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24th June 2017

WorldHealthOrganizationNews@who.int

Statement from UNICEF Executive Director Anthony Lake and WHO Director-General Margaret Chan on the cholera outbreak in Yemen as suspected cases exceed 200,000
 
NEW YORK/GENEVA, 24 June 2017 – The rapidly spreading cholera outbreak in Yemen has exceeded 200,000 suspected cases, increasing at an average of 5,000 a day. We are now facing the worst cholera outbreak in the world. 
 
In just two months, cholera has spread to almost every governorate of this war-torn country.  Already more than 1,300 people have died – one quarter of them children – and the death toll is expected to rise. 
 
UNICEF, WHO and our partners are racing to stop the acceleration of this deadly outbreak. We are working around the clock to detect and track the spread of disease and to reach people with clean water, adequate sanitation and medical treatment. Rapid response teams are going house-to-house to reach families with information about how to protect themselves by cleaning and storing drinking water. 
 
UNICEF and WHO are taking all measures to scale up prevention and treatment interventions.  We call on authorities in Yemen to strengthen their internal efforts to stop the outbreak from spreading further.  
 
This deadly cholera outbreak is the direct consequence of two years of heavy conflict. Collapsing health, water and sanitation systems have cut off 14.5 million people from regular access to clean water and sanitation, increasing the ability of the disease to spread.  Rising rates of malnutrition have weakened children’s health and made them more vulnerable to disease.  An estimated 30,000 dedicated local health workers who play the largest role in ending this outbreak have not been paid their salaries for nearly 10 months.
 
We urge all authorities inside the country to pay these salaries and, above all, we call on all parties to end this devastating conflict.
 
Anthony Lake
Executive Director
UNICEF
 
Dr Margaret Chan
Director-General
World Health Organization
Date: Mon, 19 Jun 2017 10:59:59 +0200
By Thomas Cabral with Brigitte Hagemann in Lisbon

Pedrógão Grande, Portugal, June 19, 2017 (AFP) - More than 1,000 firefighters on Monday battled a giant forest fire that swept through central Portugal at the weekend, killing at least 62 people.

The country was in mourning after the deadliest such disaster in Portugal's recent history, with many victims burnt as they were trapped in their cars.   "The fire has reached a level of human tragedy that we have never seen before," said a visibly moved Prime Minister Antonio Costa, who announced three days of mourning from Sunday.   Portugal's national route 236 was transformed into a road of hell as the ferocious blaze ripped through the wooded countryside around the epicentre in Pedrogao Grande.

Although the searing temperatures in Portugal had dropped slightly on Monday, the fire was still raging, spreading to neighbouring regions of Castelo Branco and Coimbra.   Firefighters were continuing a grim search for bodies, with Costa warning on Sunday that the death toll could still rise.   Police chief Almeida Rodrigues blamed dry thunderstorms for the blaze which broke out on Saturday in Pedrogao Grande, saying a tree had been struck by lightning.

"Everything burnt very quickly given the strong winds. The flames passed within two or three kilometres of my house," said local resident Isabel Ferreira, 62.   "I knew several of the victims. One of my colleagues lost her mother and her four-year-old girl as she could not get them out of the back of the car."   The expanse of wooded hills in the area north of Lisbon, which 24 hours before had glowed bright green with eucalyptus plants and pine trees, was gutted by the flames.

A thick layer of white smoke blanketed either side of a motorway for about 20 kilometres (12 miles) on Sunday, as blackened trees leaned listlessly over charred soil.   A burnt-out car sat outside partly destroyed and abandoned houses, while a few metres away police in face masks surrounded the corpse of a man hidden under a white sheet.

- 'Everything burnt quickly' -
Secretary of State for the Interior Jorge Gomes said 18 of those burned to death had been trapped in their cars engulfed by flames on the road between Figueiro dos Vinhos and Castanheira de Pera.   Other bodies were found in houses in isolated areas. At least three villages near Pedrogao Grande were evacuated.

Another 62 people were injured, with five in a critical state including a child and four firefighters.   Luisilda Malheiro and her husband Eduardo Abreu, a couple of farmers, both 62, escaped the hellish route N-236.   "We escaped in time, me on the tractor and he with our van," Luisilda said.   "Our house is still there but we lost everything else: the chickens, the rabbits and the ducks. We were only able to save two goats," she said.

The international community stepped in to help, with the European Union and neighbouring Spain offering water-bombing planes   "I am shocked and horrified by the many lives claimed by today's devastating fires," said UN Secretary General Antonio Guterres, who comes from Portugal.   "The United Nations stands ready to assist in any way possible," he said.

- 'Sharing their pain' -
Portugal was sweltering under a severe heatwave over the weekend, with temperatures topping 40 degrees Celsius (104 degrees Fahrenheit) in several regions.   About 35 forest fires continued to burn across the country on Monday, with more than 2,000 firefighters and 660 vehicles mobilised.

Dozens of people who fled their homes were taken in by residents of the nearby municipality of Ansiao.    "There are people who arrived saying they didn't want to die in their homes, which were surrounded by flames," said Ansiao resident Ricardo Tristao.   President Marcelo Rebelo went to the Leiria region to meet victims' families, saying he was "sharing their pain in the name of all the Portuguese people". 

Portugal was hit by a series of fires last year which devastated more than 100,000 hectares (1,000 square kilometres) of the mainland.    Fires on the tourist island of Madeira in August killed three people, while across 2016 around 40 homes were destroyed and 5,400 hectares of land burned.    In 1966, a blaze in the forest of Sintra, west of Lisbon killed 25 soldiers trying to battle the flames.
Date: Mon, 19 Jun 2017 06:14:53 +0200
By Serge DANIEL

Bamako, June 19, 2017 (AFP) - Suspected jihadists crying "Allahu Akbar" stormed a tourist resort popular with foreigners on the edge of the Malian capital Bamako on Sunday, briefly seizing more than 30 hostages and leaving at least two people dead.   The assault on the Kangaba Le Campement resort comes after a similar strike less than two years ago on a luxury hotel in Bamako, which lies in the south of the troubled country.

Four assailants were killed by security forces, Mali's security minister said late Sunday, without specifying if more were on the run.   Nearby residents had first reported the attack after hearing shots while smoke billowed into the air, with at least one building ablaze.   "It is a jihadist attack. Malian special forces intervened," Security Minister Salif Traore told AFP, adding that two people had been killed, including a Franco-Gabonese.

He later told journalists that "we have recovered the bodies of two attackers who were killed" and were searching for the bodies of two others.   "We were able to rescue around 36 guests and workers from the resort", including around 15 French nationals and a similar number of Malians, he added.   The special forces were supported by UN soldiers and French counter-terrorism troops.   Mali's army earlier said that one of the attackers was wounded and gave up his weapon. He also left behind "bottles containing some explosive substances", the security ministry said.

At least 14 people, both Malians and foreigners, were injured, according to the ministry.   A witness interviewed on local television ORTM said he saw a man arrive on a motorcycle who "started shooting at the crowd" followed by "two or three people" who came in another vehicle.   The landlocked west African country has been fighting a jihadist insurgency for several years, with Islamist fighters roaming the north and centre of Mali.   French President Emmanuel Macron, who is scheduled to visit Bamako on July 2 for a meeting with five Sahel countries, "is following the situation very closely," the presidency told AFP Sunday.

- 'Increased threat of attacks' -
Several people rescued at Kangaba said assailants had shouted "Allahu Akbar (God is Greatest)", although no group has yet claimed responsibility.   The US embassy in Bamako had warned earlier this month "of a possible increased threat of attacks against Western diplomatic missions, places of worship, and other locations in Bamako where Westerners frequent".   At a France-Africa summit in Bamako in January, the owner of Kangaba, Herve Depardieu, had complained about the "alarming security information" given by foreign consulates "which seriously disturb our love of life and our freedoms".

In November 2015, gunmen took guests and staff hostage at the luxury Radisson Blu hotel in Bamako in a siege that left at least 20 people dead, including 14 foreigners.   That attack was claimed by Al-Qaeda's North African affiliate Al-Qaeda in the Islamic Maghreb (AQIM).   In March the same year, a grenade and gun attack on La Terrasse nightclub in Bamako killed five people, including foreigners.   The Kangaba, located on the eastern edge of Bamako, boasts accommodation in hut-style rooms, as well as restaurants and swimming pools, according to its website.

- State of emergency -
A state of emergency has been renewed several times since the Radisson Blu attack, most recently in April when it was extended for six months, but attacks are continuing.   In 2012 Mali's north fell under the control of jihadist groups linked to Al-Qaeda who hijacked an ethnic Tuareg-led rebel uprising, though the Islamists were largely ousted by a French-led military operation in January 2013.

But jihadists have continued to mount numerous attacks on civilians and the army, as well as on French and UN forces still stationed there.   The unrest has continued despite a 2015 peace deal between the government and Tuareg-led rebels offering partial autonomy to the north.   Sunday's attack is the latest in a series of high-profile assaults in north and west Africa, targeting locals and tourists.   In January 2016, 30 people were killed, including many foreigners, in an attack on a top Burkina Faso hotel and a nearby restaurant in the capital Ouagadougou. AQIM claimed the assault, saying the gunmen were from the Al-Murabitoun group of Algerian extremist Mokhtar Belmokhtar.

In March 2016, at least 14 civilians and two special forces troops were killed when gunmen stormed the Ivorian beach resort of Grand-Bassam, which was also claimed by AQIM.   The United Nations has a 12,000-strong force in Mali known as MINUSMA, which began operations in 2013.   It has been targeted constantly by jihadists, with dozens of peacekeepers killed, including five on Saturday.   France also has 4,000 soldiers in its Bakhane force in five countries -- Mali, Mauritania, Niger, Chad and Burkina Faso -- all of which are threatened by the jihadists across their porous borders.
Date: Sun, 18 Jun 2017 18:23:41 +0200
By Valeria PACHECO

Bogota, June 18, 2017 (AFP) - Colombia's leaders and main rebel groups pledged Sunday that a mall bombing that killed three women would not disrupt the country's peace process, though authorities were scrambling to discover who was responsible for the carnage.   The victims -- two Colombians and a Frenchwoman -- perished when a device exploded in a ladies' toilet in the crowded Andino shopping center in Bogota on Saturday. At least nine people were also wounded, officials said.   President Juan Manuel Santos called the incident a terrorist attack.   Rebel groups condemned the blast and said it was an attempt to undermine their steps along with the government to end Colombia's half-century civil conflict.

Police said the explosion occurred at about 5:00 pm (2200 GMT) on Saturday, leaving people to run for their lives in panic.   "There was a strong boom and the floor shook," said shop worker Milena Carcenas.    "There was smoke coming out of the bathroom. People were coming out of there covered in ash."   National police chief General Jorge Nieto told reporters "a device" was placed "behind one of the toilets in the women's bathroom."   Witness Andres Bermudez, his hands still trembling after the attack, said people were crying at the scene.   "It's a miracle I'm alive," he told AFP outside the mall, which he was visiting to pay some bills.

- Raining on peace -
The explosion comes at a delicate time for Colombia's historic peace process. The country's biggest rebel group, the Revolutionary Armed Forces of Colombia (FARC), is scheduled to complete its disarmament by Tuesday.   The last active rebel force, the National Liberation Army (ELN), meanwhile, has started talks with the government, though confrontations with state forces have been continuing.

"Those who want to rain on the peace parade will not succeed," said Santos, who won a Nobel Peace Prize last year for sealing an accord with FARC leaders.   "If this (bombing) is that kind of gesture, then rest assured that we will pursue those enemies of peace without rest and without quarter," he said, speaking at the site of the blast.   The peace deal was initially narrowly rejected by Colombians in a referendum, with critics saying it had been too lenient on the FARC.   A redrafted agreement from Santos and the FARC has since been pushed through congress.

- Life as normal -
"Terrorists are not going to change our ways," Santos said, urging Colombians to continue their normal lives and enjoy the Father's Day holiday, though he did not identify who could be behind Saturday's attack.   A security council meeting will take place Sunday "to discuss further steps to ensure calm in Bogota," he added.   Bogota Mayor Enrique Penalosa called Saturday's incident "a cowardly terrorist attack."

He said the Frenchwoman who died, aged 23, had spent six months working in a school in a poor neighbourhood.   The leftist ELN said on Twitter it "condemns this deplorable incident," noting that the attack was "against civilians."   "We share the pain and stand in solidarity with the victims," the group wrote. "The state should investigate thoroughly to identify those responsible."   The leader of the communist-inspired FARC, Rodrigo Londono -- known as Timochenko -- also denounced the explosion.   "This act can only come from those who want to close the roads of peace and reconciliation," he wrote on Twitter.    The blast was the second major attack this year in the Colombian capital.   In February the ELN claimed responsibility for a bombing at a bullring in Bogota, which killed a police officer and wounded more than 20 people.

- 'Far-right paramilitary' theory -
Colombia's civil conflict erupted in 1964 over land rights. It has drawn in leftist guerrillas, right-wing paramilitary groups and state forces.   Analyst Victor Currea-Logo of Colombia's National University said it was unlikely either of the leftist groups involved in the peace drive would have carried out the attack.   But he told AFP: "There are some far-right paramilitary-style groups who have been responsible for killing civil leaders and for actions against the peace effort."   Efforts to disrupt the process, however, is unlikely he said, citing public support for peace.
Date: Sun, 18 Jun 2017 16:10:26 +0200

Stockholm, June 18, 2017 (AFP) - Four people were listed as missing Sunday after an earthquake sparked a tsunami off Greenland and forced some residents to be evacuated.   "Four people are missing," local broadcaster KNR quoted local police chief Bjorn Tegner Bay as telling a news conference in the autonomous Danish territory.   There were no confirmed fatalities, but Bay said 11 houses had been swept away after a magnitude 4 overnight quake off Uummannaq, a small island well above the Arctic Circle.    "The huge waves risk breaking over Upernavik and its environs. The residents of Nuugaatsiaq are going to be evacuated," police said on Facebook, referring to nearby hamlets.

Some residents posted images to social media showing huge waves breaking over buildings in the town.   "A good explanation is that the quake created a fault at the origin of a tsunami," meteorologist Trine Dahl Jensen told Danish news agency Ritzau, warning of potential aftershocks.   "It's not normal, such a large quake in Greenland," she said.   KNR quoted Ole Dorph, mayor of Qaasuisup, a municipality in the area affected, as lamenting "a serious and tragic natural catastrophe which has affected the whole region."   Danish Prime Minister Lars Lokke Rasmussen tweeted news of what he termed a "terrible natural catastrophe at Nuugaatsiaq."   The world's largest island situated between the North Atlantic and Arctic oceans, Greenland, population 55,000, has an ice sheet particularly vulnerable to climate change.
Date: Sat, 17 Jun 2017 00:01:56 +0200

Cancún, Mexico, June 16, 2017 (AFP) - Three dismembered bodies stuffed in suitcases were found Friday in Cancun, hours after the Mexican resort town was rocked by a shootout and police chase that left one gunman dead.   It was unclear whether there was a link between the grisly discovery near the Caribbean beach and the dramatic shootout Thursday night, which terrorized the downtown area.   Cancun, a tourist paradise popular with foreign travelers, has seen a surge in violence in recent months that authorities blame on warring drug cartels.

The dismembered bodies, which have not yet been identified, were found near a mangrove at the edge of the hotel zone, a local security official who was not authorized to talk about the case told AFP on condition of anonymity.   Some six hours earlier, a police operation went awry when a group of suspects opened fire on officers who had come to arrest them.

They then led police on a high-speed chase through the city center, a hail of bullets terrifying residents and passers-by.   One suspect was killed. Four others were arrested.   The incidents come as Cancun prepares to host foreign ministers from around the region next week for a meeting of the Organization of American States.   In April, authorities deployed 1,000 police and army reinforcements in Cancun and the nearby resort town Playa del Carmen in response to a string of multiple shootings.
Date: Sat 17 Jun 2017
Source: Outbreak News Today [edited]

One person has died from the bacterial infection leptospirosis.

The Cordillera Administrative Region in northern Luzon, Philippines has seen a 40 percent rise in the disease during the 1st 6 months of 2017 compared to the same period last year [2016], according to the Department of Health, Cordillera Administrative Region (DOH-CAR).

DOH records show that Baguio City and Kalinga province had the largest number of cases at 21.4%, followed by Benguet and Ifugao provinces (14.3%), and Apayao (7.1%). Flash floods in some regions have been linked to the increase.

Geeny Austria, Nurse V of DOH-CAR, advised: "Please keep out of flooded areas, and wear proper protective gear when going out during rainy season to avoid being infected with the disease."

Leptospirosis, caused by a corkscrew-shaped bacterium called _Leptospira interrogans_, is often referred to as "rat fever" due to the principal role rats play in spreading the disease (scientists refer to this type of animal as a reservoir host). Other animals can also be important reservoirs of the disease.

These animals can spread the disease in their urine, contaminating water, soil, or food. People who live in close contact with domestic animals or wildlife are at higher risk for getting the disease.

People become infected by coming into contact with contaminated urine, water, food, or soil through breaks in the skin, eyes, mouth, or nose. Outbreaks of leptospirosis are usually caused by exposure to contaminated water, such as floodwaters. Person-to-person transmission is rare.

Infected individuals initially experience fever, severe headache and muscle aches, abdominal pain, and occasionally a skin rash. Patients in the later stages of disease can suffer from jaundice, kidney failure, bleeding from the mouth or nose, and bloody urine, and the disease can be fatal, especially without proper treatment.
===================
[Leptospirosis is an infection transmitted to humans by exposure to soil or fresh water contaminated with the urine of wild and domestic animals (including dogs, cattle, swine, and especially rodents) that are chronically infected with pathogenic _Leptospira_. The spirochete _Leptospira_ may survive in contaminated fresh water or moist soil for weeks to months. Outbreaks of leptospirosis frequently follow heavy rainfall, flooding with fresh water, and increasing rodent numbers.

Cordillera Administrative Region (CAR) is a landlocked region on the island of Luzon with 6 provinces: Abra, Apayao, Benguet, Ifugao, Kalinga and Mountain Province. The regional center is Baguio City, located in Benguet province and 247 km (153 miles) north of Manila, the capital of the Philippines (<https://www.google.com/maps/dir/Manila,+Metro+Manila,+Philippines/Baguio,+Benguet,+Philippines>).

A map showing the provinces of CAR can be found at

For a discussion of leptospirosis in Manila, see ProMED-mail posts Leptospirosis - Philippines: (Metro Manila) flooding

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/1z-3>. - ProMED Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Sun 18 Jun 2017
Source: XinHuaNet [edited]

The death toll from cholera in war-torn Yemen has increased to 1054 since 27 Apr 2017, with the total suspected cases reaching 151,000, the Yemeni health authorities said on Sat 17 Jun 2017 in a statement published by Saba news agency.

Earlier in June 2017, the United Nations International Children's Emergency Fund (UNICEF) expected suspected cases could hit 130,000 in 2 weeks, while last month [May 2017], WHO expected they could reach 300 000 in the next 6 months. The outbreak has spread fast in 20 out of 22 Yemeni governorates in just 7 weeks, since 27 Apr 2017.

Yemen is facing total collapse as the war continues. 2/3rds of the total population, around 19 million, need humanitarian and protection aid. About 10.3 million people are close to famine, and 14.5 million lack access to safe drinking water. Less than 45 percent of the country's hospitals are operational at the moment, but even the operational ones are coping with huge challenges, on top of which is a lack of medications, medical equipment and staffs.

The blockade on Yemen, part of a Saudi-led bombing campaign launched in March 2015, has deepened the crisis in the country, which used to import most of its basic needs.
Date: Thu 8 Jun 2017
Source: Correodelcaroni.com [in Spanish, trans. KS, edited]
<http://www.correodelcaroni.com/index.php/mas/salud/item/56645-brote-de-paludismo-mata-a-tres-personas-en-zona-rural-de-ciudad-guayana>

The malaria outbreak has killed 3 people in the rural region of Ciudad Guayana, Bolivar state. Malaria continues to advance in the Ciudad Guayana area at never before seen levels. While 2 years ago in Caroni there were just over 100 cases, the Guayana mayor said in a press release on 5 Jun 2017 that malaria currently "affects more than 50 percent of the population of Guayana."

The most affected parish of Ciudad Guayana is Pozo Verde. On Tuesday [6 Jun 2017], residents protested at the outpatient clinic to warn that 3 people have already died from the malaria epidemic due to the shortage of antimalarial drugs and drugs in general in this rural area, located on the road to El Pao.

The protest began because today [8 Jun 2017], an elderly man died inside the outpatient clinic of Pozo Verde, "and the family told us it was due to malaria. The problem with malaria there is serious," confirmed Antonio Agrimón, a spokesman for Pozo Verde's Circle of Popular Struggle (CLP) number 3. The activist has followed the progress of malaria in the parish as he participates in neighbourhood efforts to equip the Pozo Verde clinic with more supplies. "I know that yesterday (7 Jun 2017) they received a large lot of drugs (anti malaria), but they were used up by this morning. The problem is widespread; many people are sick."

The death of the elderly man this morning [8 Jun 2017] comes on top of the deaths of a young girl and an adult woman over the weekend, according to Joel Freites, another activist in the area. "We are talking about 3 dead this week alone. We know that there are more so far this year [2017], but I do not have the names at hand," said the spokesman. Agrimón added that some 700 malaria tests are processed daily in the Pozo Verde outpatient clinic "and 90 percent of them are positive." This Tuesday [13 Jun 2017?] at 3:00 p.m. they expect to receive another batch of anti-malarial medicine, which must be taken daily for 15 continuous days. If a day is missed, the treatment loses effectiveness.

According to the Epidemiological Bulletin of the Ministry of Health, malaria increased by 76.4 percent throughout the country between 2015 and 2016, for a total of 240 613 malaria sufferers in Venezuela. Of the total, 177 619 of the infected are located in the state of Bolívar. "Malaria is a tragedy that is being lived in Pozo Verde. It has to do with people who are going to the mines to look for opportunities. There has been a problem for some time, but now a rebound has emerged like never before," Freites said.

Malaria is a disease transmitted by the Anopheles mosquito, which typically reproduces in jungle ecosystems. The municipality of Sifontes, south of Bolivar, has always been the national leader in the number of malaria infections. By the end of 2016, they had reported 102 543 confirmed cases, according to the Epidemiological Bulletin of the Ministry of Health.

The lack of public health systems has resulted in mine workers becoming infected with malaria then carrying the sickness to the municipality of Caroní, where the disease has rapidly spread. According to the Epidemiological Bulletin, the municipality of Caroni reported 8138 cases of malaria in 2016, a massive increase from 2015, when they only reported 922. The parish with the highest number of cases is Pozo Verde, which at the end of 2016 had 6412 malaria infections. The Ministry of Health has not updated the figures of the Epidemiological Bulletin for June 2017, but the residents of the sector confirm that "every day there are more cases."

Freites clarified that "there are people who say that they have had malaria several times, but that is not so; it is the same parasite that has not been exterminated; they have not really recovered; ...that is because there is no medicine." The respondents said that at the Pozo Verde outpatient clinic, IV fluids and equipment necessary to help the dehydrated patients are scarce.

"There are people who are healthy and can resist the disease, but hypertensive, obese, diabetic, or pregnant people are at risk if they get malaria," said Freites, referring to risky -- potentially deadly -- cases. It is worth mentioning that a year ago, residents of Puerto Libre in the Cachamay parish also protested after the deaths of 3 people in the community suffering from malaria, and to demand the government fumigate in their sector.

On 5 Jun 2017, the Social Development Department of the Caroní City Council donated 3 microscopes to carry out malaria tests for patients in Pozo Verde, 5 de Julio and Yocoima, the "parishes with the highest number of people affected" by malaria in Caroní, according to this institution. It was in this communication that the municipality revealed that more than 50 percent of the population of Ciudad Guayana is affected by malaria. Correo del Caroní has been able to confirm the rapid advance of the disease in the city between 2016 and 2017, including the parish Vista al Sol, a town that until 2 years ago had not reported any cases.

"We are going to make an extensive investigation of inhabitants of the municipality of Caroní with the purpose of attacking malaria from the root and thus proceed to the delivery of medicines and fumigation in each community of Ciudad Guayana," said the press release by the political secretary of the Mayor's Office, Roy Quiaragua. The official said that "in the coming weeks" the Social Patriotic Services Corporation will clean up stagnant water in rural parishes "to strengthen the fight against malaria."

The actions of the municipality do not include days of fumigation or distribution of mosquito nets with insecticides, measures that are essential to eradicate malaria according to the World Health Organization (WHO). Currently, malaria is a disease eradicated from the 1st world. Venezuela has been experiencing an unprecedented upswing in the last year, which shows the ineffectiveness of epidemiological control in the local and national public health system.
=================
 [ProMED has been reporting on the evolving return of malaria to Venezuela over the past few years. A recent map from the CDC (Atlanta) indicates that risk of malaria exists in the whole country, and all visitors are advised to take malaria prophylaxis (<https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/yellow-fever-malaria-information-by-country/venezuela#5337>). - ProMED Mod.EP]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/55916>.]
Date: 4-10 Jun 2017 [latest update: 9 Jun 2017]
Source: ECDC Communicable Disease Threats Report [edited]
<http://ecdc.europa.eu/en/publications/Publications/Communicable-disease-threats-report-9-june-2017.pdf>

Yellow fever is a mosquito-borne viral infection present in some tropical areas of Africa and South America. On 6 Jan 2017, Brazil reported an outbreak of yellow fever that started in December 2016 and is still ongoing. Bolivia, Colombia, Ecuador, Peru and Suriname have also reported cases of yellow fever in 2017.

Between 18-31 May 2017, Brazil has reported 34 additional confirmed cases of yellow fever in the states of Espírito Santo (24 [cases]), Minas Gerais (5), Rio de Janeiro (3), Distrito Federal (1) and Mato Grosso (1). These are the 1st confirmed cases of locally-acquired yellow fever in Distrito Federal and Mato Grosso since the beginning of the outbreak.
========================= 
Date: Sat 17 Jun 2016
Source: Relief Web [edited]
<http://reliefweb.int/report/brazil/brazil-yellow-fever-dref-operations-update-n-1-mdrbr008>

Brazil is experiencing its largest outbreak of yellow fever in decades; the outbreak is mainly occurring in the states of Minas Gerais and Espiritu Santo, which have the largest number of confirmed cases. However, the disease has spread to other regions in the country, affecting 407 municipalities. On 13 Jan 2017, the Ministry of Health declared a public health emergency in the state of Minas Gerais.

According to the last epidemiological report from the Ministry of Health dated 31 May 2017, the distribution of cases and deaths have doubled and expanded since this Disaster Relief Emergency Fund (DREF) was published; this report further states that 3240 suspected cases of wild-type yellow fever were reported, of which 792 were confirmed (24.5 percent), 519 are still being studied (16 percent), and 1929 (59.5 percent) were ruled out, with a fatality rate of 34.5 percent. In total, 83.1 percent of the cases involved men between 16 and 65 years of age.
=========================
[Apparently, the yellow fever (YF) outbreak in Brazil is not over. The latest PAHO/WHO summary for Brazil issued on 24 May 2017 indicated that the last human cases occurred during week 16 (6-22 Apr 2017). The above report indicates that cases have occurred after that time. The reported cases are presumably human ones and not monkeys.

Cases in non-human primates have been very widespread in Brazil this year (2017), having been reported in the Federal District and in the states of Alagoas, Amazonas, Bahia, Goiás, Espírito Santo, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Paraíba, Paraná, Pernambuco, Rio Grande do Norte, Rio Grande do Sul, Rio de Janeiro, Rondônia, Roraima, Santa Catarina, São Paulo, Sergipe, and Tocantins.

(see Yellow fever - Americas (47): Brazil, PAHO/WHO Archive Number: http://promedmail.org/post/20170530.5071826). The above 34 recent, confirmed cases are probably spill-over from the sylvan (forest) cycle of transmission and not the urban, _Aedes aegypti_ transmitted cycle, or surely that would have been mentioned, and the alarm bells would have been sounded.

Maps of Brazil can be accessed at
<http://s13.postimg.org/jumnalk87/map_of_Brazil.gif> and
<http://healthmap.org/promed/p/6>.

A map showing the South American countries mentioned can be accessed at
<http://www.worldatlas.com/webimage/countrys/samerica/southamericalarge.jpg>. - ProMED Mod.TY]
 
[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/6>.]