Immunisation and vaccine-preventable diseases quarterly report
July to September 2023 (Q3)
An Official Statistics publication for Scotland
- Published
- 05 December 2023
- Type
- Statistical report
- Author
- Public Health Scotland
Results and commentary
Diphtheria
An error has been noted in the text in the pertussis (whooping cough) section of this report concerning 2017 data. The error was in the text only and did not affect the underlying data or any of the published figures. All publications affected are in the process of being updated.
An error has been noted in the vaccine preventable diseases summary table for 2022 measles data in this report. This error affects this table only. Correct data and figures were reported in the surveillance update for measles. All publications affected are in the process of being updated.
Background information
Diphtheria is an acute bacterial infection affecting the upper respiratory tract or the skin, caused by the diphtheria toxin produced by toxigenic strains of Corynebacterium diphtheriae (C. diphtheriae), Corynebacterium ulcerans (C. ulcerans), and less commonly Corynebacterium pseudotuberculosis (C. pseudotuberculosis).
The most common symptoms of diphtheria affecting the upper respiratory tract are membranous pharyngitis with fever, lymphadenopathy and upper respiratory tract soft tissue swelling 'bull neck' potentially leading to life-threatening airway obstruction. Cutaneous diphtheria may cause pus-filled blisters on legs, hands and feet, and ulceration of the skin.
In unvaccinated or partially vaccinated individuals, systemic absorption of the toxin can lead to late complications such as cardiac and neurological conditions, and sometimes death.
Surveillance
Diphtheria has been rare in the UK because babies and children have been vaccinated against it since the 1940s. Prior to the introduction of a vaccine up to 70,000 cases a year were confirmed, causing around 5,000 deaths.
There was one case of toxigenic diphtheria (C.ulcerans) reported in the third quarter of 2023. Prior to this, the last case of toxigenic diphtheria in Scotland was reported in 2020.
The UK Health Security Agency (UKHSA) reported an increase in cases of toxigenic C. diphtheriae among asylum seekers arriving by small boat to England since 2022, with similar increases reported elsewhere in Europe. Further details can be found here: Diphtheria: cases among asylum seekers in England, 2022 and 2023 - GOV.UK (www.gov.uk).
Vaccination Information
More information on vaccines against diphtheria can be found on the following pages:
Vaccine uptake statistics
Vaccine uptake statistics for children are published in Teenage booster immunisation statistics Scotland - School year 2020/2021 and childhood immunisation statistics quarterly report.
Haemophilus influenzae
An error has been noted in the text in the pertussis (whooping cough) section of this report concerning 2017 data. The error was in the text only and did not affect the underlying data or any of the published figures. All publications affected are in the process of being updated.
An error has been noted in the vaccine preventable diseases summary table for 2022 measles data in this report. This error affects this table only. Correct data and figures were reported in the surveillance update for measles. All publications affected are in the process of being updated.
Background information
Haemophilus influenzae (H. influenzae) are bacteria commonly carried in the respiratory tract, which can cause acute invasive disease. They are divided into encapsulated and unencapsulated (non-typeable) strains. Encapsulated strains can be classified into six serotypes, from a to f, of which type b (Hib) was most prevalent prior to vaccine introduction. Infection with H. influenzae can cause the following conditions:
- meningitis
- septicaemia
- acute respiratory infections
Less frequent conditions which may be caused by H. influenzae infection include:
- epiglottitis
- osteomyelitis
- septic arthritis
For more information on H. influenzae type b, visit NHS inform.
In 1992, following introduction of the Hib vaccine for young children, the number of H. influenzae type b cases fell dramatically, not only in the vaccinated group but also in older age groups.
Due to reduced carriage of the organism within the respiratory tract of vaccinated children, transmission to the wider community was effectively suppressed.
The addition of the Hib booster vaccine in 2006 to the childhood immunisation schedule, reduced case numbers further.
In Scotland, typing is conducted on cases with positive laboratory reports for invasive H. influenzae in order that national trends in disease subtypes can be monitored.
Further enhanced surveillance is carried out for all invasive H. influenzae cases identified in children under the age of five and type b strains across all age groups.
Surveillance update for July to September 2023
There were 17 invasive H. influenzae cases reported in the third quarter of 2023, bringing the total number of cases to the end of the third quarter to 76 as shown in Figure 1. This is higher than the number of cases reported for the same period of the previous four years (range 18 to 52).
Of the 76 cases reported to the end of the third quarter of 2023:
- 46 were people aged over 40 years
- five were people aged between 21 and 40 years
- eight were people aged between five and 20 years
- 17 were children aged under five years old, eight of whom were infants aged under one year.
Figure 2 demonstrates the epidemiological impact of the Hib vaccine, for those aged under five (routinely vaccinated group) and for all ages (including under-fives).
There was a marked decrease in cases from 1992 in all age groups, followed by a rise in case numbers in the early 2000s. Case numbers decreased again following the introduction of the Hib booster vaccine, and figures have remained relatively stable since 2011. See the vaccine-preventable disease summary for the number and incidence of Haemophilus influenzae disease in Scotland over the last five years.
Figure 3 presents laboratory reports by serotype, since the introduction of the Hib booster campaign in 2003.
Of the 76 isolates in the first half of 2023: isolates
- 46 were non-typable (i.e., non-encapsulated type)
- two were identified as type e
- one was identified as type a
- one was identified as type f
- typing was not carried out/available for the remaining 26 isolates
Vaccination information
More information on vaccines against invasive Haemophilus influenzae type b can be found on the following pages:
Vaccine uptake statistics
Vaccine uptake statistics are published in our childhood immunisation statistics quarterly report.
Measles
An error has been noted in the text in the pertussis (whooping cough) section of this report concerning 2017 data. The error was in the text only and did not affect the underlying data or any of the published figures. All publications affected are in the process of being updated.
An error has been noted in the vaccine preventable diseases summary table for 2022 measles data in this report. This error affects this table only. Correct data and figures were reported in the surveillance update for measles. All publications affected are in the process of being updated.
Background information
Measles is a rash illness resulting from infection with the measles virus. It can affect people of all ages but infants less than one year of age and those who are immunocompromised are at increased risk of complications and death. It is one of the most communicable diseases with one case having the potential to infect another 12 to 18 individuals through airborne transmission and respiratory droplets in susceptible populations.
Before vaccination, measles was a very common childhood disease in Scotland and deaths attributable to measles were substantial.
Following the introduction of measles vaccine in 1968 and the subsequent introduction of the MMR vaccine in 1988, the incidence of the disease has decreased dramatically.
However, as Figure 4 shows, outbreaks have occurred in recent years. These outbreaks have largely occurred in under-immunised populations.
Surveillance update for July to September 2023
There were no cases of laboratory-confirmed measles reported to the end of the third quarter of 2023, and only one case reported in 2022 which was the first case reported since 2019.
As shown in Figure 5, the number of cases each year has been variable. See the vaccine-preventable disease summary for the number and incidence of measles in Scotland over the last 5 years.
A single case in 2022 (February) was imported from outwith the UK. No further transmission occurred in Scotland, highlighting the success of the MMR vaccination programme and the importance of maintaining high vaccine uptake in Scotland.
Of the 18 laboratory-confirmed cases of measles reported in 2019:
- one case was acquired elsewhere within the UK, outwith Scotland, from which two further Scottish cases were identified,
- seven cases were imported from outwith the UK, and resulted in two import-related cases in Scotland,
- six laboratory-confirmed cases of measles in Scotland were of unknown origin, four of which had typing available. The type identified (D8) indicated that these cases were strains identified elsewhere in the UK and Europe, which demonstrates transmission within the UK and across the continent prior to the COVID-19 pandemic.
In highly vaccinated populations such as Scotland, it is rare but possible for individuals who have received two doses of MMR vaccine to develop symptoms following exposure to a measles case. However, symptoms are usually attenuated, and individuals are unlikely to be as infectious.
The age distribution of measles cases has varied over recent years, but most cases are observed in children and young adults. Of cases reported in 2019, the median age of the 18 laboratory-confirmed measles cases was 24 years. This is similar to the median age of cases in 2016, which was 22 years, and 2017 which was 27 years. Of the two laboratory-confirmed cases reported in 2018, one case was in the under one year age group and the other case reported was in the 30 to 39 year age group.
Measles in Europe
Measles outbreaks occurred across Europe throughout 2018 and continued into 2019 but there was a notable reduction in cases from March 2020. Following a rise in laboratory-confirmed cases since late 2022, several countries in the WHO European Region have reported measles cases in recent months. In February 2023, WHO Europe issued the following press statement: Immediate and targeted catch-up vaccination needed to avert measles resurgence.
In the most recent 12 months up to September 2023 there were a total of 1238 cases of measles reported to the European Centre for Disease Prevention and Control. The EU/EEA countries with highest reported rate of cases between this time period were Liechtenstein, Romania, Austria and Belgium with rates of 76.3, 48.7 and 17.2 and 3.7 cases per million of population, respectively.
Data published by UKHSA reports a total of 128 cases of laboratory confirmed measles in England between 1 January to the end of June 2023, the majority of which were reported in London. However, all regions in England have had at least one case reported this year.
Ongoing measles activity in Europe and globally poses a threat to international travellers and Scotland will continue to face an elevated risk of imported cases from other countries and other regions of the UK.
Vaccination information
More information on vaccines against measles can be found on the following page:
Vaccine uptake statistics
Vaccine uptake statistics are published in our childhood immunisation statistics quarterly report.
Meningococcal Disease
An error has been noted in the text in the pertussis (whooping cough) section of this report concerning 2017 data. The error was in the text only and did not affect the underlying data or any of the published figures. All publications affected are in the process of being updated.
An error has been noted in the vaccine preventable diseases summary table for 2022 measles data in this report. This error affects this table only. Correct data and figures were reported in the surveillance update for measles. All publications affected are in the process of being updated.
Background information
Meningococcal disease is an invasive infection of Neisseria meningitidis (N. meningitidis) bacteria in:
- blood
- cerebrospinal fluid (CSF)
- other normally sterile site
Meningococcal disease cases overwhelmingly show symptoms of meningitis (inflammation of the meninges) or septicaemia (blood poisoning). It can also present as a combination of both or as a rarer clinical presentation, such as joint infection. Meningitis can be caused by a variety of viruses or bacteria, of which N. meningitidis is one. Meningococcal disease is a significant cause of morbidity and mortality in children and young adults.
Although approximately 10% of the population are estimated to carry N. meningitidis in the nasopharynx, the vast majority do not have symptoms or develop invasive disease. Invasive cases acquire infection through inhalation of, or direct contact with, respiratory droplets, from either an infected person or asymptomatic carrier.
N. meningitidis is classified according to its outer membrane characteristics via a process known as serogrouping. There are several different serogroups, the most common of which in the UK is B, followed by W. Cases of serogroup Y, Z and C disease have also been reported.
In 1999, the Meningococcal Invasive Disease Augmented Surveillance (MIDAS) system was introduced.
The surveillance scheme is managed jointly by Public Health Scotland and the Scottish Haemophilus Legionella Meningococcus and Pneumococcus Reference Laboratory (SHLMPRL).
Surveillance data from MIDAS informs the epidemiology of meningococcal disease in Scotland, as analyses can be conducted according to:
- age
- serogroup
- molecular typing
- clinical presentation
- outcome
Against a background of declining cases of meningococcal disease in the UK, surveillance indicated that there had been an increase in cases of severe invasive disease caused by serogroup W (MenW) since 2009. Clinical follow up of cases revealed that intensive care admission was high, particularly among older children and young adults, and for the first time in a decade MenW was associated with fatal outcomes in children and adolescents. MenACWY vaccine was recommended by the Joint Committee on Vaccination and Immunisation (JCVI) and offered to 14 to 18-year-olds as a measure to address the increasing number of meningococcal serogroup W cases in this age group. A phased catch-up programme ran in Scotland between August 2015 and March 2016.
The vaccine was also offered to students under the age of 25 attending university for the first time from Autumn 2015. MenACWY vaccine continues to be offered routinely to those in secondary school year 3 (S3).
Surveillance update for July to September 2023
There were 14 cases of meningococcal disease reported in the third quarter of 2023, bringing the total number of cases to the end of the third quarter of 2023 to 38. This is higher than the number of cases reported for the same period in 2022 (n=19), 2021 (n=8) and 2020 (n=28), but lower than in 2019 (n=43) as shown in Figure 6.
Figure 7 shows the number of meningococcal disease cases, according to age group and by quarter from 2001 to the end of the third quarter of 2023.
To the end of the third quarter of 2023, there were:
- five cases aged under five years, three of whom were aged under one year
- 21 cases in the five to 24 years age group
- 12 cases in those aged 25 years or over
Of the 38 cases of meningococcal disease reported to the end of the third quarter of 2023:
- 26 were serogroup B
- one was serogroup W
- 11 cases were based on clinical diagnosis, as shown in Figure 8
Serogroup W cases continue to be reported separately following introduction of the MenACWY immunisation programme. Figure 9 demonstrates a positive impact of the MenACWY vaccine for the eligible population. One serogroup W case has been reported in 2023 so far (first quarter).
The number of deaths between 2003 and the end of the third quarter of 2023, reported by serogroup, is shown in Figure 10. There were three deaths from meningococcal disease to the end of quarter 3 of 2023.
See the vaccine-preventable disease summary for the number and incidence of invasive meningococcal disease in Scotland over the last 5 years.
Vaccination information
More information on vaccines against meningococcal disease can be found on the following pages:
Vaccine uptake statistics
Vaccine uptake statistics are published in our childhood immunisation statistics quarterly report.
Vaccine uptake statistics for the teenage MenACWY vaccine can be found at: Teenage booster immunisation statistics Scotland Publications - Public Health Scotland.
Mumps
An error has been noted in the text in the pertussis (whooping cough) section of this report concerning 2017 data. The error was in the text only and did not affect the underlying data or any of the published figures. All publications affected are in the process of being updated.
An error has been noted in the vaccine preventable diseases summary table for 2022 measles data in this report. This error affects this table only. Correct data and figures were reported in the surveillance update for measles. All publications affected are in the process of being updated.
Background information
Mumps is a disease resulting from infection by the mumps virus.
It was a common childhood disease prior to the introduction of the MMR vaccine in 1988, with more than 85% of adults having evidence of previous infection.
The rate of disease has decreased substantially following the introduction of the vaccine. However, there was a widespread increased incidence of mumps throughout the UK, from 2004 with the number of laboratory-confirmed cases peaking in 2005. These numbers substantially declined by 2008 although cases have remained higher than those reported before 2004.
Cases of mumps are commonly identified by laboratory testing based on positive PCR or IgM serology and reported to PHS, with only laboratory-confirmed cases presented in this report. However, many cases of mumps may be diagnosed clinically, with no laboratory confirmation testing, or go undiagnosed since individuals may not present to healthcare. Therefore, the reliance on laboratory reports may represent an underestimate of the true rate of disease in the community.
For more information on mumps, visit NHS Inform.
Surveillance update for July to September 2023
There were 14 cases of laboratory-confirmed mumps reported to the end of September 2023, nine of which were reported between January and March. In 2022 there were seven laboratory-confirmed cases of mumps reported in total.
Since April 2020, there has been a substantial reduction in number of cases of mumps reported with only one laboratory-confirmed case of mumps reported in 2021. As shown in Figure 11, outbreaks occurred in:
- 2009
- 2012
- 2014 to 2015
At these points in time, most of the individuals affected were adolescents and young adults in higher education who had not received two doses of MMR vaccine.
See Appendix 1 for the number and incidence of mumps in Scotland over the last five years.
In 2020, the majority of reported cases occurred in the first three months, as shown in Figure 12. The decrease in reported cases since April 2020 was likely a result of social distancing measures and restrictions implemented in response to the COVID-19 pandemic, which will also have interrupted the transmission of mumps. These measures also reduced attendance to the primary care setting, resulting in reduced opportunity to diagnose cases.
NHS boards experienced clusters of mumps into the first quarter of 2020, occurring mainly in adolescents and young adults. The observed increase in cases in 2019 and early 2020, prior to the implementation of COVID-19 social restriction measures, may have represented poorer initial immune response to the mumps component of the MMR vaccine, waning immunity, or a combination of both within fully and partially vaccinated individuals.
Age distribution of cases
Figure 13 shows that the majority of mumps cases in recent years have been in those aged 17 to 34 years.
Although the vaccination status of cases is not routinely collected, this is consistent with the age groups that are likely to be under-immunised with a mumps-containing vaccine, or for whom there is waning immunity.
The incidence of mumps by age group in 2020, shown in Figure 14, reflects a higher incidence among individuals aged 17 to 20 years compared to other ages (137 cases per 100,000 population).
This was followed by those aged 21 to 24 years (88 cases per 100,000 population).
*There is insufficient data from 2021, 2022 and 2023 to represent the ages of cases, therefore 2020 data has been presented to reflect the age distribution of cases, which is similar to that seen in previous years.
Vaccination information
More information on vaccines against mumps can be found on the following page:
Vaccine uptake statistics
Vaccine uptake statistics are published in our childhood immunisation statistics quarterly report.
Pertussis
An error has been noted in the text in the pertussis (whooping cough) section of this report concerning 2017 data. The error was in the text only and did not affect the underlying data or any of the published figures. All publications affected are in the process of being updated.
An error has been noted in the vaccine preventable diseases summary table for 2022 measles data in this report. This error affects this table only. Correct data and figures were reported in the surveillance update for measles. All publications affected are in the process of being updated.
Background information
Pertussis (or whooping cough) is an acute bacterial disease of the respiratory tract, resulting from infection with Bordetella pertussis.
It can affect people of all ages. Unimmunised infants are more likely to develop complications from pertussis infection which can require hospital treatment and, in severe cases, can be fatal. It is often less severe in adolescents and adults, however they may suffer a prolonged cough.
In response to the increase in cases and to protect young infants in the first few weeks of life until starting the routine childhood immunisation programme at eight weeks, a programme was introduced in October 2012 to offer pertussis vaccination to all pregnant women.
Pregnant women are typically vaccinated between gestational weeks 16 and 32 in order to protect newborn babies from disease before they are old enough to receive their first vaccine at 8 weeks. Antibodies that protect against disease, produced by the vaccinated mother, can be transferred across the placenta to protect the baby. Women may still be immunised after week 32 of pregnancy but this may not offer as high a level of passive immunological protection to the baby. Vaccination late in pregnancy may, however, directly protect the mother against disease and thereby reduce the risk of exposure to her infant. As pertussis continues to circulate in Scotland, immunisation of pregnant women and young children is vital.
The immunity that young infants receive from their mother, although very important in the first few weeks of life, offers only short-term protection. Therefore, it is important that infants are vaccinated as part of the routine childhood schedule on time to provide longer-term protection.
For more information on pertussis, visit NHS inform.
Surveillance update for July to September 2023
There were no cases of laboratory-confirmed pertussis in the first quarter of 2023, three cases reported in the second quarter, and 14 cases in quarter three, bringing the total number of cases to the end of September to 17. In 2022 and 2021, there were three and four cases of laboratory-confirmed pertussis reported, respectively.
In 2020, there were 198 laboratory reports of B. pertussis, the majority of which occurred in the first quarter of the year. This reduction is likely to be attributable to social distancing measures implemented to mitigate the transmission of COVID-19.
Figure 15 shows the number of positive laboratory reports of B. pertussis in Scotland from 2012 to the end of September 2023.
In 2012 and 2013, an outbreak occurred in Scotland, with 1,896 and 1,188 laboratory reports of pertussis, respectively.
Since then, the number of reports annually has been lower than those years:
- 533 in 2017
- 443 in 2018
- 746 in 2019
Age breakdown of cases
Figure 16 presents the percentage of cases of pertussis by age group and year from 2012 to the end of September 2023. Case numbers in 2021 and 2022 were low, and age distribution for those years should be interpreted in that context. Although 2023 has seen relatively low case numbers to the end of quarter three, the age distribution of cases appears to be returning to a similar picture to recent pre-COVID pandemic years.
Figure 17 presents the number of laboratory reports for pertussis by age group from January to December of 2020. The graph shows that the 50 to 59 age group accounted for the highest number of cases. However, incidence is consistently highest among children under one year of age as shown in Figure 18. Incidence of cases between 2016 and 2021 show a similar pattern across all age groups, all of which have displayed decreases over this time, except for a peak year in 2019.
*Data for 2020 is presented due to the low number of cases in 2021 (n=4), 2022 (n=3) and to the end of the third quarter of 2023 (n=17).
Vaccination information
More information on vaccines against pertussis can be found on the following pages:
Vaccine uptake statistics
Childhood vaccine uptake statistics are published in our childhood immunisation statistics quarterly report.
Invasive pneumococcal disease
An error has been noted in the text in the pertussis (whooping cough) section of this report concerning 2017 data. The error was in the text only and did not affect the underlying data or any of the published figures. All publications affected are in the process of being updated.
An error has been noted in the vaccine preventable diseases summary table for 2022 measles data in this report. This error affects this table only. Correct data and figures were reported in the surveillance update for measles. All publications affected are in the process of being updated.
Background information
Pneumococcal infections are defined as invasive or non-invasive according to which area of the body is affected. Invasive pneumococcal disease (IPD) is caused by infection of normally sterile sites, for example, blood and cerebrospinal fluid (CSF).
IPD is a major cause of morbidity and mortality, especially amongst:
- the very young
- the elderly
- those with impaired immunity
Non-invasive forms of the infection commonly cause:
- middle ear infection (otitis media)
- worsening of bronchitis
- pneumonia
As with most infectious respiratory diseases, the numbers of cases of pneumococcal infection peak during winter. Up to 50% of people can carry pneumococci in their nose and throat without developing serious infection.
Streptococcus pneumoniae (S. pneumoniae) is the bacterium responsible for causing pneumococcal infection and is characterised by its outer coat, known as capsular polysaccharide. Different capsular types can be distinguished via a process known as serotyping. Over 90 different types of pneumococci have been identified, about a quarter of which are known to cause serious illness.
For further information on pneumococcal disease, visit NHS inform.
IPD surveillance is based on local and reference laboratory reports confirming isolation of Streptococcus pneumoniae from sterile body sites, mainly blood and cerebrospinal fluid (CSF).
In 1999, the Scottish Pneumococcal Invasive Disease Enhanced Reporting (SPIDER) scheme was introduced. The enhanced surveillance scheme is jointly managed by Public Health Scotland and the Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory (SHLMPRL).
Data from SPIDER informs understanding of the epidemiology of IPD in Scotland.
Surveillance update July to September 2023
There were 79 cases of IPD reported in the third quarter of 2023, bringing the total for to the end of the third quarter of the year to 321.
This is higher than the number of cases reported for the same period in 2022 (n=233), 2021 (n=181) and 2020 (n=222), but lower than the number of cases reported in 2019 (n=429) as shown in Figure 19.
The lower number of cases of IPD observed since early 2020 is likely due to the impact of social distancing measures and other restrictions implemented in response to the COVID-19 pandemic.
Figure 20 presents data on cases by age group and indicates that the burden of IPD is in adults over 35 years. To the end of the third quarter of 2023:
- 150 cases were aged 65 years or older (46.7%)
- 115 cases were aged 35 to 64 years (35.8%)
- 15 cases were aged 15 to 34 years (4.7%)
- Four cases were aged five to 14 years (1.2%)
- 37 cases were aged under five years (11.5%), of whom seven were infants aged under one year
IPD in children under five years old
Of the 321 IPD cases reported to the end of the third quarter of 2023, 37 were children under five years of age, 34 of whom were old enough to have been eligible for at least a first dose of PCV13 vaccination.
This is the same as the number of cases in children aged under five years for the same period in 2022, but higher than case numbers for the same period in 2021 (n=23), 2020 (n=13) and 2019 (n=26).
Serotypes detected in children aged under five years, to the end of the third quarter, are shown in Table 1.
| serotype | <=2 mths | 3-11 mths | 1 yr | 2 yrs | 3 yrs | 4 yrs | Total < 5 years |
|---|---|---|---|---|---|---|---|
| 3 | 0 | 1 | 0 | 0 | 0 | 0 | 1 |
| 3A | 0 | 0 | 0 | 0 | 1 | 0 | 1 |
| 9N | 0 | 0 | 0 | 0 | 1 | 0 | 1 |
| 10A | 0 | 0 | 1 | 0 | 0 | 0 | 1 |
| 10B | 0 | 0 | 0 | 0 | 0 | 1 | 1 |
| 15C | 0 | 0 | 0 | 1 | 0 | 0 | 1 |
| 19A | 0 | 0 | 0 | 0 | 2 | 0 | 2 |
| 19F | 0 | 1 | 0 | 1 | 0 | 0 | 2 |
| 22F | 0 | 0 | 0 | 0 | 1 | 0 | 1 |
| 23A | 0 | 0 | 0 | 1 | 0 | 0 | 1 |
| 23B | 0 | 1 | 0 | 0 | 0 | 2 | 3 |
| 24F | 0 | 0 | 1 | 0 | 1 | 0 | 2 |
| 27 | 0 | 0 | 1 | 0 | 0 | 0 | 1 |
| 33F | 0 | 1 | 1 | 0 | 0 | 0 | 2 |
| 35B | 1 | 0 | 0 | 0 | 0 | 0 | 1 |
| NA* | 2 | 0 | 5 | 1 | 4 | 2 | 14 |
| Total | 3 | 4 | 11 | 4 | 11 | 4 | 37 |
*Typing results not available
Pneumonia and septicaemia were the most common clinical presentations in children aged under five years old.
Eleven of the 37 children aged under five years who had IPD to the end of the third quarter of 2023 were known to have an underlying condition.
Circulating serotypes of Streptococcus pneumoniae
All IPD isolates and specimens should be sent to the reference laboratory for further typing and antimicrobial sensitivity testing. Typing results were available for 256 of the 321 cases reported to the end of the third quarter of 2023. This accounts for 79.7% of the cases reported.
The three most common serotypes reported were:
- Serotype 3 (41 cases)
- Serotype 8 (37 cases)
- Serotype 22F (25 cases)
A total of 66 cases, or 25.7% of those with available typing results, were caused by serotypes covered by the PCV13 vaccine.
For the most recent information on antimicrobial resistance in Streptococcus pneumoniae, see Scottish One Health Antimicrobial Use and Antimicrobial Resistance in 2022.
Vaccination information
More information on vaccines against pneumococcal disease can be found on the following pages:
Vaccine uptake statistics
Vaccine uptake statistics for children are published in our childhood immunisation statistics quarterly report.
Poliomyelitis
An error has been noted in the text in the pertussis (whooping cough) section of this report concerning 2017 data. The error was in the text only and did not affect the underlying data or any of the published figures. All publications affected are in the process of being updated.
An error has been noted in the vaccine preventable diseases summary table for 2022 measles data in this report. This error affects this table only. Correct data and figures were reported in the surveillance update for measles. All publications affected are in the process of being updated.
Background information
Poliomyelitis (polio) is an acute viral illness caused by one of the three serotypes of poliovirus. Most infections cause no symptoms, but in a small number of people can result in a potentially life-threatening infection that can cause temporary or permanent paralysis.
People may become infected with the poliovirus through contact with infected faecal matter or respiratory secretions.
For more information on polio see NHS Inform.
Surveillance
Following the introduction of the vaccine, the number of cases fell rapidly:
- the last UK case of poliomyelitis caused by wild polio virus was in 1984.
- the last imported case of polio in the UK was 1993.
Poliovirus is targeted by the World Health Organization (WHO) for eradication and, due to the efforts of countries worldwide, polio is now eliminated from four of the six WHO regions. Pakistan and Afghanistan are considered the countries with the highest risk, where the virus is endemic. Polio outbreaks do occur in other countries when the disease is spread amongst people who may not be fully vaccinated. More information on those who may be at risk of exposure through travel can be found at our fitfortravel pages.
In early 2022, vaccine-derived poliovirus type 2 (VDPV2) was detected in sewage samples from London sewage works (for details, please visit: Poliovirus detected in sewage from North and East London - GOV.UK (www.gov.uk). These detections suggest some spread between closely linked individuals in areas of London. No associated cases of paralysis or human infections of poliovirus have been reported in the UK. This particular strain of poliovirus has been identified in wastewater elsewhere with cases of poliomyelitis in Israel and the USA. A full list of countries currently reporting circulating VDPV is available from the Polio Global Eradication Initiative (external site, PDF).
Vaccination Information
More information on vaccines against polio can be found on the following pages:
Vaccine uptake statistics
Vaccine uptake statistics for children are published in our childhood immunisation statistics quarterly report.
Rotavirus
An error has been noted in the text in the pertussis (whooping cough) section of this report concerning 2017 data. The error was in the text only and did not affect the underlying data or any of the published figures. All publications affected are in the process of being updated.
An error has been noted in the vaccine preventable diseases summary table for 2022 measles data in this report. This error affects this table only. Correct data and figures were reported in the surveillance update for measles. All publications affected are in the process of being updated.
Background information
Rotavirus is highly infectious and a leading cause of gastroenteritis in children worldwide. In Scotland, most children will have had at least one rotavirus infection by five years old.
Rotavirus infections in children and adults can last approximately three to eight days and symptoms include:
- severe diarrhoea
- vomiting
- stomach cramps
- mild fever
The combination of symptoms can lead to dehydration, requiring admission to hospital, especially in young infants.
Before the introduction of a national infant rotavirus vaccination programme in 2013, an estimated 55,000 gastroenteritis cases caused by rotavirus occurred in Scotland each year in children less than five years old. Approximately 1,200 of these children were hospitalised (2.2% of cases). Rotavirus reports peaked between February and April. This caused considerable additional pressure on the NHS, particularly in primary care and paediatric healthcare facilities.
In July 2013, Rotarix®, a live attenuated vaccine was introduced into the routine infant vaccination schedule in the UK, with doses given at 8 and 12 weeks.
For further advice on the transmission and prevention of rotavirus, visit NHS inform.
Surveillance update July to September 2023
Figure 21 shows the number of rotavirus laboratory reports in Scotland from 2011 to the end of September 2023. Please note that data differs slightly from previously published data due to a revalidation exercise.
Following the introduction of the immunisation programme, there was a marked reduction in the number of laboratory reports, which clearly demonstrates the impact of the vaccine.
A reduction of laboratory-confirmed rotavirus samples has also been seen in unvaccinated children suggestive of indirect population protection due to the vaccine. See the vaccine-preventable disease summary for the number and incidence of rotavirus laboratory reports in Scotland over the last 5 years.
Vaccination information
More information on the rotavirus vaccine can be found on the following page:
Vaccine uptake statistics
Vaccine uptake statistics are published in our childhood immunisation statistics quarterly report.
Rubella
An error has been noted in the text in the pertussis (whooping cough) section of this report concerning 2017 data. The error was in the text only and did not affect the underlying data or any of the published figures. All publications affected are in the process of being updated.
An error has been noted in the vaccine preventable diseases summary table for 2022 measles data in this report. This error affects this table only. Correct data and figures were reported in the surveillance update for measles. All publications affected are in the process of being updated.
Background information
Rubella is a rash illness caused by the rubella virus. It's generally a mild illness, but if acquired by women in the first 16 weeks of pregnancy can have devastating effects on the unborn child, leading to Congenital Rubella Syndrome (CRS). The virus can affect all foetal organs and lead to serious birth defects such as learning difficulties, cataracts, deafness, cardiac abnormalities, restriction of intrauterine growth and inflammatory lesions of the brain, liver, lungs and bone marrow
Before the introduction of rubella vaccination, more than 80% of adults had evidence of previous exposure to rubella.
A vaccination programme targeting girls and non-immune women of childbearing age was introduced in the UK in 1970 and reduced the number of congenital rubella syndrome (CRS)-related births and terminations.
In 1988, the Measles, Mumps and Rubella (MMR) vaccine was introduced for both boys and girls and further decreased cases of rubella to near elimination levels (Figure 22).
In 2016, the decision was made to end the national policy of screening for rubella susceptibility (external site, PDF) in pregnancy. This followed a review of evidence by the UK National Screening Committee and considering the high levels of uptake of the MMR vaccine.
For more information on rubella see NHS inform.
Surveillance update July to September 2023
No laboratory-confirmed cases of rubella were reported in the third quarter of 2023, with the last reported case of laboratory-confirmed rubella in Scotland reported in 2017.
Congenital rubella surveillance
Congenital rubella surveillance can be viewed on the Royal College of Paediatrics and Child Health (RCPCH) website.
Vaccination Information
More information on vaccines against rubella can be found on the following page:
Vaccine uptake statistics
Vaccine uptake statistics are published in our childhood immunisation statistics quarterly report.
Shingles
An error has been noted in the text in the pertussis (whooping cough) section of this report concerning 2017 data. The error was in the text only and did not affect the underlying data or any of the published figures. All publications affected are in the process of being updated.
An error has been noted in the vaccine preventable diseases summary table for 2022 measles data in this report. This error affects this table only. Correct data and figures were reported in the surveillance update for measles. All publications affected are in the process of being updated.
Background information
Shingles, also known as herpes zoster, is caused by reactivation of latent varicella zoster virus. Varicella zoster is the same virus that causes chickenpox.
Shingles is characterised by a painful skin rash. The main complication from shingles is post-herpetic neuralgia (PHN), a long-lasting neuropathic pain after the rash has disappeared.
PHN can persist for months or years and the risk and severity increases with age. Its effect can be very debilitating.
The Scottish Morbidity Record 01 (SMR01) is a national dataset held by the NHS Information Services Division and provides data on inpatient and day case admissions. It is used to investigate the burden of disease on hospital inpatient and day-case discharges from acute specialties from hospitals in Scotland.
Shingles surveillance data
Shingles is not a notifiable disease, so the number of hospital admissions for shingles and related complications are used to estimate the burden of shingles.
Figure 23 shows the rate of admissions per 100,000 population for shingles and related complications by age group between 2010 and 2022. In 2022, there were 268.6 hospital admissions per 100,000 population for shingles and related complications.
This graph shows that the rate of admissions is higher among the older age groups, which is why older age groups are offered shingles vaccine.
*Rates are calculated using an updated methodology, which differs from that previously used to estimate burden of disease. This is therefore not comparable to graphs in previous reports.
Vaccination information
More information on shingles vaccination can be found on the following page:
Vaccine uptake statistics
Tables 2 and 3 present the shingles Zostavax® vaccine coverage by NHS Board among the routine cohort (aged 70 years) and catch-up cohort (those aged between 71 and 79 years) for the most recent season 1 September 2021 to 31 August 2022. Table 4 presents the Scottish annual coverage in the routine cohort, catch up cohort and all eligible age groups from seasons 2015/2016 to 2021/2022. The Vaccine Management Tool is now used for recording shingles vaccination events and work is currently underway within PHS to develop public-facing dashboards for reporting up-to-date vaccine uptake/coverage statistics.
The national coverage in 2021 to 2022 for the routine cohort was 45.12%, an increase from the previous season 2020 to 2021 of 24.48%. The national coverage in 2021 to 2022 in the catch-up cohort was 63.08%, increased from 55.49% in the previous season.
| NHS Board | Number individuals in routine cohort* | Number of individuals in routine cohort vaccinated | Shingles vaccination coverage amongst routine cohort (%) |
|---|---|---|---|
| Ayrshire & Arran | 4,503 | 1,702 | 37.80 |
| Borders | 1,494 | 665 | 44.51 |
| Dumfries & Galloway | 2,002 | 1,314 | 65.63 |
| Fife | 3,530 | 1,616 | 45.78 |
| Forth Valley | 3,375 | 2,365 | 70.07 |
| Grampian | 5,666 | 1,112 | 19.63 |
| Greater Glasgow & Clyde | 10,657 | 6,557 | 61.53 |
| Highland | 4,093 | 1,414 | 34.55 |
| Lanarkshire | 6,621 | 1,503 | 22.70 |
| Lothian | 8,175 | 3,279 | 40.11 |
| Orkney | 280 | 145 | 51.79 |
| Shetland | 265 | 158 | 59.62 |
| Tayside | 4,515 | 2,974 | 65.87 |
| Western Isles | 353 | 250 | 70.82 |
| Scotland | 55,529 | 25,054 | 45.12 |
*The figures in this column are based on the number of individuals registered at a GP practice and may thus be slightly lower than the overall population in this age group.
| NHS Board | Number of individuals | Number of individuals vaccinated | Shingles vaccination coverage (%) |
|---|---|---|---|
| Ayrshire & Arran | 35,370 | 20,364 | 57.57 |
| Borders | 11,871 | 8,019 | 67.55 |
| Dumfries & Galloway | 15,746 | 9,775 | 62.08 |
| Fife | 27,746 | 18,574 | 66.94 |
| Forth Valley | 25,279 | 19,145 | 75.73 |
| Grampian | 41,989 | 24,563 | 58.50 |
| Greater Glasgow & Clyde | 76,754 | 47,460 | 61.83 |
| Highland | 30,892 | 19,362 | 62.68 |
| Lanarkshire | 48,940 | 26,522 | 54.19 |
| Lothian | 61,570 | 38,744 | 62.93 |
| Orkney | 2,162 | 1,585 | 73.31 |
| Shetland | 2,038 | 1,440 | 70.66 |
| Tayside | 35,393 | 26,539 | 74.98 |
| Western Isles | 2,659 | 1,847 | 69.46 |
| Scotland | 418,409 | 263,939 | 63.08 |
*The figures in this column are based on the number of individuals registered at a GP practice and may thus be slightly lower than the overall population in this age group.
| Year | Vaccination coverage in Routine cohort (70 years) | Vaccination coverage in in Catch up cohort (71 to 79 years) | Vaccination coverage in all eligible groups (70 to 79 years) |
|---|---|---|---|
| 2015 - 2016 | 54.41 | 33.07 | 35.60 |
| 2016 - 2017 | 46.56 | 43.64 | 44.01 |
| 2017 - 2018 | 44.88 | 50.64 | 49.75 |
| 2018 - 2019 | 41.88 | 58.31 | 56.10 |
| 2019 - 2020 | 40.17 | 60.66 | 58.08 |
| 2020- 2021 | 24.48 | 59.73 | 55.49 |
| 2021- 2022 | 45.12 | 63.08 | 60.98 |
Tetanus
An error has been noted in the text in the pertussis (whooping cough) section of this report concerning 2017 data. The error was in the text only and did not affect the underlying data or any of the published figures. All publications affected are in the process of being updated.
An error has been noted in the vaccine preventable diseases summary table for 2022 measles data in this report. This error affects this table only. Correct data and figures were reported in the surveillance update for measles. All publications affected are in the process of being updated.
Background information
Tetanus is a disease resulting from infection with the bacteria Clostridium tetani. These bacteria are common in the environment and are present in soil and the manure of animals. They may cause infection by producing a neurotoxin when they enter the body through a wound, burn, puncture or scratch.
The most common symptoms of infection are lockjaw, muscle spasms, fever, sweating and tachycardia (high heart rate). If not treated, symptoms can get worse over the following hours and days. Tetanus cannot spread from person to person although people who inject drugs (PWID) are at increased risk of infection, through sharing contaminated objects such as needles, and clusters of infection have been previously reported in PWID.
Immunisation against tetanus is the most effective method of prevention and has been part of the childhood immunisation schedule since 1961.
For more information on tetanus see NHS Inform.
Surveillance
No cases of tetanus have been reported in Scotland since 2014. Data on the annual reported cases of tetanus in England from the UKHSA can be found on Tetanus in England: annual reports - GOV.UK (www.gov.uk).
Vaccination information
Find out more information about vaccines against tetanus:
Vaccine uptake statistics
Vaccine uptake statistics for children are published in our childhood immunisation statistics quarterly report.
Vaccine-preventable disease summary
An error has been noted in the text in the pertussis (whooping cough) section of this report concerning 2017 data. The error was in the text only and did not affect the underlying data or any of the published figures. All publications affected are in the process of being updated.
An error has been noted in the vaccine preventable diseases summary table for 2022 measles data in this report. This error affects this table only. Correct data and figures were reported in the surveillance update for measles. All publications affected are in the process of being updated.
| Disease | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| H. Influenzae | 82 | 83 | 51 | 51 | 74 |
| Invasive Pneumococcal disease | 621 | 610 | 274 | 286 | 374 |
| Measles | 2 | 18 | 0 | 0 | 0 |
| Meningococcal disease | 74 | 59 | 33 | 17 | 29 |
| Mumps | 281 | 784 | 864 | 1 | 7 |
| Pertussis | 443 | 746 | 198 | 4 | 3 |
| Rotavirus* | 446 | 272 | 257 | 112 | 102 |
* Please note that rotavirus data differs slightly from previously published data due to a revalidation exercise.
| Disease | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| H. Influenzae | 1.51 | 1.52 | 0.93 | 0.93 | 1.35 |
| Invasive Pneumococcal disease | 11.42 | 11.17 | 5.01 | 5.22 | 6.82 |
| Measles | 0.04 | 0.33 | 0.00 | 0.00 | 0.00 |
| Meningococcal disease | 1.36 | 1.08 | 0.6 | 0.31 | 0.53 |
| Mumps | 5.17 | 14.35 | 15.81 | 0.02 | 0.13 |
| Pertussis | 8.15 | 13.65 | 3.62 | 0.07 | 0.05 |
| Rotavirus* | 8.22 | 5.00 | 4.70 | 2.05 | 1.86 |
* Please note that rotavirus data differs slightly from previously published data due to a revalidation exercise.