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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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Togo

Togo US Consular Information Sheet
September 10, 2008
COUNTRY DESCRIPTION:
Togo is a small West African country with a stagnant economy in a state of political uncertainty.
French is the official language, but Ewe and Mina are commonl
spoken as well.
Tourism facilities are limited, especially outside the capital city, Lomé.
Read the Department of State Background Notes on Togo for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and visa are required.
Travelers are encouraged to obtain visas prior to arrival due to recent difficulties with requesting them at the airport in Lomé or at some of the land borders.
Visas issued in Togo are limited to 7 days and can take an hour or more to be issued.
Travelers applying for visa extensions can also experience significant delays.
Vaccination against yellow fever is required before entry.
U.S. citizens should carry copies of their U.S. passports and vaccination records with them at all times while traveling in Togo so that, if questioned by local officials, they have proof of identity, U.S. citizenship, and required vaccinations readily available.

Travelers may obtain the latest information and details from the Embassy of the Republic of Togo, 2208 Massachusetts Avenue NW, Washington, DC
20008; telephone (202) 234-4212.
Overseas, inquiries should be made at the nearest Togolese 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.

SAFETY AND SECURITY:
U.S. citizens are urged to avoid political rallies, street demonstrations, and maintain security awareness at all times.
Togo has experienced periodic violence, strikes, and political tensions since 1990.
Following the death of President Eyadema in February 2005, political activists took to the streets and held demonstrations throughout the country that resulted in more than 500 deaths.
Land borders with Ghana and Benin are routinely shut down during elections. The October 2007 legislative elections were non-violent with only minor incidents reported during the single post-election demonstration. The next major elections are the presidential elections scheduled for 2010.

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:
Over the past year, Togo has seen a marked increase in incidents of violent crime throughout the country, including several recent machete attacks in poorly lit areas of Lomé.
Rapid inflation and food shortages have contributed to increases in already critical crime levels in urban areas.
Particular areas for Americans to avoid within Lomé, especially during the hours of darkness, include the Grand Marché area, the beach road, and the Ghana-Togo border areas.
Travelers should avoid the beach even during daylight hours as purse-snatchings and muggings occur there regularly.
Pick pocketing and theft are common in Togo, especially along the beach and in the market areas of Lomé.
While incidents of residential burglary are less common against foreigners, carjacking is on the rise, and even western diplomats have been victims of carjacking. Theft while riding in taxis is also increasing, as thieves steal bags, wallets, and passports.
Taxicabs should not be shared with strangers.
Perpetrators of business fraud often target foreigners, including Americans.
Formerly associated with Nigeria, these fraud schemes are now prevalent throughout western Africa, including Togo, and pose a danger of both financial loss and physical harm.
An increasing number of Americans have been the targets of such scams, losing anywhere from several thousand to several hundred thousand dollars.
Typically, these scam operations begin with an unsolicited communication, usually by e-mail, from an unknown individual who describes a situation that promises quick financial gain, often by assisting in the transfer of a large sum of money or valuables out of the country.
The scenarios vary:
an American must pretend to be the next-of-kin to a recently deceased Togolese who left a fortune unclaimed in a Togolese bank, or a person claiming to be related to present or former political leaders needs assistance in transferring large sums of cash, or even a business deal that appears to be legitimate.
The requests are usually for the payment of advance fees, attorneys’ fees, or down payments on contracts.
The final payoff does not exist; the purpose of the scam is to get any money possible and to gain information about the American’s bank account.
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.
You should carefully check out any unsolicited business proposals originating in Togo before you commit any funds, provide any goods or services, or undertake any travel.
Please check the Embassy web site at http://togo.usembassy.gov/ for the most current information on fraud in Togo.
For additional information, please see the Department of State brochure on International Financial Scams.

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.

The local equivalent to the “911” emergency line in Togo is: 117 or 171 for police, 172 for Gendarmerie, 242 for the Pharmacy on Duty, and 118 for Fire Services.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Togo are limited and of very poor quality, with no adequate emergency medical care.
Availability of medications through local pharmacies is unreliable, and travelers should carry all necessary medications, properly labeled, with them.
Malaria, a serious and sometimes fatal disease, is prevalent in Togo.
For additional information on malaria, including protective measures, see the CDC travelers’ health web site at http://www.cdc.gov/malaria/.

For information on avian influenza (bird flu), please refer to the Department of State's Avian Influenza Fact Sheet.
According to the Togolese Ministry of Foreign Affairs and Ministry of Health, there are no HIV/AIDS entry restrictions for visitors to or foreign residents of Togo.

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.
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 Togo is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

While some major thoroughfares in urban parts of Togo are paved, many secondary streets are not, and become severely flooded every time it rains.
Driving conditions are hazardous throughout Togo due to the presence of pedestrians, large numbers of small motorcycles, disorderly drivers (moped, car and truck drivers), livestock on the roadways, and the poor condition of the roads, including deep potholes.
Overland travel off the main network of roads generally requires a four-wheel-drive vehicle.
Many drivers in Togo do not obey traffic laws and most traffic signals do not function properly.
Drivers should be prepared for other vehicles to run red lights or stops signs and drive in the wrong direction on one-way streets.
Nighttime travel on unfamiliar roads is dangerous.
Poorly marked checkpoints, often manned by armed, undisciplined soldiers, exist throughout the country, including in the capital.
Banditry, including demands for bribes at checkpoints, has been reported on major inter-city highways, including the Lomé-Cotonou coastal highway.
Travelers are advised to be aware of their surroundings and to drive defensively.
At official checkpoints, Togolese security officials prefer that you approach with your dome light on, and have your driver’s license, registration, and proof of insurance ready.
Americans should be aware of the staged-accident ploy when driving in Lomé.
In this scam, a motorbike will cut in front of you, cause a collision, and draw a crowd, which can turn hostile if you attempt to leave the scene of the so-called accident.
Such encounters appear designed to extort money from the vehicle driver.
Pedestrians also cause staged accidents.
Genuine accidents can also draw hostile crowds.
Travelers should drive with their car doors locked and windows closed, and have a cell phone in the vehicle.
If you are involved in this kind of accident and can drive away, you should leave the scene, drive to a safe location, and alert both the police and the U.S. Embassy.
Violent carjackings are periodically reported in Togo and tend to increase during the summer months and holiday season. Travelers are advised to exercise caution when using any form of local public transportation.
Never get into a taxi with unknown passengers and always agree on the fare before getting in.

Please refer to our Road Safety page for more information.
Visit the web site of the country’s tourist office at http://www.togo-tourisme.com/.

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

SPECIAL CIRCUMSTANCES:
Power outages, voltage fluctuations, and water shortages are common throughout the country.
Only certain U.S. credit cards are accepted in Togo.
Most major hotels and their restaurants accept American Express, MasterCard, and Visa, while smaller hotels and restaurants do not.
Travelers planning to use credit cards should know which cards are accepted before they commit to any transaction.
Travelers should keep all credit card receipts, as unauthorized card use and overcharging are common.
There are some Automatic Teller Machines that dispense local currency in major banks and they are generally considered safe.
Well-known money transfer firms, including Western Union, operate in Togo.
Photographing places affiliated with the government of Togo, including official government buildings, border crossings, checkpoints, police stations, military bases, utility buildings, airports, government vehicles, and government or military personnel, is strictly prohibited, and local authorities will confiscate film and cameras.
Government buildings are not always clearly identifiable, as they vary from being very well marked to being not marked at all.
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 Togo’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Togo 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 Togo are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Togo.
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 on Boulevard Eyadema, Neighborhood Lomé II, Lomé; telephone (228) 261-5470, fax (228) 261-5499. The local mailing address is B.P. 852, Lomé.
The web site is http://togo.usembassy.gov/
* * *
This replaces the Country Specific Information for Togo dated March 3, 2008, to update the sections on Crime, Information for Victims of Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Wed, 15 Jan 2020 03:48:17 +0100 (MET)
By Emile Kouton with Celia Lebur in Lagos

Lome, Jan 15, 2020 (AFP) - After he was struck down by malaria and typhoid, Togolese tailor Ayawo Hievi thought he was set to recover when he started taking drugs prescribed by his doctor.   But far from curing him, the medication he was given at the neighbourhood clinic made him far worse -- eventually costing him one of his kidneys.    The drugs were fake.   "After four days of care, there was no improvement, but I started to feel pain in my belly," Hievi, 52, told AFP.

After two weeks of suffering he became unable to walk and was rushed into the university hospital in the West African nation's capital Lome.    "The doctors told me that my kidneys had been damaged... the quinine and the antibiotics used to treat me in the medical office were fake drugs."   Now, over four years later, he remains crippled by chronic kidney failure and has to go to hospital for dialysis regularly.    Hievi's horror story is far from unique in a continent awash with counterfeit medicines.    The World Health Organization (WHO) estimates that every year some 100,000 people across Africa die from taking "falsified or substandard" medication.

The American Society of Tropical Medicine and Hygiene estimated in 2015 that 122,000 children under five died due to taking poor quality anti-malaria drugs in sub-Saharan Africa.   Weak legislation, poor healthcare systems and widespread poverty have encouraged the growth of this parallel -- and deadly -- market. Since 2013, Africa has made up 42 percent of the fake medicine seized worldwide.    The two drugs most likely to be out-of-date or poor, ineffective copies are antibiotics and anti-malarials, say experts.    And bogus drugs not only pose a risk to the patient -- they also play a worrying part in building resistance to vital frontline medications.

- 'Difficult to trace' -
In a bid to tackle the scourge, presidents from seven countries -- the Republic of Congo, Gambia, Ghana, Niger, Senegal, Togo and Uganda -- meet Friday in Lome to sign an agreement for criminalising trafficking in fake drugs.    The goal is to bolster cooperation between governments and encourage other African nations to join the initiative.   But even if leaders put pen to paper, the task of stamping out the flows of counterfeit medication is huge.    Medicines spread out on plastic sheets or offered at ramshackle stalls are for sale at markets across West Africa.

Those hawked on the streets are often a fraction of the price of what's available in more reputable pharmacies where controls are stricter and supplies often have to come through official channels.    "It is very difficult to trace where the fake medicines come from," said Dr Innocent Kounde Kpeto, the president of Togo's pharmacist association.    "The countries which are mentioned on the boxes are often not the countries of origin or manufacture of these drugs. The manufacturers cover their tracks so as not to be identified".

It is estimated that between 30 and 60 percent of medicine sold in Africa is fake and Kpeto said most of it comes from China or India.    Efforts to staunch the deadly torrents of counterfeits have made some headway.    Some trafficking hubs have been dismantled, such as Adjegounle market in Cotonou that served as a key gateway for fakes heading to giant neighbour Nigeria.   In mid-November, the police in Ivory Coast made a record seizure of 200 tonnes in Abidjan and arrested four suspects including a Chinese national.

Togo is one of the pioneer countries trying to stop the flow.    It changed the law in 2015 and now traffickers can face 20 years in jail and a fine of some $85,000 (75,000 euros).   In a show of force in July the authorities burnt over 67 tonnes of counterfeit pharmaceuticals discovered between     But even given these recent successes, those in the industry like Dr Kpeto insist that the threat is still grave and involves "highly organised criminal networks".    "The phenomenon remains major," he said.    Traffickers can turn an investment of just $1,000 (900 euros) into a profit of $500,000, he claimed.   The fake medicines are smuggled in the same way as guns or narcotics and often bring higher returns.

- 'Die for nothing' -
Nigeria, Africa's most populous country with a market of 200 million people, is the number one destination on the continent for fake drugs and a showcase of difficulties being faced.    In September 2016 the World Customs Organization seized tens of millions of fake pills and medicines at 16 ports around Africa: 35 percent were intended for Nigeria.    Across the vast nation there are tens of thousands of vendors selling the counterfeits.   Competition between traffickers is fierce and the official agency meant to combat the problem is overwhelmed.

In a bid to improve the situation, Vivian Nwakah founded in 2017 start-up Medsaf and raised $1.4 million to help Nigerians track their medication from producer to user.    "The country doesn't have a reliable and centralised distribution network," she said.    "A hospital sometimes has to deal with 30 or 40 distributors for all the medications it needs. How can you have quality control with so many suppliers?"   As a result, fake or faulty medicine has not just flooded markets but also pharmacies and hospitals -- both state and private.    Sometimes, without hospital administrators even being aware, that means the drugs that reach the patients can be expired, poorly stored or the wrong doses. 

Medsaf works to ensure the quality control of thousands of products at over 130 hospitals and pharmacies in Nigeria. It looks forward to expanding deeper into Nigeria as well as Ivory Coast and Senegal.   The company uses technology, database management and analytics to monitor the movement of medications and verifies their official registration number, the expiry dates and storage conditions.   "Technology we use can help to solve most of the issues related to fake drugs," Nwakah said. "People die for nothing. We can change that."
Date: Mon 7 Jan 2019
Source: Outbreak News Today [edited]

The Togo government confirmed last week [week of 1 Jan 2019] a Lassa fever case reported in Doufelgou district [Kara region] in the north of the country, according to a Agence de Presse Africaine report (computer translated).

This was a haemorrhagic fever case according to officials.

Lassa fever is a rare but potentially life-threatening viral haemorrhagic disease. The risk of infection is low but can occur if someone comes into contact with an infected person's blood or bodily fluids. Lassa fever cannot be spread through casual contact, including skin to skin contact, without exchange of bodily fluids. Those at highest-risk would be health care workers treating patients in facilities known to have Lassa fever and family members caring for infected patients.

Early diagnosis and supportive care are essential. One should consult a medical professional if he or she has been in direct contact with an infected person within the past 3 weeks and have symptoms of Lassa fever, which include: fever, chest, stomach or back pain, cough, vomiting, diarrhoea, or mucosal bleeding.
=========================
[Lassa fever virus is endemic in much of northwest Africa, including Benin, Togo, and Burkina Faso. There have been cases of Lassa fever in Togo as recently as 2017. In the 2017 report, health authorities in Togo implemented the following measures to respond to these Lassa fever cases, including:
- deployment of rapid response teams to the affected areas for epidemiological investigation;
- identification of contacts and follow-up;
- strengthening of infection prevention and control measures in health facilities and briefing of health workers;
- strengthening of cross border collaboration and information exchanges between Togo, Burkina, Mali, and Benin.

It seems odd that the case report above does not mention contact with rodent reservoirs of the virus or their excrement as a source of infection. Lassa fever virus is transmitted to humans from contact with food or household items contaminated with excreta of multimammate rats (_Mastomys_ spp), the reservoir host. Public education is an important measure to prevent infections in the home.

Images of the rodent reservoirs of Lassa fever virus can be seen as follows:
_Mastomys natalensis_:
_M. erythroleucus_ and _Hylomyscus pamfi_:

[Maps of Togo:
Date: Mon, 24 Sep 2018 21:11:35 +0200

Lome, Sept 24, 2018 (AFP) - A former lawmaker in Togo was on Monday on hunger strike to call for the release of opposition supporters who were arrested during anti-government demonstrations.   Nicodeme Ayao Habia, head of the Democrats party, began his protest six days ago in front of Ghana's embassy in the Togolese capital, Lome.   "I am on hunger strike to demand the release of all people who were arrested during protests by the opposition coalition who are still languishing in prison," he told AFP.   "I won't move from here as long as these people are in prison," he said, holding a small sign with photos of three of those detained.   "This morning, police tried to move me along but I refused as I am within my rights. They even tried to rough me up."

Habia held a two-day hunger strike previously this month in front of the US Embassy in Lome.   Some 44 people who were arrested during opposition protests against President Faure Gnassingbe and his government remain in prison, according to the coalition.   The oppositions wants the re-introduction of a two-term limit for presidents, applied retroactively, which would prevent Gnassingbe from standing for re-election in 2020.   The government has agreed to the two-term limit but not the retroactive element, which would allow the president to  stand at polls in 2020 and 2025.   He has already been in power since the death of his father, Gnassingbe Eyadema, in 2005. The army general seized power of the West African state in 1967.

As well as the release of opposition detainees, Habia said he also wanted the government to stick to the roadmap set out by leaders of the West African bloc ECOWAS.   "The regime must absolutely respect the recommendations contained in the ECOWAS roadmap," he added.   On Sunday, the government and opposition finally agreed common ground in the composition of the country's independent national electoral commission (CENI).   Lack of agreement about the make-up of the body had delayed an announcement of the date of local and parliamentary elections.    Local polls and a referendum on the proposed constitutional reforms will now take place on December 16, with parliamentary elections four days later.
Date: Wed, 31 Jan 2018 16:22:49 +0100

Lome, Jan 31, 2018 (AFP) - Togo's government was facing fresh turbulence on Wednesday as healthcare workers went on strike, joining thousands of demonstrators holding opposition protests on the streets.   The two-day nationwide strike was called by the National Union of Hospital Practitioners of Togo (SYNPHOT) who are demanding better equipment and more nursing staff.   "The strike is well-followed throughout the country. We will take stock tomorrow evening to know what to do in the coming days," SYNPHOT secretary-general Atchi Walla told AFP.

At Sylvanus Olympio university hospital, the country's largest health care centre, several departments were closed, according to an AFP journalist.   "We are here only for very urgent cases. The other patients will be rescheduled," said a worker at the entrance to the emergency surgery department.   There was a similar situation in the operating room and at reception, where only one person was working.   "This situation is tiring. I came to get treatment but nobody can help because they are on strike," said Albert Kudju, a retired civil servant.    "The authorities should meet the demands of the workers."

Primary and public school teachers are also on strike, demanding an increase in their wages, while students are protesting against a sharp rise in tuition fees.   The walk-outs come against a backdrop of widespread discontent with the government and opposition calls for the resignation of President Faure Gnassingbe.   Gnassingbe has been in power since 2005 and took over from his father, General Gnassingbe Eyadema, who himself ruled Togo for 38 years.   A coalition of 14 opposition parties has been organising almost weekly marches for the past five months.
Date: Wed, 20 Sep 2017 17:23:54 +0200

Lome, Sept 20, 2017 (AFP) - Thousands thronged the streets of Togo's seaside capital Wednesday after the ruling party asked supporters to march at the same time as planned opposition protests demanding the removal of President Faure Gnassingbe, the scion of Africa's oldest political dynasty.   The rival demonstrations in Lome came a day after the opposition boycotted a vote on constitutional reform which would have included a presidential term limit, arguing that it was a ploy to let Gnassingbe remain in power till 2030.

The opposition wanted the limit to apply retroactively so that Gnassingbe, who has been in power since 2005, could not run again in 2020. His father Gnassingbe Eyadema ruled from 1967 till his death in 2005.   The opposition marches began at around 11:00 am (1100 GMT) at three meeting points.   They came after giant rallies on September 6 and 7 seeking the president's ouster that drew more than 100,000 people on the streets -- a record in a country which has been widely criticised for stifling democracy.    The protesters held up posters declaring "Faure must go" and "Free my country, 50 years is enough".

Police and soldiers armed with heavy machine guns flanked the streets in pick-up trucks. Mobile  phone networks and 3G services appeared to have been severed.   "We are not jihadists, we are not rebels," said Abdallah, 42, a supporter of the Panafrican National Party (PNP). "We just want democracy, we are tired."   Communications Minister Guy Lorenzo condemned what he called a "coup d'etat" on the streets.   The government meanwhile asked the opposition to show "responsibility and restraint" and warned that "people of foreign nationalities were looking to participate in acts of violence"  during the marches.

- 'Explosive situation' -
More protests are planned on Thursday against what veteran opposition leader Jean-Pierre Fabre called "the monstrous machine that has been crushing Togo's people for more than 50 years".   He said there would be "no let-up" as long as Gnassingbe remains in power.   Comi Toulabor, head of research at the Institute of Political Studies in Bordeaux, called the counter-rallies by the ruling Union for the Republic (UNIR) party "a strategy to disrupt the opposition protest".   "It's very amateurish but it shows the party isn't ready to give way," he told AFP, calling the situation "explosive".

About one thousand UNIR supporters quietly gathered on the beach in Lome on Wednesday, some sitting in the shade of palm trees.   "It is a pleasure to be here," UNIR supporter Georgia, 34, told AFP. "We are peaceful."   One young protester said he received 5,000 CFA francs (7.50 euros, $9) to participate in the pro-government rally.   "You think we're here for politics?" asked Justin, 17, as his friends nodded approval.   The failure to pass the constitutional reform bill in parliament forced a referendum, which a member of the government said will be held in the coming months.   Gnassingbe has now won three elections, the results of which have been contested by the opposition.   Half of Togo's population lives below the poverty line, according to the United Nations, despite a GDP growth rate of five percent over the last three years.
More ...

Trinidad and Tobago

Trinidad and Tobago - US Consular Information Sheet
March 04, 2009
COUNTRY DESCRIPTION:
Trinidad and Tobago is a developing nation in the Caribbean composed of two islands.
The islands gained independence from the British in 1962.
>The country is one of the most prosperous in the Caribbean, largely as a result of petroleum and natural gas industries.
Tourist travel is mostly to the smaller of the two sister islands, Tobago.
Tourist facilities are widely available.
Read the Department of State Background Notes on Trinidad and Tobago for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid passport is required of U.S. citizens for entry to Trinidad and Tobago.
U.S. citizens do not need a visa for tourism or business-related visits of 90 days or less.
Work permits are required for compensated and some non-compensated employment, including missionary work.
Visas may be required for travel for purposes other than business or tourism.
For further information concerning entry, employment and customs requirements, travelers may contact the Embassy of Trinidad and Tobago, 1708 Massachusetts Avenue NW, Washington, DC
20036, telephone (202) 467-6490, or the Trinidad and Tobago Consulates in Miami or New York City.
Visit the Embassy of Trinidad and Tobago’s web site.

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:
American citizens traveling to or residing in Trinidad and Tobago should avoid large crowds and demonstrations.
While non-violent demonstrations occur on occasion, widespread civil disorder is not typical.
The downtown area of Port of Spain experienced four bombings in 2005.
While no similar incidents have occurred since that time, the perpetrator(s) have not been arrested and their identities and motive remain unknown.
Americans visiting or residing in Port of Spain are advised to exercise caution, especially in crowded urban areas.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, 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 A Safe Trip Abroad.

CRIME:
Incidents of violent crime have been steadily on the rise on both islands.
Visitors to Trinidad and Tobago should exercise caution and good judgment as in any large urban area. Particular caution should be exercised when traveling after dark from Trinidad's Piarco Airport as incidents have been reported involving armed robbers trailing arriving passengers from the airport and accosting them in remote areas of the airport parking lot, on the highway leading from the airport to downtown Port of Spain, and outside the gates of residences.
Areas of metro Port of Spain to avoid include Laventille, Morvant, Sea Lots, South Belmont, scenic rest stops (after dark), walking across the Queen’s Park Savannah, and downtown Port of Spain (after dark), as tourists are particularly vulnerable to pick pocketing and armed assaults in these locations.
Holiday periods, especially Christmas and Carnival, often see an increase in criminal activity.
Violent crimes, including assault, kidnapping for ransom, sexual assault and murder, have involved foreign residents and tourists, including U.S. citizens.
The perpetrators of many these crimes have not been arrested.
Burglaries of private residences are common.
Robbery is a risk, particularly in urban areas and especially near ATMs and shopping malls.
Visitors should avoid wearing expensive jewelry or displaying large amounts of money in public.
One victim was targeted for driving an expensive new car.
In some cases, robberies of Americans have turned violent and resulted in injuries after the victim resisted handing over valuables.
In Tobago, the media have reported an increase in the incidence of violent crimes.
While local authorities have announced increased measures to fight crime, the U.S. Embassy advises that when making reservations at private accommodations, visitors should ensure that 24-hour security is provided.
There have been reports of home invasions in the Mt. Irvine area, and robberies occurring at the waterfalls and on isolated beaches in Tobago where visitors are not in a group.
Visitors to Tobago should ensure that all villas or private homes have adequate security measures.
Visitors to Trinidad and Tobago are also advised to be cautious when visiting isolated beaches or scenic overlooks where robberies can occur.
Visitors should not walk alone or in unfamiliar areas.
Valuables left unattended on beaches and in other public places are vulnerable to theft.
Visitors should avoid neighborhoods known for high crime rates.
When in doubt, consult the establishment where you are staying to identify areas to be avoided.
Taxis available at the major hotels or through pre-arranged pick-ups with reputable companies are generally safe and reliable.
The U.S. Embassy urges caution in the use of the small buses or vans in Trinidad, known as "Maxi Taxis" (full-size inter-city buses are usually safe.)
Unmarked shared taxis authorized to pick up passengers will have the letter 'H' as the first letter on their license plates.
Some shared taxis and maxi taxis have been linked to petty crime and serious traffic accidents.
Valuables including travel documents should not be left unattended in parked cars, especially in parking lots, as several thefts have been reported.

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.

The local equivalent to the “911” emergency line in Trinidad and Tobago is:
Police 999 or 555, Fire 990, Ambulance-Trinidad 811, Ambulance-Tobago 639-4444, and Coast Guard (yachting emergencies) 634-4440.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
We strongly recommend that you obtain comprehensive travel and medical insurance before traveling.
Medical care is limited compared to that in the United States.
Care at public health facilities is significantly below U.S. standards for treatment of serious injuries and illness, with limited access to supplies and medications.
While care at some private facilities is better than at most public health facilities, patients may be expected to prove their ability to pay before assistance is given, even in emergency situations.
Patients requiring blood transfusions are expected to arrange for at least the same amount to be donated on their behalf.
Physicians and nurses may go on strike, causing serious strain on both public and private medical resources.
Ambulance service is extremely limited both in the quality of emergency care and in the availability of vehicles in many parts of the country.
According to the Trinidad & Tobago Ministry of Health, recent monkey deaths on the island of Trinidad have been laboratory confirmed as due to yellow fever.
Although no human cases have been reported since 1979, the virus appears to be permanently embedded in forested areas of the central/south region of the island of Trinidad.
Evident outbreaks among monkeys may appear every 10-20 years after long periods of epidemiologic silence.
CDC continues to recommend yellow fever vaccine for travel to Trinidad & Tobago.
Dengue fever presents significant risk in urban and rural areas.
Precautions against insect bites are recommended such as wearing long sleeved shorts/trousers, the use of bed nets and insect repellants which contain DEET, picaridin (KBR 3023), Oil of Eucalyptus/PMD, or IR 3535.
Ciguatera poisoning is prevalent and results from eating reef fish such as grouper, snapper, amberjack, and barracuda.
The toxin remains even when fish is well cooked.
Marine hazards include corals, jellyfish, sharks, and sea urchins.
Heed posted warnings at organized beaches, and do not bathe at unmarked, unpatrolled beaches.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Trinidad and Tobago.
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.
For information about outbreaks of infectious diseases abroad, consult the World Health Organization’s (WHO) web site.
Further health information for travelers is available from the WHO.
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 Trinidad and Tobago is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Traffic moves on the left in Trinidad and Tobago.
Most vehicles are right-hand drive, but left-hand drive vehicles are permitted.
Rental cars are available, and are generally right-hand drive.
A U.S. driver's license and/or an International Driving Permit are valid for up to 90 days after arrival.
Seatbelts are required for drivers and front seat passengers, and cars may be pulled over and drivers fined for not wearing seatbelts.
Trinidad has several good four-lane highways and one controlled-access highway.
However, road quality decreases quickly on secondary roads.
Rural roads are narrow and often have deep drainage ditches on either side.
Some are in poor repair, and are frequently congested.
Night travel should be avoided other than on major highways.
Roadside assistance exists, but is limited and may be subject to lengthy delays.
The Beetham Highway, a main thoroughfare in and out of the city, is dangerous if your vehicle has broken down.
If your vehicle is drivable get out of the area before seeking help.
The Ministry of Works and Transport is responsible for road conditions and safety in the country.
Emergency ambulance services exist but may take prolonged amounts of time to reach the site of an accident and may not provide service in rural areas.
Trinidadian drivers may use hand signals to indicate turning, stopping, or slowing, which do not necessarily correspond to hand signals used in the United States.
Trinidadian drivers are generally courteous, but can be flexible with the rules of the road.
For example, cars traveling north on a two way street may cross into the southbound lane to stop and let passengers out.
Visitors need to be attentive and alert.
Intoxicated drivers on the road are a particular concern on the weekends, especially after dark when many locals are going to or returning from social events.
Drivers should take extra precaution on narrow and winding roads leading in and out of beaches and small towns in Trinidad and Tobago.
As always, defensive driving is strongly encouraged.
The country has an extensive system of taxis, maxi-taxis (vans) and some larger buses.
Although the larger inter-city buses are generally safe, the maxi-taxis have been linked to many road accidents and some instances of crime.
Fares should be agreed upon in advance.
Taxis will often stop at any point along the road to pick up or discharge passengers, often with little or no warning.

Please refer to our Road Safety page, and the Trinidad and Tobago’s Ministry of Tourism home page for more information.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Trinidad and Tobago’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Trinidad and Tobago’s air carrier operations.
For more information, travelers may visit the FAA web site.

MARINE SAFETY AND OVERSIGHT:
Visitors arriving in Trinidad and Tobago aboard a private vessel must register any firearms with local customs authorities.
Failure to declare firearms or making false customs declarations is a serious offense.
U.S. citizens have been jailed and fined for possession of unlicensed firearms and ammunition, attempting to export ammunition, making false customs declarations and not declaring their firearms.
There is a small community of private boat owners who stay in Trinidad temporarily during the hurricane season.
There have been several incidents within the past few months in which vessels were boarded and the occupants were assaulted and robbed.
Sailors should report any incidents to the Coast Guard and local police, and are encouraged to check with the Trinidad and Tobago Coast Guard and yacht facility managers for current information.

SPECIAL CIRCUMSTANCES:
Trinidad and Tobago is prone to occasional earthquakes, though no major earthquake has hit in recent history.
Tobago has suffered extensive damage from only two hurricanes since 1963.
In 2004, parts of Tobago were severely affected by flooding and mudslides from Hurricane Ivan and several other major storms that followed soon thereafter.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) website.

Travelers are cautioned against wearing military or camouflage clothing in public, as it is against local laws to do so, unless they are in Trinidad and Tobago on official military business.

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 Trinidad and Tobago laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Trinidad and Tobago 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.

Many of the US citizens incarcerated in Trinidad and Tobago were arrested attempting to transport suitcases or packages containing drugs in or out of the country.
Even if a package or suitcase is being carried for someone else, the traveler is liable for its contents.
Americans should be aware that cursing and use of foul language in public is a criminal offense in Trinidad and Tobago subject to arrest and fines.
Several Americans have been arrested for this offense. While the penalty for public cursing is usually a fine, it can cause considerable disruption in travel plans due to arrest procedures, requirements to appear at hearings, and even incarceration if bail cannot be posted.

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 Trinidad and Tobago are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Trinidad and Tobago.
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 15 Queen's Park West, telephone 868-622-6371, Consular Section fax 868-822-5555.
American Citizen Services public hours of operation are 8:00 AM – 11:30 AM, and 1:00 PM through 3:00 PM, Monday - Friday, except U.S. and Trinidad and Tobago national holidays.
For additional information, you may send email inquiries.
*

*

*
This replaces the Country Specific Information for Trinidad and Tobago dated April 13, 2007, to update sections on Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Tue 3 Dec 2019
Source: Trinidad Express [abridged, edited]

The number of local deaths from the influenza virus has risen to 24. At the Health Ministry's update last week, 16 fatalities were reported from the flu, with Health Minister Terrence Deyalsingh appealing to citizens -- especially those considered at-risk -- to get vaccinated.
Date: Wed 27 Nov 2019
Source: Jamaica Observer [edited]

At least 16 people have died so far this year [2019] as health authorities embark on a "robust nationwide influenza vaccination drive" to protect the population against the flu virus. The Ministry of Health said that as of last Friday [22 Nov 2019], the number of suspected cases for this flu season had reached 2738 and that there had been 16 confirmed deaths. The ministry said that the cumulative number of vaccines administered to the public so far was 16 301.

"The influenza virus is serious and is generally more severe than the common cold. The flu vaccine is available, at no cost, at all health centres," the Ministry of Health said, adding that children and people with chronic medical conditions should be among those getting the vaccine. It said that the flu season runs until May next year [2020] and that individuals in the healthcare and essential-services sectors should also ensure that they receive the vaccine.
Date: Mon 10 Jun 2019
Source: Saturday Express [edited]

There have been 17 malaria cases thus far in Trinidad and Tobago in 2019, and 13 are Venezuelans. One case is a Trinbagonian, one is from Uganda, one is from Ghana, and one is from Guyana.

This was disclosed by health minister Terrence Deyalsingh as he responded to a question from Oropouche West MP Vidia Gayadeen-Gopeesingh on whether there was truth to social media reports that many Venezuelan nationals seeking medical attention at Port of Spain and San Fernando general hospitals have malaria and are HIV-positive.  [Byline: Ria Taitt]
=========================
[It is noteworthy that 13 of the 17 imported cases are from Venezuela. Over the past few years, malaria has surged in Venezuela and is not endemic and widespread, with no control policy and a lack of basic drugs. This is a clear threat to neighbouring countries, where imported cases can start new local transmission, so-called "introduced malaria."

"Trinbagonian" refers to a native or inhabitant of Trinidad and Tobago. All malaria cases are imported, and Trinidad and Tobago is indeed regarded as a malaria-free country. - ProMED Mod.EP]

[HealthMap/ProMED-mail maps:
Date: Thu 29 Mar 2018
Source: Daily Express [edited]

This media source quotes the Health Minister as saying they're imported cases:

"speaking during a news conference at the Ministry of Health in Port of Spain, Deyal Singh, said the cases of malaria in T&T are persons who visited other countries where malaria is present and returned to the country."  [Byline: Camille Hunte]
----------------------------------------
Communicated by
Viki Hansen-Landis
International SOS
=======================
[ProMED thanks Viki Hansen-Landis, International SOS, for informing us about the statement by Deyal Singh that all the 13 cases diagnosed in Trinidad and Tobago are imported cases. However, with a tropical climate and the presence of Anopheles mosquitoes, there is always a risk that malaria may be reintroduced.

A map of Trinidad & Tobago: <http://healthmap.org/promed/p/28>. - ProMED Mod.EP]
Date: Fri 27 Apr 2018
Source: News Day [edited]

With the start of the wet season less than 2 months away, former Health Minister Dr Fuad Khan has described the resurgence of the mosquito-borne disease malaria as "worrying" due to flooding, which occurs in central and south Trinidad every year.

Khan was commenting on World Malaria Day (WMD) 2018 observances themed: "Ready to Beat Malaria."

He observed that while Trinidad and Tobago has been relatively malaria free since 1965, he said the nation was witnessing a "re-emergence of this dreaded disease," as the Ministry of Health has reported 13 cases as of 30 Mar 2018.

He said the number of malaria cases has ranged between 7 and 24 cases over the past 10 years.

"This new development is worrying for a society that has constant issues with flooding, particularly in central and southern areas of Trinidad. Even though malaria was said to be eradicated in 1965, because of our tropical conditions, vast swamplands and thickly forested areas, our environment is still an easy target for the importation of the female anopheles mosquito containing a plasmodium parasite that is then transmitted from one person to another by that infected mosquito," he said. "Therefore, its eradication should not be taken for granted."

Khan said TT was able to begin to get ahead of the malaria problem when in 1944, the New York-based Rockefeller Foundation came to Trinidad to begin testing for the anopheles mosquito utilizing dichlorodiphenyltrichloroethane, commonly known as DDT, which is a larvacide for the spraying of the mosquitoes.

"While we acknowledge the dangers malaria poses to the people of Trinidad and Tobago, we must emphasize the need for the population to do its part in preventing the spread of this disease. We can do so by getting rid of pools of stagnant water, clearing bushes from around houses and planting lemon grass, which can all reduce the number of mosquitoes nearby," he said. "Do your part. Be responsible," he said.

According to the Centres for Disease Control and Prevention, people with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die.
================
[It is not clearly stated in the text, but we presume that the 13 cases were infected in Trinidad and Tobago and are not imported cases. If that is the case, the previous Minister of Health is indeed right that it is a serious situation because the island thus has sustained local transmission or autochthonous malaria. However, Trinidad and Tobago is not listed as a country with malaria in the 2017 WHO World Malaria Report (<http://www.who.int/malaria/publications/world-malaria-report-2017/wmr2017-regional-profiles.pdf?ua=1>), and thus the 13 cases may indeed be imported cases.

It is also not clear whether it was _Plasmodium falciparum_ or _Plasmodium vivax_. ProMED will be happy for a clarification from the authorities. - ProMED Mod.EP]

[HealthMap/ProMED-mail map:
Trinidad & Tobago: <http://healthmap.org/promed/p/28>]
More ...

World Travel News Headlines

Date: Sun 23 Feb 2020
Source: Q Costa Rica News [edited]
<https://qcostarica.com/costa-rica-is-the-first-country-in-america-where-very-resistant-antibiotic-bacteria-for-meningitis-is-isolated/>

A 50-year-old man and a senior became the 1st 2 people in Costa Rica -- and in the Americas -- found to be infected with the bacteria most resistant to antibiotics used in the treatment of meningitis and meningococcal septicaemia that cause serious brain damage and even death. The Centro Nacional de Referencia en Bacteriolog­a (CNRB) -- National Center of Reference in Bacteriology, of the Instituto Costarricense de Investigacian y Enseaanza en Nutricin y Salud (Inciensa) -- Costa Rican Institute for Research and Education in Nutrition and Health (Incense), issued an alert, in early February [2020], after documenting the circulation of _Neisseria meningitidis_ (_N. meningitidis_) serogroup Y, resistant to penicillin and not sensitive to cefotaxime [and ceftriaxone?], two 3rd generation antibiotics, reports La Nation.
====================
[Invasive meningococcal disease (meningococcaemia and meningitis) is a life-threatening infection caused by _Neisseria meningitidis_ that evolves rapidly, often even when appropriate treatment has been started promptly. Because antimicrobial treatment for invasive meningococcal disease with a 3rd-generation cephalosporin (cefotaxime and ceftriaxone) is the widely accepted standard recommendation (<https://academic.oup.com/cid/article/39/9/1267/402080>), resistance of _N. meningitidis_ to cefotaxime and ceftriaxone is very worrisome.

The news report above says that 2 patients in Costa Rica were infected with _N. meningitidis_ serogroup Y resistant to penicillin and 2 3rd generation cephalosporins, one of which was cefotaxime. The other 3rd generation cephalosporin is not specified, but is perhaps ceftriaxone, the other 3rd generation cephalosporin usually used to treat this disease. We are also not told in the news report above if the 2 patients were epidemiologically linked, nor are we told the extent (that is, MICs [minimum inhibitory concentration] of penicillin or cefotaxime), the mechanisms of resistance, or resistance to any of the other antimicrobial drugs used to prevent or treat this disease.

More information would be appreciated from knowledgeable sources. Reduced susceptibility of _N. meningitidis_ to penicillin has been reported in the past in many countries, including the US (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169190/>), usually due to decreased affinity of target penicillin-binding proteins for penicillin and less commonly to beta-lactamase production (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC89938/>, <https://pubmed.ncbi.nlm.nih.gov/3134848-relative-penicillin-g-resistance-in-neisseria-meningitidis-and-reduced-affinity-of-penicillin-binding-protein-3/>, and <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC162989/pdf/392577.pdf>).

Meningococcal isolates with reduced susceptibility to penicillin G usually were reported susceptible to 3rd-generation cephalosporins (cefotaxime and ceftriaxone). For example, despite the decrease in susceptibility to penicillin G in 33% of 2888 isolates of _N. meningitidis_, all isolates were susceptible to ceftriaxone in Brazil from 2009 to 2016 (<https://pubmed.ncbi.nlm.nih.gov/29717974-surveillance-of-antimicrobial-resistance-in-neisseria-meningitidis-strains-isolated-from-invasive-cases-in-brazil-from-2009-to-2016/>). Similar data have been reported for the US (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169190/>).

However, one previous study reported 8 clinical isolates _N. meningitidis_ in Delhi, India in 2006 that were resistant to ceftriaxone and cefotaxime, with most also resistant to penicillin, ciprofloxacin, and chloramphenicol (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698303/>). All of the isolates were identified as serogroup A _N. meningitidis_, but no further details concerning these isolates were given in this report (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1865813/>).

Resistance to other antimicrobial agents that may be used for therapy of meningococcal infections or for prophylaxis of case contacts has been reported in several countries. This includes resistance to chloramphenicol, fluoroquinolones, and rifampin. Horizontal exchange of genes that encode resistance for penicillin, rifampin, and the fluoroquinolones from other _Neisseria_ species that share a common ecological niche with _N. meningitidis_ in the nasopharynx has been proposed as one possible mechanism of acquisition of meningococcal antibiotic resistance (<http://jac.oxfordjournals.org/cgi/content/full/49/3/545>). - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Costa Rica: <http://healthmap.org/promed/p/17>]
Date: Tue 25 Feb 2020
From: Anne Laudisoit, PhD [edited]
<laudisoit@ecohealthalliance.org>

A suspect plague outbreak cluster has been noted in the the Godjoka health area as of 19 Feb 2020. The chief medical officer of the Rethy Health zone, the head nurse and the laboratory team from the Rethy General reference hospital investigated the outbreak site. The Godjoka village is located in the Linga health zone, Djugu territory, Ituri province, in the Congo DR (N 02.01'47.9'' and E030.44'56.6'', 1940m) in the plague endemic area.
 
There have been 6 suspected cases of plague, including 5 deaths and 1 recovering patient. The index case is a young boy who died on 19 Feb 2020. His mother, the neighbour and her child all died on 21 Feb 2020 and were buried the night of 24 Feb 2020, under pressure from the villagers. Finally the traditional healer ["tradipraticien"] who took care of the mother (who was the 2nd case) died in turn on 25 Feb 2020, and samples were taken that same day. The rapid diagnostic test was positive for plague.  Because of their rapidly fatal course, pneumonic plague is suspected for one or more of the 5 fatal cases. 

The only survivor has been under treatment at the Godjoka Health center since 22 Feb; he is the 20 year-old brother of the index case. The test on the sputum of this patient was negative.
-------------------------------------
Francoise Ngave Nyisi, Rethy General Reference Hospital, DR Congo
Mandro Michel, Provincial Division of Health, Bunia, DR Congo
Adroba Pascal, Provincial Division of Health, Bunia, DR Congo
Laudisoit Anne, Ecohealth Alliance, New York, USA
=====================
[ProMED thanks Dr Laudisoit and her hardworking Congolese colleagues for this important report.  Thus far the diagnosis of plague rests on the single positive diagnostic test obtained from the traditional healer, as it appears that the first 4 fatal cases were buried before diagnostic tests could be obtained. Following this logic, It is possible that the sole survivor thus far has the bubonic form of the disease, and thus a negative sputum result.  We seek and hope to obtain further information on all of these cases, including age, nature and duration of symptoms, presence or absence of buboes, etc.

This putative plague cluster is in a known historic plague-endemic region, where there were 31 cases and 8 deaths between Jan - Oct 2019, as previously reported by ProMED (Plague - Congo DR (02): (IT) fatal http://promedmail.org/post/20191016.6731137).  The Ituri district, of course, has also been affected by the still smouldering North Kivu-Ituri Ebola outbreak that began in July 2018.  This district has also been, and continues to be, a region of great civil unrest, with multiple armed insurgency groups operating near and across the Ugandan border.

The following background information on plague by Mod.LL is copied from our most recent ProMED post on plague [see below under See Also]:

"The bacterium that causes plague is _Yersinia pestis_. Most cases of plague are due to bubonic plague following the bite of an infected rodent flea causing a swollen and very tender lymph gland. The swollen gland is called a "bubo." Bubonic plague should be suspected when a person develops a swollen gland, fever, chills, headache, and extreme exhaustion, and has a history of possible exposure to infected rodents, rabbits, or fleas. A person usually becomes ill with bubonic plague 2-6 days after being bitten. At this point in the illness, there is no risk of person-to-person spread, so if this was indeed a case of bubonic plague, no isolation or quarantine is necessary.

When bubonic plague is left untreated, plague bacteria invade the bloodstream. As the plague bacteria multiply in the bloodstream, they spread rapidly throughout the body and cause a severe and often fatal condition. Infection of the lungs with the plague bacterium causes the pneumonic form of plague, a severe respiratory illness. The infected person may experience high fever, chills, cough, and breathing difficulty and may expel bloody sputum. If plague patients are not given specific antimicrobial therapy, the disease can progress rapidly to death. At this stage, as appears to have happened in this case, person-to-person spread can occur, causing other cases of "primary" plague pneumonia. - ProMED Mod.LL]

[A ProMED/HealthMap of DR Congo is available at: DR Congo:
Date: Thu, 27 Feb 2020 09:14:05 +0100 (MET)
By Anuj Chopra and Haitham El-Tabei

Riyadh, Feb 27, 2020 (AFP) - Saudi Arabia on Thursday suspended visas for visits to Islam's holiest sites for the "umrah" pilgrimage, an unprecedented move triggered by coronavirus fears that raises questions over the annual hajj.   The kingdom, which hosts millions of pilgrims every year in the cities of Mecca and Medina, also suspended visas for tourists from countries with reported infections as fears of a pandemic deepen.

Saudi Arabia, which so far has reported no cases of the virus but has expressed alarm over its spread in neighbouring countries, said the suspensions were temporary. It provided no timeframe for when they will be lifted.   "The kingdom's government has decided to take the following precautions: suspending entry to the kingdom for the purpose of umrah and visit to the Prophet's mosque temporarily," the foreign ministry said in a statement.   "Suspending entry into the kingdom with tourist visas for those coming from countries, in which the spread of the new coronavirus (COVID-19) is a danger."

The move comes as Gulf countries implement a raft of measures, including flight suspensions and school closures, to curb the spread of the disease from people returning from pilgrimages to Iran.  Even as the number of fresh coronavirus cases declines at the epicentre of the disease in China, there has been a sudden increase across the Middle East.

Since its outbreak, the United Arab Emirates has reported 13 coronavirus cases, Kuwait has recorded 43, Bahrain has 33 and Oman is at four cases.   Iran has emerged as a major hotspot in the region, with 19 fatalities from 139 infections -- the highest death toll outside China, where COVID-19 originated.   While no cases have been reported in Saudi Arabia, one citizen is reported to be infected in Kuwait along with four Saudi women in Bahrain -- all of whom had returned from Iran.

- 'Unprecedented' move -
The umrah, which refers to the Islamic pilgrimage to Mecca that can be undertaken at any time of year, attracts millions of devout Muslims from all over the globe each year.    There was no clarity over how the move would affect the annual hajj pilgrimage due to start in late July.   Some 2.5 million faithful travelled to Saudi Arabia from across the world to take part in last year's hajj -- one of the five pillars of Islam.

The event is a key rite of passage for Muslims and a massive logistical challenge for Saudi authorities, with colossal crowds cramming into relatively small holy sites.   "This move by Saudi Arabia is unprecedented," Ghanem Nuseibeh, founder of London-based risk consultancy Cornerstone Global Associates, told AFP.   "The concern for Saudi authorities would be Ramadan, which starts at the end of April, and hajj afterwards, should the coronavirus become a pandemic."

The holy fasting month of Ramadan is considered a favourable period by Muslim pilgrims to perform the Umrah.   Saudi Arabia's custodianship of Mecca and Medina -- Islam's two holiest sites -- is seen as the kingdom's most powerful source of political legitimacy.     But a series of deadly disasters over the years has prompted criticism of the Sunni kingdom's management of the pilgrimage.

In September 2015, a stampede killed up to 2,300 worshippers -- including hundreds of Iranians -- in the worst disaster ever to strike the pilgrimage.   The pilgrimage forms a crucial source of revenue for the government, which hopes to welcome 30 million pilgrims annually to the kingdom by 2030.   De facto ruler Crown Prince Mohammed bin Salman's Vision 2030 reform plan seeks to shift the economy of Saudi Arabia -- the world's top crude exporter -- away from oil dependency towards other sources of revenue, including religious tourism.
Date: Thu, 27 Feb 2020 05:04:04 +0100 (MET)

Kuala Lumpur, Feb 27, 2020 (AFP) - Badminton's German Open will not go ahead next week and the Polish Open has been postponed, officials said as two more Olympic qualifying events fell victim to the coronavirus.   It hasn't yet been decided whether the German Open, originally scheduled for March 3-8, will be postponed or cancelled entirely, the Badminton World Federation said late Wednesday.   New dates are being sought for the Polish Open, which was meant to take place on March 26-29, but it will not now fall in the qualifying period for the Tokyo Olympics.

Both events were in the same month as the All England Open, one of the biggest events in the badminton calendar, although that tournament is currently still set to go ahead.   "The BWF is continuing to monitor all official updates on COVID-19 with no change to the intention to stage other HSBC BWF World Tour or BWF-sanctioned tournaments," said a statement.   This week the Vietnam International Challenge, which also carried rankings points for the Olympics, was shifted from late March to early June.

The loss of qualifying tournaments will pose a problem for many players including two-time Olympic champion Lin Dan, who needs a rapid rise up the rankings to win a place on the Chinese team.   Many of China's players are currently in Britain and have been cleared to play during what is a "critical period" of Olympic qualifying, the Chinese Badminton Association said last weekend.   China have been the dominant force in badminton at recent Olympics, sweeping all five titles at London 2012 and winning the men's singles and doubles gold medals four years ago in Rio.
Date: Thu, 27 Feb 2020 09:58:42 +0100 (MET)

Tallinn, Feb 27, 2020 (AFP) - Estonia reported its first coronavirus case on Thursday, a day after the man returned to the Baltic nation of just 1.3 million people from his homeland Iran.    "The person, a permanent resident of Estonia who is not a citizen, arrived in Estonia on Wednesday evening," Social Affairs Minister Tanel Kiik told public broadcaster ERR.   He said the Iranian citizen is currently hospitalised.

Local media said the man arrived in Tallinn by bus from the Latvian capital Riga.   "For now, there are no plans of putting cities in quarantine following this one case," Kiik said.    "The patient is isolated, there is no risk of the disease spreading, now we have to identify all the people the patient was in contact with."   Iran has announced a total of 19 deaths and more than 130 infections, including the country's deputy health minister.   Iran's coronavirus death toll is the highest after that of China, where more than 2,700 people have died from the disease.
Date: Wed, 26 Feb 2020 19:27:33 +0100 (MET)

Vynnyky, Ukraine, Feb 26, 2020 (AFP) - Ukrainian authorities began the task of destroying 37,000 bottles of illicit adulterated vodka on Wednesday, a national "record" in a country where consumption of illegal alcohol regularly poisons and even kills.    Minister of Justice Denys Malyuska launched the operation in the city of Vynnyky in the central Lviv region where the bottles, holding 14 tonnes of alcohol, have been stored since their seizure in 2014.   "It is difficult to say what is in there but consumption is strictly not recommended," said the minister.    "This adulterated alcohol poses a huge threat to people's health and their lives."    In front of the media, the contents of several bottles were poured into plastic tanks or blue dye was added, to rule out any illegal re-sale of the beverage.

The procedure should last about a week, after which the liquid will be poured into the sewers at a secret location, according to the minister.   "This is the first time this procedure has been used so that everyone can see that the alcohol that has been seized is really destroyed," said Maliouska.   The minister said that in the past there had been "complaints" from the business community that because of corruption within the police, the illicit alcohol had often turned up in shops after being seized.   Cases of poisoning from adulterated drinks are a regular occurence in Ukraine, where the consumption of alcohol, especially spirits, remains high. And they are often fatal.

In 2016, 73 people died from a total of 150 people who were poisoned by adulterated alcohol.    The following year, six poisoning cases killed three people and, according to Ukrainian media, ten poisonings recorded by the authorities in 2018 led to nine deaths.   The tax department of the Lviv region told AFP on Wednesday that the most adulterated alcohol was vodka, which is then sold in shops in small towns or cafes located along the roads.
Date: Thu, 27 Feb 2020 07:21:09 +0100 (MET)

Copenhagen, Feb 27, 2020 (AFP) - Denmark reported its first coronavirus case Thursday, a man who had returned from a skiing holiday in northern Italy which has become a hotspot for the disease.   "The man who came back from a skiing trip with his wife and son on February 24 has been suffering since then from a cough and a temperature," Denmark's public health agency said in a statement.   "The man tested positive, but the results of his wife and son are negative," it said.   The man is relatively well and has returned to his home, where he remains in isolation with his family, it added.   According to public TV station TV2, the man is one of its employees.   Italy has reported 400 coronavirus cases, mostly in the north, and 12 deaths.
Date: Wed, 26 Feb 2020 23:18:10 +0100 (MET)

Bucharest, Feb 26, 2020 (AFP) - Romania reported its first confirmed case of the novel coronavirus on Wednesday -- a man who was in contact with an Italian who visited the country last week.    "The patient, who is in good health and is showing no symptoms, will be transferred to Bucharest's hospital of infectious diseases," Health Minister Victor Costache told a press conference.

Seven other people who live at the same address as the man in the south-eastern Gorj county have all tested negative but will be quarantined for 14 days as a precaution, emergency department official Raed Arafat said.   The Italian believed to be the source of Romania's first diagnosis tested positive for the deadly virus upon returning to Italy after a four-day visit to Gorj.

New cases have been emerging across Europe, many linked to the continent's coronavirus hotspot in northern Italy.    Several governments have advised against travel to Italy, which has now recorded 400 cases and 12 deaths.   The COVID-19 outbreak has killed over 2,700 people and infected more than 80,000 in 34 countries, although the vast majority of cases remain in China, according to the World Health Organization.
Date: Wed, 26 Feb 2020 21:33:56 +0100 (MET)

Oslo, Feb 26, 2020 (AFP) - Norwegian health authorities on Wednesday announced the first case of coronavirus in the Nordic nation in someone who returned from China last week, but said the patient was not "in danger".   "The person is not ill, they are in good health and do not present any symptoms," Line Vold, an official at the Norwegian Institute of Public Health, told reporters. "We think it is very unlikely that they have infected" others.   Routine tests had given a "weekly positive result" and detected traces of the new coronavirus, the institute said.
Date: Wed, 26 Feb 2020 20:03:47 +0100 (MET)

Tbilisi, Feb 26, 2020 (AFP) - Georgia on Wednesday announced its first confirmed case of the novel coronavirus in the South Caucasus region.   "A Georgian national has tested positive for the novel coronavirus," Health Minister Ekaterine Tikaradze told a news conference, adding that the infected man has been placed in isolation in a Tbilisi hospital.   "Three different tests of the 50-year-old man's nasopharyngeal smear gave positive results, but he is doing well, he is clinically healthy," head of Georgia's national centre for disease control, Amiran Gamkrelidze told journalists.

The man had arrived in Georgia from Iran via Azerbaijan, Gamkrelidze said.   Tikaradze said Georgia would introduce a two-week ban on Iranian nationals entering Georgia, but flatly dismissed fears of a coronavirus epidemic in the ex-Soviet country "at this point".   On Sunday, Georgia's neighbour Armenia closed its border with Iran and suspended flights as fears over an outbreak of coronavirus in Iran sent neighbouring countries scrambling to contain the outbreak.