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Andorra

General
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This small country is situated between France and Spain. Because of its elevation and proximity to the Pyrenees the climate is generally pleasant throughout the year.
Climate
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During the summer months the temperatures can rise to 30c but there is usually a cooling breeze. Lightening storms can occur during the summer months associated with torrential rain.
Sun Exposure and Dehydration
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Those from Northern Europe can develop significant sun exposure and so remember to use a wide brimmed hat when necessary. The altitude can also lead to significant tiredness and dehydration so take sufficient initial rest and drink plenty of fluids.
Safety & Security
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The level of crime throughout the country directed at tourists is very low. Nevertheless take care of your personal belongings at all times and use hotel safety boxes where possible.
Local Customs
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There are strict laws regarding the use of illegal drugs. Make sure you have sufficient supplies of any medication you required for your trip and that it is clearly marked. The European E111 form is not accepted in Andorra and so it is essential that you have sufficient travel insurance for your trip.
Winter Sports
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Andorra is one of the regions where many travel to partake of their winter sport facilities. Generally this is well controlled and one of the safer regions. Nevertheless, make certain your travel insurance is adequate for the activities you are planning to undertake.
Vaccination
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The only standard vaccine to consider for Andorra would be tetanus in line with many other developed countries of the world.

Travel News Headlines WORLD NEWS

Date: Thu, 12 Jul 2018 15:24:06 +0200

Andorra la Vella, Andorra, July 12, 2018 (AFP) - The tax haven of Andorra has long been a favourite destination for smokers looking to stock up on cheap cigarettes, but the enclave said Thursday that it would soon stop advertising the fact.   The government said it had signed up to the World Health Organization's (WHO) anti-tobacco convention, which aims to encourage people to quit smoking and combat contraband sales.   "The goal is to contribute to public health and pursue the fight against trafficking," government spokesman Jordi Cinca said at a press conference.

The tiny principality of Andorra, perched in the Pyrenees on the border between France and Spain, attracts millions of shoppers each year to duty-free stores, where prices of alcohol, cigarettes, electronics and clothes can be up to 20 percent cheaper than elsewhere in the EU.   High taxes on tobacco imposed by many countries to help people kick smoking make Andorra's cigarettes a particularly good deal.   The average pack costs just three euros ($3.50) compared with eight euros in France, which has said it will gradually raise the price to 10 euros a pack by November 2020.

Tobacco sales bring in some 110 million euros a year for Andorra, whose economy is otherwise based almost entirely on tourism.   It is also an enticing destination for smugglers, with French and Spanish border agents regularly seizing cartons from people trying to sneak them out, either by car or by hiking down the mountain trails which criss-cross the Pyrenees.   No date has been set for the advertising ban, which will come into effect three months after the ratification of the WHO accord is voted by parliament.
Date: Fri, 16 Mar 2018 02:41:51 +0100

Andorra la Vella, Andorra, March 16, 2018 (AFP) - The tiny principality of Andorra is witnessing a once in a generation phenomenon -- a widespread strike.   Around a third of civil servants across the mountainous micro-state have walked out to protest proposed reforms to their sector in what has been described as Andorra's first large-scale strike since 1933.

With no negotiation breakthrough in sight, picket lines are expected to be manned again on Friday with customs officers, police, teachers and prison staff among those taking part.   The first major strike in 85 years was sparked by plans from the government of Antoni Marti to reform civil servant contracts.   He has assured officials "will not do an hour more" work under the reforms and that 49 million euros would be allocated for the next 25 years to supplement civil servant salaries.   But government workers are unconvinced with unions warning the reforms could risk their 35 hour working week and pay.

Customs officers involved in the strike interrupted traffic on the Andorran-Spanish border this week, according to unions, while some 80 percent of teachers have walked out of classes.   Strikers have occupied the government's main administrative building and held noisy protests outside parliament calling for Marti's resignation.    "We have started collecting signatures to demand the resignation of the head of government and now nobody will stop us," Gabriel Ubach, spokesman for the public service union, told reporters.
Date: Mon 27 Sep 2017
Source: Contagion Live [edited]

A recent Dispatch article published in the Centers for Disease Control and Prevention (CDC)'s Emerging Infectious Diseases journal, offers insight into a large norovirus outbreak that sprung up in Spain in 2016 that had been linked with bottled spring water. The Public Health Agency of Catalonia (ASPCAT) reported a staggering 4136 cases of gastroenteritis from 11-25 Apr 2016. Of the 4136 cases, 6 individuals required hospitalization. The CDC defines a "case-patient" as an "exposed person who had vomiting or diarrhoea (3 or more loose stools within 24 hours)," as well as 2 or more of the following symptoms: nausea, stomach pain, or fever.

ASPCAT investigators traced back the outbreak to contaminated bottled spring water in office water coolers. The water came from a source in Andorra, a small independent principality located between Spain and France. Norovirus is a "very contagious virus," according to the CDC, and it is common for individuals to become infected by eating contaminated food. Although it is possible to be infected by consuming contaminated drinking water, this mode of transmission is "rare in developed countries," according to the article.

The investigators collected water samples from a total of 4 19-L water coolers in 2 different offices located in Barcelona, "from which affected persons had drunk; samples 1 and 2 came from 2 water coolers in one office, while samples 3 and 4 came from 2 water coolers in another office. Using "positively charged glass wool and polyethylene glycol precipitation for virus concentration," the investigators tested the samples.

"We detected high RNA levels for norovirus genotype I and II, around 103 and 104 genome copies/L, in 2 of the 4 water cooler samples concentrated by glass wool filtration and polyethylene glycol precipitation," according to the article. The investigators noted that a drawback of using molecular methods is that they are not able to differentiate between particles that are infectious and those that are not. Therefore, they "predicted the infectivity of norovirus in the concentrated samples by treating the samples with the nucleic acid intercalating dye PMA propidium monoazide and Triton X surfactant before RT-qPCR," which allowed them to "distinguish between virions with intact and altered capsids."

In those 2 water samples, they found high genome copy values -- 49 and 327 genome copies/L for norovirus genotype I and 33 and 660 genomes copies/L for norovirus genotype II. This was not an unexpected finding, due to the large number of infected individuals associated with the outbreak. Through "PMA/Triton treatment before RT-qPCR assays," the investigators found that the proportion of infected virions accounted for 0.3% to 5.6% of the total number of physical particles in the water samples, "which was enough to cause gastrointestinal illness."

The investigators also analyzed faecal samples collected from infected individuals who worked at the office in which the 1st 2 water samples were collected. They detected the following genotypes in those faecal samples: GI.2 and GII.17. In the faecal samples collected from the other office, they isolated the following genotypes: GII.4/Sydney/2012, GI.2, GII.17, and GII.2.

"We hypothesize that the spring water was contaminated by all 4 strains (GI.2, GII.2, GII.4, and GII.17) but levels of viral contamination for each genotype were not homogeneous in all bottled coolers," the investigators wrote. "We may have detected only the GII.4 genotype in water samples 1 and 2 because of a higher concentration of this specific genotype or because of bias caused by the sampling, concentration, and molecular detection procedures."

The investigators admit one limitation to their study: the small number of water samples collected and analyzed. They attribute this to the fact that on 15 Apr 2016, 4 days after the onset of the outbreak, the company that produced the drinking water recalled over 6150 containers of water "of suspected quality" as a precautionary measure. The recall prevented the investigators from collecting more samples to assess, according to the article.

Although the exact cause of the contamination has not yet been identified, the investigators posit that "the high number of affected persons from 381 offices that received water coolers, and the many different genotypes found in some patients' faecal specimens" suggest that the spring aquifer had been contaminated by "sewage pollution," and the Andorra Ministry of Health and Welfare banned further use of the spring.

The investigators suggest that assessing commercially-produced mineral waters for different harmful pathogens, such as norovirus would be beneficial. They note, however, that creating, enhancing, and managing such "virus surveillance systems" would be costly. Thus, the investigators suggest taking a "balanced approach to keep both the cost and the time required for the analyses within feasibility limits."  [Byline: Kristi Rosa]
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[The interesting article published in the September 2017 issue of Emerging Infectious Diseases is:
Blanco A, Guix S, Fuster N, et al: Norovirus in bottled water associated with gastroenteritis outbreak, Spain, 2016. Emerg Infect Dis. 2017; 23(9): 1531-34; https://wwwnc.cdc.gov/eid/article/23/9/16-1489_article. - ProMED Mod.LL]

[Catalonia and Andorra can be located on the HealthMap/ProMED-mail map at http://healthmap.org/promed/p/1341. - ProMED Sr.Tech.Ed.MJ]
Date: Thu, 26 Dec 2013 22:25:05 +0100 (MET)

ANDORRA LA VELLA, Andorra, Dec 26, 2013 (AFP) - A Spanish skier and a French snowboarder have died in avalanches in different mountain ranges in Europe, officials said Thursday.

The 27-year-old skier, a woman from Barcelona, died Wednesday while going off-piste alone in the Soldeu resort in Andorra, in the Pyrenees mountains between France and Spain, a resort manager told AFP.   Although she was rescued within 10 minutes, after her glove was spotted on the surface, she was unable to be revived despite a helicopter dash to hospital.

In the Italian Alps, close to the border with France, a 24-year-old Frenchman who was snowboarding with three friends on a closed run died Thursday when an avalanche swept over him in the resort town of Les Arnauds.   Local officials said he succumbed to multiple injuries, asphyxia and hypothermia.

Avalanches are common in Europe's ski resorts at this time of year, when early snows are heavy with moisture, and several deaths occur each winter.   Last Sunday, a 35-year-old Frenchman died in an avalanche in the Alps near the Italian border while on a three-day trek with a friend.
Date: Fri 7 Feb 2003 From: Jaime R. Torres Source: EFE Salud, Thu 6 Feb 2003 (translated by Maria Jacobs) [edited] -------------------------------------------------- Close to 300 students in one school and 173 tourists staying in 7 hotels in the Principality of Andorra have been affected by outbreaks of gastroenteritis that, according to local authorities, are not related to each other. Monica Codina, Minister of Health, stated that the outbreak that has affected almost 300 children and 8 adults in the San Ermengol school was detected last Monday [3 Feb 2003] but that it may have started Wednesday or Thursday of the previous week. The epidemiological surveys of a group of pre-school and grammar school students that may also be affected have not been performed yet. Also pending are the results of the microbiological tests of the food and water served in the school dining room, but the minister has indicated that the probable cause of the outbreak is the fact that water pitchers were filled with hoses directly from the faucet. The Minister stated that this outbreak of gastroenteritis is not related to the one that affected 173 tourists, most of them young people on holiday, who where staying in 7 hotels of the Principality. The government is also investigating the cause of this outbreak and has indicated that an anomaly in the system that supplies water to the hotels was detected, requiring a process of chlorination, which has not been carried out due to the heavy snowfall of the past few days. * * * * * * * * * * [The suspicion that defective water supplies may be responsible for all of these independent outbreaks suggests that the etiologic agent may be an enterovirus, hepatitis A virus, or non-viral, rather than one of the noroviruses associated with sudden-onset viral gastroenteritis. Information on the outcome of diagnostic tests in progress would be welcomed. - ProMed Mod.CP]
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Benin

Benin - US Consular Information Sheet
April 28, 2008

COUNTRY DESCRIPTION:
Benin is a developing country in West Africa. Its political capital is Porto Novo. However, its administrative capital, Cotonou, is Benin's largest city and the
site of most government, commercial, and tourist activity. Read the Department of State Background Notes on Benin for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. Visas are not routinely available at the airport. Visitors to Benin should also carry the WHO Yellow Card (“Carte Jaune”) indicating that they have been vaccinated for yellow fever. Contact the Embassy of Benin for the most current visa information. The Embassy is located at: 2124 Kalorama Road NW, Washington, DC 20008; tel: 202-232-6656.

Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
U.S. citizens should avoid crowds, political rallies, and street demonstrations and maintain security awareness at all times.
U.S. citizens should not walk on the beach alone at any time of day. It is also highly recommended not to carry a passport or valuables when walking in any part of the city. Travelers should carry a notarized photocopy of the photo page of their passport (see Crime section). They should not walk around the city after dark, and should take particular care to avoid the beach and isolated areas near the beach after dark.
The ocean currents along the coast are extremely strong and treacherous with rough surf and a strong undertow, and several people drown each year.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.

CRIME: Street robbery is a significant problem in Cotonou. Robbery and mugging occur along the Boulevard de France (the beach road by the Marina and Novotel Hotels) and on the beaches near hotels frequented by international visitors. Most of the reported incidents involve the use of force, often by armed persons, with occasional minor injury to the victim. Travelers should avoid isolated and poorly lit areas and should not walk around the city or the beaches between dusk and dawn. Even in daylight hours, foreigners on the beach near Cotonou are frequent victims of robberies. When visiting the beach, travelers should not bring valuables and should carry only a photocopy of their passport. If you are a victim of crime, you should contact the U.S. Embassy immediately. There has been a continued increase in the number of robberies and carjacking incidents after dark, both within metropolitan Cotonou and on highways and rural roads outside of major metropolitan areas. Motorists are urged to be wary of the risk of carjacking. Keep the windows of your vehicle rolled up and the doors locked. Stay alert for signs of suspicious behavior by other motorists or pedestrians that may lead to carjacking, such as attempts to stop a moving vehicle for no obvious reason. Travelers should avoid driving outside the city of Cotonou after dark and should exercise extreme caution when driving in Cotonou after dark (see Traffic Safety and Road Conditions below). Overland travel to Nigeria is dangerous near the Benin/Nigeria border due to unofficial checkpoints and highway banditry.
Travelers should avoid the use of credit cards and automated teller machines (ATMs) in Benin due to a high rate of fraud. Perpetrators of business and other kinds of fraud often target foreigners, including Americans. While such fraud schemes in the past have been largely associated with Nigeria, they are now prevalent throughout West Africa, including Benin, and are more frequently perpetrated by Beninese criminals. Business scams are not always easy to recognize, and any unsolicited business proposal should be carefully scrutinized. There are, nevertheless, some indicators that are warnings of a probable scam. Look out for:

Any offer of a substantial percentage of a very large sum of money to be transferred into your account, in return for your "discretion" or "confidentiality";

Any deal that seems too good to be true;
Requests for signed and stamped, blank letterhead or invoices, or for bank account or credit card information;
Requests for urgent air shipment, accompanied by an instrument of payment whose genuineness cannot immediately be established;
Solicitations claiming the soliciting party has personal ties to high government officials;
Requests for payment, in advance, of transfer taxes or incorporation fees;
Statements that your name was provided to the soliciting party either by someone you do not know or by "a reliable contact";
Promises of advance payment for services to the Beninese government; and
Any offer of a charitable donation.
These scams, which may appear to be legitimate business deals requiring advance payments on contracts, pose a danger of both financial loss and physical harm. Recently more American citizens have been targeted. The perpetrators of such scams sometimes pose as attorneys. One common ploy is to request fees for “registration” with fictitious government offices or regulatory authorities. The best way to avoid becoming a victim of advance-fee fraud is common sense – if it looks too good to be true, it probably is. Travelers should carefully check out any unsolicited business proposal originating in Benin before committing any funds, providing any goods or services, or undertaking any travel. For additional information, please see the Department of State’s Bureau of Consular Affairs brochure, International Financial Scams.

Scams may also involve persons posing as singles on Internet dating sites or as online acquaintances who then get into trouble and require money to be "rescued." If you are asked to send money by someone you meet online please contact the U.S. Embassy before doing so.

INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical facilities in Benin are limited and not all medicines are available. Travelers should bring their own supplies of prescription drugs and preventive medicines. Not all medicines and prescription drugs available in Benin are USFDA-approved. Malaria is a serious risk to travelers to Benin. For information on malaria, its prevention, protection from insect bites, and anti-malarial drugs, please visit the CDC Travelers' Health web site at http://www.cdc.gov/malaria/.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s website at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Benin is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

With the exception of the road linking Cotonou in the south to Malanville on the border with Niger in the north, and from Parakou in central Benin to Natitingou in the northwestern part of the country, roads in Benin are generally in poor condition and are often impassable during the rainy season. Benin's unpaved roads vary widely in quality; deep sand and potholes are common. During the rainy season from mid-June to mid-September, dirt roads often become impassable. Four-wheel drive vehicles with full spare tires and emergency equipment are recommended.
Most of the main streets in Cotonou are paved, but side streets are often dirt with deep potholes. Traffic moves on the right, as in the United States. Cotonou has no public transportation system; many Beninese people rely on bicycles, mopeds, motorbikes, and zemidjans (moped taxis). All official Americans are required to wear safety helmets when on a motorcycle and are strongly discouraged from using zemidjans. Travelers using zemidjans, particularly at night, are much more vulnerable to being mugged, assaulted or robbed. Buses and bush taxis offer service in the interior.
Gasoline smuggled from Nigeria is widely available in glass bottles and jugs at informal roadside stands throughout Cotonou and much of the country. This gasoline is of unreliable quality, often containing water or other contaminants that can damage or disable your vehicle. Drivers should purchase fuel only from official service stations. There are periodic gas shortages, which can be particularly acute in the north of the country where there are few service stations.
U.S. citizens traveling by road should exercise extreme caution. Poorly maintained and overloaded transport and cargo vehicles frequently break down and cause accidents. Drivers often place branches or leaves in the road to indicate a broken down vehicle is in the roadway. Undisciplined drivers move unpredictably through traffic. Construction work is often poorly indicated. Speed bumps, commonly used on paved roads in and near villages, are seldom indicated. Drivers must be on guard against people and livestock wandering into or across the roads. Nighttime driving is particularly hazardous as vehicles frequently lack headlights and/or taillights, and brake lights are often burned out.
With few exceptions, Cotonou and other cities lack any street lighting, and lighting on roads between population centers is non-existent. The U.S. Embassy in Cotonou prohibits non-essential travel outside of metropolitan areas after dusk by official Americans and strongly urges all U.S. citizens to avoid night driving as well. There have been numerous carjackings and robberies on roads in Benin after dark, several of which resulted in murder when the driver refused to comply with the assailants' demands. The National Police periodically conduct vehicle checks at provisional roadblocks in an effort to improve road safety and reduce the increasing number of carjackings. When stopped at such a roadblock, you must have all of the vehicle's documentation available to present to the authorities.
Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office at http://www.benintourisme.com.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Benin, the U.S. Federal Aviation Administration (FAA) has not assessed Benin’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
U.S. citizens are advised to keep a notarized photocopy of the photo page of their passport with them at all times when traveling in Benin.
The Embassy has had a few reports of officials requesting a "gift" to facilitate official administrative matters (e.g., customs entry). Such requests should be politely but firmly declined.
It is prohibited to photograph government buildings and other official sites, such as military installations, without the formal consent of the Government of Benin. In general, it is always best to be courteous and ask permission before taking pictures of people. Beninese citizens may react angrily if photographed without their prior approval.
Obtaining customs clearance at the port of Cotonou for donated items shipped to Benin from the United States may be a lengthy process. In addition, to obtain a waiver of customs duties on donated items, the donating organization must secure prior written approval from the Government of Benin. Please contact the U.S. Embassy in Cotonou for more detailed information.Please see our Customs Information.

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Benin laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Benin are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.

CHILDREN'S ISSUES: For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Benin are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Benin. Americans withoutInternet access may register directly with the U.S. Embassy. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located at Rue Caporal Anani Bernard in Cotonou. The Embassy's mailing address is B.P. 2012, Cotonou, Benin. The 24-hour telephone numbers are (229) 21-30-06-50, 21-30-05-13, and 21-30-17-92. The Embassy’s general fax number is (229) 21-30-06-70; the Consular Section’s fax number is (229) 21-30-66-82; http://cotonou.usembassy.gov/.
* * *
This replaces the Country Specific Information for Benin dated August 17th, 2007 to update sections on Safety and Security and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Fri, 10 May 2019 19:38:30 +0200
By Hazel WARD and Daphne BENOIT

Paris, May 10, 2019 (AFP) - French special forces have freed two French hostages, an American and a South Korean in northern Burkina Faso in an overnight raid in which two soldiers died, authorities announced Friday.   The operation was launched to free two French tourists who had disappeared while on holiday in the remote Pendjari National Park in neighbouring Benin on May 1.

But during the raid, the French troops were surprised to discover two women also in captivity, with top officials saying they had been held for 28 days.    The French tourists were identified as Patrick Picque, 51, and Laurent Lassimouillas, 46, but the women's identities were not immediately clear.     "No one was aware of (the women's) presence," French Defence Minister Florence Parly told reporters, while French armed forces chief Francois Lecointre said.   "We know little about these other two hostages," Parly told reporters, saying that even Seoul and Washington did not appear to be aware the pair were in increasingly unstable Burkina Faso.    The raid was approved by French President Emmanuel Macron in what was seen as the last opportunity to stop the hostages being transferred to lawless territory in Mali to the north.

Parly said it was "too early to say" who had snatched the two French nationals from Benin, which has long been an island of stability in a region where Islamist militants are increasingly active.   "The message to terrorists and criminal gangs is clear: those who attack France and its nationals know that we will not spare any effort to track them down, find them and neutralise them," she said.   Four of the six kidnappers were killed in the raid.    French forces, helped by intelligence provided by the United States, had been tracking the kidnappers for several days as they travelled across the semi-desert terrain of eastern Burkina Faso from Benin to Mali.   They seized the opportunity to prevent "the transfer of the hostages to another terrorist organisation in Mali," Lecointre said, referring to the Macina Liberation Front (FLM).   The FLM is a jihadist group formed in 2015 and headed by a radical Malian preacher, Amadou Koufa. It is aligned with Al-Qaeda in the region.

- US intelligence support -
In a statement, Macron congratulated the special forces on the operation, in which he also expressed sorrow over the death of the two soldiers "who gave their lives to save those of our citizens".   And Parly thanked authorities in Benin and Burkina Faso for their help with the "complex operation", as well as the United States which provided intelligence and support.

The operation was also made possible by the presence of France's Operation Barkhane, which counts some 4,500 troops deployed in Mali, Burkina Faso, Niger and Chad to help local forces battle jihadist groups.   American special forces and drones are also known to operate in the violence-wracked Sahel region, which France fears could become further destabilised as jihadist groups are pushed out of north Africa, Iraq and Syria.   Burkina Faso has suffered from increasingly frequent and deadly attacks attributed to a number of jihadist groups, including the Ansarul Islam group, the Group to Support Islam and Muslims (GSIM) and Islamic State in the Greater Sahara.

- Relief and sadness -
The French tourists -- Patrick Picque who works in a Paris jewellery shop, and Laurent Lassimouillas a piano teacher, -- went missing with their guide on the last leg of their holiday in usually peaceful Benin.   The Pendjari wildlife reserve, which is famed for its elephants and lions, lies close to the porous border with Burkina Faso.   The badly disfigured body of their guide was found shortly after they disappeared, as well as their abandoned four-wheel Toyota truck.   The two freed men will be flown back to France on Saturday, alongside the South Korean woman, where they will be met on arrival by Macron and other top French officials.   Washington thanked the French forces for freeing the American hostage, with France saying she would likely be "repatriated independently" from the other three. 

The two dead French soldiers were named as Cedric de Pierrepont and Alain Bertoncello, decorated naval special forces members born in 1986 and 1991 respectively.   They were part of the prestigious Hubert commando unit of the French naval special forces which was deployed to the Sahel at the end of March.   A total of 24 French soldiers have died in the region since 2013 when France intervened to drive back jihadist groups who had taken control of northern Mali. The last death was on April 2.
Date: Tue 15 Jan 2019
Source: Punch [edited]

The Kwara state government has confirmed 2 cases of Lassa fever infecting a husband and wife in the state.

Speaking with newsmen on Tuesday [15 Jan 2019] at a news briefing, the Kwara commissioner for health, Alhaji Usman Rifun-Kolo, said the outbreak of Lassa fever was identified in a farm settlement in Taberu, Baruten local government area.

He explained that the 2 cases of the disease affected a husband and wife, natives of Benin republic, which shares a border with the state. He added that the husband and wife are farming in Baruten. "These cases of Lassa fever originated from Benin republic, whose citizen have interrelations with people in the Baruten area," he said.

According to him, the husband and wife were diagnosed in a health facility, and the state government had already deployed a disease-surveillance team to identify those who have been in contact with the patients.

Rifun-Kolo further explained that the surveillance team identified 4 people with a history of fever in the area. He said that the 4 cases raised suspicion of Lassa fever, which prompted them to take samples from the individuals for further investigation. He noted that the 4 individuals have commenced treatment in Taberu, Baruten LGA.
=====================
[The above report states that the couple was infected in Benin, although the timeline when that may have occurred is not given. The report also mentions 4 individuals in the Kwara state who had a history of Lassa fever, implying that the virus is present in that state in Nigeria as well. In December [2018], there were Lassa fever cases in Benin that were imported from Nigeria as well as infections that were locally acquired in Benin, so the Lassa fever cases cross the border in both directions. The source of the infecting virus for any of these cases is not mentioned. - ProMED Mod.TY

[HealthMap/ProMED-mail maps:
Kwara state, Nigeria: <http://healthmap.org/promed/p/19690>]
Date: Wed 26 Dec 2018
Source: Quotidein Le Matinal [in French, trans. ProMED Corr.SB, edited]

Minister of health Benjamin Hounkpatin confirmed on Wednesday [26 Dec 2018] 4 new cases of Lassa haemorrhagic fever in Benin, including one in Cotonou. This occurred in the period from 15-26 Dec 2018.

In the case of Cotonou, a 28-year-old (has been infected). His case was detected on 24 Dec [2018], but his illness commenced the previous week. He had a fever, a cough, a cold, and fatigue. Due to the persistence of the cough and cold, and with the appearance of traces of blood in nasal discharge on 24 Dec 2018, the alert was given.

The patient was placed in isolation on [Tue 25 Dec 2018], and on the morning of Wed 26 Dec 2018, his result from the laboratory came back positive [for Lassa fever]. Subsequently, the patient was isolated and put on treatment.

According to the details provided by Hounkpatin, there is no indication of travel [by the patient] to an epidemic locality of Lassa fever. According to the patient's statements, there is no known contact with rodents.

Taking advantage of this opportunity, the minister reassured the public that public health measures are underway. He also reminded people of the behaviours that will help avoid becoming infected. This involves washing hands regularly with soap and water; avoiding contact with stool, sperm, urine, saliva, vomit, and contaminated objects from a person suspected to be ill or dead from Lassa; and protecting food and keeping it in a safe place, out of reach of rodents.

It should be recalled that 7 cases have been recorded since the beginning of the epidemic to date, including 5 positive cases.
=======================
[One case is located in Cotonou on the Benin coast and apparently was locally acquired, perhaps from contact with the rodent host or its excrement. The location of the other 3 cases is not mentioned, but a 13 Dec 2018 report indicated that there were 3 cases in the municipality of Parakou in Borgou Department, in the northern part of Benin. Perhaps these 3 cases, which came from the village Taberou (in Nigeria), located 5 km [3.1 mi] from Tandou in the commune of Tchaourou, are the ones mentioned in this report.

The previous Lassa fever cases in Benin this year [2018] occurred in January and also involved case importation from Nigeria. A previous WHO report stated that Lassa fever is endemic in bordering Nigeria, and, given the frequent population movements between Nigeria and Benin, the occurrence of additional cases is not unexpected. Strengthening of cross-border collaboration and information exchange between the 2 countries is, therefore, needed. - ProMED Mod.TY]

[Images of the rodent reservoirs of Lassa fever virus can be seen as follows:
For _Mastomys natalensis_, see
For _M. erythroleucus_ and _Hylomycus pamfi_, see

HealthMap/ProMED-mail maps:
Date: Fri, 29 Jun 2018 13:37:32 +0200

Cotonou, June 29, 2018 (AFP) - Benin's Constitutional Court has banned the right to strike by workers in the country's defence, security, justice and health sectors, sparking concern among union officials and legal observers.   The ruling, issued late on Thursday, came after months of wrangling between the government and the court, which had previously said the measure was unconstitutional.

"Civil servants, public security forces and equivalents should fulfil their duties in all circumstances and not exercise their right to strike," the court said in its new ruling.   "There should be no disruption to the duties of public sector defence, security, justice and health workers."   The decision was taken "in the public interest" and for "the protection of citizens", it said.

Speaking on Friday, one senior union leader, who asked to remain anonymous, described the ruling as shocking and a "hammer blow".   And Benin legal affairs expert Albert Medagbe told AFP the decision was a "worrying sudden legal U-turn".   Earlier this month, a close ally of President Patrice Talon, Joseph Djogbenou, was elected to lead the Constitutional Court during a vote held behind closed doors.   Djogbenou is Talon's former personal lawyer and was previously  Benin's attorney general.

Until his arrival, the court had strained relations with Talon, and had criticised the government for misunderstanding and failing to respect the constitution.   The small West African nation was last year hit by a wave of public sector strikes, which brought the education, health and justice system to a near halt.   The industrial action was sparked by Talon's attempts to introduce free-market reforms.
Date: Wed, 21 Feb 2018 17:31:52 +0100

Cotonou, Feb 21, 2018 (AFP) - Nine people appeared in a Benin court Wednesday on charges of selling fake drugs at the start of a landmark trial in a regional campaign against illicit medicines.   The suspects, who include executives from major pharmaceutical companies operating in the West African nation, were remanded in custody until March 6 on technical grounds.   They are accused of "the sale of falsified medicines, (and) display, possession with a view to selling, commercialisation or sale of falsified medical substances."   A tenth defendant, the head of the Directorate for Pharmacies, Medications and Diagnostic Evaluation (DPMED) under the control of the ministry of health, was not in court on the trial's opening day.   He is accused of failing to prevent the offences.

Benin launched the crackdown last year after mounting alarm about the scale of the trafficking of expired and counterfeit drugs in West Africa.   Fake medicines are drugs that are bogus or below regulatory standards but often are outwardly indistinguishable from the genuine product.   Taking them may do nothing to tackle an illness or -- in the case of antibiotics -- worsen the problem of microbial resistance.   According to an investigation by the Paris-based International Institute of Research Against Counterfeit Medicines (IRACM), West African markets are awash with fake drugs made in China and India.

In 2015, the American Society of Tropical Medicine and Hygiene estimated that 122,000 children under five died due to taking poor-quality antimalarial drugs in sub-Saharan Africa.   A 15-nation regional body, the Economic Community of West African States (ECOWAS), last April announced an investigation into the fake drugs business.   A lawyer for the civilian plaintiffs told AFP that the trial in Benin was adjourned until March 6 at their request "in order to incorporate another case, of illegal pharmaceutical practice".
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Travel News Headlines WORLD NEWS

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Reunion

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Thu 2 May 2019
Source: France TV Info [trans. ProMED SB, edited]

Ti Baba nursery in Saint-Paul has been affected by cases of salmonellosis. Five babies were infected with the bacterium. They were examined by the nursery doctor following symptoms of acute gastroenteritis. For several days, symptoms of acute gastroenteritis have been occurring in the toddlers.

The analyses were carried out on the foodstuffs, the menus served to the children, and, according to the director of the SPL Ti Baba, the service providers in charge of the meals The LRA and the various health authorities are continuing the investigations to find the source of the infection.  [Byline: Rahabia Issa]
=======================
[The source of salmonellosis here is not yet known. Although a foodborne outbreak in the centre is possible, introduction of this enteric pathogen into the day care centre by a child is also possible.

Reunion, one of the overseas departments of France, is an island with a population of about 800 000 located in the Indian Ocean, about 943 km (586 mi) east of Madagascar and about 200 km (120 mi) southwest of Mauritius, the nearest island. A map showing the location of Reunion Island in the Indian Ocean and its main cities can be accessed at <http://www.nationsonline.org/oneworld/map/reunion-map.htm>.

A HealthMap/ProMED-mail interactive map of Reunion Island can be accessed at
<http://healthmap.org/promed/p/45149>. - ProMED Mod.LL]
- La Reunion. 10 Apr 2019

From 800 confirmed cases the previous week, the dengue epidemic increased to 904 cases in the week.
<https://la1ere.francetvinfo.fr/reunion/dengue-barre-900-cas-confirmes-semaine-est-depassee-698934.html> [in French, trans. ProMED Corr.SB]

- La Reunion. 12 Apr 2019. Dengue La Reunion (French overseas territory): dengue cases near 5000 in Q1 2019. New transmission zones have been identified in Saint-Andre, Saint-Denis, Sainte-Marie, and Sainte-Suzanne. In addition, the number of hospitalizations is increasing with 25-30 recorded weekly.

- La Reunion. 27 Mar 2019. The circulation of the dengue virus continues at a sustained level, say the prefecture and the ARS. From 11-17 Mar 2019, 682 cases of dengue fever were confirmed. Since the beginning of the year [2019], 153 emergency room visits have been recorded and 80 patients have been hospitalized. In addition, 5 deaths have been reported since the beginning of 2019, of which 2 have been considered, after investigation, as directly related to dengue fever. The most active households are located at: the Saint-Louis River, Saint Louis, Saint Pierre, the Etang-Sale Cabris Ravine.
- Reunion Island. Fri 24 Aug 2018

6476 dengue cases gave been confirmed since January 2018; 138 hospitalized, 20 cases of severe dengue, including 3 deaths.

[HealthMap/ProMED-mail map of Reunion Island:
Reunion Island. 23 May 2018

In the Indian Ocean, it is also serotype 2 that predominates during the dengue epidemic affecting western and southern Reunion. According to the last assessment of [22 May 2018], 3416 biologically confirmed or probable cases have been reported since [1 Jan 2018, including 387 in a single week. Among them, 75 cases were hospitalized, including 9 severe cases.

[HealthMap/ProMED-mail map of Reunion Island:
Date: Fri 25 May 2018, 5:29 PM
Source: Linfo [in French, trans. ProMED Corr.SB, edited]
<http://www.linfo.re/la-reunion/societe/leptospirose-89-cas-confirmes-depuis-le-debut-de-l-annee-a-la-reunion>

Since the beginning of the year, 89 cases of leptospirosis have been reported in Reunion (against 50 in 2017). This disease can be contracted through contact with contaminated wetland (stagnant water, mud, etc). The West and South are the most affected regions with 21 confirmed cases in Saint-Paul.

Once again, the cleaning of courtyards and gardens or bathing in fresh water [flood water that is contaminated with urine from infected animals, e.g., rats, dogs?] after heavy rains is particularly at risk. The ARS Indian Ocean [the French Regional Health Agency in charge of health administration for Mayotte and La Reunion islands] wants to sensitize the population: it is essential to apply protective measures and fight against rats.

In addition, in the context of a proven epidemic of dengue fever, it is recommended to consult your doctor in case of high fever, in order to be tested and treated appropriately if necessary. [Byline: Lucie Touza]
===================
[Leptospirosis is a zoonotic bacterial infection that is distributed widely throughout the world in warm climates and is transmitted to humans by direct contact of abraded skin or mucous membranes with the urine of infected animals or by contact with wet soil, vegetation, or water that has been contaminated with infected animal urine. _Leptospira_ bacteria shed in urine may survive in fresh water or moist soil for weeks to months.

Many species of wild and domestic animals (including dogs, cattle, swine, and especially rats) are susceptible to chronic kidney infection with pathogenic _Leptospira_. Different leptospiral serovars are prevalent in particular geographical regions. Inadequate disposal of trash and debris provides a suitable habitat for rat infestation in urban settings.

Outbreaks of leptospirosis frequently follow heavy rainfall, flooding with fresh water, and increasing rodent numbers. Reunion experiences seasonal outbreaks of leptospirosis probably related to the rainfall. Reunion, one of the overseas departments of France, is an island with a population of about 800,000 located in the Indian Ocean, about 943 km (586 mi) east of Madagascar and about 200 km (120 mi) south west of Mauritius, the nearest island.

A map showing the location of Reunion Island in the Indian Ocean and its main cities can be accessed at
<http://www.nationsonline.org/oneworld/map/reunion-map.htm>.

A HealthMap/ProMED-mail interactive map of Reunion Island can be accessed at
<http://healthmap.org/promed/p/45149>. - ProMED Mod.ML]
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Ethiopia

Ethiopia - US Consular Information Sheet
November 26, 2008
COUNTRY DESCRIPTION:
The Federal Democratic Republic of Ethiopia is a developing country in East Africa.
It is comprised of nine states and two city administrations (Addis Aba
a and Dire Dawa).
The capital is Addis Ababa.
Tourism facilities can be found in the most populous regions of Ethiopia, but infrastructure is basic.
The ruling EPRDF party and Prime Minister Meles Zenawi maintain strong control of the government and economy.
Despite several years of high economic growth, the country remains vulnerable to external economic shocks and recurring drought.

Read the Department of State Background Notes on Ethiopia for additional information.

ENTRY/EXIT REQUIREMENTS:
To avoid possible confusion or delays, travelers are advised to obtain a valid Ethiopian visa at the nearest Ethiopian Embassy prior to arrival, and must do so if entering across any land port-of-entry.
For example: travelers wishing to enter Ethiopia from Kenya at the land border at Moyale, must obtain an Ethiopian visa first.
Ethiopian visas ARE NOT available at the border crossing point at Moyale.
Travelers should apply for Ethiopian visas at the Ethiopian Embassy in Nairobi or at other Ethiopian embassies in other countries.
Ethiopian visas are available to U.S. citizens upon arrival at Bole International Airport in Addis Ababa.
U.S. citizens may obtain one-month or three month, single-entry tourist visas or 10-day single-entry business visas upon arrival at Bole International Airport.
This service is available only at Bole International Airport and is not available at any other ports of entry in Ethiopia.
The visa fee at Bole International Airport is payable in U.S. dollars.
Such visas can be extended by applying at the Main Immigration Office in Addis Ababa.
Business visas of up to three-months validity can also be obtained at Bole International Airport upon arrival if the traveler has a sponsoring organization in Ethiopia that has made prior arrangements for issuance through the Main Immigration Office in Addis Ababa.
Travelers whose entry visa expires before they depart Ethiopia, must obtain a visa extension and pay a monthly penalty fee of $20 USD per month.
Such travelers may also be required to pay a court fine of up to 4000 ETB (USD $435) before being permitted to depart from Ethiopia.
Travelers are required to pay the penalty fee before they will be able to obtain an exit visa (USD $20) permitting them to leave Ethiopia.

Individuals intending to stay in Ethiopia for a prolonged period of time are advised to contact the Ethiopian Embassy in Washington prior to traveling.
The Ethiopian Embassy is located at 3506 International Drive NW, Washington, DC 20008; telephone (202) 364-1200; fax (202) 587-0195.
For the most current visa information, visit the Embassy’s web site at www.ethiopianembassy.org.
Inquiries by Americans located overseas may be made at the nearest Ethiopian embassy or consulate.

Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
While Ethiopia is generally stable, domestic insurgent groups, extremists from Somalia, and the heavy military buildup along the northern border pose risks to safety and security, particularly along Ethiopia’s border areas and in the Somali region.
In the past year, there has been an increase in targeted bombings in Addis Ababa and in other parts of Ethiopia.
In November 2008, the Government of Ethiopia issued a warning to its citizens alerting them of the potential for terrorist attacks and subsequently increased security measures to unprecedented levels.

Throughout Ethiopia:
Americans are strongly advised to review their personal safety and security posture, to remain vigilant and to be cautious when frequenting prominent public places and landmarks.
Targeted bombings in Addis Ababa and south eastern Ethiopia in 2008 resulted in numerous injuries and deaths.
Americans are advised to avoid public gatherings and public places, including hotels, if possible, and using public transportation and transportation hubs.
They are advised to beware of unattended baggage or packages left in any location, including in mini-buses and taxis.

Ethiopia/Eritrea Border Area:
Ethiopia and Eritrea signed a peace agreement in December 2000 that ended their border war.
However, the border remains an issue of contention between the governments of Ethiopia and Eritrea.
The border area is a militarized zone where there exists the possibility of armed conflict between Ethiopian and Eritrean forces.
American citizens are advised to avoid travel in the areas along the Eritrean/Ethiopian border (within 50 km/30 miles of the Ethiopian/Eritrean border) because of the dangers posed by land mines and because of the possibility of conflict between Ethiopian and Eritrean defense forces.
Due to abductions and banditry, Americans are advised to avoid travel within 30 miles of the Ethiopian-Eritrean border west of Adigrat to the Sudanese border, with the exception of the town of Axum, and within 60 miles east of Adigrat to the Djiboutian border.
Embassy personnel are permitted to travel in these areas only on a case-by-case basis. Travel to the northern Afar Region towards the Eritrean border is also discouraged.
Embassy personnel are permitted to travel there only on a case-by-case basis.

Somali Region:
Since the mid-1990's the members of the Ogaden National Liberation Front (ONLF) have clashed with Ethiopian government forces near the city of Harar and in the Somali regional state, particularly in the Ogaden zones.
In April 2007, the ONLF claimed responsibility for attacking a Chinese oil exploration installation south of Jijiga, in Ethiopia's Somali region.
The attack resulted in deaths, kidnappings and the wounding of dozens of Chinese and Ethiopian citizens.
In 2008, a hotel in the town of Jijiga was bombed and two hotels in the town of Negele Borena were bombed.

American citizens are reminded that the U.S. Embassy strongly discourages travel to Ethiopia's Somali region and that a Travel Warning for Somalia has been issued that advises against all travel to that country.
Armed insurgent groups operate within the Somali, Oromiya and Afar regions of Ethiopia.
In December 2006, the Ethiopian Government, at the invitation of the Transitional Federal Government of Somalia, began military operations against extremists in Somalia.
As of November 2007, military operations continue in Mogadishu, where an African Union peacekeeping force, AMISOM, is deployed.
In 2008, two staff members of a non-governmental organization (NGO) were abducted in the Somali region.

Gambella Region:
Sporadic inter-ethnic clashes remain a concern throughout the Gambella region of western Ethiopia following outbursts of violence there in 2003 - 2004.
There is a heavy military and police presence in the town of Gambella.
While the security situation in the town of Gambella is calm, it remains unpredictable throughout the rest of the region, and violence could recur without warning.
Travel to this region is discouraged.

Travel in Ethiopia via rail is discouraged due to past episodes of derailment, sabotage, and bombings.
In southern Ethiopia along the Kenyan border, banditry and incidents involving ethnic conflicts are also common.
Travelers should exercise caution when traveling to any remote area of the country, including the borders with Eritrea, Somalia, Kenya and Sudan.
Ethiopian security forces do not have a widespread presence in those regions.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Pick-pocketing, “snatch and run” thefts, and other petty crimes are common in Addis Ababa.
These are generally crimes of opportunity rather than planned attacks.
Travelers should exercise caution in crowded areas and should avoid visiting the Mercato in Addis Ababa, a large open-air market.
Violence in the Mercato has been on the rise.
In 2008 an explosion in the Mercato killed several and wounded more than a dozen individuals.
Also in 2008, there was a shooting in the Mercato.
Travelers should limit the amount of cash they carry and leave valuables, such as passports, jewelry, and airline tickets in a hotel safe or other secure place.
Travelers should keep wallets and other valuables where they will be less susceptible to pick-pockets.
Travelers should be cautious at all times when traveling on roads in Ethiopia.
There have been reports of highway robbery, including carjacking, by armed bandits outside urban areas.
Some incidents have been accompanied by violence.
Travelers are cautioned to limit road travel outside major towns or cities to daylight hours and travel in convoys, if possible.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
See our information on Victims of Crime.

There is no local equivalent to the “911” emergency line in Ethiopia.
Distress calls should be made to the local police station, the telephone number of which can be obtained by calling directory assistance at 997.
This is the number for directory assistance throughout Ethiopia.
In Addis Ababa, the number for police is 991, for the fire brigade 939, and for an ambulance 907.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Health facilities in Addis Ababa are very limited and are generally inadequate outside the capital.
Even the best hospitals in Addis Ababa suffer from inadequate facilities, antiquated equipment, and shortages of supplies (particularly medicines).
There is a shortage of physicians.
Emergency assistance is limited.
Psychiatric services and medications are practically nonexistent.
Serious illnesses and injuries often require travelers to be medically evacuated from Ethiopia to a location where adequate medical attention is available.
Such “medevac” services are very expensive and are generally available only to travelers who either have travel insurance that covers medevac services or who are able to pay in advance the considerable cost of such services (often in excess of USD 40,000).
See Medical Insurance below.
Travelers must carry their own supplies of prescription drugs and preventive medicines, as well as a doctor's note describing the medication.
If the quantity of drugs exceeds that which would be expected for personal use, a permit from the Ministry of Health is required.
Malaria is prevalent in Ethiopia outside of the highland areas.
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and explain to the health care provider their travel history and which anti-malarials they have been taking.
For additional information on malaria, protection from insect bites, and anti-malarial drugs, please visit the CDC Travelers' Health web site at http://www.cdc.gov/malaria/index.htm.
Tuberculosis is an increasingly serious health concern in Ethiopia.
For further information, please consult the CDC's Travel Notice on TB at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx

Ethiopia is a mountainous country and the high altitude may cause health problems, even for healthy travelers.
Addis Ababa is located at an altitude of 8,300 feet.
Travelers may experience shortness of breath, fatigue, nausea, headaches, and inability to sleep.
Individuals with respiratory (including asthma) or heart conditions should consult with a health care professional before traveling to Ethiopia.
Travelers to Ethiopia should also avoid swimming in any lakes, rivers, or still bodies of water.
Most bodies of water have been found to contain parasites.
Travelers should be aware that Ethiopia has a high prevalence of HIV/AIDS.
Ethiopia has had outbreaks of acute watery diarrhea, possible cholera, typhoid, or other bacterial diarrhea in the recent past, and the conditions for reoccurrences continue to exist.
Further information on prevention and treatment of cholera and other diarrheal diseases can be found at the CDC web site at http://wwwn.cdc.gov/travel/contentDiseases.aspx.
Ethiopian authorities are monitoring the possibility of avian influenza following the deaths of poultry and birds; preliminary results are negative.
For additional information on avian flu please visit the CDC website at http://www.cdc.gov/flu/avian/.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Ethiopia.
Please verify with the embassy of Ethiopia before you travel.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Specific medevac insurance, which generally covers evacuation of a patient from Ethiopia to a location where adequate medical attention is available, is often inexpensive and available through a variety of companies that can be accessed online.
Medicare and Medicaid recipients are not covered overseas and are advised to purchase supplemental health and medical evacuation insurances.
Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Ethiopia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
According to the World Health Organization (WHO), Ethiopia has the highest rate of traffic fatalities per vehicle in the world.
Roads in Ethiopia are poorly maintained, inadequately marked, and poorly lighted.
Road travel after dark outside Addis Ababa and other cities is dangerous and discouraged due to hazards posed by broken-down vehicles left in the road, pedestrians walking in the road, stray animals, and the possibility of armed robbery.
Road lighting in cities is inadequate at best and nonexistent outside of cities.
Excessive speed, unpredictable local driving habits, pedestrians and livestock in the roadway, and the lack of basic safety equipment on many vehicles are daily hazards on Ethiopian roads.
While travel during daylight hours on both paved and unpaved roads is generally considered safe, land mines and other anti-personnel devices can be encountered on isolated dirt roads that were targeted during various conflicts.
Before undertaking any off-road travel, it is advisable to inquire of local authorities to ensure that the area has been cleared of mines.
Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Ethiopia’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Ethiopia’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa/.
The Ethiopian government has closed air routes near the border with Eritrea and has referred to the airspace as a “no-fly zone.”
The FAA currently prohibits U.S. aircraft and U.S. pilots from flying in Ethiopian airspace north of 12 degrees north latitude, the area along the country's northern border with Eritrea.
For complete information on this flight prohibition, travelers may visit the FAA's web site at http://www.faa.gov/airports_airtraffic/air_traffic/publications/notices/2008-11-20/PART3_SEC1.cfm.
SPECIAL CIRCUMSTANCES:
Ethiopia does not recognize dual nationality.
The government of Ethiopia considers Ethiopians who have become naturalized U.S. citizens to be Americans.
Such individuals are not subject to Ethiopian military service.
The Ethiopian government has stated that Ethiopian-Americans in almost all cases are given the same opportunity to invest in Ethiopia as Ethiopians.
Several years ago the government of Ethiopia arrested people of Eritrean origin who initially failed to disclose their U.S. citizenship.
However, this has not occurred in recent years.
Ethiopian officials have recently stated that Eritrean-Americans are treated as U.S. citizens and are not subject to arrest simply because of their ties to Eritrea.
For additional information, see our dual nationality flyer.
Permits are required before exporting either antiques or animal skins from Ethiopia.
Antique religious artifacts, including "Ethiopian” crosses, require documentation from the National Museum in Addis Ababa for export.
Foreign currency should be exchanged in authorized banks, hotels and other legally authorized outlets and proper receipts should be obtained for the transactions.
Exchange receipts are required to convert unused Ethiopian currency back to the original foreign currency.
Penalties for exchanging money on the black market range from fines to imprisonment.
Credit cards are not accepted at most hotels, restaurants, shops, or other local facilities, although they are accepted at the Hilton and Sheraton Hotels in Addis Ababa.
Some hotels and car rental companies, particularly in Addis Ababa, may require foreigners to pay in foreign currency or show a receipt for the source of foreign exchange if paying in local currency.
However, many hotels or establishments are not permitted to accept foreign currency or may be reluctant to do so.

Ethiopian institutions have on occasion refused to accept 1996 series U.S. currency, although official policy is that such currency should be treated as legal tender.
Ethiopian law strictly prohibits the photographing of military installations, police/military personnel, industrial facilities, government buildings, and infrastructure (roads, bridges, dams, airfields, etc.).
Such sites are rarely marked clearly.
Travel guides, police, and Ethiopian officials can advise if a particular site may be photographed.
Photographing prohibited sites may result in the confiscation of film and camera.
There is a risk of earthquakes in Ethiopia.
Buildings may collapse due to strong tremors.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/
Please see our Customs Information.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Ethiopia’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Ethiopia are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Ethiopia are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Ethiopia.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at Entoto Avenue, P.O. Box 1014, in Addis Ababa; telephone: 251-11-124-2424; emergency after-hours telephone: 251-11-124-2400; consular fax: 251-11-124-2435; web site: http://ethiopia.usembassy.gov/
* * *
This replaces the Country Specific Information for Ethiopia dated April 30, 2008 to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Thu 31 Oct 2019
Source: News 18 [abridged, edited]

For the past 10 months, Ethiopia has been experiencing a measles outbreak, which began in Oromio region and later affected 3 additional regions: Afar, Amhara and Somali. Since the beginning of the year [2019], a total of 8514 suspected measles cases, including 57 deaths (case fatality ratio 0.67%), were reported.

The World Health Organisation (WHO) says measles is endemic in Ethiopia with outbreaks reported annually. A quarter of the people affected during the current outbreak are 15 years and above, and more than 82.6% of cases were either not vaccinated or their vaccination status was unknown.
Date: Sun 20 Oct 2019
Source: WHO-AFRO [abridged, edited]

Weekly bulletin on outbreaks and other emergencies Week 42: 14-20 Oct 2019
Summary: Cases: 8514; deaths: 57; CFR [case fatality ratio]: 0.67%

Description
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Ethiopia has been experiencing a measles outbreak since late December 2018. The outbreak was initially reported in Oromia region and later affected 3 additional regions: Afar, Amhara, and Somali.

In week 41 (week ending 13 Oct 2019), 24 suspected cases with no deaths were reported. Between week 1 and week 41 in 2019, a total of 8514 suspected measles cases, including 57 deaths (CFR 0.67%), were reported. Of the 8514 suspected cases, 180 samples were tested, and 14 tested IgM-positive for measles virus infection at the Ethiopian Public Health Institute laboratory in Addis Ababa. The peak of the outbreak was reached in week 9 (week ending 3 Mar 2019), with 642 cases reported, followed by a gradual decline in the number of cases to 24 cases reported in week 41.

A total of 4 regions have confirmed measles outbreaks, including 28 zones and 113 woreda [districts]. Oromia region is the most affected, accounting for 58% of the total reported cases, followed by Somali (28%), Amhara (8%), and Afar (6%) regions.

The majority of affected cases are children under 5 years old, comprising 50.4% of all cases, followed by the age group 15-44 years (25.4%) and 5-14 years (23.3%). Upon investigation of the vaccination status of the cases, it was noted that 72.6% had never received a single measles dose.

Public health actions
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- A national coordination committee was set up at the Ethiopian Public Health Institute to coordinate the response to the measles outbreak as well as regional coordinating committees in each of the affected regions.
- Enhanced surveillance activities continue to enable the early detection of cases and prompt treatment.
- The Ethiopian government together with WHO, UNICEF, and other partners supported a responsive vaccination campaign in Somali region.
- In early February 2019, Ethiopia launched a measles vaccine 2nd dose (MCV2) vaccination into the routine immunization programme in the 2nd year of life.
- Management of measles cases is ongoing at healthcare facilities in the affected regions.

Situation interpretation
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Measles is endemic in Ethiopia with outbreaks reported annually. A quarter of the people affected during the current outbreak are 15 years and above, and more than 82.6% of cases were either not vaccinated or their vaccination status was unknown. In addition, an effective cold-chain system for storage and transport of the vaccine is lacking in a number of regions, especially Afar and Somali regions. The estimated measles vaccine 1st dose (MCV1) coverage by WHO and UNICEF in 2018 was 61%, and the administrative coverage for the same period was 88%. This is suboptimal to protect a community against an outbreak (to achieve herd immunity, usually 95% and above coverage is required).

There is a need to apply simple yet innovative approaches to address the health system challenges that impact the effective delivery of measles vaccines, and other vaccines, to the population, especially those located in the hard-to-reach areas of the country. Routine measles vaccination for children, combined supplemental immunization activities (SIAs) and strong community engagement are key public health strategies to reduce the incidence of the disease.
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Date: Tue, 15 Oct 2019 20:35:37 +0200 (METDST)

Addis Ababa, Oct 15, 2019 (AFP) - Rescue workers on Tuesday used excavators to dig out bodies after a landslide in southern Ethiopia washed away homes and killed more than 20 people, a local official said.    The landslide in the remote district of Konta occurred Sunday following 10 hours of heavy rains, said the official, Takele Tesfu.   "There are 22 people dead and we have only been able to dig up 17 using manpower and machine power," Takele told AFP.   "So far, we cannot get the others, so tomorrow we will continue to dig."     He said the victims included nine women and six children.

While the district -- located in Ethiopia's Southern Nations, Nationalities, and Peoples' Region -- sees landslides with some regularity, Takele said this was the deadliest he could remember.    "The area where this occurred is very mountainous, and this means the landslide was very dangerous," he said.    Ethiopia is nearing the end of its rainy season, but security forces are nonetheless relocating some families for fear that more rain in the coming days could lead to similar disasters, Takele said.
Date: Thu, 10 Oct 2019 20:02:59 +0200 (METDST)
By Robbie COREY-BOULET

Addis Ababa, Oct 10, 2019 (AFP) - A palace that once housed Ethiopia's emperors and also served as a torture site under the communist Derg regime is to open to the public in a controversial government tourism project.    The palace compound in Addis Ababa, which Prime Minister Abiy Ahmed's government has rebranded "Unity Park", was formally launched Thursday and will be open from Friday.    Abiy's office said on Twitter Thursday that the project "symbolises our ability to come together".

But critics have dismissed it as vanity project for Abiy that could prove divisive.   Backed by the United Arab Emirates, the project cost more than $160 million (145 million euros), Ethiopian officials told reporters at a briefing earlier this week.    Built in the late 1800s by Emperor Menelik II, who founded Addis Ababa, the palace was the residence of Ethiopia's rulers for more than a century.   Abiy himself does not live there, and it has seen little activity in recent years.    Abiy's advisers say he has taken a keen interest in transforming the palace into a tourist attraction since coming to power in April 2018 -- visiting the site every day in recent weeks to monitor progress.

The government's "Home-Grown Economic Reform" agenda, unveiled last month, describes tourism as a primary engine of potential job creation.    On Thursday, government officials and the diplomatic corps toured the expansive site before attending a banquet that was expected to draw five regional heads of state and other dignitaries.    The restored rooms feature items like Menelik's sword and a life-size wax replica of former Emperor Haile Selassie, who lived at the palace and was then etained there after the Derg overthrew him in 1974.

The site also includes a sculpture garden with installations representing Ethiopia's nine regions, and a zoo is expected to open by the end of the year.    Aklilu Fikresilassie, an Ethiopian employee of the United Nations who attended the launch Thursday, said he was "really fascinated" to set foot inside a place that had been closed to the public his entire life.    "For us it's like a government house, so now when you enter that palace it tells you that we are getting somehow closer to our leaders," he said.

But not everyone is convinced the palace will succeed in bringing Ethiopians together.   In a country grappling with ethnic divisions, some worry that the palace could alienate ethnic Oromos who contend that their ancestors were forced off their land when Addis Ababa was built.    Journalist and former political prisoner Eskinder Nega said the renovations were undertaken "without consultation from the public", which he called "a huge mistake."    "This is all about heritage, about preserving heritage. The people should have had a say in it," he said.    "Like everything else this was decided from the top and implemented only by the decision of the prime minister."
Date: Tue 2 Jul 2019
Source: Anadolu Agency [edited]

Ethiopia has diagnosed 871 people with cholera, an acute infectious diarrheal disease, an official said. "So far, 871 people have been diagnosed with cholera in different areas," the local broadcaster FANA stated, quoting the Director General of Ethiopian Public Health Institute, Getachew Tolera. The cholera cases have spread in Oromia, Amhara, Tigray, Somali and Afar provinces, as well as in 2 major cities of the country. The disease has so far caused deaths of 17 persons, FANA quoted Getachew as saying.

The majority of cases have been reported from Oromia province, with 350 people diagnosed with the infectious disease. As many as 202 people have contracted it in Amhara, 19 in Tigray, 131 in Afar and 33 in Somali regions. Some 125 persons have been diagnosed with the disease in the capital Addis Ababa and one in Dire Dawa city in Eastern Ethiopia. In a bid to control further spread of the disease, 26 quarantine centres have been set up across the nation. Getachew said medicines are being made available to the affected areas. At least 291 000 people have been vaccinated in the West Harerghe zone of Oromia province, according to the local broadcaster.  [Byline: Addis Getachew Tadesse]
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World Travel News Headlines

Date: Tue, 10 Dec 2019 10:50:09 +0100 (MET)

Sydney, Dec 10, 2019 (AFP) - The death toll from New Zealand's White Island volcano eruption rose to six late Tuesday, after an injured person died in an Auckland hospital, police said.   "Police can confirm a further person has died following the eruption on Whakaari/White Island, bringing the official toll to six," a police statement said.   Eight more people who remain missing are presumed dead after the volcano erupted Monday.
Date: Tue, 10 Dec 2019 09:27:57 +0100 (MET)
By Andrew BEATTY, with Daniel de Carteret in Gosford

Sydney, Dec 10, 2019 (AFP) - Toxic haze blanketed Sydney Tuesday triggering a chorus of smoke alarms to ring across the city and forcing school children inside, as "severe" weather conditions fuelled deadly bush blazes along Australia's east coast.   Fire engines raced office-to-office in the city centre with sirens blaring, as inland bushfires poured smoke laden with toxic particles into commercial buildings.   Emergency services responded to an "unprecedented" 500 automatic call-outs inside a few hours according to New South Wales Fire and Rescue's Roger Mentha.

A regional fire headquarters miles from the nearest blazes was itself evacuated while throngs of mask-wearing commuters choked their way through thick acrid air and the organisers of a harbour yacht race declared it was unsafe to proceed.   "The smoke from all the fires is just so severe here on the harbour that you just can't see anything, so it's just too dangerous," said spokeswoman Di Pearson of an event that normally foreshadows the famed Sydney-Hobart yacht race. "The vision is just so poor."   Some of the city's commuter ferries were also cancelled "due to thick smoke" and school kids were kept inside at breaktime and sent home early as pollution levels soared far above "hazardous" levels.

For weeks the east of the country has been smothered in smoke as drought and climate-fuelled bushfires have burned. But the scale of the problem on Tuesday shocked even hardened residents.   Bruce Baker -- an 82-year-old who lives in Gosford, north of Sydney -- said he was skipping his daily morning walk because of the smoke.   "This is the worst it's been, for sure," he told AFP. "It dries your throat. Even if you're not asthmatic, you feel it."   Authorities recommended that the vulnerable cease outdoor activity altogether and that everyone stay inside as much as possible, although one couple braved the toxic air to get married on the waterfront in front of Sydney Harbour Bridge shrouded in smog.

A cricket match between New South Wales and Queensland also went ahead, despite a barely visible ball.   Tuesday had been expected to bring strong winds and high temperatures that made for "severe conditions where embers can be blown ahead of the fire into suburbs and threaten properties."   But New South Wales Rural Fire Service said "deteriorating fire conditions have been delayed by a thick blanket of smoke" over the east of the state.   As the day developed there were nearly 100 bushfire incidents in the state of New South Wales alone and dozens more in Queensland.   Total fire bans were put in place across much of the east of the country and in large parts of western Australia.   Temperatures in some inland areas eased past 44 degrees Celsius (111 Fahrenheit).

- The 'big dry' -
To the northwest of Sydney, several fires already burning for weeks have combined to create a "megafire" that has already destroyed 319,000 hectares (788,000 acres) of land, mostly inside national parks.   Prime Minister Scott Morrison  -- who for weeks has not commented on the smoke haze -- defended his government's handling of the fires and said there were no plans to professionalise the countryside's largely volunteer force.    "Our policy is sensible when it comes to addressing and taking action on climate change. Our actions on climate change are getting the results they're intended to get," he said.   Morrison's conservative coalition has been criticised by former fire chiefs for failing to heed warnings about climate change.   The crisis has been propelled by a prolonged drought that has made vegetation tinder dry.

The Bureau of Meteorology has reported that Australia experienced its driest November on record this year.   The "big dry" has left farmers desperate and small towns facing the prospect of running out of water completely.   A swathe of the east of the country has seen "rainfall deficiencies" since early 2017 -- almost three years.   Many dams in New South Wales are empty and almost all are well below capacity.   Firefighters south of Brisbane recently reported 1,000 litres of water were stolen from tanks at their station.   Amid the shortage, Tuesday also saw the toughest water restrictions in a decade being introduced for Sydney -- with curbs on everything from hosepipe use to washing cars.
Date: Tue, 10 Dec 2019 03:09:17 +0100 (MET)
By Allison JACKSON

Sao Paulo, Dec 10, 2019 (AFP) - Gripping the deadly snake behind its jaws, Fabiola de Souza massages its venom glands to squeeze out drops that will save lives around Brazil where thousands of people are bitten every year.   De Souza and her colleagues at the Butantan Institute in Sao Paulo harvest the toxin from hundreds of snakes kept in captivity to produce antivenom.    It is distributed by the health ministry to medical facilities across the country.

Dozens of poisonous snake species, including the jararaca, thrive in Brazil's hot and humid climate.    Nearly 29,000 people were bitten in 2018 and more than 100 died, official figures show.   States with the highest rates of snakebite were in the vast and remote Amazon basin where it can take hours to reach a hospital stocked with antivenom.   Venom is extracted from each snake once a month in a delicate and potentially dangerous process.

Using a hooked stick, de Souza carefully lifts one of the slithering creatures out of its plastic box and maneuvers it into a drum of carbon dioxide.    Within minutes the reptile is asleep.    "It's less stress for the animal," de Souza explains.    The snake is then placed on a stainless steel bench in the room where the temperature hovers around 27 degrees Celsius (80 degrees Fahrenheit).    De Souza has a few minutes to safely extract venom before the snake begins to stir.      "It's important to have fear because when people have fear they are careful," she says.

- Antivenom 'crisis' -
The snakes are fed a diet of rats and mice that are raised at the leafy institute and killed before being served up once a month.   After milking the snake, de Souza records its weight and length before placing it back in its container.    The antivenom is made by injecting small amounts of the poison into horses -- kept by Butantan on a farm -- to trigger an immune response that produces toxin-attacking antibodies.

Blood is later extracted from the hoofed animals and the antibodies harvested to create a serum that will be administered to snakebite victims who might otherwise die.   Butantan project manager Fan Hui Wen, a Brazilian, says the institute currently makes all of the country's antivenom -- around 250,000 10-15 millilitre vials per year.

Brazil also donates small quantities of antivenom to several countries in Latin America.    There are now plans to sell the life-saving serum abroad to help relieve a global shortage, particularly in Africa.    About 5.4 million people are estimated to be bitten by snakes every year, according to the World Health Organization (WHO). 

Between 81,000 and 138,000 die, while many more suffer amputations and other permanent disabilities as a result of the toxin.   To cut the number of deaths and injuries, WHO unveiled a plan earlier this year that includes boosting production of quality antivenoms.   Brazil is part of the strategy. It could begin to export antivenom as early as next year, Wen says.   "There is interest for Butantan to also supply other countries due to the global crisis of antivenom production," she says.
Date: Mon, 9 Dec 2019 14:14:15 +0100 (MET)

Dec 9, 2019 (AFP) - New Zealand, struck by a deadly volcanic eruption Monday, lies in a zone where Earth's tectonic plates collide, making it a hotspot for earthquakes and volcanic activity.   In one of its worst natural disasters, a huge mass of volcanic debris from the eruption of Mount Ruapehu triggered a mudslide in 1953 that washed away a bridge and caused a passenger train to plunge into a river with the loss of 151 lives.  After Monday's eruption on New Zealand's White Island, here is a recap of some of the deadliest volcanic eruptions around the world in the past 25 years.

- 2018: Indonesia -
In December the Anak Krakatoa volcano, a small island in the Sunda Strait between Java and Sumatra, erupts and a section of its crater collapses, sliding into the ocean and generating a tsunami. More than 420 people are killed and 7,200 wounded.

- 2018: Guatemala -
The June eruption of the Fuego volcano, about 35 kilometres (22 miles) from the capital, unleashes a torrent of mud and ash that wipes the village of San Miguel Los Lotes from the map. More than 200 people are killed.

- 2014: Japan -
The sudden eruption in September of Mount Ontake, in the central Nagano region, kills more than 60 people in Japan's worst volcanic disaster in nearly 90 years. The mountain is packed with hikers at the time. In 1991 an eruption of the southwestern Unzen volcano kills 43.

- 2014: Indonesia -
At least 16 people are killed on the island of Sumatra in February by a spectacular eruption of Mount Sinabung, which had lain dormant for 400 years before roaring back to life five months earlier. In 2016 villages are scorched and farmland devastated after another eruption kills seven.

- 2010: Indonesia -
Indonesia's most active volcano, Mount Merapi on Java island, starts a series of explosions in October, eventually killing more than 320 people. An 1930 eruption of the volcano killed 1,300 people and one in 1994 claimed more than 60 lives.

- 2002: DR Congo -
The eruption in July of Mount Nyiragongo in the eastern Democratic Republic of Congo destroys the centre of Goma town, along with several residential areas, and kills more than 100 people.

- 1997: Montserrat -
The capital of the small British colony, Plymouth, is wiped off the map and 20 are killed or left missing in avalanches of hot rock and ash clouds when its volcano erupts in June.

- 1995: The Philippines -
At least 70 are killed and another 30 missing after the crater of the Parker volcano in the south of the island of Mindanao collapses. Five years earlier the eruption of Mount Pinatubo, 80 kilometres north of the capital Manila, kills more than 800 people.

- Worst ever -
The explosion of Indonesia's Krakatoa volcano in 1883 is considered the worst ever seen. The eruption sent a jet of ash, stones and smoke shooting more than 20 kilometres (12 miles) into the sky, plunging the region into darkness, and sparking a huge tsunami that was felt around the world. The disaster killed more than 36,000 people.

The most famous eruption in history is that of Mount Vesuvius in modern-day Italy in 79 AD, which destroyed the towns of Herculaneum, Stabiae and Pompeii, wiping out an estimated 10 percent of the population of the three cities.
Date: Mon 9 Dec 2019
Source: Fox 29 Philadelphia [edited]

A total of 31 people have been sickened by salmonellosis at 4 health care facilities in south-eastern Pennsylvania. A majority of those cases occurred after individuals ate pre-cut fruit from New Jersey-based Tailor Cut Produce. The Food and Drug Administration (FDA) announced the salmonellosis outbreak in conjunction with the Pennsylvania Department of Health (DOH) on [Fri 6 Dec 2019]. The North Brunswick distributor has recalled its fruit mix with cantaloupe, honeydew, pineapple and grapes as a result.

Tailor Cut Produce reports that its products may be found in restaurants, banquet facilities, hotels, schools and institutional food service establishments in Pennsylvania, New Jersey and New York. "We recommend that any facility who use Tailor Cut Produce pre-cut fruit to immediately stop and throw it away," Pennsylvania Secretary of Health Dr. Rachel Levine said.

Salmonellosis is an infection caused by _Salmonella_ bacteria that generally affects the intestinal tract. People usually become infected by either eating or drinking contaminated food or water, by contact with infected people or animals, or through contact with contaminated environmental sources.
Date: Mon 9 Dec 2019
Source: Sixth Tone [edited]

Dozens of researchers in northwestern China's Gansu province have been infected with brucellosis, an animal-borne disease that causes flu-like symptoms and, potentially, lingering problems. In a statement [Fri 6 Dec 2019], the Lanzhou Veterinary Research Institute, an affiliated institute of the Chinese Academy of Agricultural Sciences, said that the 1st few grad students from the institute's foot-and-mouth disease prevention team tested positive for brucellosis antibodies on [28 Nov 2019]. The labs affected have been closed, the institute said, and national and local health authorities have assembled a team to investigate the outbreak.

Li Hui, an official at the health commission in Lanzhou, the provincial capital, told Sixth Tone on [Mon 9 Dec 2019] that the total number of brucellosis cases at the institute had climbed to 96. None have shown clinical symptoms, according to domestic media, and it remains unclear how they were exposed to the bacteria.

Brucellosis -- also known as Malta, Mediterranean, or undulant fever -- is a zoonotic disease that mainly affects animals, including livestock and dogs, which can in turn transmit the bacteria to humans through direct contact. Symptoms include fever, chills, sweating, lethargy, and aches and pains, according to the WHO. In the absence of early diagnosis and treatment, brucellosis can become a chronic condition that is difficult to cure.

In China, brucellosis is a Class B disease, ranking below a more serious category that includes cholera and plague. Human-to-human transmission has only been known to occur between lactating mothers and their babies. According to state broadcaster China National Radio, the brucellosis outbreak at the Gansu veterinary institute has prompted health checks among local students and staff who fear that they may have come into contact with infected animals.

One of the last brucellosis outbreaks in China occurred in 2011, when an agricultural university in the northeastern Heilongjiang province reported 28 cases stemming from infected goats being used in lab research. The school publicly apologized, fired 2 administrators, and offered each of the students' affected monetary compensation.

Scientific labs are subject to different experimental standards depending on their biosafety level, according to a researcher surnamed Yang at the Shanghai Institutes for Biological Sciences, an affiliate of the Chinese Academy of Sciences.

"If the protection levels don't keep pace (with biosafety levels), there will be a risk of infection," Yang, who studies viruses and works in a Biosafety Level 2+ lab, told Sixth Tone. As a result, labs generally require researchers to undergo safety training or even pass an exam to earn a certification, said Yang, who only used her surname because she was not authorized by her employer to speak to media.

The Lanzhou Veterinary Research Institute describes itself as "China's only authorized research center for working with the live virus that causes foot-and-mouth disease," a highly contagious disease affecting livestock. The institute is reportedly also one of the few in China with Biosafety Level 3 labs, which are required for _brucella_ pathogen studies, according to the National Health Commission.

As the local agriculture department tries to ascertain the source of the recent infections, Lanzhou's health commission said [Fri 6 Dec 2019], it is implementing precautionary measures so that brucellosis does not pose a threat to neighbouring communities. [Byline: Yuan Ye]
=================
[An earlier report suggested that 4 persons were clinically ill but this is not confirmed here.  Brucellosis (<http://www.medicinenet.com/brucellosis/article.htm>) is a disease that is thought to have existed since ancient times, as it was 1st described more than 2000 years ago by the Romans and Hippocrates. It was not until 1887 that a British physician, Dr. David Bruce, isolated the organism that causes brucellosis from several deceased patients from the island of Malta. This disease has had several names throughout its history, including Mediterranean fever, Malta fever, Crimean fever, Bang's disease, and undulant fever (because of the relapsing nature of the fever associated with the disease).

The 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. 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. In this outbreak, it is not clear what symptoms the students had or whether they were just seropositive. ProMED would like more information about this episode. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Gansu Province, China: <http://healthmap.org/promed/p/333>]
Date: Tue 3 Dec 2019
Source: Outbreak News Today [edited]

In late November [2019], Uganda health authorities notified the World Health Organization of a fatal Rift Valley fever (RVF) case from Obongi district.  The case was a 35-year-old man from South Sudan who was living in the Palorinya Refugee camp in Obongi district, Uganda. The case had travel history to South Sudan between 12 and 19 Nov 2019 to harvest cassava. While in his home country, he developed fever and other symptoms and was treated for malaria; however, his condition got worse.  He later returned to the refugee camp in Uganda and his symptoms progressed and he was hospitalized. Viral hemorrhagic fever was suspected. Samples were collected and sent to the Uganda Virus Research Institute; however, the patient died. A safe and dignified burial was performed on 22 Nov 2019. As of 24 Nov 2019, a total of 19 contacts were recorded during the active case search including 10 healthcare workers.
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[The circumstances and specific location under which the man became infected with Rift Valley fever (RVF) virus in South Sudan is not mentioned. It is worth noting that there was an RVF outbreak in the Eastern Lakes region of South Sudan during the 1st 3 months of last year (2018). At the end of that outbreak, the OIE's follow-up report no. 3 reported: "The event cannot be considered resolved, but the situation is sufficiently stable. No more follow-up reports will be sent. Information about this disease will be included in the next 6-monthly reports."

There were more human cases than animal ones in that outbreak, prompting Mod.AS to comment: "Unfortunately, during the recent South Sudan RVF event, as in most -- if not all -- previous RVF events in other African countries, humans served as sentinels. Improved surveillance in animals is desperately needed in Africa, to allow timely measures applied, predominantly preventive vaccination, before the development of a full-blown epizootic involving secondary infection in humans." Intensified surveillance is needed in South Sudan in those localities where the affected man had been prior to his return to Uganda.

It is likely that RVF virus has persisted in this area in transovarially infected eggs of _Aedes_ mosquito vectors. These eggs can remain viable for long periods of time and hatch when flooded during future rain events, with the subsequent emergence of infected females ready to transmit the virus. This risk provides justification for maintaining livestock of the area well vaccinated into the future. This may have accounted for the reappearance of RVF in South Sudan in 2018, after nearly 2 years without additional reported cases in humans or livestock and again with this human case in 2019. - ProMED Mod.TY]

Obongi district, Uganda is located approximately 50 km (30 mi) from the South Sudan border.
HealthMap/ProMED-mail maps:

According to OIE's data, a total of 2 outbreaks of RVF affecting animals have been reported from Sudan during the event. The 1st outbreak started in the Arabaata dam area, Red Sea state, on 25 Sep 2019, affecting goats. The 2nd (and, so far, last) outbreak started 10 Oct 2019 in the River Nile state, affecting sheep and goats. Both outbreaks have been declared as 'resolved' on 14 Nov 2019.

Outbreak summary:
Total outbreaks = 2 (Submitted)
Species / Susceptible / Cases / Deaths / Killed and disposed of / Slaughtered
Goats / 1700 / 37 / 7 / 0 / 0
Sheep / 1550 / 37 / 5 / 0 / 0

According to the recent (5 Dec 2019) OCHA (UN Office for the Coordination of Humanitarian Affairs) update, the (human) RVF situation in Sudan, as of 26 Oct 2019, was the following: "a total of 345 suspected RVF cases -- including 11 related deaths -- reported in the states of Red Sea (128), River Nile (212), Khartoum (1), White Nile (1), Kassala (2), and Gedaref (1). The most affected age group is 15 to 45 years, which accounts for 83% of the total suspected cases. The male to female ratio is 2.6, with a high proportion of the cases being farmers (37.5 per cent). RVF is endemic in Sudan and 3 outbreaks affecting people have been documented in 1973, 1976, and 2008. During the outbreak in 2008, a total of 747 laboratory-confirmed cases were reported, including 230 deaths."

Egypt suffered its 1st RVF outbreak in 1977/78 with serious human disease and death as well as severe losses in livestock; several additional events have been recorded since. A recent historical review paper [1] concluded: "due to the availability and abundance of the potential vectors, the suitability of environmental conditions, continuous importation of livestock's from Sudan, and the close association of susceptible domestic animals with humans, the RVF virus could possibly occur and circulate in Egypt."   (https://tinyurl.com/whz3pz5)

Reference
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1. Kenawy MA, Abdel-Hamid YM, Beier JC. Rift Valley fever in Egypt and other African countries: Historical review, recent outbreaks, and possibility of disease occurrence in Egypt. Acta Trop. 2018; 181: 40-49; <https://doi.org/10.1016/j.actatropica.2018.01.015>  - ProMED Mods.AS/TY]
Date: Fri 6 Dec 2019 5:53 PM MST
Source: CTV News [edited]

A syphilis outbreak is worsening in Alberta [Canada], and the majority of new cases are in the Edmonton zone. Edmonton saw 1186 of the 1753 infectious syphilis [primary, secondary and early latent syphilis] cases reported in Alberta in 2019, a total of 68 per cent.

Alberta Health Services [AHS] declared an outbreak in July 2019, saying cases had 'increased dramatically' in the province since 2014. The number increased again in July [2019]  [<https://edmonton.ctvnews.ca/alberta-declares-province-wide-syphilis-outbreak-1.4510737>].

AHS sent a new public health alert to doctors on [27 Nov 2019], asking for their help to control the outbreak [<https://www.albertahealthservices.ca/assets/info/hp/phys/if-hp-phys-moh-ez-syphilis-outbreak.pdf>]. "It's very significant," said Dr Ameeta Singh, a clinical professor in infectious diseases. "That's an alarming rise in new syphilis cases in Alberta." She said it's the highest number of cases the province has seen since the 1940s.

According to Dr Singh, the increase in cases being reported is partially due to a greater number of people getting tested. "We know more people are coming in to get tested, but if we look a bit closer at the data we have, we do see there's, in fact, a [bigger] rise in the number of cases than we would expect to see," said Singh.

Another factor could be the rise in methamphetamine use in Edmonton. "I believe this is a major factor. Meth also stimulates risky sexual behaviour and increases the chance people will engage in multiple, usually casual or anonymous partners as well and not use precautions such as condoms to protect themselves during sex," she said.

What's also alarming, Singh said, is the spike in cases of congenital syphilis, where the disease is passed on to newborns. According to AHS, there have been 38 cases of congenital syphilis in 2019, 31 of which were in the Edmonton area. That accounts for more than half of the 61 cases of congenital syphilis reported since 2014.

"Those are not numbers we should be talking about in Canada ever...in a country that has universal access to health care, in a major city in Canada where syphilis testing is offered to all pregnant women who access prenatal care," she said. "What we're seeing with the congenital syphilis cases is many of the women are not accessing prenatal care until they come into the hospital to deliver and then the tests are being done."
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[A recent ProMED-mail post (Syphilis - Canada (04): (AB) RFI http://promedmail.org/post/20190718.6574300) reported a rise in "infectious syphilis" cases over a 4-year period: from 2014 to 2018 but made no mentioned of contributing factors. As illicit drug use has been cited as a contributing factor to recent increases in syphilis cases in the Canadian provinces of Ontario and Manitoba, I questioned in this prior ProMED-mail post if use of illicit drugs, in particular, methamphetamine, could similarly be contributing to the rise of syphilis cases in Alberta. The news article above reports that the rise in methamphetamine use in Edmonton, as well as increased testing for syphilis, are thought to be contributing factors in Alberta.

Methamphetamine can be swallowed, snorted, smoked or injected by needle and syringe

When methamphetamine is injected, transmission of syphilis may occur as a consequence of sharing a needle/syringe contaminated with infected blood from somebody who has primary or secondary syphilis (<https://ucsdnews.ucsd.edu/archive/newsrel/health/04-28TransmissionSyphilis.asp>); but syphilis can also be acquired by direct contact with an infected lesion during oral, vaginal, or anal sex when the drug is taken by any route of administration. Methamphetamine use is associated with sexual behaviors that increase the risk for acquiring syphilis and other sexually transmitted diseases, including having multiple sex partners, inconsistent condom use, and exchange of sex for drugs or money (<https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a4.htm>).

The linkage of methamphetamine use and syphilis transmission is reminiscent of the increase in syphilis among heterosexuals during the crack cocaine epidemic of the 1980s and 1990s, when the practice of trading sex with multiple partners for drugs, especially crack cocaine, played a major role in the transmission of syphilis. Under these circumstances, the identities of sex partners are often unknown, which weakens the traditional syphilis-control strategy of partner notification.

Bacteremia due to _Treponema pallidum_, the cause of syphilis, which occurs during primary, secondary, and latent syphilis, can result in transplacental transmission of this organism to the fetus during pregnancy and cause congenital syphilis. An increase in the incidence of syphilis in women in the population is commonly accompanied by increasing rates of congenital syphilis.

Edmonton, with a population of 932 546 residents in 2016, is the capital of the Canadian province of Alberta
(<https://en.wikipedia.org/wiki/Edmonton>).

A map showing the location of Edmonton can be found at
<https://goo.gl/maps/Rfq6XC2vvwi19ypb6>. - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Alberta, Canada:
9 December 2019
https://www.who.int/bangladesh/news/detail/09-12-2019-cholera-vaccination-campaign-launched-to-protect-635-000-people-in-cox-s-bazar

Cox’s Bazar, Bangladesh

Over 635,000 Rohingya refugees and Bangladeshi host community will be vaccinated against cholera in a 3-week-long campaign beginning today at the refugee camps in Cox’s Bazar and nearby areas, to protect vulnerable population against the deadly disease amidst increasing number of cases of acute watery diarrhoea (AWD).


The Oral Cholera Vaccination (OCV) campaign will be implemented in the refugee camps from 8-14 December to reach 139,888 Rohingya aged 1 year and less than 5 years. In the host community, the campaign will take place from 8-31 December and aims to reach any person older than 1 year (495,197). In total, 635,085 people are expected to be reached.

Led by the Ministry of Health and Family Welfare, with support of the World Health Organization (WHO), UNICEF and other partners, the campaign aims to reach people who missed some or all previous cholera vaccination opportunities. The campaign, including operational costs, is funded by Gavi, the Vaccine Alliance.

“We want to equip these populations with more protection against diarrheal diseases. Despite the progresses made to ensure access to quality water and sanitation, such diseases remain an issue of concern: approximately 80% of host community living near the camps have not been targeted in previous OCV campaigns and are still vulnerable”, says Dr Bardan Jung Rana, WHO Representative in Bangladesh.

Earlier rounds of cholera vaccination, which have taken place since the beginning of the emergency response in 2017, have helped prevent outbreaks of the disease. To this date, over 1 million people were vaccinated against cholera.
6th December 2019
https://www.theguardian.com/world/2019/dec/06/flooding-hits-new-zealand-tourist-hubs-of-wanaka-and-queenstown

Heavy rain has led to rivers bursting their banks, forcing the closure of shops and restaurants

Streets in the South Island tourist towns of Wanaka and Queenstown were slowly going under water on Friday, after Lake Wanaka and Lake Wakatipu burst their banks earlier in the week, flooding businesses and sewerage systems.

Water and large debris closed the main street of Wanaka, a popular spot with Instagrammers thanks to its famous tree that appears to have grown out of the lake. On Friday businesses were sandbagging as heavy rain continued to fall.

Sewerage systems in the town were also at risk of contaminating the lake, with the Queenstown Lakes District council taking the precautionary measure of shutting down the sewer connection to a handful of premises.

Wanaka residents were told to be on “high alert” with heavy rain predicted all weekend.

The streets of the usually bustling tourist town were largely empty, and the popular cafes and restaurants on the lake shore were closed.