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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".
More ...

Seychelles

General:
************************************
This group of islands are situated off the eastern coast of Africa in the Indian Ocean. The main Island is Mahe and it has a population of under 100,000. The other two islands with significant popula
ions are Praslin and La Digue. Generally, tourist facilities are well developed throughout these main islands. Elsewhere facilities are poor. The islands enjoy an oceanic tropical climate with only mild variations throughout the year. Rainfall fluctuations do occur with more rainfall occurring between October to April each year.
Safety and Security:
***********************************
The majority of tourists visiting the Seychelles will have a very peaceful time and the rate of crime throughout the country is small. However, like many other destinations this situation is changing and there are increasing numbers of reports of petty crime - even on the more popular beaches. Generally it is unwise to leave valuables unattended while you bathe and walking around the main streets in Victoria after dark is not recommended especially for women. All money exchanges must be transacted with official designated dealers and a receipt obtained. Otherwise strict penalties may be enforced.
Health Facilities:
***********************************
The level of healthcare in the main tourists resorts is perfectly adequate for most situations but outside these regions the level of care is significantly less. On isolated islands doctors are often unavailable and it may take many hours before you could move to a better equipped location. Always make sure your travel and health insurance is up to date before you leave home.
Food & Water Facilities:
***********************************
The level of food and water preparation in the main tourist resorts is excellent but when travelling to isolated regions the standards drop considerably. Consuming foods cooked in local homes will be a significant risk in many circumstances and usually best avoided. However, well cooked fresh fish and other well prepared local delicacies should not present any particular difficulty. As always it is wise to avoid all under cooked bivalve shellfish such as oysters, mussels and clams. Unprepared cold foods like lettuce are also better left untasted and fruit which has been previously peeled will be potentially contaminated. If you peel it yourself it should be fine. Check the tap water smells of chlorine and if not, do not use it for drinking or even brushing your teeth.
Insect Bites and Malaria:
***********************************
No malaria risk occurs throughout the Seychelles so prophylaxis will not be required. This is excellent news but you should be aware that mosquitoes can still be a problem and so careful avoidance techniques are required - particularly between dusk and dawn. Dengue Fever has been found on the Islands through there has been no epidemic of the disease for some years.
The risk of Rabies:
***********************************
The Seychelles are rabies free but obviously care should still be taken to avoid any contact with warm-blooded animals such as dogs, cats and monkeys. With the difficulties in patrolling the extensive coastline of the Seychelles it is always possible that the disease will be introduced at some stage in the future.
Swimming:
***********************************
Take care to listen to local advice before swimming in the sea. Strong currents and various marine life may lead to a severely spoiled holiday. Never swim after a heavy meal or significant intake of alcohol and always swim in the company of others.
Sun Exposure:
***********************************
The strength of the sun in the Seychelles throughout the year is significant and this can cause both sunburn and serious dehydration. After a long haul flight it may be tempting to fall asleep beside the hotel pool but this may cause dreadful sunburn and can easily ruin a holiday. Children need to be watched carefully as they are more liable to the effects of the sun, particularly on any fair skinned child. Wearing a light good fitting t-shirt and Increasing their salt intake may be very beneficial.
Road Safety:
***********************************
In the Seychelles they drive on the left side of the road but outside the main tourist resorts the roads tend to be very narrow with often shear drops. Barriers are rare and accidents can easily occur. The speed limits are between 25 to 50 mph and both drivers and front seat passengers are required to wear safety belts at all times. There is an ambulance service on the islands of Mahe, Praslin and La Digue which is summonsed by ringing 999.
Local Laws and Customs:
***********************************
There are strict regulations regarding import and export of firearms, spear-fishing equipment, fruit and vegetables. When paying for your hotel expenses a credit card must be used in most circumstances. If you have cash you must provide a receipt showing how it was obtained. A casino receipt would be adequate if you have been lucky enough!
Vaccinations for the Seychelles:
******************************************
Unless you are entering the islands from tropical Africa there are no essential vaccines for entry or exit. However for your own personal health it is recommended that travellers are covered against the following diseases;
*
Poliomyelitis (childhood booster)
*
Tetanus (childhood booster)
*
Typhoid (food and water borne disease)
*
Hepatitis A (food and water borne disease)
For those undertaking a longer more rural trip other vaccines may need to be considered including Hepatitis B.
Summary:
***********************************
Generally most tourists who maintain the usual commonsense rules stay perfectly healthy while in the Seychelles. Just remember the different climate conditions to your home situation and take care with food and water consumption. Further information is available from the Tropical Medical Bureau.

Travel News Headlines WORLD NEWS

18th Oct 2017
http://www.who.int/mediacentre/news/releases/2017/seychelles-plague-negative/en/ 

Samples from patients in Seychelles suspected to be ill with pneumonic plague tested negative at a World Health Organization (WHO) partner laboratory in Paris, France on Tuesday (17 October).
 
The ten samples were shipped by the Seychelles Ministry of Health and WHO to the collaborating centre for Yersinia at the Institut Pasteur to confirm the status of several suspected and one probable case – a 34-year-old Seychelles national who had returned from Madagascar with plague-like symptoms.

WHO is working with the Seychelles health authorities to reduce the risk of plague spreading from neighbouring Madagascar, which faces an unprecedented outbreak that has killed more than 70 people since August. No plague cases have been confirmed in the Seychelles.
Alongside support for laboratory testing, WHO has deployed experts and medical supplies to the 115-island country. The Organization is also providing guidance for the tracing and treatment of contacts of people who are suspected to have been infected.

“We are working with health authorities to reduce the risk of the spread of plague in the Seychelles by improving surveillance and preparedness,” said Dr. Ibrahima Soce Fall, WHO Regional Emergencies Director for the Africa region.

WHO is advising the Government of Seychelles on the implementation of public health measures that are in line with the WHO International Health Regulations, such as enhanced surveillance, isolation and treatment of suspect cases, contact tracing and prophylactic treatment of potential contacts.

WHO currently assesses the risk of spread of plague in the Seychelles to be low.
Date: Fri 13 Oct 2017
Source: Medical Xpress [edited]

The Seychelles government ordered schools to close [Fri 13 Oct 2017], after the discovery of 2 suspected cases of plague thought to have been brought from Madagascar where the disease has killed scores. The health ministry has also put under surveillance 320 people who have come into contact with the 2 patients. A total of 12 people showing plague-like symptoms have been admitted to hospital and given antimicrobials.

Panic gripped parents on the Indian Ocean archipelago after some students developed fevers in recent days, leading to the school closures.

"We made this decision as a precautionary measure to reassure parents," said Merida Delcy, an adviser to the education ministry, noting that they would not reopen until [Wed 18 Oct 2017], at the earliest.

Preliminary tests on the 2 people, including a Seychellois who returned from Madagascar a week ago, showed they could have plague, the health ministry said.

"It has not yet been confirmed that the 2 people are sick due to plague, samples will be sent this weekend to the Institut Pasteur (in France)," said public health commissioner Jude Gedeon. The results are expected next week [week of Sun 15 Oct 2017].

The sick include a student at Anse Boileau Elementary School on the main island of Mahe where all students have since been given antimicrobials.

As fear of plague spreads, there has been a run on surgical masks which people hope will offer protection against the highly infectious disease. Plague outbreaks are common on Madagascar, 1800 kilometres (1120 miles) to the south, where the disease is endemic. But this year [2017] both bubonic plague, spread by infected rats via flea bites, and the pneumonic type, spread person-to-person, have hit urban areas, including the capital Antananarivo, leaving at least 54 dead.

A Seychellois basketball coach who was visiting Madagascar is among the victims. The Seychelles government has begun to quarantine people who have arrived from Madagascar in the last week [week of Sun 1 Oct 2017]. The latest Madagascar health ministry report this week says 500 cases and 54 deaths [now 561 and 57 - ProMED Mod.LL] have so far been recorded, with around half of each occurring in the capital.
=====================
[There is no confirmation about any cases acquired on Seychelles on the Ministry of Health facebook page <https://www.facebook.com/mohseychellesofficial/>. ProMED awaits confirmation of additional cases of _Y. pestis_ infection on Seychelles in addition to the imported case from Madagascar. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Wed 11 Oct 2017
Source: Seychelles Ministry of Health [summ., edited]

Dr Jude Gedeon met with the media on Wed 11 Oct 2017, to give an update on the pneumonic plague situation in Seychelles. Speaking to several media houses, he addressed the case of pneumonic plague that was confirmed yesterday, 10 Oct 2017. He also stressed on current and additional measures being taken by the Ministry of Health to prevent this from spreading.

New measures being implemented against pneumonic plague:
- everyone entering Seychelles from Madagascar will immediately be referred to the isolation centre in Perseverance [Perseverance Island is an artificial island in Seychelles, lying 2 km (1.3 mi) from the capital Victoria]. - ProMED Mod.LL]
- no foreigners coming to Seychelles from Madagascar will be granted entry. Only Seychelles citizens will be allowed to enter the country.
- a Travel Advisory has been issued, in collaboration with Seychelles Tourism Board requesting all transiting points (Mauritius, Kenya, and Reunion) to redirect all passengers who are not a citizen of Seychelles.
- cargo ships will continue to be monitored as before. If anyone presents with symptoms within less than 7 days of leaving Madagascar, the ship will remain in isolation at sea. If anyone on board is sick, they will receive treatment;
- cruise ships are advised to remain at sea for at least 7 days before entering the port after visiting Madagascar. If it is less than 7 days (incubation period) all passengers and crew will remain under surveillance for the recommended time before entering the country.
*******************************
Date: Wed 11 Oct 2017 12:59 SCT
Source: Seychelles News Agency [edited]

Visitors to Seychelles who have visited Madagascar or transited through that island nation in the last 7 days will be placed under observation by health officials upon arrival to Mahe.

The Minister of Health, Jean-Paul Adam, made the statement in the National Assembly on [Wed 11 Oct 2017] when answering an urgent question from the Leader of the Opposition, Wavel Ramkalawan. Adam was called to the National Assembly after the 1st case of pneumonic plague in Seychelles was confirmed on Tue 10 Oct 2017. The patient is a man who returned to Mahe, the main island, last [Fri 6 Oct 2017], on board the last Air Seychelles flight from Madagascar.

The health minister also confirmed that 258 people are currently under observation and receiving treatment after the case of pneumonic plague was detected. "The 258 includes 41 passengers and 7 crew from the flight, 12 close family members, and 18 staff and patients from the Anse Boileau health centre where the man went when he fell ill."

The man disobeyed instructions given upon his arrival to remain at home for a period of time and attended a party that same evening. The minister explained that the result of the tests conducted on the infected man was sent to the Pasteur Institute in Paris, which confirmed the pneumonic plague.

Adam said that "all the 170 people who were at the party including the 13 staff working at the venue are also under passive surveillance. We were already putting Seychellois and tourists under active observation at their homes or at hotels. But as from today [11 Oct 2017], all those arriving from Madagascar will be put in isolation for 6 days," the Minister said.

Adam added that the authority will be using the Seychelles Coast Guard military academy as the isolation centre located at Perseverance, a reclaimed island on the outskirts of Victoria.

The national airline -- Air Seychelles -- had suspended all flights to Madagascar, following guidance and requests of the Seychelles' Public Health Authority amid concerns over the outbreak of the plague in Madagascar. To date, there are 449 cases confirmed in Madagascar and 48 people have died [now 500 cases and 54 deaths - ProMED Mod.LL]. Air Seychelles is the only airline in the region to suspend all its flights to the island.

The health ministry has also liaised with the Seychelles Fishing Authority to get fishermen who may have travelled to Madagascar recently to report their trips and if necessary to seek advice from health professionals. "We are also in contacts with boats, and we want to urge those who may have travelled to Madagascar informally to stop this practice and to report to their nearest health centres." Adam said this is important for assessment and also "for us to decide if they need to be placed under surveillance for treatment. We are also liaising with travel agents to discourage people from visiting the island."

Seychelles, a group of 115 islands in the western Indian Ocean, is on high alert ever since it was confirmed that a Seychellois basketball coach, who died in a hospital in Madagascar in September 2017, had contracted the plague.
====================
[Seychelles seems to have responded in appropriate ways related to the single importation (so far) of a person who developed pneumonic plague after returning from Madagascar. It is not clear if this case had any relationship to the basketball tournament that had occurred on Madagascar. Since there is no comment in this report regarding institution of antimicrobial prophylaxis to any of the contacts. - ProMED Mod.LL]

[HealthMap/ProMED-mail maps can be accessed at
Date: Sat, 14 Oct 2017 16:49:58 +0200

Mogadishu, Oct 14, 2017 (AFP) - More than 20 people were killed when a car bomb exploded on a busy street in Somalia's capital Mogadishu on Saturday, a police official said.   "Initial reports from emergency departments indicate more than 20 bodies picked up off the street and many more are under the wreckage of buildings destroyed by the blast", said Ibrahim Mohamed, a senior police officer.   Government security official Mohamed Aden said that bombing took place in a busy part of the city.    "There was a huge blast caused by a truck loaded with explosives. It went off at the entrance of a hotel alongside the K5 intersection," he said.   There was no immediate claim of responsibility, but the Al-Qaeda aligned Shabaab carries out frequent suicide bombings in the capital and elsewhere as it fights to overthrow the internationally-backed government.
Date: Fri, 13 Oct 2017 16:03:29 +0200

Victoria, Seychelles, Oct 13, 2017 (AFP) - The Seychelles government ordered schools to close Friday, after the discovery of two suspected cases of plague thought to have been brought from Madagascar where the disease has killed scores.   The health ministry has also put under surveillance 320 people who have come into contact with the two patients.

A total of 12 people showing plague-like symptoms have been admitted to hospital and given antibiotics.   Panic gripped parents on the Indian Ocean archipelago after some students developed fevers in recent days, leading to the school closures.   "We made this decision as a precautionary measure to reassure parents," said Merida Delcy, an adviser to the education ministry, noting that they would not reopen until Wednesday at the earliest.
 
Preliminary tests on the two people, including a Seychellois who returned from Madagascar a week ago, showed they could have plague, the health ministry said.   "It has not yet been confirmed that the two people are sick due to plague, samples will be sent this weekend to the Institut Pasteur (in France)," said public health commissioner Jude Gedeon.   The results are expected next week.   The sick include a student at Anse Boileau Elementary School on the main island of Mahe where all students have since been given antibiotics.

As fear of plague spreads, there has been a run on surgical masks which people hope will offer protection against the highly infectious disease.   Plague outbreaks are common on Madagascar, 1,800 kilometres (1,120 miles) to the south, where the disease is endemic. But this year both bubonic plague, spread by infected rats via flea bites, and the pneumonic type, spread person-to-person, have hit urban areas, including the capital Antananarivo, leaving at least 54 dead.

A Seychellois basketball coach who was visiting Madagascar is among the victims. The Seychelles government has begun to quarantine people who have arrived from Madagascar in the last week.   The latest Madagascar health ministry report this week says 500 cases and 54 deaths have so far been recorded, with around half of each occurring in the capital.
More ...

World Travel News Headlines

Date: Tue 17 Sep 2019
Source: Boston Globe [edited]

Rhode Island officials announced Tuesday [17 Sep 2019] that 2 more human cases of eastern equine encephalitis [EEE] were confirmed in the state.

The 2 people -- one a Coventry child younger than 10 and the other a person in their 50s from Charlestown -- have been discharged from the hospital and are recovering, according to a statement from the state's Department of Public Health.

Authorities think the 2 people contracted EEE in late August [2019]. The cases were confirmed by tests done at the Centers for Disease Control and Prevention. There have been 3 confirmed EEE cases in Rhode Island this year [2019]. A West Warwick resident diagnosed with the mosquito-borne illness died this month [September 2019].

All 3 people contracted EEE before areas at critical risk for the disease were aerially sprayed with pesticide, state officials said.

EEE is a rare but potentially fatal disease that can cause brain inflammation and is transmitted to humans bitten by infected mosquitoes, according to federal authorities. About 1/3 of infected people who develop the disease will die, officials have said, and those who recover often live with severe and devastating neurological complications. There is no treatment for EEE.

"This [2019] has been a year with significantly elevated EEE activity, and mosquitoes will remain a threat in Rhode Island until our 1st hard frost, which is still several weeks out," said Ana Novais, the deputy director for the state's health department. "Personal mosquito-prevention measures remain everyone's 1st defence against EEE. If possible, people should limit their time outdoors at sunrise and sunset. If you are going to be out, long sleeves and pants are very important, as is bug spray [repellent]."

EEE was also confirmed in a deer in Exeter this week [week of Mon 16 Sep 2019].

In Massachusetts, 8 human cases of EEE have been confirmed this year [2019]. Last month [August 2019], a Fairhaven woman with EEE died.
========================
[The 1st Rhode Island case died. Now there are 2 additional EEE cases who have recovered sufficiently to have been discharged from the hospital. Although most reported cases of EEE this year [2019] have occurred in horses, there have been several recent human cases as well. Individuals living in areas where human or equine EEE cases have occurred should heed the above recommendations to prevent mosquito bites. Avoidance of mosquito bites is the only preventive measure available. Fortunately, horses can be vaccinated, but there is no vaccine available for humans.

The risk of EEE virus infection for humans and horses will continue in Rhode Island and the other affected states until the 1st killing frosts occur, likely in October (2019). - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Rhode Island, United States: <http://healthmap.org/promed/p/241>]
Date: Tue 17 Sep 2019
Source: Detroit Free Press [edited]

State health officials said Tuesday [17 Sep 2019] that 3 Michiganders have died from the rare and dangerous mosquito-borne virus eastern equine encephalitis [EEE], and 4 others have been sickened by the disease, amid the biggest outbreak in more than a decade.

Those who live in all 8 of the affected counties -- Kalamazoo, Cass, Van Buren, Berrien, Barry, St. Joseph, Genesee, and Lapeer counties -- are urged to consider canceling, postponing, or rescheduling outdoor events that occur at or after dusk, especially those that involve children, according to the Michigan Department of Health and Human Services. This would include events such as late-evening sports practices or games or outdoor music practices "out of an abundance of caution to protect the public health, and applies until the 1st hard frost of the year [2019]," according to an MDHHS news release.

The 3 people who died were all adults and lived in Kalamazoo, Cass, and Van Buren counties, [respectively], said Bob Wheaton, a spokesman for the Michigan Department of Health and Human Services. The 4 other confirmed cases are in Kalamazoo, Berrien, and Barry counties.

Animals have also been confirmed to have the virus in St. Joseph, Genesee, and Lapeer counties.

The Kalamazoo County Health and Community Services Department also issued a recommendation to local communities and school districts to consider canceling outdoor events at dusk or after dark, when mosquitoes are most active, or move [the events] indoors.  "Michigan is currently experiencing its worst eastern equine encephalitis outbreak in more than a decade," said Dr. Joneigh Khaldun, MDHHS chief medical executive and chief deputy for health. "The ongoing cases reported in humans and animals and the severity of this disease illustrate the importance of taking precautions against mosquito bites."

EEE is one of the deadliest mosquito-borne viruses in the US. One in 3 people who are infected with the virus die. The only way to prevent it is to avoid mosquito bites. The MDHHS says residents should
- apply insect repellents that contain the active ingredient DEET or other US Environmental Protection Agency-registered product to exposed skin or clothing, and always follow the manufacturer's directions for use;
- wear long-sleeved shirts and long pants when outdoors. Apply insect repellent to clothing to help prevent bites;
- maintain window and door screening to help keep mosquitoes outside;
- empty water from mosquito breeding sites around the home, such as buckets, unused kiddie pools, old tires, or similar sites where mosquitoes may lay eggs; and
- use nets and/or fans over outdoor eating areas.

Symptoms of EEE include
- sudden onset of fever, chills;
- body and joint aches, which can progress to a severe encephalitis;
- headache;
- disorientation;
- tremors;
- seizures;
- paralysis; and
- coma.

Anyone experiencing these symptoms should visit a doctor.

[Byline: Kristen Jordan Shamus]
=======================
[The number of human cases remains at 7. However, 3 of these have died since the 6 Sep 2019 report (see Eastern equine encephalitis - North America (18): USA human, horse, deer http://promedmail.org/post/20190910.6667626). However, even among the survivors, there is a significant risk of permanent neurological damage following clinical encephalitis. CDC reports that many individuals with clinical encephalitis "are left with disabling and progressive mental and physical sequelae, which can range from minimal brain dysfunction to severe intellectual impairment, personality disorders, seizures, paralysis, and cranial nerve dysfunction. Many patients with severe sequelae die within a few years" (<https://www.cdc.gov/easternequineencephalitis/tech/symptoms.html>). - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Michigan, United States: <http://healthmap.org/promed/p/225>
Michigan county map:
Date: Mon 16 Sep 2019
Source: Patch [edited]

The state Department of Public Health is warning that an adult resident of East Lyme has tested positive for eastern equine encephalitis (EEE). This is the 1st human case of EEE identified in Connecticut this season [2019].  The patient became ill during the last week of August [2019] with encephalitis and remains hospitalized. Laboratory tests, which were completed today at the Centers for Disease Control and Prevention (CDC) Laboratory in Ft. Collins, Colorado, confirmed the presence of antibodies to the virus that causes EEE.  "EEE is a rare but serious and potentially fatal disease that can affect people of all ages," said DPH commissioner Renee Coleman Mitchell in a release. "Using insect repellent, covering bare skin, and avoiding being outdoors from dusk to dawn are effective ways to help keep you from being bitten by mosquitoes."  The EEE virus has been identified in mosquitoes in 12 towns and in horses in 2 other towns.

Towns where mosquitoes have tested positive for EEE include Chester, Haddam, Hampton, Groton, Killingworth, Ledyard, Madison, North Stonington, Plainfield, Shelton, Stonington, and Voluntown. Horses have tested positive for EEE virus in Colchester and Columbia this season, and the virus has been detected in a flock of wild pheasants.  Other states throughout the northeast are also experiencing an active season for EEE. In addition to the virus being found in mosquitoes, there have been a total of 8 human cases of EEE infection in Massachusetts and one human case in Rhode Island, with one case in each state resulting in a fatality. "This is the 2nd human case of EEE ever reported in Connecticut," said Dr. Matthew Cartter, director of infectious diseases for the DPH. "The 1st human case of EEE reported in Connecticut occurred in the fall of 2013."

The DPH advises against unnecessary trips into mosquito breeding grounds and marshes, as the mosquitoes that transmit EEE virus are associated with freshwater swamps and are most active at dusk and dawn. Overnight camping or other substantial outdoor exposure in freshwater swamps in Connecticut should be avoided. Even though the temperatures are getting cooler, the DPH is advising that mosquito season is not over, and residents should continue to take measures to prevent mosquito bites, including wearing protective clothing and using repellents.  Although EEE-infected mosquitoes continue to be detected in the south-eastern corner of the state, the numbers are declining, and we are not experiencing the excessively high levels of activity seen in Massachusetts. There are currently no plans to implement widespread aerial pesticide spraying in the state.

Severe cases of EEE virus infection (involving encephalitis, an inflammation of the brain) begin with the sudden onset of headache, high fever, chills, and vomiting. The illness may then progress into disorientation, seizures, and coma. Approximately 1/3 of patients who develop EEE die, and many of those who survive have mild to severe brain damage, according to the DPH.

There is no specific treatment for EEE. Antibiotics are not effective against viruses, and no effective anti-viral drugs have been discovered. Severe illnesses are treated by supportive therapy, which may include hospitalization, respiratory support, IV fluids, and prevention of other infections. It takes 4-10 days after the bite of an infected mosquito to develop symptoms of EEE.

The management of mosquitoes in Connecticut is a collaborative effort involving the Department of Energy and Environmental Protection, the Connecticut Agricultural Experiment Station, and the DPH, together with the Department of Agriculture and the Department of Pathobiology at the University of Connecticut. These agencies are responsible for monitoring and managing the state's mosquito population levels to reduce the potential public health threat of mosquito-borne diseases.

Information on what can be done to prevent getting bitten by mosquitoes and the latest mosquito test results and human infections is available online.  [Byline: Rich Kirby]
===========================
[This has been an active year for EEE virus transmission in the eastern USA from the upper Midwest to the northeastern states and south to Florida. Although historically, EEE human cases in Connecticut have been very rare, the occurrence of a human case in the state this year (2019) is not surprising. There have been equine and/or human EEE cases this summer (2019) in the 3 bordering states: Rhode Island, Massachusetts, and New York. Interestingly, pheasants are mentioned in the above report. They are susceptible and, after being infected with the virus from the bite of an EEE-carrying mosquito, become ill or moribund with viremia titers that can reach 10^9 per ml. Ill or moribund pheasant can be attacked and cannibalized by pen mates that, in turn, are infected orally and may become ill and die as well. As the above report cautions, the only way to avoid infection is for people to avoid mosquito bites. Although the incidence of EEE cases and virus-positive mosquitoes may be declining, there is a risk of infection until the 1st killing frost occurs in autumn, when the mosquitoes are no longer active. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Connecticut, United States: <http://healthmap.org/promed/p/210>]
Date: Wed 11 Sep 2019
Source: BBC Afrique [In French, trans. Mod.LXL, edited]

At least 18 people died in 10 days after eating pesticide-contaminated food in 2 localities in Burkina Faso. A dozen still remain under observation in hospitals, according to the Minister of Health.  The 1st cases were reported on [1 Sep 2019] in the town of Didyr in the centre-west of the country, said Professor Claudine Lougue, Minister of Health.  About 15 members of the same families felt unwell after eating local dishes made from bean leaves and small millet seeds, which are actually seed remains. Thirteen died later despite medical care.

On Monday [2 Sep 2019], the ministry received another alert, this time from the central-eastern region. Here again, 14 people from the same family were admitted to the health centres. Five have lost their lives. After analysis, doctors diagnosed massive food poisoning, said the minister. Complementary examinations incriminate pesticides, she said.  "Investigations have been made on samples of biological products such as blood and urine, and we found an unusually high level of pesticides in foods that were consumed. There was an abnormally high level of pesticides, and these pesticides were strongly incriminated," said the minister.

The remains of food have been secured, announced Professor Lougue, who calls on citizens to observe strict hygiene measures in the use of plant leaves for consumption. Pesticides are used for the needs of field work, especially in the countryside during this period of wintering.
Date: Wed, 18 Sep 2019 16:44:19 +0200 (METDST)

London, Sept 18, 2019 (AFP) - British Airways pilots on Wednesday cancelled a strike that had been due September 27, the British Airline Pilots Association union said after two walkouts last week that cost the company dear.   "Someone has to take the initiative to sort out this (pay) dispute and with no sign of that from BA the pilots have decided to take the responsible course," BALPA General Secretary Brian Strutton said in a statement.    The union chief added that the airline's "passengers rightly expect BA and its pilots to resolve their issues without disruption and now is the time for cool heads and pragmatism to be brought to bear.    "I hope BA and its owner IAG show as much responsibility as the pilots," he added.   It was now "time for a period of reflection before the dispute escalates further and irreparable damage is done to the (BA) brand."

However the union added that should the airline "refuse meaningful new negotiations, BALPA retains the right to announce further strike dates".   British Airways, which likes to call itself "the world's favourite airline", flew into turbulence last week as pilots staged a costly and historic two-day strike, tarnishing its global reputation according to aviation analysts.   Pilots walked out for the first time in the company's 100-year history, sparked by a bitter and long-running feud over pay.   BA faced the embarrassment of grounding its entire UK fleet on September 9 and 10, causing the cancellation of about 1,600 flights.   The move sparked travel chaos for about 200,000 passengers who had been due to fly in and out of London's Gatwick and Heathrow airports.

The disruption continued into September 11 because half of BA's 300 aircraft and more than 700 pilots were mostly in the wrong place.   As a result, BA was forced to cancel approximately ten percent of its daily 850 flights in and out of Britain that day.    BALPA and its members are demanding a bigger share of British Airways profits.   The airline has offered a salary increase of 11.5 percent over three years, which it argues would boost the annual pay of some captains to £200,000 ($250,000 or 226,000 euros).   However, the union has rejected the proposal made in July.   BALPA meanwhile estimates that last week's 48-hour strike cost the airline £80 million.   BA is owned by IAG, which was formed in 2011 with the merger of British Airways and Spain's Iberia. IAG has since added other carriers, including Austria's Vueling and Ireland's Aer Lingus.
Date: Wed, 18 Sep 2019 12:26:37 +0200 (METDST)
By Sam Reeves

Kuala Lumpur, Sept 18, 2019 (AFP) - Toxic haze from Indonesian forest fires closed schools and airports across the country and in neighbouring Malaysia Wednesday, while air quality worsened in Singapore just days before the city's Formula One motor race.   Illegal fires to clear land for agriculture are blazing out of control on Sumatra and Borneo islands, with Jakarta deploying thousands of security forces and water-bombing aircraft to tackle them.

Indonesian blazes belch smog across Southeast Asia annually, but this year's are the worst since 2015 and have added to concerns about wildfire outbreaks worldwide exacerbating global warming.   On Wednesday, air quality deteriorated to "very unhealthy" levels on an official index in many parts of peninsular Malaysia, to the east of Sumatra, with the Kuala Lumpur skyline shrouded by dense smog.    Nearly 1,500 schools were closed across Malaysia due to the air pollution, with over one million pupils affected, according to the education ministry.

A growing number of Malaysians were suffering health problems due to the haze, with authorities saying there had been a sharp increase in outpatients at government hospitals -- many suffering dry and itchy eyes.   Indonesian authorities said hundreds of schools in hard-hit Riau province on Sumatra were shut, without providing a precise number, while about 1,300 were closed in Central Kalimantan province on Borneo.    Borneo is shared between Indonesia, Malaysia and Brunei.   Poor visibility closed seven airports in the Indonesian part of Borneo, the transport ministry in Jakarta said. Scores of flights have already been diverted and cancelled in the region in recent days due to the smog.

- Singapore smog race? -
Air quality in Singapore worsened to unhealthy levels and a white smog obscured the striking waterfront skyline, featuring the Marina Bay Sands casino resort with its three towers and boat-shaped top level.    The worsening pollution increased fears that this weekend's Formula One race may be affected. Organisers say the possibility of haze is one of the issues in their contingency plan for Sunday's showpiece night race, but have not given further details.

The city-state's tourism board said spectators would be able to buy masks as protection from the haze if conditions did not improve and assistance would be provided for those who feel unwell, the Today news portal reported.   The fires have sparked tensions between Indonesia and Malaysia.    Indonesia's environment minister initially suggested the haze was from Malaysian fires despite satellite data showing hundreds of blazes in Indonesia and only a handful in its neighbour, prompting anger from her Malaysian counterpart.

Indonesia later sealed off dozens of plantations where it said fires were blazing, including some owned by Malaysia-based firms, deepening the row.   But Prime Minister Mahathir Mohamad, who has struck a diplomatic tone throughout the crisis, said Malaysia may pass legislation forcing its companies to tackle fires on plantations abroad.   Malaysia wants its firms with sites overseas to put out blazes contributing to the haze, he said, adding: "Of course, if we find they are unwilling to take action, we may have to pass a law to make them responsible."

The Indonesian government has insisted it is doing all it can to fight the blazes. But this year's fires have been worsened by dry weather and experts believe there is little chance of them being extinguished until the onset of the rainy season in October.   Indonesia's meteorology, climate and geophysics agency said Wednesday that over 1,000 hotspots -- areas of intense heat detected by satellite that indicate a likely fire -- had been sighted, most of them on Sumatra.
Date: Wed, 18 Sep 2019 12:14:44 +0200 (METDST)
By Aishwarya KUMAR

New Delhi, Sept 18, 2019 (AFP) - India announced on Wednesday a ban on the sale of electronic cigarettes, as a backlash gathers pace worldwide due to health concerns about a product promoted as less harmful than smoking tobacco.   The Indian announcement, also outlawing production, import and distribution, came a day after New York became the second US state to ban flavoured e-cigarettes following a string of vaping-linked deaths.   "The decision was made keeping in mind the impact that e-cigarettes have on the youth of today," Finance Minister Nirmala Sitharaman told reporters in New Delhi.

E-cigarettes do not "burn" but instead heat up a liquid -- tasting of everything from bourbon to bubble gum and which usually contains nicotine -- that turns into vapour and is inhaled.   The vapour is missing the estimated 7,000 chemicals in tobacco smoke but does contain a number of substances that could potentially be harmful.   They have been pushed by producers, and also by some governments including in Britain, as a safer alternative to traditional smoking -- and as a way to kick the habit.

However critics say that apart from being harmful in themselves, the flavours of e-cigarette liquids appeal particularly to children and risk getting them addicted to nicotine.   Some 3.6 million middle and high school students in the United States used vaping products in 2018, an increase of 1.5 million on the year before.   The New York emergency legislation followed an outbreak of severe pulmonary disease that has killed seven people and sickened hundreds.   President Donald Trump's administration announced last week that it would soon ban flavoured e-cigarette products to stem a rising tide of youth users.

- Big E-Tobacco -
Although few Indians vape at present, the Indian ban also cuts off a vast potential market of 1.3 billion consumers for makers of e-cigarettes.   Tobacco firms have been investing heavily in the technology to compensate for falling demand for cigarettes due to high taxes and public smoking bans, particularly in the West.

In 2018 Altria, the US maker of brands such as Marlboro and Chesterfield, splashed out almost $13 billion on a stake in one of the biggest e-cigarette makers, Juul.   A few Indian states have already banned e-cigarettes although the restrictions have been ineffective since online sale of vaping products continue.   The new ban does not cover traditional tobacco products in India.   According to the World Health Organization, India is the world's second-largest consumer of tobacco products, killing nearly 900,000 people every year.

Nearly 275 million people over 15, or 35 percent of adults, are users, although chewing tobacco -- which also causes cancer -- is more prevalent than smoking.   India is also the world's third--largest producer of tobacco, the WHO says, and tobacco farmers are an important vote bank for political parties.   According to the Associated Chambers of Commerce and Industry, an estimated 45.7 million people depend on the tobacco sector in India for their livelihood.   Tobacco is also a major Indian export, and the government holds substantial stakes, directly or indirectly, in tobacco firms including in ITC, one of India's biggest companies.
Date: Wed, 18 Sep 2019 03:56:31 +0200 (METDST)

Washington, Sept 18, 2019 (AFP) - Hurricane Humberto strengthened to a major Category 3 storm on Tuesday and was expected to pass near Bermuda, threatening it with dangerous waves and heavy rain, the US National Hurricane Center said.   "Hurricane conditions are expected to reach Bermuda by Wednesday night and continue into early Thursday morning," the Miami-based NHC said.   "Some fluctuations in intensity are likely during the next day or so, but Humberto should remain a powerful hurricane through Thursday," it said.   As of 8:00 pm (0000 GMT), the storm had maximum sustained winds of 115 miles per hour (185 kilometers per hour) and was moving east-northeast at 12 miles per hour.
Date: Wed, 18 Sep 2019 01:36:21 +0200 (METDST)

Dakar, Sept 17, 2019 (AFP) - Four people died after a boat carrying dozens of tourists capsized during heavy storms in Senegal, authorities and emergency services said Tuesday.   The death toll could rise as three passengers were said to be missing after the accident.  The boat was carrying several Senegalese nationals, six French people, two Germans, two Swedes and one person from Guinea-Bissau, when it turned over Monday in driving rain and a heavy swell, fire department chief Papa Angel Michel Diatta said.   All the dead were Senegalese, officials and emergency services said.

Two worked in a national park, one was a woman and the other victim was a child, Diatta said.   The boat was heading for the Madeleine islands, site of an offshore national park popular with tourists who travel from Dakar, coastal capital of the West African country.   Senegalese President Macky Sall appealed for "greater caution and respect for existing security norms duing the rainy season" in a tweet.

Emergency services continued to look for those missing on Tuesday. AFP journalists saw a dozen divers at the scene. Distressed families were waiting on the shore to get news of their loved ones.    "The gendarmerie called us at 5:00 am (GMT and local time). My brother was on the boat. The worst thing is not knowing," said Aminata Diop, who was among the relatives on the beach.   There are "four dead bodies and between three and four people are missing. Thirty-five people were on the boat. Search and rescue operations are continuing this morning," Interior Minister Aly Ngouille Ndiaye told AFP by telephone.

The causes of the accident were unclear. The interior minister told Senegalese media overnight that several tourists were worried about the heavy rains and wanted to return to the pier but others wanted to stay on the boat.   The survivors spent the night on the island, Ndiaye told local radio on Tuesday. Blankets and food were sent to them and they were to be ferried back to the mainland in the morning, he added.   The rainy season arrived late this year and heavy storms have resulted in several casualties this month.    Two fishermen were killed on their canoe in the same area nearly two weeks ago.
Date: Tue, 17 Sep 2019 15:38:37 +0200 (METDST)

Jakarta, Sept 17, 2019 (AFP) - Massive forest fires in Indonesia that have caused a toxic haze to spread as far as Singapore and peninsular Malaysia are also seriously affecting endangered orangutans and their habitat, a rescue foundation said Tuesday.   Jakarta has deployed thousands of troops as temporary fireman and deployed dozens of water-bombing aircraft to battle blazes that are turning pristine forest into charred landscape in Sumatra and Borneo islands.   The fires -- usually started by illegal burning to clear land for farming -- have unleashed a choking haze across parts of southeast Asia.

The Borneo Orangutan Survival Foundation said Tuesday that the haze was affecting hundreds of great apes in its care at rescue centres and wildlife re-introduction shelters.   "The thick smoke does not only endanger the health of our staff... but also it affects the 355 orangutans we currently care for", the foundation said in a statement, referring to just once cetre in Kalimantan   "As many as 37 young orangutans are suspected to have contracted a mild respiratory infection," it added.   Conditions were so bad at their Samboja Lestari facility in East Kalimantan that outdoor activities for the animals had been restricted to a few hours a day.

Orangutans have been particularly vulnerable to commercial land clearances and have seen their natural habitat shrink dramatically in the last few decades.   The population of orangutan in Borneo has plummeted from about 288,500 in 1973 to about 100,000 today, according to the International Union for Conservation of Nature.   The toxic smoke caused by the forest fires is an annual problem for Indonesia and its neighbours, but has been worsened this year by particularly dry weather.   On Borneo island, which Indonesia shares with Malaysia and Brunei, pollution levels were "hazardous", according to environment ministry data.   Hundreds of schools across Indonesia and Malaysia were shut.