scientists ensure the UK can remain a step ahead of emerging health threats. Read our other blog posts on rare and hazardous infections: * What are the symptoms of Lassa fever and how is it spread? * Marburg virus disease: what you need to know * How high is the risk of catching mpox and how can I protect myself?

Lassa virus under a microscope. Image courtesy of Centers for Disease Control and Prevention You may have seen media reports about a person who travelled to the UK who was ill with Lassa fever while in the country. While Lassa fever is rare in the UK, we have previous experience with a small number of cases in the UK, most recently in 2022. We are well equipped to identify people who have Lassa fever and work to limit the spread of infection, for example, through contact tracing activities. We are now working at speed to identify people who may have had contact with the person who had Lassa fever. This blog post summarises the key points about Lassa fever and what UKHSA does when a case of an infectious disease such as Lassa fever is identified in the UK. ## How Lassa fever is spread Lassa fever, the disease caused by Lassa virus, was first described in the 1950s. The virus was identified in 1969 after 2 missionary nurses died from the disease in the Nigerian town of Lassa. Lassa fever is endemic (meaning it is regularly found) in parts of West Africa, particularly Guinea, Liberia, Nigeria and Sierra Leone. Lassa virus is carried by a particular type of rodent, the Mastomys rodent, which occurs in high numbers in these countries. The most common way for people to catch Lassa virus in these affected countries is through eating contaminated food or breathing in the virus. People can also be infected from the droppings of infected rodents, for example on floors, home surfaces, or in food or water. Some people eat Mastomys, and they may catch Lassa virus when catching and preparing these rodents for eating. Lassa virus does not spread easily between people. It can be spread from one person to another if they have contact with the body fluids of someone who has Lassa fever, such as blood, saliva, urine or semen. ## Symptoms of Lassa fever Most people who get Lassa fever have mild symptoms and make a full recovery. However, in some cases the virus can cause more severe illness and death. Mild symptoms of Lassa fever include: * fever (high temperature) and shivering * feeling tired and weak * headache * generalised pain * sore throat More serious symptoms include: * bleeding * difficulty breathing * vomiting * facial swelling * pain in the chest, back and stomach Symptoms usually occur between 1 and 3 weeks after having contact with Lassa virus. Pregnant women are at higher risk of getting seriously ill if they catch Lassa fever, particularly in the third trimester. Catching the virus in pregnancy increases the chance of stillbirth and miscarriage, as well as serious complications and a higher chance of death for pregnant women. ## **Responding to Lassa fever in the UK** People who are found to have Lassa fever will receive supportive treatment, meaning that they will be provided with fluids, monitored for their symptoms, and treated with medications depending on which symptoms they have. There is not currently an effective single treatment for Lassa fever. In the UK, Lassa fever is considered a high consequence infectious disease. Such diseases are more likely to cause death than other diseases, and do not always have an effective treatment or way of preventing the illness, like a vaccine. Any cases of such diseases identified in the UK are contact traced, meaning we work quickly to identify people who have had contact with the person who has the disease. We then give these contacts public health advice on what they should do now, including steps they should take to avoid passing the infection on to other people. This helps to reduce the onward spread of disease.

**If you are interested in skincare, beauty and wellness, you might know of influencer Andrew Donaldson-Wheatcroft, who has well over 200,000 followers on his social media accounts. Alongside this content, Andrew is an advocate for people living with HIV. In this blog post, he shares the story of his HIV diagnosis.** Before I was diagnosed with HIV in 2015, like many other people I assumed it was unlikely to happen to me. Now I know, HIV doesn’t discriminate and anyone can catch it. Misconceptions are harmful and allow the virus to spread because it’s damaging to people’s health when they get into the mindset of ‘this doesn’t affect me, why would I test for it?’. My experience tells me that many people still believe HIV only affects gay men, but for the past 2 years, we’ve seen heterosexual HIV diagnoses overtake those of gay, bisexual and other men who have sex with men (GBMSM). Regular testing is crucial to identify an HIV infection because most people feel fine and don’t have symptoms for some time. Some people might experience a short illness after they contract the virus which can present like the flu, but even then symptoms can vary, and it’s easy to shrug off as ‘just another winter virus’. I didn’t suspect anything; I was just going about my daily life unaware – which is easy to do when you’re not regularly testing. It was only when I was rushed into hospital after becoming seriously ill with pneumonia and meningitis that I was diagnosed. When I arrived at the hospital, doctors didn’t know what was happening to my body. Even if I had known, I couldn’t have told them because I was so ill I couldn’t even speak. When the test results came back, the doctors discovered that I had HIV, and were then able to piece things together. **The risk of the unknown** Because I wasn’t regularly testing, I didn’t know my status, and this allowed the virus to silently cause damage to my immune system, so I wasn’t able to fight infections. Once the test confirmed my diagnosis, NHS staff were able to provide me with the right treatment and get my health back on track. HIV medication keeps me healthy, so I can live a normal life. The medication I take has now reduced my viral load to an undetectable level. This means the virus is still there, but it has been reduced to such small amounts in my body that it cannot be passed on, including to my husband. You may have heard of the term ‘Undetectable = Untransmittable’ or ‘U = U’; this means that people living with HIV, and who are ‘undetectable’, have a zero risk of transmitting the virus to their sexual partners. For me, HIV medication feels like a miraculous thing, but it’s a treatment, not a cure. My road to recovery wasn’t an overnight fix; it was a journey. I continue to take daily medication, and for the past 10 years I’ve had to go to regular appointments to make sure my treatment is working properly, checking that the virus is at low levels, and my immune system is well. Because of the dedication I’ve put into my health, I have been told that I am no longer required to check in with a doctor or have my bloods taken regularly, as I’m the healthiest I have ever been in my HIV journey, which I am over the moon about. HIV continues to carry a lot of stigma, usually because people lack information about it. Being vocal about my HIV positivity online might come across as easy now, but it took me 5 years to tell people I was HIV positive because of that stigma. It was the most afraid I’ve ever been of anything in my life. Outdated beliefs from the past still linger, but the reality of HIV today is completely different. Consistently using condoms is really important, but there are now other highly effective tools we can use to reduce the risk of transmission. Pre-Exposure Prophylaxis (PrEP) is a daily pill that significantly lowers the risk of getting HIV for those at higher risk. Post-Exposure Prophylaxis (PEP) is an emergency medication that can be taken within 72 hours of potential exposure to prevent the virus from taking hold. By combining these methods with regular testing and condom use, we can work towards stopping new HIV infections. Normalising the conversation about HIV, and encouraging regular testing helps break down that stigma. We should see sexual health testing as an essential part of self-care, just like eating well, exercising, and looking after our mental health. Knowing your status is about empowerment and taking control. HIV can affect anyone, no matter your gender or sexual orientation. Regular testing leads to earlier diagnosis, allowing people to start effective treatment sooner—protecting their health and preventing transmission. Protect yourself, educate yourself, and go get tested! Find your local sexual health clinic.