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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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Lithuania

Lithuania US Consular Information Sheet
May 19, 2008
COUNTRY DESCRIPTION:
Lithuania is a stable democracy undergoing rapid economic growth. Tourist facilities in Vilnius, the capital, and to a lesser extent in Kaunas and Klaipeda, are simi
ar to those available in other European cities. In other parts of the country, however, some of the goods and services taken for granted in other countries may not be available. Read the Department of State Background Notes on Lithuania for additional information.
ENTRY/EXIT REQUIREMENTS: A valid passport is required to enter Lithuania. As there are no direct flights from the U.S. to Lithuania, U.S. citizens should be aware of passport validity requirements in transit countries. American citizens do not need a visa to travel to Lithuania for business or pleasure for up to 90 days. That 90-day period begins with entry to any of the “Schengen Group” countries: Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Slovakia, Spain, and Sweden. Multiple visits to Schengen countries may not exceed 90 days in any 6 month period. Travelers remaining in Lithuania for more than 90 days within any six-month period must apply for temporary residency.

Lithuanian authorities recommend applying or a residency permit through a Lithuanian embassy or consulate before initial entry into Lithuania, as processing times can run beyond 90 days. All foreigners of non-European Union countries seeking entry into Lithuania must carry proof of a medical insurance policy contracted for payment of all costs of hospitalization and medical treatment in Lithuania. Visitors unable to demonstrate sufficient proof of medical insurance must purchase short-term insurance at the border from a Lithuanian provider for roughly $1.00 per day. The number of days will be calculated from the day of entry until the date on the return ticket. Children residing in Lithuania must have written permission to travel outside the country from at least one parent if their parents are not accompanying them on their trip. This policy is not applicable to temporary visitors. See our Foreign Entry Requirements brochure for more information on Lithuania and other countries. Visit the Embassy of Lithuania web site at www.ltembassyus.org for the most current visa information.
Note: Although European Union regulations require that non-EU visitors obtain a stamp in their passport upon initial entry to a Schengen country, many borders are not staffed with officers carrying out this function. If an American citizen wishes to ensure that his or her entry is properly documented, it may be necessary to request a stamp at an official point of entry. Under local law, travelers without a stamp in their passport may be questioned and asked to document the length of their stay in Schengen countries at the time of departure or at any other point during their visit, and could face possible fines or other repercussions if unable to do so.
Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information abut customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY: Civil unrest is not a problem in Lithuania, and there have been no incidents of terrorism directed toward American interests. Incidents of anti-Americanism are rare.

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, including 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., 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: Lithuania is a relatively safe country. Visitors should maintain the same personal security awareness that they would in any metropolitan U.S. city. Large amounts of cash and expensive jewelry should be secured in a hotel safe or left at home. Crimes against foreigners, while usually non-violent, do occur. Pickpocketing and thefts are problems, so personal belongings should be well protected at all times. Theft from cars and car thefts occur regularly. Drivers should be wary of persons indicating they should pull over or that something is wrong with their car. Often, a second car or person is following, and when the driver of the targeted car gets out to see if there is a problem the person who has been following will either steal the driver’s belongings from the vehicle or get in and drive off with the car. Drivers should never get out of the car to check for damage without first turning off the ignition and taking the keys. Valuables should not be left in plain sight in parked vehicles, as there have been increasing reports of car windows smashed and items stolen. If possible, American citizens should avoid walking alone at night. ATMs should be avoided after dark. In any public area, one should always be alert to being surrounded by two or more people at once. Additionally, criminals have a penchant for taking advantage of drunken pedestrians. Americans have reported being robbed and/or scammed while intoxicated.
Following a trend that has spread across Eastern and Central Europe, racially motivated verbal, and sometimes physical, harassment of foreigners of non-Caucasian ethnicity has been reported in major cities. Incidents of racially motivated attacks against American citizens have been reported in Klaipeda and Vilnius.
In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law. In addition, bringing them back to the United States may result in forfeitures and/or fines. More information on these serious problems is available at http://www.cybercrime.gov/18usc2320.htm.
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. For more information about assistance for victims of crime in Lithuania, please visit the Embassy’s web site at http://vilnius.usembassy.gov/service/crime-victim-assistance.html.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care in Lithuania has improved in the last 15 years, but medical facilities do not always meet Western standards. There are a few private clinics with medical supplies and services that nearly equal Western European or U.S. standards. Most medical supplies are now widely available, including disposable needles, anesthetics, antibiotics and other pharmaceuticals. However, hospitals and clinics still suffer from a lack of equipment and resources. Lithuania has highly trained medical professionals, some of whom speak English, but their availability is decreasing as they leave for employment opportunities abroad. Depending on his or her condition, a patient may not receive an appointment with a specialist for several weeks. Western-quality dental care can be obtained in major cities. Elderly travelers who require medical care may face difficulties. Most pharmaceuticals sold in Lithuania are from Europe; travelers will not necessarily find the same brands that they use in the United States. Serious medical problems requiring hospitalization and/or medical evacuation can cost thousands of dollars or more. Doctors and hospitals often expect immediate cash payment for health services, particularly if immigration status in Lithuania is unclear.

Tick-borne encephalitis and lyme disease are widespread throughout the country. Those intending to visit parks or forested areas in Lithuania are urged to speak with their health care practitioners about immunization. Rabies is also increasingly prevalent in rural areas.
The Lithuanian Government does not require HIV testing for U.S. citizens. However, sexually transmitted diseases are a growing public health problem.
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.
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. All foreigners of non-European Union countries seeking entry into Lithuania must carry proof of a medical insurance policy contracted for payment of all costs of hospitalization and medical treatment in Lithuania (please see entry/exit requirements above). 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 Lithuania is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
The Police allow Americans to drive in Lithuania with an American driver’s license for up to 90 days. Americans who reside in Lithuania for 185 days or more in one calendar year and who wish to continue driving in Lithuania must acquire a Lithuanian driver's license. The foreign license must be given to the Lithuanian Road Police to be processed by the Consular Department of the Lithuanian Ministry of Foreign Affairs, which in turn sends it to the U.S. Embassy’s Consular Section, where the owner is expected to claim it.
Roads in Lithuania range from well-maintained two- to four-lane highways connecting major cities to small dirt roads traversing the countryside. Violation of traffic rules is common. It is not unusual to be overtaken by other automobiles, traveling at high speed, even in crowded urban areas. Driving at night, especially in the countryside, can be particularly hazardous. In summer, older seasonal vehicles and inexperienced drivers are extra hazards. Driving with caution is urged at all times. Driving while intoxicated is a very serious offense and carries heavy penalties. The speed limit is 50 km/hr in town and 90 km/hr out of town unless otherwise indicated. The phone number for roadside assistance is 8-800-01414 from a regular phone and 1414 from a GSM mobile phone.
Seatbelts are mandatory for the driver and all passengers except children under the age of 12. During the winter, most major roads are cleared of snow. Winter or all-season tires are required from November 10th through April 1st. Studded tires are not allowed from April 10th through October 31st. Drivers must have at least their low beam lights on at all times while driving. Public transportation is generally safe.
Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office and national authority responsible for road safety at www.tourism.lt and at www.lra.lt/index_en.html.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Lithuania, the U.S. Federal Aviation Administration (FAA) has not assessed Lithuania’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 www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES: Lithuanian customs authorities may enforce strict regulations concerning the temporary importation into or export from Lithuania of items such as firearms and antiquities. Please see our Customs Information.
Telephone connections are generally good. American 1-800 numbers can be accessed from Lithuania but not on a toll-free basis; the international long distance rate per minute will be charged. Local Internet cafes offer computer access. ATMs are widely available. Most hotels and other businesses accept major credit cards.
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 Lithuanian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Lithuania are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or possessing or disseminating child pornography in a foreign country is a crime prosecutable in the United States. For more information about arrest procedures in Lithuania, please visit the Embassy’s web site at http://vilnius.usembassy.gov/arrests.html. Please see our information on Criminal Penalties.
CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children’s Issues web page.
REGISTRATION / EMBASSY LOCATION: Americans living or traveling in Lithuania are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, and to obtain updated information on travel and security within Lithuania. 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 Akmenu Gatve 6, tel. (370) (5) 266-5500 or 266-5600; fax (370) (5) 266-5590. Consular information can also be found on the Embassy Vilnius web site at http://vilnius.usembassy.gov/.
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This replaces the Consular Information Sheet dated November 5, 2007 to update sections on Crime and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Wed 7 Aug 2019 01:17:58 EEST
Source: Xinhua News Agency [edited]

The rate of tick-borne encephalitis in Lithuania remains the highest in Europe, announced the country's Center for Communicable Diseases and AIDS (ULAC) on [Tue 6 Aug 2019].

According to ULAC, the rate of tick-borne encephalitis cases was 16.6 cases per 100 000 population in 2017, based on the latest data provided by the European Center for Disease Prevention and Control (ECDC) in its latest annual epidemiological report.  "In Lithuania the rate of encephalitis remains the highest in Europe," said ULAC.

Lithuania was followed by the Czech Republic and Estonia with the rate of 6.4 cases per 100 000 population, according to ULAC.  ULAC notes the largest proportion of tick-borne encephalitis cases is at the age group of 45-64 years and the lowest among the children of the age of 0-4 years.  "ULAC medics remind vaccination is the most reliable protection from tick-borne encephalitis," said ULAC in the announcement, noting vaccines have a reliability rate of 98 percent.

ULAC's warning comes amid increasing number of tick-borne encephalitis cases this year [2019] in Lithuania, a Baltic country with a population of around 3 million.  More than 90 cases of tick-borne encephalitis were reported during the 1st half of the year [2019] in Lithuania, 1/3 more compared to the same period last year [2018], according to local data by ULAC.

According to the ECDC's report, the highest prevalence of tick-borne encephalitis historically is found in the Baltic countries. Tick-borne encephalitis usually reaches its seasonal peak during the warmest months -- July and August.

Tick-borne encephalitis is a human viral infectious disease of central nervous system caused by infected ticks, usually found in woodland habitats. The disease manifests itself with symptoms similar to fever, fatigue, headache, nausea, and can cause meningitis.
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[Cases of tick-borne encephalitis (TBE) have been reported before (see ProMED mail archive Tick-borne encephalitis - EU (Czech Rep., Latvia, Lithuania) http://promedmail.org/post/20040624.1677). Given the high rate of TBE cases in Lithuania reported above, there doubtless have been cases occurring there annually in recent years.

A report in Eurosurveillance Weekly in 2004 stated, "Tick-borne encephalitis (TBE) is endemic in virtually all countries in Central and Eastern Europe. It is caused by several closely related but distinct flaviviruses. 3 subtypes are recognised at present: a Far-Eastern subtype, a Siberian subtype and a European subtype. The Siberian subtype is associated with Russian spring-summer encephalitis and is transmitted predominantly by the tick _Ixodes persulcatus_, whereas the European subtype causes central European encephalitis and is transmitted by _Ixodes ricinus_.

The clinical spectrum of acute TBE ranges from symptoms of mild meningitis to severe meningoencephalitis with or without myelitis. The incubation period of central European TBE is 7-14 days. Onset is generally biphasic. The 1st phase involves a non-specific influenza-like illness with fever, headache, nausea, and vomiting, lasting about a week. After a period of remission lasting a few days, the fever returns with aseptic meningitis or encephalomyelitis. The case fatality rate is 1-5 percent and about 20 percent of survivors have neurological sequelae. Residual motor defects are rare." - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Lithuania:
Date: Wed, 3 Jul 2019 15:49:43 +0200

Vilnius, July 3, 2019 (AFP) - Lithuania declared an emergency on Wednesday as a severe drought hit the Baltic EU state, threatening to slash this year's harvest by up to half.   Apart from jeopardising crops, scant rainfall has also drastically reduced water levels in some rivers, threatening fish stocks and shipping activities.

The formal declaration of an "emergency situation" will allow the government to compensate farmers for some losses as well as help them to avoid EU financial sanctions should they fail to reach production goals.   "Farmers believe their harvest can be slashed by 40 percent or 50 percent, while fish stocks are also endangered," environment minister Kestutis Mazeika told AFP.

Mazeika said "nobody has any doubt" that global climate change is behind the prolonged and more intensive dry spells and heatwaves in recent years.   He also appealed to neighbouring Belarus to increase the water level in the Neris river by allowing more water to flow from its reservoirs.   Last month was the hottest June ever recorded with soaring temperatures worldwide capped off by a record-breaking heatwave across Western Europe, satellite data showed Tuesday.   Lithuania also registered its hottest-ever June, with a peak of 35.7 degrees Celsius (96.2 degrees Fahrenheit) recorded on June 12.

Over the last week, firefighters have fought wildfires triggered by the heat in peat bogs in western Lithuania and neighbouring Latvia.   Elsewhere in Central Europe, Polish authorities said this week that varying degrees of drought have put grain crops at risk in 14 of the EU country's 16 regional districts.   The Czech Academy of Sciences said it expects drought to affect the entire country, with 80 percent of the territory facing "exceptional to extreme drought".
Date: Thu, 13 Jun 2019 15:12:32 +0200

Vilnius, June 13, 2019 (AFP) - Lithuanian temperatures have hit record June highs, meteorologists said Thursday, as a heatwave forced school closures and threatened to reduce harvests in the draught-hit Baltic region.   Kaisiadorys in central Lithuania was the hottest place at 35.7 degrees Celsius (96.2 degrees Fahrenheit) on Wednesday, the highest-ever temperature recorded for June in the country, weather forecaster Paulius Starkus told AFP.   Six people drowned in the Baltic EU state on Wednesday, the deadliest day of the year to date, while some schools put classes on hold or cut lessons short due to the heatwave.

Scientists say the extreme weather is in part a result of climate change.   "Lithuania used to have heatwaves but now they occur more often and are more intense due to climate change," Vilnius University climatologist Donatas Valiukas told AFP.   Starkus said a downpour with thunder and hail could follow in some areas on Thursday afternoon.   Agriculture Minister Giedrius Surplys told lawmakers that some areas were experiencing "a real climatic draught" threatening harvests, while hydrologists warned that river water levels posed a threat to fish.   Demand for air-conditioning has also soared in recent weeks.   Lithuania's hot weather is expected to last through the week, then temperatures may ease below 30 degrees Celsius starting Monday.   Fellow Baltic state Latvia is also experiencing unusual heat for June, with temperatures over 32 degrees Celsius.

In recent days, Latvia's western region of Kurzeme saw thunderstorms with hail damaging buildings, smashing greenhouses and tearing power lines.   Two people have been hospitalised in the northern Latvian town of Cesis after a tree fell on their camper van while they were inside.    Fellow Baltic state Estonia had a heatwave last week and is now experiencing rainy and windy weather.   Poland has also been experiencing high temperatures this month, which has resulted in increased air-conditioner use. The power transmission system operator PSE said that on Wednesday there was record electricity demand for a summer morning at nearly 24.10 gigawatts (GW).   Forty-two people have already drowned in Poland this month, according to the government security centre RCB.
Date: Sat 30 Mar 2019
Source: PM News Nigeria [abridged, edited]

Measles in Lithuania is up to 310 cases this year [2019] compared to 30 cases for 2018 in total. The number of measles cases is projected to increase further in Lithuania, as people have lost their collective immunity to this highly contagious viral disease, Director of Lithuania's Centre for Communicable Diseases and AIDS (ULAC), Saulius Caplinskas, said on Fri [29 Mar 2019].  "The collective immunity has been lost, as a 95 per cent measles vaccination coverage rate is considered as minimum to prevent an outbreak. There are new suspected cases of measles; blood samples are being examined. I have no doubt that in the nearest future, there will be new cases,'' Caplinskas was quoted as saying by local news website lrt.lt.

Recent data from ULAC shows that the proportion of children vaccinated against measles in the country has decreased from 97 per cent in 2009 to 92.2 per cent in 2018 due to parents' reluctance to vaccinate their kids.  According to ULAC, every year, some 5000 children are not vaccinated in Lithuania. "Measles outbreaks feature certain upswings and descents, yet we will have to live under the threat of measles for a while,'' Caplinskas said.

In total, 310 cases of measles have been registered as of Fri [29 Mar 2019] in Lithuania this year [2019], compared to 30 cases for the whole of 2018, ULAC data showed.  The largest number of cases, 149, was registered in Kaunas, Lithuania's 2nd largest city. In Vilnius, the capital, 39 measles cases have been registered to date. Measles is a highly contagious, serious disease caused by a virus, says the World Health Organization.
Date: Thu, 11 Oct 2018 13:38:41 +0200

Vilnius, Oct 11, 2018 (AFP) - Lithuania's parliament on Thursday passed a law that will allow doctors to prescribe marijuana-based medicine in the Baltic EU state.   The lawmakers voted 90-0 with three abstentions in favour of the legislation that will now go to President Dalia Grybauskaite to be signed into law.   "It is a historic decision to ensure that patients can receive the best possible treatment," said lawmaker Mykolas Majauskas who tabled the bill.

Other European countries have legalised cannabis for medical purposes including Austria, Britain, Croatia, Finland, France, Germany, Greece and Italy among them.   "Of course, it does not mean cannabis will be available to get at a drugstore to smoke before going to a nightclub," Majauskas said.   The law will come into force in May next year. Selling the drugs will require a licence from the state regulator.    Recreational use of marijuana remains illegal in Lithuania, a Baltic state of 2.8 million people.
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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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Kyrgyzstan

Kyrgyzstan Republic - US Consular Information Sheet
August 29, 2008
COUNTRY DESCRIPTION:
The Kyrgyz Republic, a mountainous country of five million people, is undergoing political and economic change. Tourist facilities are not highly deve
oped, and many of the goods and services taken for granted in other countries are not yet widely available. Read the Department of State Background Notes on the Kyrgyz Republic for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. American citizens can obtain a one-month single-entry, non-extendable tourist visa upon arrival at the “Manas” International Airport outside Bishkek for a $36 fee without invitation or sponsorship. Newly enacted legislation requires that all foreigners present in the Kyrgyz Republic for more than sixty days register with the Kyrgyz Department of Visa and Passport Control. Failure to do so may cause difficulties when exiting the country. Individuals traveling to Kyrgyzstan to perform religious work or work in affiliation with any religious organization in any capacity are required by Kyrgyz law to declare so on their visa applications. Failure to do so may lead to difficulties with local law enforcement as it is considered a violation of Kyrgyz law to engage in activities not matching the purpose of travel indicated on an individual’s visa. In general, travelers should apply for the correct category of visa for their purpose of travel. Travelers cannot obtain a tourist visa at land borders or other airports. American citizens visiting the Kyrgyz Republic are not required to register with the Office of Visas and Registration. The Embassy recommends that Americans traveling in the Kyrgyz Republic also obtain Kazakh visas, as commercial air travel out of the Kyrgyz Republic is limited and Americans may need to travel through Kazakhstan to return to the United States. For further information regarding entry/exit requirements, contact the Embassy of the Kyrgyz Republic at 2630 Massachusetts Avenue, NW, Washington, DC 20008, telephone: (202) 338-5141, fax: (202) 742 6501. Visit the Embassy of the Kyrgyz Republic web site at http://www.kgembassy.org/ for the most current visa information.

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:
The Department of State urges U.S. citizens to avoid all travel to rural areas along the Kyrgyz-Uzbek and Kyrgyz-Tajik borders, and all areas to the south and west of the provincial capital of Osh. Security conditions in these parts of the southern Kyrgyz Republic differ from security conditions in the north, and the threat of violence against foreigners in the southern Kyrgyz Republic continues. Hostage-taking incidents involving foreigners occurred during the summers of 1999 and 2000, including one incident in the summer of 2000 involving American citizens. In 2007, there were reports of attempted “bride-kidnappings” in rural areas. While foreigners are not believed to be intentional targets, an American female was held against her will for several days in one reported incident. In 2006, suspected militants attacked a border post on the Kyrgyz-Tajik border, and ensuing skirmishes took place between the militants and Kyrgyz military forces throughout the southern Batken region. Land mines in Batken Oblast and near the Kyrgyz-Tajik border continue to be a concern. There are currently restrictions for U.S. Government employees traveling to areas of the Kyrgyz Republic south and west of Osh and in rural areas along the Kyrgyz-Uzbek border because of the volatile security situation in these areas.
Supporters of extremist groups such as the Islamic Movement of Uzbekistan (IMU), the Islamic Jihad Union (IJU), al-Qaeda, and the Eastern Turkistan Islamic Movement remain active in Central Asia. These groups have expressed anti-U.S. sentiments and may attempt to target U.S. Government or private interests in the region, including in the Kyrgyz Republic. Terrorist attacks involving the use of suicide bombers have previously taken place in neighboring Uzbekistan. Terrorists do not distinguish between official and civilian targets. Because of increased security at official U.S. facilities, terrorists are seeking softer civilian targets such as residential areas, clubs and restaurants, places of worship, hotels, schools, outdoor recreation events, resorts, beaches, maritime facilities, airports and aircraft.
In 2005-2007, there were several large-scale demonstrations and protests. Demonstrations in Bishkek have occurred in front of the Presidential Administration building (White House) and on Alatoo Square in the city center. The Embassy does not always have advance information regarding new demonstrations. Therefore, all Americans are reminded to remain vigilant and are urged to avoid the vicinity of all protests, because even protests that are intended to be peaceful can turn confrontational and possibly escalate into violence.
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 pamphletA Safe Trip Abroad.
CRIME: The U.S. Embassy advises U.S. citizens to exercise caution in urban areas of the Kyrgyz Republic due to the high rate of violent crime against foreigners. Travelers arriving at Manas International Airport should arrange their transportation from the airport in advance. Foreign travelers have been the victims of extortion by airport taxi drivers, who appeared in some cases to be colluding with airport personnel to identify their victims. Travelers should not take public transportation or walk after dark, and should be extremely cautious in or near hotels, bars, parks and all places that attract an expatriate clientele. The Kyrgyz Republic has a high rate of violent crime due to unemployment and a large number of organized gangs. Muggings often occur after dark and can be quite violent, leaving the victim severely injured. Other common crimes include auto theft, mugging, and pick pocketing in crowded places such as markets, Internet cafes and on public transportation. U.S. citizens have been the victims of such crimes as rape, assault, kidnapping and robbery while in urban and rural parts of Kyrgyzstan, and there have been reports of U.S. citizens who were robbed by groups of young men who had followed them back to their residences from hotels and bars. Police officers rarely speak English and no victims’ assistance programs are available. Medical and psychiatric care for victims is limited.
Harassment and extortion by people who purport to be Kyrgyz police officers are common. According to Kyrgyz law, any person claiming to be a police officer must show identifying documents on demand. U.S. citizens should not act upon requests by people, whether in civilian dress or in police uniform, if they have no official identification. Also U.S. citizens should not get into cars with someone they do not know, even if the person claims to be a police officer.

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 lines in Kyrgyzstan are: 101 for fire; 102 for police;
103 for first aid ambulance (state-funded); 151 (from landline), 0 312 684466 (from landline or cellphone); and 161 for rescue service (under the Ministry of emergency situations.)

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical services in the Kyrgyz Republic are extremely limited. Elderly travelers and those with existing health problems may be at risk due to inadequate medical facilities. The U.S. Embassy strongly recommends that travelers to the Kyrgyz Republic carry medical evacuation insurance in case of emergency. The Consular Section of the U.S. Embassy in Bishkek maintains a list of foreign-trained and local physicians who have agreed to give medical assistance to Americans. This list is available on the Embassy web site at http://bishkek.usembassy.gov.
Some HIV/AIDS entry restrictions exist for visitors to and foreign residents of Kyrgyzstan. There is no legal requirement for HIV/AIDS testing during the visa application or registration process. Kyrgyz law does state that if a foreign citizen refuses to submit to HIV/AIDS testing when requested while in Kyrgyzstan, that person could be deported. Please verify this information with the Embassy of Kyrgyzstan at http://www.kgembassy.org before you travel.

Tuberculosis is an increasingly serious health concern in Kyrgyzstan. For further information, please consult the CDC's Travel Notice on TB available at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.

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 the Kyrgyz Republic is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Most of the Kyrgyz Republic’s road infrastructure consists of two-lane roads, which are all in various states of disrepair, and are poorly marked and lit. Many local drivers tend to disobey fundamental traffic laws – such as stopping at red lights. As a result, driving can be very dangerous. Accidents involving severe injury and/or death are not uncommon.
Drivers must exercise particular caution to avoid uneven pavement, potholes and open drains and manholes. Night driving should be avoided, as roads are inadequately lit. In winter, roads are seldom plowed and ice and snow make the poor driving conditions even more hazardous. Pedestrians routinely walk in the road, often wearing dark clothes at night, necessitating even greater caution for drivers. Mountain roads in the Kyrgyz Republic are often narrow and treacherous, and may close without notice due to snow, ice or rockslides. Guardrails and barriers preventing falling rocks are often missing. The Kyrgyz Republic does not have a roadside assistance infrastructure. Towing companies do not exist. Although mechanics are available in cities there is little organized oversight or certification of their practices or abilities. Rest areas are infrequent and very primitive. Service stations are generally available in and near cities, but the fuel they provide may be adulterated or of poor quality.
The road between Almaty, Kazakhstan and Bishkek, Kyrgyz Republic, is especially treacherous at night or during poor weather. Americans and other travelers have been killed in traffic accidents on that road, and travel at night is not recommended.
Generally, speed limits are 60 km per hour in the cities and 90 km per hour in rural areas. Kyrgyz law mandates that all automobile passengers wear seat belts and that motorcycle riders wear helmets. International driving permits are recognized in the Kyrgyz Republic.

Drivers may face harassment by traffic police, who have been known to demand payment for arbitrary "fines" for purported infractions.

The Kyrgyz Republic has a "zero tolerance" policy for driving under the influence of alcohol.
Public transportation in the Kyrgyz Republic is limited to buses, taxis, and very few intercity trains. Travelers should be particularly careful when using public transportation. Buses tend to be very crowded and can be unsafe and unreliable. Taxis too can be dangerous. Due to the danger of theft or assault, travelers should avoid entering a cab that already contains passengers. Taxis are seldom metered, and travelers should negotiate a fare prior to entering a cab and be aware that cab drivers often try to charge foreigners a high fare. Drivers of vehicles that are not taxis are often willing to drive people for fares. However, U.S. citizens should avoid using any of these "private taxis" and unmarked taxis.

Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office and national authority responsible for road safety at insert site here.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in the Kyrgyz Republic, the U.S. Federal Aviation Administration (FAA) has not assessed the Kyrgyz Republic’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:
Kyrgyz customs authorities may enforce strict regulations concerning temporary importation into or export from the Kyrgyz Republic of items such as antiquities or hunting trophies. It is advisable to contact the Embassy of the Kyrgyz Republic in Washington at 2630 Massachusetts Avenue, NW, Washington, DC 20008, telephone: (202) 338-5141, fax: (202) 742 6501 or at http://www.kgembassy.org/ for specific information regarding customs requirements.
The Kyrgyz Republic is a cash-only economy. The banking system is not well developed. ATMs are available, but the security of these machines remains untested. A hotel or bank may, on occasion, accept traveler’s checks or credit cards, but the fees can be as high as 20 percent for traveler’s checks.
U.S. citizens are encouraged to carry a copy of their U.S. passport with them at all times, so that, if questioned by local officials, proof of identity and citizenship are readily available.

In accordance with the Vienna Convention on Consular Relations and certain bilateral treaties, a consular officer from the U.S. Embassy must be given access to any U.S. citizen arrested in the Kyrgyz Republic. U.S. citizens who are arrested or detained should ask that the U.S. Embassy be contacted immediately. This is generally recognized, though there can be a sizeable delay in notification times depending on the local authorities’ interpretation of the case’s legal status.
The Kyrgyz Republic is an earthquake-prone country. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov.
Hunting and trekking are popular sports for locals and tourists in the Kyrgyz Republic; however, American citizens traveling to the Kyrgyz Republic should know that hunting in the Kyrgyz Republic without proper licenses is illegal. It is illegal to import or own firearms in the Kyrgyz Republic without a permit issued by the Kyrgyz government. Foreign hunters who do not have official permission to hunt or take trophies out of the country may face criminal and civil charges. Both hunting and trekking infrastructures are underdeveloped with limited services, especially in the high mountainous regions popular with trekkers and hunters. Avalanches and landslides are common in these mountainous regions, often cutting off villages for weeks at a time. These villages and hunting areas are in isolated, rugged, mountainous areas inaccessible by the limited rescue services available in the Kyrgyz Republic. Americans traveling to the Kyrgyz Republic to hunt or trek need to be aware of the risks involved. The Embassy recommends that all Americans register with the Embassy in Bishkek for the duration of their stay in the country.
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 the Kyrgyz Republic’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in The Kyrgyz Republic 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 the Kyrgyz Republic 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 the Kyrgyz Republic. Americans withoutInternet 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 in Bishkek is located at 171 Prospect Mira, 720016 Bishkek, Kyrgyz Republic. The phone number is 996-312-551-241, fax: 996-517-777-202, and web site: http://bishkek.usembassy.gov
* * *
This replaces the Country Specific Information for the Kyrgyz Republic Dated January 8, 2008, to update sections on Country Description, Entry/Exit Requirements, Crime, Information for Victims of Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Wed 9 Jan 2019
Source: AKIpress [abridged, edited]

A total of 722 cases of measles have been registered since the beginning of 2018 in Kyrgyzstan compared with one case in January through November 2017, the National Statistics Committee reports.

[Full story is available only by subscription.]
=====================
[HealthMap/ProMED-mail map:
Date: Wed 21 Nov 2018 14:26 KGT
Source: Kazakh Telegraph Agency (KazTAG] [edited]

KyrTAG [Kyrgyzstan Telegraph Agency] reports 2 people have been hospitalized in the Jalal-Abad region with anthrax assumption. "2 inhabitants of Suzak district have been hospitalized with anthrax assumption. The lab tests made in Jalal-Abad have shown a negative result, we sent the analysis to Osh for a repeated research," said Usen Zhorobayev, head of center of state sanitary-epidemiological surveillance of the Suzak district. In his words, the hospitalized men had been butchering a cow. The patients are in satisfactory condition
=============================
[To find Suzak in western Kyrgyzstan, go to:
<http://www.fallingrain.com/world/KG/03/Suzak.html>.

For a description of Jalal-Abad region, go to

Outbreaks in Jalal-Abad are an overflow of infection from the enzootic state of this disease in the adjoining Fergana Valley of Uzbekistan. Jalal-Abad is in western Kyrgyzstan at the head of the Fergana Valley. The Fergana Valley is rife with livestock anthrax. Without a coordinated vaccination-control program between the 2 countries in this region, we will continue to see outbreaks there. In spite of an initial negative test result, not uncommon with human cases, the authorities are assuming a greater probability of cutaneous anthrax based on the exposure history of these 2 farm workers. A pity they did not get their veterinary colleagues to test what was still available from this dead cow. - ProMED Mod.MHJ]

[HealthMap/ProMED-mail map of Kyrgyzstan:
Date: 27 Jun 2018
Source: Interax Kazakhstan [edited]

Nine people have been hospitalized with suspected anthrax infection in the Jalal-Abad region of southern Kyrgyzstan, Mamatzhan Miyanov, the coordinator of the healthcare ministry for the Jalal-Abad region, told Interfax on Wednesday [27 Jun 2018].
Date: Tue 13 Mar 2018
Source: XinHuaNet [edited]

A total of 14 people, including 4 children, were hospitalized after a mass botulism food poisoning outbreak in southern Kyrgyzstan, the Health Ministry said [Tue 13 Mar 2018]. It said 3 of them are in a serious condition. An epidemiological investigation has been conducted and all patients have received the botulinum antitoxin.

The first case of food poisoning in the city of Uzgen in the Osh region was reported on [Sun 11 Mar 2018]. According to preliminary data, the poisoning occurred due to eating homemade canned vegetable salad. A month earlier [February 2018], 17 people in southern Kyrgyzstan were hospitalized for the same reason; 2 of the 7 children affected died in that outbreak.
======================
[It is unclear if these clusters are related. Most clusters of botulism are associated with home prepared food. - ProMed Mod.LL]

[HealthMap/ProMED-mail map:
Date: Tue 5 Sep 2017 16:10
Source: Evening Bishjkek [in Russian, trans. ProMED Mod.NR, edited]

Currently in the at-Bashy district of Naryn region 3 recorded cases of anthrax infection are in the hospital, and 15 under the supervision of experts. Doctors say that the locals butchered the carcass of an animal, and 10 days later the 1st symptoms of this dangerous infection appeared on the skin of the wrist areas and forearms.

People have turned to professionals with complaints of ulcers. Then on [Wed 30 Aug 2017] 3 people were hospitalized in the Infectious Diseases Department. Tests confirmed the preliminary diagnosis. Doctors have checked all sick family members and friends, and currently they are under surveillance.

The incubation period of the infection is 10-14 days.[Actually it can be as short as 3 days and up to 60 days. - ProMED Mod.MHJ] At the end of this period, if there is no suspicion, patients are discharged from the hospital. "This disease is curable, it is treatable by conventional antibiotics. It's just included in the list of especially dangerous infections classifications of the World Health Organization. The main sources of infection are animals", - said the Director of the Republican center of Quarantine and Especially Dangerous Infections the Sabyrzhan of Abdykaimov.

It is likely that the meat of an infected animal got into the markets. According to some reports, some infectious contaminated products were located in the market town of Tokmak. Now multiple site checks are in hand by the Investigative Department. In addition, the market site and the territory around the cattle slaughter site have been quarantined, say doctors. And veterinary control has been initiated, along with the population being educated.

However, the situation is aggravated by the confused information from the sick individuals. They can't exactly tell where the infected meat was sent, said Abdykaimov. "One says that the meat is buried. Another says sold. Now this is in the hands of the investigating authorities and veterinary services. They don't say what happened: just stopped someone in a car; it was loaded, and they left. And where, on what car - they don't specify. The investigating authorities are handling this, but we in Public Health are doing our best to explain what should happen," - said Abdykaimov.  [Byline: Rodion Reshetov]
====================
[Comment by ProMED Mod.NP. In the territory of the Republic there are 1219 natural foci of anthrax. Concreted and enclosed only 1000 of them. Vaccination of cattle is held only periodically, delayed due to problems with funding and vaccine supplies, increasing the risk disease anthrax in both animals and humans. Annually in the territory of the Republic there are nearly 20 cases of anthrax in people. In this case, the situation is compounded by the fact that there is no accurate information on location of infected meat, which can lead to new cases of the disease. - ProMED Mod.NP]

[Public Health as it really is and not as shown on television. People get confused and, fearing legal action, may make up stories. My thanks to my colleague Natalia. It seems that circulation of the news in English is limited and widely available in Kyrgyz. - ProMED Mod.MHJ]

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

World Travel News Headlines

Date: Tue, 25 Feb 2020
13:15:00 +0100 (MET)
By Ella IDE and Jastinder KHERA

Rome, Feb 25, 2020 (AFP) - Italy's new coronavirus spread south on Tuesday to Tuscany and Sicily, as the civil protection agency reported a surge in the number of infected people and Rome convened emergency talks.    Prime Minister Giuseppe Conte has blamed poor management in a hospital in the country's north for the outbreak, which has caused seven deaths in Italy so far and infected the largest number of people in Europe.    Tuscany reported its first two cases, including one in the tourist destination of Florence, while Sicily marked one: a tourist from the worst-hit Lombardy region, where 212 people have tested positive. The female tourist in Sicily, who had been staying in a hotel in Palermo, tested positive on the first swab but was awaiting the definitive result from Italy's institute of infectious diseases, civil protection agency chief Angelo Borrelli said.

Health ministers from neighbouring countries were to meet in Rome as the 
number of confirmed infections jumped to 283, with over 50 new cases reported since Monday.    The EU's health commissioner and other international health officials were also expected in the Italian capital Tuesday.    Hundreds of people were confined to their rooms at a Tenerife hotel after an Italian tourist was hospitalised with a suspected case of coronavirus, health officials in the Canary Islands said.  While no neighbouring country has closed its borders with Italy, several governments have announced additional measures for travellers arriving from Italy, in particular from the two northern regions of Lombardy and Veneto.  They range from medical screening to recommendations to self-isolate.

- 'Mission Impossible' -
Several upcoming matches in Italian Serie A and the Europa League will be played behind closed doors to combat the spread of the disease.    Production of the latest "Mission: Impossible" film starring Tom Cruise in Venice has been stopped following the outbreak.    The main centre of infection in Italy has been the town of Codogno, a town of some 15,000 people around 60 kilometres (35 miles) to the south of Milan. Codogno and several others in northern Italy have been put under isolation in an attempt to stem the spread of the virus.

The 38-year-old man dubbed "Patient One" by Italian media was admitted to 
hospital last Wednesday in Codogno, and it is thought a large number of the cases in the worst-hit region of Lombardy can be traced back to him.    His heavily pregnant wife, several doctors, staff and patients at the hospital are thought to have caught the virus from him.    As well as the towns placed under quarantine, further wide-ranging measures have affected tens of millions of inhabitants in the north of Italy, with schools closed and cultural and sporting events cancelled.    Elsewhere in the country officials have also been recommending precautionary measures.  In Calabria in the south, bishops have asked their worshippers not to make the sign of peace during mass, media reported.    All seven of those who have died so far in Italy were either elderly or had pre-existing medical conditions.
Date: Tue, 25 Feb 2020 11:48:12 +0100 (MET)

Madrid, Feb 25, 2020 (AFP) - Hundreds of people were confined to their rooms at a Tenerife hotel Tuesday after an Italian tourist was hospitalised with a suspected case of coronavirus, health officials in the Canary Islands said.   "Hundreds of hotel clients are being monitored for health reasons and the degree of supervision will be assessed during the day, but so far, we're not talking about quarantine," health authority spokeswoman Veronica Martin told AFP, confirming that the Italian tourist "was staying at this hotel while on holiday in Tenerife".
Date: Tue, 25 Feb 2020 11:40:20 +0100 (MET)
By Laurent Thomet with Dario Thuburn in Geneva

Beijing, Feb 25, 2020 (AFP) - Fresh deaths and a surge in new coronavirus cases in Iran, Japan and South Korea on Tuesday fuelled fears of a pandemic, as the disease took root in some of the world's poorest -- and worst-equipped -- countries.  The rapid spread abroad came as the World Health Organization announced that the epidemic had peaked at its epicentre in China, where it has killed more than 2,600 people and infected over 77,000 others.

But the situation has worsened elsewhere with nearly 2,700 other cases and more than 40 deaths globally, prompting restrictions on travellers from infected nations, the cancellation of football matches and national efforts to isolate suspected patients.    South Korea, Italy and Iran have each logged sharp increases in infections and deaths, while several Middle Eastern countries also reported their first confirmed COVID-19 cases.

WHO chief Tedros Adhanom Ghebreyesus insisted the virus could still be contained, praising China's drastic quarantine measures in several cities for helping to prevent an even bigger spread.   "For the moment we are not witnessing the uncontained global spread of this virus and we are not witnessing large-scale deaths," Tedros told reporters in Geneva on Monday.   He added, however, that countries should do everything they can to "prepare for a potential pandemic" -- a term is used to describe an illness that spreads across numerous communities.   The White House plans to spend $2.5 billion to combat the epidemic, according to US media. There are 53 cases in the United States so far.

- Iran hotspot -
Iran has emerged as a major hotspot with the death toll rising to 15 on Tuesday as three more people succumbed to the disease.   The country has been scrambling to contain the epidemic since last week when it announced its first two deaths in Qom, a centre for Islamic studies and pilgrims that attracts scholars from abroad.

Iran has confirmed 61 cases so far, making its mortality rate exponentially higher than anywhere else in the world and raising suspicion that many more people have contracted the disease there.   A WHO team was due in Iran on Tuesday.   Several neighbours have enacted measures to block arrivals from Iran but the virus has already spread to Afghanistan and elsewhere in the Middle East.   The WHO has warned that poorer countries with weak health care systems are the most at risk.

- Games off -
South Korean President Moon Jae-in warned that the outbreak was "very grave" as the country's death toll rose to 10 and the number of confirmed infections approached 1,000 -- the largest total outside China.   Scores of events have been cancelled or postponed as the outbreak has spread in the world's 12th-largest economy, from K-pop concerts to the World Team Table Tennis championship.   Parliament closed for cleaning Tuesday after confirmation a person with the coronavirus had attended a meeting last week.   More than 80 percent of the infections have been in and around Daegu, South Korea's fourth-largest city.

Streets there have been largely deserted for days, apart from long queues at the few shops with masks for sale.   Most of the country's infections are linked to the Shincheonji Church of Jesus, an entity often accused of being a cult.   The US Centers for Disease Control warned Americans against "all nonessential travel to South Korea".   In Japan, a fourth former passenger of the coronavirus-stricken Diamond Princess cruise ship died, according to local media. The man was in his 80s.   Nearly 700 people from the quarantined ship have tested positive for the illness so far.

Infections have also spiked inside Japan, with at least 160 cases including one death.   The government has expanded the number of hospitals that can receive suspected patients and asked people with moderate symptoms to stay home.   Businesses were asked to "let people stay away from offices, to avoid rush hour commuting hours, and to encourage telecommuting," Health Minister Katsunobu Kato said.   Italy -- which has reported seven deaths and over 200 cases -- has locked down 11 towns, while upcoming football matches in its Serie A and the Europa League will be played behind closed doors.    Prime Minister Giuseppe Conte has said that residents could face weeks of lockdown.

- China cases slow -
In China, 508 new cases were reported, with all but nine at the outbreak's epicentre in central Hubei province.   The death toll nationwide reached 2,663 on Tuesday after 71 more people died, the lowest rise in almost three weeks.   Reassured by the official numbers, the country is gingerly returning to business.   Beijing is seeing more cars on the street, factories are resuming work, Apple is reopening several stores, and some regions are relaxing traffic restrictions.   But schools remain closed, the capital has a mandatory 14-day quarantine for returning residents, and authorities are keeping some 56 million people in Hubei under lockdown.
Date: Sun 23 Feb 2020
Source: ZBC News [edited]

Mbire, Mashonaland Central Province has been affected by an outbreak of anthrax prompting the Veterinary Services Department to place an embargo on the movement of cattle from the province.

The acting provincial coordinator, Richard Chipfuwa, said 34 beasts had so far succumbed to the disease in the remote district, which sits on the border with Mozambique and Zambia. "These (the 34) are the reported cases, but we suspect there could be many more that were not reported. We have since mobilized vaccines to the district's 5 dip tanks: Nyatsengwa, Masomo, Tengu, Bonga and Sapa, so that farmers can have the remaining herd saved," he said.

But a poor road network in the district is making it difficult for veterinary officials to access some of the dip tanks, a situation made worse by the ongoing rains. The officials, in addition to treating infected animals, are also educating communities against consuming meat from dead animals, because this could pose health risks to people.

The anthrax outbreak in Mbire, an arid district rich in an assortment of wildlife, is suspected to have been passed on to livestock by infected wild animals such buffaloes, which are typical carriers of the disease. Last year [2019], the province lost nearly 1300 cattle due to anthrax and other livestock diseases.
=====================
[For a description of Mashonaland, go to: <https://en.wikipedia.org/wiki/Mashonaland>. It is in northern Zimbabwe and is made up of 3 provinces, East, West, and Central. For a map showing the location of Mashonaland Central Province go to: <https://en.wikipedia.org/wiki/Mashonaland_Central_Province>.

In these hard to reach areas, it is a constant concern knowing what is happening where. And this goes a long way as to why some 34 animals are reported affected and probably more. And why it is so important to get the necessary volumes of vaccine out to these communities as soon as possible. We wish the provincial veterinary service well and all the luck that they enjoy. - ProMED Mod.MHJ]

[HealthMap/ProMED map available at:
Mashonaland Central Province, Zimbabwe:
Date: Mon, 24 Feb 2020 16:22:59 +0100 (MET)

Dubai, Feb 24, 2020 (AFP) - The new coronavirus hit four more Middle Eastern states on Monday, with Bahrain, Iraq, Kuwait and Oman reporting new cases and the UAE calling on its citizens not to travel to Iran and Thailand.   Oman also halted flights to and from Iran  -- which is battling the deadliest outbreak outside China --with immediate effect.   The move came shortly after two Omani women who had returned from Iran were diagnosed with the disease.

The three cases in Kuwait and the one in Bahrain were also in individuals who had returned from Iran, where the virus has claimed the lives of 12 people.   Bahrain also shut three schools after a man who had transported children to the institutions tested positive after returning from Iran on February 21 via Dubai airport, the health ministry said.

In Kuwait, a 53-year-old Kuwaiti, a 61-year-old Saudi national and a 21-year-old stateless Arab who tested positive had all returned from Iran's holy city of Mashhad, the Kuwaiti health ministry said.   In Iraq, the virus was confirmed in an Iranian national studying in the southern shrine city of Najaf, health officials said.   All seven bourses in the oil-rich Gulf states were down on Monday as fears of a pandemic hit crude prices. The Saudi stock exchange led the slide, shedding 2.95 percent.

- Travel bans -
Iran's confirmed death toll rose to 12 on Monday, with the government vowing to be transparent and dismissing a lawmaker's claim the toll could be as high as 50.   The outbreak has prompted travel bans from nearby countries.

Last week, Kuwait banned entry of all ships from the Islamic republic and suspended flights to and from the country.   Kuwait also banned non-citizens coming from Iran from entering the Gulf state and operated chartered flights to bring back hundreds of Kuwaiti Shiite pilgrims from the Islamic republic.

Around a third of Kuwait's 1.4 million citizens are Shiite Muslims, who travel regularly to Iran to visit religious shrines. Kuwait also hosts roughly 50,000 Iranian workers.   Over half of Bahrain's population of under one million are Shiites, who also travel frequently to Iran.   The United Arab Emirates has already announced 13 cases of the novel coronavirus, all of them foreigners. The latest were a 70-year-old Iranian man, whose condition is unstable, and his 64-year-old wife.

On Monday, Abu Dhabi authorities called on all UAE citizens "to not travel to Iran and Thailand at present and up until further notice" as part of its efforts to monitor and contain the spread of the disease.   UAE airlines have suspended most flights to China -- where the virus first emerged in December -- except to the capital Beijing, but have not yet taken any measures to restrict travel to and from Iran. Around half a million Iranians live and work in the UAE.

Two Gulf states -- Saudi Arabia and Qatar -- remain free of the virus, but all have suspended flights to China.   Qatar Airways said on Monday that people arriving from Iran and South Korea would be asked to stay in home isolation or a quarantine facility for 14 days.   China's death toll from COVID-19 rose to nearly 2,600 on Monday, while the virus has now spread to more than 30 countries.
Date: Mon, 24 Feb 2020 17:49:00 +0100 (MET)

Kolkata, Feb 24, 2020 (AFP) - Rangers have suspended safari rides in a popular nature reserve in eastern India after five one-horned female rhinoceroses died from a suspected infectious disease, officials said Monday.  The animals were found dead over four days last week in Jaldapara National Park, nearly 700 kilometres (434 miles) north of West Bengal state's capital Kolkata.

India is home to two-thirds of the world's remaining one-horned rhinos, a vulnerable species on the IUCN red list   "Blood smears from carcasses have been sent to a laboratory in Kolkata," the reserve's chief conservator Ujjal Ghosh told AFP.   "All the five dead rhinos were adult females. We have put our staff on alert."

The park -- spread over 200 square kilometres (77 square miles) in the foothills of the eastern Himalayas -- is home to 204 rhinos according to the last official count in 2015.  More than 70 captive elephants used for safaris and patrolling also live in the reserve. The safari rides are carried out on elephants.   Activists said the animals may have died from anthrax, a communicable disease that attacks herbivores.

Humans can contract anthrax directly or indirectly from animals or animal products.  "We suspect that the animals died from a communicable disease like anthrax. Jaldapara forest has the odd case of anthrax which killed animals earlier," wildlife activist Animesh Bose told AFP.   Rangers were riding on elephants to reach the rhinos and vaccinate them using dart guns, the Hindustan Times reported.   Drones would try to find out if other animals have died or fallen ill, the newspaper said.
Date: Tue, 25 Feb 2020 04:50:33 +0100 (MET)

Jakarta, Feb 25, 2020 (AFP) - Dozens of Jakarta neighbourhoods were flooded Tuesday after torrential rains pounded Indonesia's capital, less than two months after nearly 70 people were killed in some of the megacity's worst flooding in years.   There were no immediate reports of casualties after the latest deluge, but parts of the city ground to a halt as whole neighbourhoods were swamped in muddy water, while power outages hit some districts.   At least 81 neighbourhoods were inundated with a dozen toll roads closed and some commuter train lines shuttered, according to an announcement by Indonesia's Disaster Mitigation Agency.

More torrential rains were expected later in the day.    "So the flooding will likely spread," agency spokesperson Agus Wibowo said on Twitter.   Floodwaters in some districts were as high as 127 centimetres (4 feet).   The low-lying city is prone to flooding during the wet season which starts around November.   Torrential rain in January triggered flooding and landslides that killed nearly 70 people in and around Jakarta while thousands more were forced to evacuate to shelters.
Date: Mon 24 Feb 2020
Source: Dhaka Tribune [edited]

In Baliadanga upazila of Thakurgaon district, 2 members of a family have died and 3 other members fell sick of an unknown disease. The deceased are MB 35, wife of HI, and her sister in law PB, wife of H from Songaon village of the upazila.

Quoting family members, local schoolteacher SPL said: "MB fell sick and died on Friday [21 Feb 2020] and on Saturday [22 Feb 2020], PB fell sick. "She came back home after undergoing primary treatment at Baliadanga Health Complex; however, she died early Sunday [23 Feb 2020]."

Soon afterwards, 3 other members of the family -- TA, HK and AA -- fell sick and were taken to Adhunik Sadar Hospital, she added.

Thakurgaon Civil Surgeon Dr MD Mahfuzar Rahman Sarker said a representative team of the health department has visited the village to investigate the cause of deaths.

The reasons of the deaths are yet to be known; however, the ones who fell sick are in better condition now, he added.

In 2019, 4 members of a family died due to Nipah virus in the same upazila. Locals are assuming the current deaths are occurring for the same reason.
===================
[With these cases described only as fatal or ill without mention of symptoms, it is not possible to speculate on what the etiology of thisdisease might be. The above report does mention that 4 fatal Nipah virus infections occurred in the same locality last year (2019). Nipah virus must surely be on the list of rule-outs in these current cases. This is the season when Nipah virus is circulating in Bangladesh in giant fruit bats (_Pteropus_ species) with spill-over of the virus by the bats' contamination of fruit or of palm sap juice in collecting pots on the palms. Person-to-person transmission of the virus can also occur. The transmission season is usually January to April.

As noted earlier, it is unfortunate that the public awareness efforts have not prevented these cases from occurring. Perhaps because cases are sporadic and geographically scattered there is little public perception of risk of infection and serious disease. Until effective public education to prevent infection by avoiding eating contaminated fruit or date palm sap is implemented, sporadic cases will continue to occur.

An image of a Pteropus fruit bat can be found at

HealthMap/ProMED map available at:
A map showing the location of the area where the cases occurred can be accessed at the above URL. - ProMED Mod.TY]

24-02-2020 -- Italy has reported a rapid increase in cases of laboratory-confirmed coronavirus (COVID-19) since 21 February 2020. An initial investigation by Italian authorities has found several clusters of cases in different regions of northern Italy, with evidence of local transmission of COVID-19.

A WHO-led team of experts from WHO and the European Centre for Disease Prevention and Control (ECDC) arrived in Italy on Monday 24 February to support Italian authorities in understanding the situation. WHO experts are providing support in the areas of clinical management, infection prevention and control, surveillance and risk communication. At this stage the focus is on limiting further human-to-human transmission.

While limited local person-to-person transmission of COVID-19 in countries outside of China was expected, the rapid increase in reported cases in Italy over the past two days is of concern. However, it should also be noted that based on current data, in the majority of cases (4 out of every 5) people experience mild or no symptoms.

“COVID-19 is a new virus that we need to take very seriously. This mission to Italy is one of the ways in which WHO/Europe is supporting countries across the Region. We are working hard with our Member States to ensure that they are ready for COVID-19, preparing for the arrival of cases and possible localized spread. It is vital that we treat patients with dignity and compassion, put measures in place to prevent onward transmission, and protect health workers,” commented Dr Hans Kluge, WHO Regional Director for Europe.

Health authorities in Italy are implementing measures to prevent onward transmission, including closing of schools and bars and cancelling of sports events and other mass gatherings in the areas affected. This aligns with the containment strategy currently being implemented globally in an effort to stop the spread of COVID-19. “WHO stands by the Government of Italy in its efforts and commitment to mitigate this outbreak and manage the cases effectively. Now is the time for solidarity and cooperation, to work together to protect everyone’s health,” added Dr Kluge.

Countries across the European Region continue to prepare for and respond to cases of COVID-19. This includes establishing how to promptly detect sick people, testing samples from suspect cases, ensuring appropriate infection control and case management to minimize the risk of the virus spreading, and maintaining communication with the public.

Best Regards,
WHO Media Team

Date: Mon, 24 Feb 2020 12:29:01 +0100 (MET)
By David Vujanovic

Tehran, Feb 24, 2020 (AFP) - Iran's government vowed Monday to be transparent after being accused of covering up the deadliest coronavirus outbreak outside China, dismissing claims the toll could be as high as 50.

The authorities in the Islamic republic have come under mounting public pressure since it took days for them to admit to "accidentally" shooting down a Ukrainian airliner last month, killing 176 people.   The government said on Monday that Iran's coronavirus death toll had jumped by four to 12 -- by far the highest outside China -- as its neighbours closed their borders and imposed strict quarantine measures.

But Ahmad Amirabadi Farahani, a lawmaker from the holy city of Qom, south of Tehran, alleged the government was "lying" about the full extent of the outbreak.   The ILNA news agency, which is close to reformists, said the lawmaker spoke of "50 deaths" in Qom alone.   "The rest of the media have not published this figure, but we prefer not to censor what concerns the coronavirus because people's lives are in danger," ILNA editor Fatemeh Mahdiani told AFP.

Farahani was wearing a face mask during the closed session of parliament but left after speaking, as he felt unwell, state news agency IRNA reported, adding sanitary workers then cleaned his seat.   Iran's government rejected his claim that the virus had killed 50 in Qom.   "I categorically deny this information," Deputy Health Minister Iraj Harirchi said in a news conference aired live on state television.   "This is not the time for political confrontations. The coronavirus is a national problem," he added.

- Transparency pledge -
The government pledged transparency over the outbreak.   "We will announce any figures (we have) on the number of deaths throughout the country. We pledge to be transparent about the reporting of figures," its spokesman Ali Rabiei said.   Iran has been scrambling to contain the COVID-19 outbreak since it announced the first two deaths in the holy city of Qom on Wednesday last week.   Authorities have since ordered the closure of schools, universities and other educational centres across the country as a "preventive measure".

A spokesman for Iran's parliament, Assadollah Abbassi, announced the latest four deaths among more than 60 infections after Monday's closed-door gathering of lawmakers.   Citing Health Minister Said Namaki, he said that "the cause of coronavirus infections in Iran are people who have entered the country illegally from Pakistan, Afghanistan and China".   Iran has yet to give a breakdown of where the other deaths occurred.   The worst-hit province for infections is Qom, with 34 cases, according to health ministry figures.

The others are in Tehran with 13 infections, Gilan with six, Markazi with four, Isfahan with two and one each for Hamedan and Mazandaran.   But the health minister said that one person who died of coronavirus in Qom, south of Tehran, was a businessman who had made several trips to China.   Namaki had unsuccessfully pleaded in January for Iran's government to order the suspension of all commercial flights between Iran and China.   In his remarks to state television on Sunday, the minister said direct flights between Iran and China were now suspended, but the Qom businessman had travelled there "on a connecting flight".

- Border closures -
Since it emerged in December, the new coronavirus has killed more than 2,500 people in China.   Iran now accounts for nearly half of the deaths elsewhere in the world, which currently stand at 30.   Many of Iran's neighbours have reported cases of coronavirus in people who had travelled to the Islamic republic.   Afghanistan on Monday reported its first case in a person who had travelled to Qom.   Baghdad also reported its first case on Monday -- an elderly Iranian citizen living in the southern Iraqi city of Najaf.

Iraq has shut its border with the Islamic republic and imposed a travel ban.   Similar preventive measures were imposed by Afghanistan, Armenia, Pakistan and Turkey.    Qom is a centre for Islamic studies and pilgrims, attracting scholars from Iran and beyond.   Kuwait and Bahrain also confirmed their first novel coronavirus cases, all of whom had come from Iran.