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Date: Thu, 11 Jan 2018 21:08:33 +0100

Yangon, Jan 11, 2018 (AFP) - A strong 6.0-magnitude earthquake hit a remote region of central Myanmar early Friday, the US Geological Survey said.   The shallow quake struck some 40 kilometres (24 miles) west of the town of Pyu, the USGS said. It was followed by three weaker tremors in the region, all of magnitudes 5.3, the survey reported.   "There is a low likelihood of casualties and damage," USGS said, but noted that residential structures in the region are typically vulnerable to earthquake shaking.

The epicentre was located in a sparsely populated region between the capital Naypyidaw to the north and commercial hub Yangon to the south, at least 150 kilometres from each.   Earthquakes are relatively common in Myanmar, where six strong quakes of 7.0 magnitude or more struck between 1930 and 1956 near the Sagaing Fault, which runs north to south through the centre of the country, according to the USGS.

A powerful 6.8-magnitude earthquake in the ancient capital Bagan in central Myanmar killed three people in 2016, also toppling spires and crumbling temple walls at the tourist destination.   In November 2012, another powerful 6.8 magnitude earthquake struck the centre of the country, killing 26 people and injuring hundreds.

The impoverished Southeast Asian nation has a strained medical system, especially in its rural states.   The breakneck pace of development in Myanmar's cities, combined with crumbling infrastructure and poor urban planning, has also made the country's most populous areas vulnerable to earthquakes and other disasters, experts say.   There were no immediate reports of casualties on Friday.
Date: Thu, 11 Jan 2018 15:25:43 +0100

Tehran, Jan 11, 2018 (AFP) - A series of six moderate earthquakes shook Iran on Thursday, lightly injuring five people, the ISNA news agency reported, nearly two months after a powerful tremor killed more than 600 people.   A magnitude 5.1 quake was recorded in the southern province of Kerman at 6:48 am (0318 GMT), and five others with magnitudes of between 5.0 and 5.6 hit the western province of Kermanshah near the border with Iraq, the Iranian seismology centre reported.

The respective epicentres were in the areas of Hedjak, about 770 kilometres (475 miles) southeast of Tehran, and Sumar, 570 kilometres (350 miles) west of the capital, the centre said.   It said the quakes struck at depths of between eight and 12 kilometres.   ISNA said the five injured were in Kermanshah province, and state television reported no major damage.

AFP correspondents said the quakes were also felt across Iraq and in Iraqi Kurdistan bordering Iran.   Iran sits atop several fault lines and has been hit by a series of earthquakes in recent weeks.   On November 12, a 7.3-magnitude quake killed 620 people in Kermanshah and eight in Iraq.
Date: Wed, 10 Jan 2018 22:32:20 +0100

Rome, Jan 10, 2018 (AFP) - Three Italian air transport unions on Wednesday announced their intention for a nationwide strike for Ryanair staff on February 10, expressing disappointment after the first meeting with management of the Irish low-cost airline.

The strike notice includes pilots, even though pilots' union ANPAC said management had a "positive approach" during talks on Tuesday. Ryanair had raised the possibility a deal could be reached with ANPAC before the end of the month.   But the three other Italian air transport unions were not satisfied, calling for "serious negotiations" on wages, contracts and guarantees for "all categories of personnel".

Ryanair suffered a turbulent end to 2017, forced to cancel 20,000 flights through to March 2018, mainly because of botched holiday scheduling for pilots.   The fiasco triggered pilots' demands for better working conditions and representation, with some departing for other carriers.   The discontent also saw Ryanair hit by the first-ever strike action by pilots in its 32-year history, with German staff staging a short stoppage ahead of Christmas resulting in delays but no cancellations.

In December, Ryanair made moves to formally recognise unions, facing the threat of further strikes in Italy, Ireland and Portugal.
Date: Wed, 10 Jan 2018 19:33:44 +0100

Washington, Jan 10, 2018 (AFP) - The United States unveiled a way to warn its citizens about the dangers of foreign travel Wednesday, with a four-point safety ranking system for countries and an interactive world map.   Ten war zones and failed states are ranked Level Four, "Do Not Travel": Afghanistan, Central African Republic, Iran, Iraq, Libya, Mali, Somalia, South Sudan, Syria and Yemen.   North Korea is also Level Four, with the additional restriction that US law prohibits American travelers from using their passports there, effectively banning visits. 

But some of the other country ratings may raise eyebrows -- or international anger -- even if the State Department says it is only presenting existing advice in a new format.   Officials insisted the change was to make advice clearer to US travelers, but the travel warning system has long been controversial and often offends foreign capitals.   "These are not political documents. These are simply based on our assessment of the security situation," senior consular official Michelle Bernier-Toth said.

Major European allies like Britain, France and Germany are Level Two, "exercise increased caution," while authoritarian Uzbekistan gets Level One, "exercise usual precautions."   On Tuesday, US senators heard State Department officials say someone known to the Cuban government has a mystery weapon that they use to cause brain trauma to Americans in Havana.   But Cuba is ranked only Level Three, "Reconsider Travel."

Officials insisted the change was to make advice clearer to US citizens that plan to travel.   Some countries have complained in the past that warnings exaggerate dangers and damage tourism, or suspect they have been subjected to a US diplomatic rebuke.   But each warning is accompanied by a country page on the travel.state.gov website, explaining what specific threats have been identified and why the advice has been given.   Western European capitals, for example, while prosperous and politically stable, have seen recent attacks by Islamist militants in areas popular with tourists.

Mexico, a Level Two country, has complained in the past that US alerts hurt tourism, but the site gives a detailed breakdown of areas to avoid because of drug cartel violence.    The United States itself is not rated in the new system.   But as a rough guide, America's per capita murder rate of 4.88 per 100,000 people puts it between Cuba at 4.72 ("reconsider travel") and Somalia at 5.56 ("do not travel").
Date: Wed, 10 Jan 2018 18:39:32 +0100

The Hague, Jan 10, 2018 (AFP) - Amsterdam announced Wednesday it will impose a new 30-day curb on renting out private homes via websites like Airbnb from next year, seeking to stem a deluge of tourists flocking to its famous canals.

The current 60-day limit per year will now be halved "to stem the negative influence of holiday home rentals," the city council's executive said in a statement.   "During the last few years there has been massive growth in the market of renting out homes to tourists.   "The increase in numbers has increasingly had an (unwanted) effect on various Amsterdam neighbourhoods."

The Dutch capital is now flooded with 17 million tourists per year, attributed to the city's ease of access and a highly successful marketing campaign.    In 2013, there were around 4,500 holiday rentals on offer on various websites, but by last year the number had grown to 22,000, according to the latest city council figures.   Residents have complained of rowdy crowds of tourists and late-night disturbances.

Tourist numbers are often boosted by visiting groups -- who see the tolerant and open-minded city as a party destination.   The council based its decision on a recent ruling by the Amsterdam District Court which sought to clarify the rules about which homes can be used for holiday rentals, including a maximum time limit, the number of persons allowed per home and an obligatory tourist tax.   Rentals have to be reported to authorities who check whether the 30-day rule is being respected, the city council said.

Amsterdam reached a landmark agreement with home rental website Airbnb in December 2016 to limit private rental sharing to 60 days.   "The current agreement with platforms such as Airbnb and Booking.com lasts until January 1, 2019," it said.   Amsterdam is not the only city battling large tourist numbers and excessively rowdy crowds.    From Budapest to Barcelona, residents have protested against the takeover of their neighbourhoods by disrespectful revellers.
Date: Wed 10 Jan 2018
Source: Limerick Leader [edited]
<http://www.limerickleader.ie/news/home/291006/cryptosporidium-outbreak-in-limerick-suburb-being-monitored-by-hse.html>

The Department of Public Health (HSE) is investigating an outbreak of an infectious type of gastroenteritis in a Limerick city suburb. The HSE is looking into 11 reported cases of cryptosporidiosis, caused by the parasite _cryptosporidium_, in Castletroy, including 6 confirmed cases among children attending the Tall Trees Creche in Monaleen.

Potentially fatal for those with compromised immune systems, the illness results in diarrhoea, vomiting, stomach cramps and fever. Human cryptosporidiosis became a notifiable disease in Ireland in 2004, which means all medical practitioners are required to report an incidence of the illness to the Department of Public Health.

Cryptosporidiosis is passed on through infected water sources, farm or animal exposure or through direct contact. Limerick's public water supply has been tested for the presence of the parasite but it has not been detected, the Department of Public Health confirmed. The Tall Trees Creche has been temporarily closed following the outbreak in order to break the cycle of transmission, according to owner and manager Pamela Walsh Hennessy. "We wanted to take every precaution so our crèche has been stripped back to 4 walls and decontaminated. We started from scratch, replacing items that couldn't be sterilised, getting rid of items. It has been a huge undertaking but the most important thing is the health and safety of our kids," she said.

Children attending day care centres have an increased risk of contracting the illness. This is the 1st case of the parasite at the centre in 13 years, according to Ms Walsh Hennessy. A control team including representatives from the HSE and TUSLA was immediately convened to manage the current outbreak, according to the HSE spokesperson. "Parents of the crèche have been contacted directly by the Department of Public Health with relevant advice," said a spokesperson.

The crèche is expected to reopen this [Thu 11 Jan 2017], following its closure on [Sat 6 Jan 2017], but is awaiting confirmation. [Byline: Jess Casey] -- Communicated by: ProMED-mail from HealthMap Alerts <promed@promedmail.org> [Infection caused by _Cryptosporidium_ spp. (often _C. parvum_ in human infections) is a zoonosis with reservoir in ruminants. It is often a problem in areas where the drinking water is drawn from surface water as lakes and rivers and are resistant to chlorination. It is mentioned here that analysis of drinking water so far has been negative, but the cyst number is often low and concentration methods are needed. - ProMED Mod.EP]

[HealthMap/ProMED-mail map:
Limerick, Limerick, Ireland: <http://healthmap.org/promed/p/2218>.]
Date: Wed 10 Jan 2018
Source: The Kathmandu Post [edited]

A baby died of seasonal flu in Junichande Rural Municipality of Jajarkot on [Mon 8 Jan 2018], putting the flu death toll in the district to 10 in 2 weeks.

Dr Pawan Shakya said RBN's 2-month-old son B was the latest victim of flu outbreak in different parts of the district.

The District Health Office (DHO) has deployed health teams to the affected areas to control the epidemic. "We have already treated more than 800 patients in the last 4 days," said Dr Shakya.

More than 2000 people have contracted flu in Junichande Rural Municipality. According to health workers, people in Juni, Chande, Kapra, Badkule, Karkigaun, Syala, Majkot, Alimaugana, Dandakot, Parale, Kortang and Kalli areas have been affected the most.

Chief of the DHO Ram Bahadur Nepali said health workers were visiting every household in the affected areas to provide treatment.
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[Borrowing the quote from ProMED Mod.SN: "It is not clear from the news report above which strains of influenza virus are currently circulating in Nepal and whether the other 9 fatal cases belonged to any high risk groups for developing influenza-associated complications. Of note, 2 influenza A/H3 and 11 influenza B (lineage not determined) cases were reported from Nepal during the week of 25-31 Dec 2017 , <http://apps.who.int/flumart/Default?ReportNo=2>". - ProMED Mod.UBA]
Date: Wed 10 Jan 2018
Source: Pakistan Today [edited]

A total of 400 suspected cases of H1N1 influenza have been reported across the country so far, out of which 120 influenza positive cases have been confirmed, resulting in 20 deaths.

Talking to Pakistan Today, National Institute of Health (NIH) Senior Scientific Officer Dr Mumtaz Ali Khan said that a total of 400 suspected cases have been reported so far, out of which around 120 cases were positive. He said that the virus had also caused 20 deaths, including one in Islamabad, while the rest were reported in Multan where the disease had resulted in an epidemic.

However, Dr Mumtaz said that influenza alone was not responsible for the deaths because most of the patients were already admitted in the intensive care units (ICU) of different hospitals with heart and diabetic problems.

He said that no normal patient had died hitherto, which indicated that influenza was not the reason behind their deaths. However, he confirmed that they were diagnosed with influenza too.

He further said that most of the cases were reported from Punjab, out of which around 70 influenza cases were reported from Multan alone, while around 6 cases were also reported from Swabi district of Khyber Pakhtunkhwa (KP). The doctor confirmed that a total of 7 influenza cases had been reported from the federal capital so far.

Keeping in view the recent upsurge in influenza A cases in different parts of the country, the NIH, Ministry of National Health Services Regulations and Coordination, Islamabad, in collaboration with Pakistan Institute of Medical Sciences (PIMS), organised a one-day seminar on influenza awareness for healthcare professionals here on [Wed 10 Jan 2018].

The purpose of the seminar was to provide updated influenza information on the epidemiology, current situation in Pakistan and global trends in influenza research. Earlier, while speaking at the seminar, Dr Mumtaz highlighted the role of NIH and said that, "Regular advisories regarding prevention, control, diagnosis and management of influenza are being issued by NIH."

He said Seasonal Awareness and Alert Letters (SAAL) have also been circulated for sensitising the medical fraternity and the general public against epidemic-prone diseases, including influenza. Updated guidelines have also been posted on the official website, he added.

He informed the audience that NIH had established a countrywide laboratory-based seasonal influenza surveillance network at 7 sites across Pakistan which would provide baseline knowledge on the different strains of influenza viruses present in the country and provide support for laboratory detection of novel influenza strains.

PIMS Administrator Dr Altaf Qureshi, who was the chief guest on the occasion, appreciated the NIH for arranging this seminar at a critical time when the disease had created a media hype in the country. He said that such type of awareness seminars could be helpful to control any disease, adding that the services of PIMS were available to support such activities in the future.

During the seminar, speakers provided technical guidance on different aspects of influenza, including management, treatment, vaccination, laboratory diagnostics and prevention and control. They informed the audience about the latest global trends in influenza research while also highlighting the epidemiology of seasonal influenza and emergence of pandemic influenza viruses.

They briefed the audience about preventive strategies and emphasised on maintaining cleanliness on a daily basis, including washing hands, following coughing etiquettes and use of disinfectants. They also informed the audience about the high-risk groups, availability and use of anti-viral medicines and recommendations for the use of vaccination.

Moreover, PIMS Infectious Disease Department Physician Dr Naseem Akhtar briefed the audience about the objectives of the seminar. On the occasion, NIH Surveillance Coordinators Dr Uzma Bashir and Dr Ambreen Chaudhry shared their experiences regarding handling the current influenza situation in the country and stressed upon the audience to adopt preventive measures.

At the end of the seminar, a panel of health professionals, including, Dr Najeeb Durrani, Dr Mumtaz Ali Khan, Nazish Badar, Dr Rubeena, Dr Naseem Akhtar and Dr Uzma Aamer, answered the questions put forth by the audience.  [Byline: Hamid Khan Wazir]
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[The increased reports of influenza cases including both Influenza A/H1N1 and A/H3N2 from all over Pakistan indicates that there is circulation of influenza viruses in the community; with a large number of Influenza-like Illness (ILI) cases presenting to health care facilities and Severe Acute Respiratory Illness (SARI) associated hospitalizations are being reported since last week of December 2017.

Vaccination is the most effective way to prevent infection and severe outcomes caused by influenza viruses. Development and production of influenza vaccines, planning for their supplies and use, as well as provision of other respective health care resources are essential components of a comprehensive seasonal and pandemic influenza response. The seasonal influenza viruses reported from Pakistan and shared with the WHO GISRS are compatible with the recommended 2017/18 seasonal influenza vaccine and vaccination at least in the high risk population groups should be ensured

There is a need to emphasize that establishment of routine influenza surveillance systems can help understand the seasonality and disease trends and enable detection of unusual surge or increase in cases by comparing the prevalence rates with the same time period in previous years. As influenza is not a priority disease in many developing countries, the exact burden of influenza associated morbidity and mortality remains largely undetermined in the general and at-risk populations. - ProMED Mod.UBA]
Date: Wed 10 Jan 2018, 11:12 AM
Source: Ultima Hora, Paraguay [in Spanish, machine trans., edited]

The Institute of Tropical Medicine confirmed 76 suspected cases of brucellosis in recent days while the fully confirmed cases remain at 21. They are mostly students and teachers of Veterinary UNA.

Miguel Cardozo, of the Institute of Tropical Medicine, explained that in the last days there were 76 cases that are under suspicion of brucellosis, after the clinical consultations of people who manifested some symptoms. Of the total, 4 people are in treatment for high suspicion of being carriers of the disease [see below - ProMED Mod.LL]. Cardozo indicated that brucellosis is a slow-growing bacterial disease that can appear 2 to 3 months after having been in contact with infected animals, so he urged people who were exposed to clinical examinations.

Those affected are mostly students and professors of the Faculty of Veterinary Sciences of the National University of Asuncion (UNA). Several months ago, an outbreak of brucellosis was detected in the institution where students, teachers and officials of the house of studies were exposed. The fact cost him the international academic accreditation he had. Finally, the case that occurred due to apparent negligence ended with the resignation of the dean of the Faculty of Veterinary Sciences of UNA. Cabrera was also charged for the crime of marketing harmful food, since it is presumed that the institution sold the milk of the infected animals.
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[The organism involved has been previously reported to be _B. melitensis_. Symptoms and signs of brucellosis may develop from days to months after the initial exposure to the organism. While some individuals may develop mild symptoms, others may go on to develop long-term chronic symptoms. It is not clear if the 4 individuals noted as "carriers" have been diagnosed as chronic brucellosis and if so what organs are involved. Additionally, a previous ProMED report noted a fatality which is not mentioned in this posting.

The signs and symptoms of brucellosis are extensive and they can be similar to many other febrile illnesses, so recognition of potential exposure -- from ingestion of unpasteurized milk or cheese, employment as a veterinarian or veterinary student, in a slaughter house or meat processing plant, or working in a microbiology lab -- is vital.

The following is a recent review of caprine brucellosis:
Rossetti CA, Arenas-Gamboa AM and Maurizio E: Caprine brucellosis: A historically neglected disease with significant impact on public health. PLoS Negl Trop Dis. 2017 Aug 17;11(8):e0005692, available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560528/>.

Abstract
--------
"Caprine brucellosis is a chronic infectious disease caused by the gram-negative cocci-bacillus _Brucella melitensis_. Middle- to late-term abortion, stillbirths, and the delivery of weak offspring are the characteristic clinical signs of the disease that is associated with an extensive negative impact in a flock's productivity. _B. melitensis_ is also the most virulent _Brucella_ species for humans, responsible for a severely debilitating and disabling illness that results in high morbidity with intermittent fever, chills, sweats, weakness, myalgia, abortion, osteoarticular complications, endocarditis, depression, anorexia, and low mortality. Historical observations indicate that goats have been the hosts of _B. melitensis_ for centuries; but around 1905, the Greek physician Themistokles Zammit was able to build the epidemiological link between "Malta fever" and the consumption of goat milk. While the disease has been successfully managed in most industrialized countries, it remains a significant burden on goat and human health in the Mediterranean region, the Middle East, Central and Southeast Asia (including India and China), sub-Saharan Africa, and certain areas in Latin America, where approximately 3.5 billion people live at risk. In this review, we describe a historical evolution of the disease, highlight the current worldwide distribution, and estimate (by simple formula) the approximate costs of brucellosis outbreaks to meat- and milk-producing farms and the economic losses associated with the disease in humans. Successful control leading to eradication of caprine brucellosis in the developing world will require a coordinated Global One Health approach involving active involvement of human and animal health efforts to enhance public health and improve livestock productivity."

Maps of Paraguay can be seen at
and <http://healthmap.org/promed/p/4191>.

The City of Asuncion, Ciudad de Asuncion (<https://es.wikipedia.org/wiki/Asunci%C3%B3n>), is an autonomous capital district, not a part of any department. The metropolitan area, called Gran Asuncion, includes the cities of San Lorenzo, Fernando de la Mora, Lambare, Luque, Mariano Roque Alonso, Nemby, San Antonio, Limpio, Capiata, and Villa Elisa, which are part of the Central Department. The Asuncion metropolitan area has around 2 million inhabitants. - ProMED Mod.LL]
Date: Thu 11 Jan 2018
Source: The Navhind Times [edited]

A person tested positive for Kyasanur Forest disease (KFD) or monkey fever on [Wed 10 Jan 2018], taking the number of cases detected in Sattari to 8.

Health officer at the Community Health Centre [CHC], Dr Gajanan Naik, said that Manipal Centre for Virus Research, Manipal University detected 8 cases of monkey fever this season, and added that the patients are from Kumthal, Velge, and Budruk-Karmalli.

The 7 patients are fine and discharged from CHC, Dr Naik added. He further said that a male patient, who has tested positive on [Wed 10 Jan 2018], is undergoing treatment at the CHC. The number of cases found positive for KFD has raised concern among the residents of Sanvorde panchayat. The authorities will be intensifying their awareness in the villages by conducting information, education and communication (IEC) programmes.

"We have distributed DMP [dimethyl phthalate] tick repellent oil to the villagers of Budruk-Karmali and held an advocacy workshop for the villagers" said Dr Naik.

Before handing over the oil to the villagers, nodal officer Dr Abhijit Wadkar said: "Preventive measures against the monkey fever are being implemented. The villagers cannot stop themselves from venturing into the cashew plantations, as it is their livelihood. Measures such as covering the entire body before entering the forest and applying DMP oil can prevent them from getting affected by the disease."
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[Kyasanur Forest disease (KFD) is a tick-borne viral haemorrhagic fever endemic to South Asia. The disease was first reported from Kyasanur Forest near Sagar in Shivamogga district of Karnataka in India in 1957. Its outbreak then was among monkeys, killing several of them. Hence, the disease is locally known as 'monkey fever'. It is caused by a virus belonging to the family Flaviviridae, which also includes yellow fever and dengue fever. The disease is carried by ticks, rodents, birds, etc., and it affects monkeys and human beings. It is a vector borne disease. KFD is common in states like Goa, Karnataka (in Shivamogga), and Kerala (in Wayanad and Malappuram). It was also reported from parts of Bandipur National Park (Chamarajanagar) and parts of the Nilgiris. The disease mostly occurs between November to March.

The spread of KFD to newer areas is a major cause for concern. It is endemic in 5 districts of Karnataka, and there are recent reports of spread to Chamarajanagar, Nilgiri, Wayanad, and Malappuram districts of the Western Ghats, which stretch from north to south, covers the states of Gujarat, Maharashtra, Goa, Karnataka, Tamil Nadu, and Kerala, and comprises 39 properties including wildlife sanctuaries, national parks, and reserve forests (World Heritage Centre. United Nations Educational Scientific and Cultural Organization (UNESCO). Western Ghats (<http://whc.unesco.org/en/list/1342/>). The spread of KFDV to newer areas is most probably due to the movement of monkeys and small rodents, which harbour the virus. People residing in the forest areas, as well as those working in the parks, sanctuaries, and reserve forests are at high risk of acquiring the disease.

No specific exposure is mentioned in the report above and any evidence of human to human transmission needs further epidemiological investigation - ProMED Mod.UBA]

[Maps of India:

A HealthMap/ProMED-mail map can be accessed at: