WORLD NEWS

Getting countries ...
Select countries and read reports below or

Andorra

General
************************************
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
**************
*********************
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
***************************************
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
************************************
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
************************************
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
************************************
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
************************************
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]
=====================
[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]
More ...

Puerto Rico

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Thu, 16 Jan 2020 02:45:27 +0100 (MET)
By Ivelisse RIVERA, con Leila MACOR en Miami

Yauco, Puerto Rico, Jan 16, 2020 (AFP) - Living out in the open, their nerves on edge after a series of earthquakes that have shaken Puerto Rico, some 5,000 people are hoping that their president, Donald Trump, will heed the island's plea to be designated a disaster zone and free up much-needed aid.   Since December 28, more than 1,000 tremors have rattled the US island territory in the Caribbean, which just two years ago was devastated by two powerful hurricanes in quick succession.

In Yauco, one of the areas worst hit by the earthquakes, dozens of people were sitting on cot beds Wednesday in the parking lot of a municipal stadium, sheltered from the sun by white tents and blue tarps handed out by the federal disaster management agency, known as FEMA.  "The most difficult thing is the psychological aspect," said Wilfredo Rodriguez, 31. His house had been fractured by the seismic movement and he has spent a week living with his kids, aged six and 10, under an awning.    "We are living in constant fear of another powerful tremor," he said.

He only returns to his house to wash, then hurries back to the shelter. "We worry that there'll be a more powerful tremor while we are inside the house," he said.   Throughout the day, volunteers arrive to hand out food and toys for the children who fill the shelters: schools have been suspended because the buildings are not sturdy enough to withstand another quake.    The island's earthquake detection system has registered 1,104 tremors in the past two weeks alone, of which 186 could be felt by the population. By comparison, during the whole of 2019 there were 6,442 tremors, of which just 62 could be felt by people on the island.

Further south, in Guanico, Juan Santiago decided to move into a shelter on Saturday after a tremor of 5.9 on the Richter scale hit the island. "The mountain shook and rocks and earth started to come down," said the 30-year-old.  "My house has a crack in it and is about to fall down," he added. His home had weathered the Category Five winds of Hurricane Maria in September 2017 and of Hurricane Irma which followed it just two weeks later.   "It's different to a hurricane. What is happening now is much nastier," he said.

As he was talking the earth shook again, a tremor of 5.2 magnitude. Vehicles rocked like hammocks in the wind, but the quake-hardened victims barely reacted.   The houses in this part of the island are mostly rudimentary constructions built by the people who live in them with scant resources available in the mountains, where no regulations stipulate that buildings should be earthquake resistant.    The government of Puerto Rico said that as of Monday, there were 4,924 people living in 28 shelters in 14 municipalities. There were no figures on how many buildings had been damaged or destroyed.

- Seeking disaster designation -
Puerto Rico's governor Wanda Vazquez Garced called on Trump to declare the earthquake a disaster and clear the way for desperately needed aid. Trump had declared an emergency days before, but the governor wanted more.   The declaration of an emergency frees up to $5 million dollars in aid for the island, although Congress can bump that figure up. But if the situation is designated a disaster, there is no ceiling on funding, a FEMA spokesman said.   On Wednesday, the government said it would release $8.2 billion in delayed hurricane relief that had been stalled after the president threatened to divert Puerto Rico's emergency funds to help pay for his wall on the US-Mexico border.

In the past few days there have been growing calls among Democratic lawmakers for Trump to declare the situation in Puerto Rico a disaster.   It is a delicate subject, as Trump has accused the government of Puerto Rico of incompetence and of siphoning off hurricane relief money, triggering a public spat between the president and the mayor of San Juan, Carmen Yulin Cruz, as well as the former governor Ricardo Rossello, who was forced to step down last summer amid massive protests.   The Puerto Rican leaders accused Trump of treating the population of the island like second class citizens.
Date: Sat, 11 Jan 2020 15:43:12 +0100 (MET)

Washington, Jan 11, 2020 (AFP) - A 5.9 magnitude earthquake rocked Puerto Rico Saturday, the latest in a series of powerful tremors that have shaken the US territory in recent days, the US Geological Survey reported.

The latest quake occurred at 8:54 am local time (1254 GMT) around 13 kilometres (eight miles) southeast of Guanica, a town on the island's southern Caribbean coastline that was hard hit by earlier quakes.   The USGS revised its initial report of a 6.0 magnitude quake to 5.9.   It follows a 6.4 magnitude quake Tuesday that killed one person, knocked
out electric power and caused widespread damage.

Puerto Rico Governor Wanda Vazquez declared a state of emergency after Tuesday's quake, which forced an automatic shutdown of the power grid.    Puerto Rico's electric power authority reported outages in the towns of Ponce, Lares, Adjuntas and San German after the latest quake.   The Pacific Tsunami Information Center in Hawaii issued a statement saying there was "no significant tsunami threat" but a small possibility of tsunami waves along coasts nearest the epicentre.

The island is still recovering from Hurricane Maria, which came ashore more than two years ago as a devastating Category 4 storm.   Starting December 28, a wave of tremors have swept the island, putting residents on edge.   The 6.4 quake on January 7 came a day after a 5.8 magnitude quake; it was followed by major aftershocks.   Saturday's quakes were also preceded by a string of smaller tremors.
Date: Tue, 7 Jan 2020 23:44:45 +0100 (MET)
By Ricardo Arduengo

Guayanilla, Puerto Rico, Jan 7, 2020 (AFP) - Puerto Rico's governor declared a state of emergency on Tuesday after a powerful 6.4 magnitude earthquake killed at least one person in the south of the island and caused widespread damage.   Governor Wanda Vazquez said the declaration would allow for the activation of National Guard troops in the US territory still recovering from a devastating 2017 hurricane.   The US Geological Survey said the quake struck at 4:24 am (0824 GMT) with the epicenter off the coast of the southern city of Ponce, and was followed by more than a dozen aftershocks.

Tuesday's quake was the most powerful in a series of tremors that have shaken the island since December 28.   Scientists initially sent out an alert about a potential tsunami but it was later canceled.   The island's electricity authority said the quake had forced an automatic shutdown of the power grid, already severely damaged by Hurricane Maria more than two years ago.   The worst damage appeared to be in towns on the southwest coast, including Ponce, Guayanilla and Guanica.   El Nuevo Dia newspaper said a 73-year-old man died after a wall fell in his home in Ponce. Eight others there were reported injured.

Two power plants in Guayanilla sustained major damage, the Puerto Rico Electric Power Authority said. The city could be without power for two weeks, its mayor Nelson Torres Yordan said.   Celebrity chef Jose Andres announced that a charity he runs, World Central Kitchen, had started serving meals and distributing solar-powered lamps in quake-hit areas.   Vazquez announced that $130 million in emergency aid funding will be disbursed.   On social media, people wrote of being shaken awake by the force of the quake.   One woman on Twitter said she had been "wrenched from sleep."   "Everybody is awake & scared all over," she posted.   In Guayanilla, the Inmaculada Concepcion church, built in 1841, was heavily damaged.   Volunteers salvaged statues and other valuable items from the ruins as a priest consoled distraught parishioners.

- 'Be safe' -
A 5.8 magnitude quake on Monday toppled some structures, caused power outages and small landslides, but did not result in any casualties.   It also destroyed a popular tourist landmark, Punta Ventana, a natural stone arch that crumbled on the island's southern coast.   Vazquez, the governor, said government employees were being given the day off on Tuesday to take care of their families.   "We want everyone to be safe," she said.   She said ports were undamaged and there are several weeks' supply of gasoline, diesel and natural gas stored so people need not worry about shortages.

The White House said President Donald Trump had been briefed and Pete Gaynor, head of the Federal Emergency Management Agency (FEMA), had been in touch with the governor.   Trump's administration came under severe criticism for its response to Hurricane Maria.   The Category 4 storm destroyed the island's already shaky power grid, overwhelmed public services, left many residents homeless and claimed several thousand lives, according to government estimates.
Date: Tue, 7 Jan 2020 12:52:34 +0100 (MET)

Washington, Jan 7, 2020 (AFP) - A strong earthquake struck south of Puerto Rico early Tuesday, the US Geological Survey said, the latest in a series of tremors that have shaken the island since December 28.   The shallow 6.5 magnitude quake struck 13.6 kilometres (8.5 miles) south of the city of Ponce, the USGS said, revising down its initial reading of 6.6.   The quake struck just off the US territory's southern Caribbean coastline at 4:24 am local time (0824 GMT).   "The whole island is without power," the director of Puerto Rico Electric Power Authority, Jose Ortiz, told local media.

Puerto Rico's governor Wanda Vazquez Garced posted on Twitter that the government's security protocols had been activated.   She said government employees were not expected at work, adding: "We want everyone to be safe."   On social media, people wrote of being shaken awake by the force of the quake.   One woman on Twitter said she had been "wrenched from sleep", adding "Everybody is awake & scared all over."

Dramatic images also shared on social media appeared to show widespread damage in the town of Guayanilla, home to around 20,000 people, as well as nearby Guanica.   The mayor of Guayanilla told local news channel NotiUno that the town's church had collapsed in the incident.

An alert issued by the Tsunami Warning Center immediately following the earthquake was later cancelled.   Tuesday's quake was the strongest of a series of tremors that have shaken the island since December 28, topping Monday's 5.8 quake.   That earthquake toppled houses and caused power outages, but there were no reports of casualties.
Date: Mon, 6 Jan 2020 18:04:21 +0100 (MET)

Miami, Jan 6, 2020 (AFP) - A 5.8-magnitude earthquake shook Puerto Rico Monday, toppling houses and causing power outages and small landslides but there were no reports of casualties, the US Geological Survey said.   The quake, just off the US territory's southern Caribbean coastline, was felt throughout much of the island, including the capital San Juan.

Some 250,000 customers were hit by electric power outages after the quake, which struck at 6:32 am local time (1032GMT).   Images posted on social media showed houses tumbled from their supporting pillars, cracks in walls, cars crushed under collapsed houses and small scale landslides.   The quake was the strongest of a series that have rippled through the island since December 28, and it was followed by at least eight aftershocks, officials said.   No tsunami alerts were issued.
More ...

Benin

Benin - US Consular Information Sheet
April 28, 2008

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

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

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

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

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

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

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

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

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

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

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

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

See our information on Victims of Crime.

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

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

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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/.
* * *
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.
=====================
[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.
More ...

Barbados

General
******************************
Barbados is an island country in the West Indies. This Caribbean Island gained its independence from Britain in 1966 and enjoys a pleasant climate throughout much of the year. The main rainfall occurs betwe
n May to October and it may be affected by hurricanes along with many other Caribbean countries during September or October. The tourism facilities are well developed and Barbadian English is the main spoken language.
Safety & Security
******************************
The level of street crime is low but tourists are encouraged to maintain a close eye on personal processions and to use the hotel safety boxes for any particular valuables. Take care when walking through crowded market places, using a body pouch for your belongings. Ask advice before walking along deserted beaches at nighttime. If necessary, use an authorised taxi at all times to and from nightclubs.
Medical Facilities
******************************
Health care facilities throughout the main tourist regions are good but if travelling around the island you should be aware that these facilities are less developed. It is wise to ensure that you carry sufficient personal medication for the duration of your trip though medical supplies within Barbados are usually excellent.
Road Travel
******************************
The traffic in Barbados travels on the left side of the road and generally the infrastructure is well maintained along the tourist routes. Nevertheless, hiring cars or mopeds is usually not recommended due to the high risk of accidents. Hiring a taxi is usually a safer option.
Local Customs
******************************
Many countries (including Barbados) have strict rules regarding the possession of illegal drugs. Never carry any item for another individual and always make sure your own personal medications are well marked at all times. Sometimes it is wise to have an official letter from your prescribing doctor outlining the reason for your medication.
Swimming
******************************
As always when abroad, make sure you take heed of local advice before swimming in the Caribbean. Strong currents can occur and occasionally passing cruise ships or tankers may pollute the sea. Never swim alone, away from the main tourist resorts or soon after a meal. Take care to watch children at all times even around the hotel swimming pools. If planning to undertake water sports while abroad make sure your travel insurance is sufficient and always check that the company you use has well maintained equipment and that good safety procedures are in place. Talking to other tourists or the hotel representative before booking will help give you a clearer picture of the facilities on offer.
Sun Exposure & Dehydration
******************************
The temperature in Barbados is generally similar throughout the year with levels between 20 to 30C at most times. Sun exposure most commonly occurs in those who do not cover up sufficiently and particularly if asleep beside the pool, exhausted due to jet lag, soon after arrival. Take care that children are kept cool, drink plenty of fluids and take extra salt in their diet (crisps, salted biscuits etc) to help overcome these effects.
Food & Water
******************************
The level of food hygiene in the main tourist resorts is high but care should be taken with regard to the consumption of seafood. Contamination of fish and shellfish has been reported in the past. Ciguatera poisoning associated with consumption of snappers, parrot fish, mackerel, moray eels and barracudas has been reported. Water hygiene is usually excellent though drinking bottled water is usually a wise precaution while abroad.
Rabies risks
******************************
Barbados has been rabies free for over 150 years. Nevertheless, avoiding animal bites is still a wise option and particularly take care that young children do not befriend any animals including birds, monkeys, cats and dogs.
Malaria & Mosquito Bites
******************************
Malaria transmission does not occur within the West Indies including Barbados. However other mosquito borne diseases such as Dengue Fever can be a significant problem. Mosquitoes that tend to bite in urban areas during the daylight hours transmit this disease and so care against insect bites is encouraged throughout the whole day.
Vaccinations for Barbados
******************************
There are no vaccines required for entry to Barbados from Ireland. However, most tourists would be encouraged to consider cover against the following:
*
Tetanus (childhood booster)
*
Typhoid (food & water borne)
*
Hepatitis A (food & water borne)
Those planning a more extensive trip or undertaking adventure sports should also consider cover against Hepatitis B.
Summary
******************************
The majority of tourists to Barbados will enjoy a healthy time on the island with little reason for concern providing they follow some simple commonsense rules regarding seafood consumption, sun exposure and dehydration. Further information, including any recent news reports, is available through the Tropical Medical Bureau at the numbers below.

Travel News Headlines WORLD NEWS

Date: Fri 17 Aug 2018
Source: Outbreak News Today [edited]

Barbados health officials are reporting an increase in syphilis in pregnant women in recent years. The health ministry is now seeing an abnormally high rate of syphilis in pregnant women and, by extension, an increase in the number of babies born at risk for congenital syphilis.

Statistics show a rise from the average one or 2 cases a year of syphilis in pregnant women to 17 in 2016. According to the Ministry official, preliminary analyses from 2017 show a similarly high rate.

Dr. Anton Best, senior medical officer of health with responsibility for the HIV/STI programme, said that effective prevention and detection of congenital syphilis depends on the identification of the sexually transmitted infection (STI) in pregnant women. He noted that the Ministry of Health and Wellness' guidelines make it clear that all pregnant women should be offered a screening test for syphilis at booking and at 28 weeks gestation.
===================
[The number of syphilis cases in Barbados was reported to have started to increase in 2012, from 24 in 2011 to 41 in 2012 and to 112 in 2013, and then to have stabilized in 2014 (100 cases), 2015, and 2016 (<http://www.nationnews.com/nationnews/news/98007/stis-major-concern-ministry-health>).  72 percent of new syphilis cases reportedly occurred in men between the ages of 15 and 49 years old, with the average age being 34; more than 95 percent of pregnant women were screened for syphilis during pregnancy, and no increase in syphilis cases in pregnant women occurred during a 4-year study (2011-2014), with only one case of syphilis being transmitted through birth in 2014  (<https://caribbeannewsservice.com/now/syphilis-outbreak-in-barbados/>).

However, the news report above says that, although only one or 2 cases a year of syphilis occurred in pregnant women previously, 17 cases occurred in 2016, and a similar number occurred in 2017, but we are not given the number treated or outcome of these pregnancies.

Syphilis is a bacterial infection caused by the spirochete _Treponema pallidum_. Transmission from mother to fetus occurs via the bloodstream during maternal spirochetal infection. Transmission may also occur during delivery if maternal genital lesions are present. Late abortion, stillbirth, and neonatal death may result from congenital infection in untreated pregnancies. Among survivors, manifestations that develop in the 1st 2 years of life are called "early" and are similar to adult secondary syphilis; manifestations that develop after age 2 years are called "late" and include tooth abnormalities (Hutchinson teeth), bone changes (saber shins), "Clutton's joints" (bilateral painless swelling of the knee joints), neurological involvement, blindness, and deafness.

Control of congenital syphilis is achieved by antenatal screening and treatment of mothers who are infected. Routine serologic screening should be done at the 1st prenatal visit in all pregnant women, and, in communities and populations in which the risk for congenital syphilis is high, serologic testing and a sexual history also should be obtained at 28 weeks gestation and at delivery. Groups at high risk include uninsured women, women living in poverty, sex workers, illicit drug users, women diagnosed with sexually transmitted diseases, and those living in communities with high syphilis morbidity (<http://www.ahrq.gov/clinic/uspstf09/syphilis/syphpgsum.htm>). No mother or neonate should leave the hospital without maternal serologic status having been documented at least once during pregnancy and, if the mother is considered high risk, also at delivery.

Barbados, with a population of 277 821 residents, is a sovereign country and the easternmost island in the Caribbean region of North America; its capital and largest city is Bridgetown  (<https://en.wikipedia.org/wiki/Barbados>).

A map showing the location of Barbados can be found at
<https://en.wikipedia.org/wiki/West_Indies#/media/File:Caribbean_general_map.png>. - ProMED Mod.ML]

[HealthMap/ProMED-mail map:
Date: Tue, 9 Feb 2016 20:01:58 +0100

Miami, Feb 9, 2016 (AFP) - Barbados on Tuesday confirmed three cases of Zika in pregnant women, bringing to seven the number of people on the Caribbean island with the virus, which is believed to be linked to birth defects.   The women will be given specialized obstetric care, the Ministry of Health said in a statement. The new cases were announced on the Barbados government information services Facebook page.

Zika, a primarily mosquito-borne illness, has spread rapidly through Latin America and the Caribbean. It generally causes mild symptoms but has been blamed for a rapid rise in the number of children born with microcephaly -- abnormally small heads and brains.   Barbados said that link has not been confirmed.    "The situation is still evolving and information is being updated regularly," the Ministry of Health said.   The World Health Organization has declared a global medical emergency to combat Zika and individual countries and regions are beginning to mobilize. With no cure or vaccine for the virus, some countries have taken the extraordinary step of urging women to delay getting pregnant.

According to the Pan-American Health Organization, 26 countries have confirmed cases, spanning 7,000 kilometres (4,400 miles) from Mexico to Paraguay.   The hardest hit country is Brazil, which hosts the Summer Olympics starting in August.   Brazil has warned pregnant women not to travel there but Games organizers have said by the time the Olympics start, the main mosquito season will be over and they don't expect the illness to affect the sporting extravaganza.
Date: Tue, 18 Feb 2014 11:17:11 +0100 (MET)

WASHINGTON, Feb 18, 2014 (AFP) - An earthquake measuring 6.7 struck Tuesday in the Caribbean near the island of Barbados, the US Geological Survey said.   The quake hit at 0927 GMT about 170 kilometers (110 miles) northeast of the town of Bathsheba on Barbados, the USGS said.   It struck at a depth of 172 kilometers (11 miles).   There were no immediate reports of damage or injuries in Barbados media outlets.   The Daily Nation newspaper said people called radio stations to report the quake.
Date: Mon, 8 Jul 2013 11:53:25 +0200 (METDST)

MIAMI, United States, July 08, 2013 (AFP) - Tropical Storm Chantal, which formed in the Atlantic overnight, headed towards the Caribbean Sea on Monday, the US National Hurricane Center reported.   At 0900 GMT Chantal was located about 1,130 kilometers (705 miles) east of Barbados packing maximum sustained winds of 65 kilometers (40 miles) per hour, the NHC said.

The storm is moving in a northwesterly direction at 43 kilometers per hour.   If it continues on its current path it will reach southern Puerto Rico and the island of Hispaniola -- shared by the Dominican Republic and Haiti -- on Wednesday or Thursday, according to the NHC forecast.   Tropical storm warnings are in effect for the French islands of Martinique and Guadeloupe, as well as for Barbados, Dominica and Santa Lucia, the NHC said.

Chantal is expected to strengthen during the next 48 hours and "produce rain accumulations of two to four inches over the Leeward and Windward Islands, with maximum amounts of six inches possible," the NHC said.   Poverty-stricken Haiti, which is still recovering from a devastating earthquake in January 2010, is especially prone to landslides triggered by heavy rain.
Date: Fri, 3 Aug 2012 06:28:26 +0200 (METDST)

MIAMI, Aug 3, 2012 (AFP) - Tropical storm Ernesto, the fifth of the Atlantic hurricane season, threatened Barbados and the Windward Islands Friday as it advanced across the Atlantic with winds of 85 kilometers per hour.

At 0300 GMT, the storm's center was 130 kilometers (80 miles) east of Barbados and 295 kilometers (185 miles) east of St Lucia, the Miami-based National Hurricane Center said. "The center of Ernesto should pass near Barbados later tonight, be near the northern Windward Islands by early Friday and emerge over the eastern Caribbean sea by Friday afternoon," the center said. It said tropical storm warnings were up in Barbados, St Vincent and the Grenadines, Dominica, St Lucia, Martinique and Guadeloupe.

Ernesto formed on Thursday from a tropical depression, becoming the fifth tropical storm of the current hurricane season, which runs from June 1 to November 30. The storm was expected to strengthen somewhat over the next two days, the center said. US weather forecasters have said they expect this to be a relatively mild hurricane season, with nine to 15 topical storms and between four and eight hurricanes.
More ...

Congo, Democratic Republic

Democratic Republic of the Congo US Consular Information Sheet
23rd September 2008
COUNTRY DESCRIPTION: The Democratic Republic of the Congo (Congo-Kinshasa) located in central Africa, is the third largest country on the continent. The capital
s Kinshasa. French is the official language. Years of civil war and corruption have badly damaged the country's infrastructure. Read the Department of State Background Notes on the Democratic Republic of the Congo (DRC) for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport, visa and evidence of yellow fever vaccination are required for entry. Some travelers arriving in the DRC without proper proof of yellow fever vaccination have been temporarily detained, had their passports confiscated, or been required to pay a fine. Information about yellow fever vaccination clinics in the U.S. may be found at http://www2.ncid.cdc.gov/travel/yellowfever/.
Visas must be obtained from an embassy of the DRC prior to arrival.
Travelers to the DRC frequently experience difficulties at the airport and other ports of entry, such as temporary detention, passport confiscation and demands by immigration and security personnel for unofficial “special fees.”
All resident foreigners, including Americans, are required to register at the office of the Direction General de Migration (DGM) in the commune of their place of residence.
Visitors who wish to travel in any mining areas must first obtain government approval from various government agencies or ministries, an often cumbersome and time consuming process.
Dual nationals arriving in the DRC should carefully consider which passport they use to enter the DRC. For departure from the DRC, airlines will require a valid visa for all destination countries before they will issue a ticket or allow a passenger to board. Airlines also require that the passenger have the correct entry stamp in the passport they wish to use to exit the country. Passengers who are unable to leave the country on the passport they used to enter the DRC may not be able to continue on their travel itinerary.
Additional information about visas may be obtained from the Embassy of the Democratic Republic of the Congo, 1726 M Street NW, Washington, DC 20036, tel. (202) 234-7690, or the DRC's Permanent Mission to the UN, 866 United Nations Plaza, Room 511, New York, NY 10017, tel. 212-319-8061, fax: 212-319-8232, web site http://www.un.int/drcongo. Overseas, inquiries should be made at the nearest Congolese embassy or consulate. Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
See the Department of State’s Travel Warning for the Democratic Republic of the Congo.

Though the DRC is now significantly more stable than it has been over the past decade, security remains problematic. The first democratic elections in more than forty years were held in 2006, and a new government is now in place. Post-election disturbances occurred as recently as March 2007 in Kinshasa, resulting in deaths of civilians and military personnel. During civil disturbances in 2007 there were incidents of hostility towards U.S. citizens and other expatriates.

Both inside and outside Kinshasa, there can be roadblocks, especially after dark. Vehicles are often searched for weapons and valuables, and travelers are checked for identity papers. Security forces regularly seek bribes. If confronted with such a situation, it is suggested that U.S. citizens remain courteous and calm. If detained, report the incident to the U.S. Embassy in Kinshasa as soon as possible.

The United Nations has its largest peacekeeping operation in the world in the DRC. Known by its French acronym of MONUC, it has close to 17,000 peacekeepers deployed in the country – primarily in the east. Violence nevertheless persists in the eastern DRC due to the presence of several militias and foreign armed groups, with sporadic outbreaks occurring in North Kivu, South Kivu, and northern Katanga provinces, as well as in the Ituri District of Orientale province. Members of the Lord’s Resistance Army entered into northeastern DRC from Sudan in 2005, and have camps in an isolated region of the DRC, Garamba National Park, where they killed eight MONUC peacekeepers in January 2006.

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 overseas callers, 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:
In the DRC, poor economic conditions continue to foster crime, especially in urban areas. Travel in many sections of Kinshasa, Kisangani, Lubumbashi and most other major cities, is generally safe during daylight hours, but travelers are urged to be vigilant against criminal activity which targets non-Congolese, particularly in highly congested traffic and areas surrounding hotels and stores. Outlying, remote areas are less secure due to high levels of criminal activity and the lack of adequate training, supervision, and salary payments to the security forces present.

Vehicle thefts, burglaries, and armed robbery occur throughout the country; there have been recent reports of after-dark carjackings, resulting in deaths in the North Kivu area. It is recommended to drive with doors locked and windows closed at all times. If confronted by members of the military or security forces, visitors should not permit soldiers or police officers to enter their vehicles nor get into the vehicle of anyone purporting to be a security official. It is recommended that in such instances U.S. citizens remain courteous and calm and, if threatened, not resist. All incidents should be reported to the U.S. Embassy in Kinshasa.

Consistency in administering laws and regulations is notably absent. Travelers should note that in cases of theft and robbery, legal recourse is limited. Therefore, valuable items may be safer if kept at home or another secure location.

Security officials and/or individuals purporting to be security officials have detained and later robbed American citizens and other foreigners in the city of Kinshasa. This type of crime has increased in recent months, but generally occurs more frequently during the Christmas and New Year's holidays.

Travelers using public transportation or visiting high pedestrian traffic areas of any type are advised to be vigilant against robbery and pick-pocketing which is a persistent problem in all major cities in the DRC. The presence of “street children”, who can be persistent and sometimes aggressive, remains a problem particularly in Kinshasa.
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:
In the DRC, medical facilities are severely limited, and medical materials are in short supply. Travelers should carry properly labeled prescription drugs and other medications with them and should not expect to find an adequate supply of prescription or over-the-counter drugs in local stores or pharmacies. Payment for any medical services required is expected in cash, in advance of treatment.

Malaria is common throughout the DRC and outbreaks of cholera, typhoid, yellow fever, the Ebola virus, and hemorrhagic fever occur.
Travelers should take appropriate precautions to prevent the spread of HIV/AIDS.
Tuberculosis is an increasingly serious health concern in the DRC.
For further information, please consult the CDC's Travel Notice on TB at: http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of the DRC.

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:
For planning purposes, the minimum estimated cost of medical air evacuation to the nearest suitable health care facility (in South Africa) is $35,000.

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 DRC is provided for general reference only, and may vary according to location or circumstance.

Inter-city roads are scarce, and throughout the DRC roads are generally in poor condition, and often impassable in the rainy season. When driving in cities, keep windows up and doors locked. At roadblocks or checkpoints, documents should be shown through closed windows. In the event of a traffic incident involving bodily injury to a third party or pedestrian, do not stop to offer assistance under any circumstances. Proceed directly to the nearest police station or gendarmerie to report the incident and request official government intervention. Attempting to provide assistance may further aggravate the incident, resulting in a hostile mob reaction such as stoning or beating.

Presidential and other official motorcades pose serious risks to drivers and pedestrians in Kinshasa. When hearing sirens or seeing security forces announcing the motorcade's approach, drivers should pull off the road as far as possible, stop their vehicles, and extinguish headlights. Vehicles should not attempt to move until the entire motorcade has passed by; the security forces will physically indicate when this has occurred. Failure to comply may result in arrest, and/or vehicle damage with possible personal injury.

Public transportation of all forms is unregulated and is generally unsafe and unreliable. Taxis, mini-buses, and trains are in poor mechanical condition and are invariably filled beyond capacity.

Visitors who wish to travel in any mining areas must first obtain government approval from various government agencies or ministries, an often cumbersome and time consuming process.

Drivers should stop their cars and pedestrians should stand still when passing a government installation during the raising and lowering of the Congolese flag. This ceremony occurs at roughly 7:30 a.m. and 6:00 p.m.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of the DRC’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of the DRC’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
Civil aviation in the DRC continues to experience air incidents and accidents; more than a dozen crashes and in-flight accidents resulted in more than 300 fatalities between 2000 and August 2008. Incidents included hard landings, engine failures, collapsed landing gear, and planes veering off the runway.
In-country air travel schedules are unreliable and planes are frequently overloaded with passengers and/or cargo.
The U.S. Embassy in the DRC has prohibited official travel by U.S. government employees and contractors on all DRC-owned and -operated commercial air transportation services due to concerns regarding safety and maintenance.
International flights on foreign-owned and -operated carriers are not affected by this notice.
SPECIAL CIRCUMSTANCES:
Photography: Travelers should note that photography in public places in Kinshasa and around any public or government building or monument in the DRC is strictly forbidden. Persons caught photographing such sites will likely have their photographic equipment confiscated and risk detention and possible arrest.

Travel to and from Congo-Brazzaville (Republic of Congo): Ferry service to and from Kinshasa and Brazzaville stops running in the late afternoon, does not operate on Sundays, and may close completely with minimal notice. If ferry service is functioning, a special exit permit from the DRC's Immigration Service and a visa from the Republic of the Congo (Congo-Brazzaville) are required for U.S. citizens to cross the Congo River from Kinshasa to Brazzaville.

Ferry and riverboat service to the Central African Republic is suspended due to rebel control of the Ubangui River.
Phone Service: In the DRC, cellular phones are the norm, as other telephone service is unreliable. Depending on the type of phone, it may be possible to locally purchase a SIM card to use an American-compatible cell phone in the DRC.

Currency: U.S. currency is widely accepted in the urban areas, but most vendors and banking institutions will accept only Series 1996 bills or newer, with the large, off-center portraits, that provide stronger protection against counterfeiting. In addition, bills must be in near perfect condition; even those with minor stains or small tears will be rejected. One dollar bills are rarely accepted, even if in mint condition. U.S. bills should be examined before they are accepted to ensure that they are legitimate, as counterfeit currency is widely circulated. It is recommended that currency exchange be conducted at reputable banks and not on the street where several schemes exist to either short-change the unwitting customer or to pass counterfeit bills.

CRIMINAL PENALTIES:
While in any 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. 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.

Penalties for breaking the law can be more severe in the DRC than in the United States for similar offenses.
Persons violating Congolese laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the DRC are severe, and convicted offenders can expect long jail sentences and heavy fines. Accusations of engaging in crimes against the security of the State, which are loosely defined, often result in detention for prolonged periods without being formally arrested. The DRC’s justice system remains plagued by corruption and uneven application of the law. Attorney fees can be expensive and are expected to be paid in advance of services rendered.

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 DRC 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 the Congo. Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency. The U.S. Embassy is located at 310 Avenue des Aviateurs; tel. 243-081-225-5872 (do not dial the zero when calling from abroad). Entrance to the Consular Section of the Embassy is on Avenue Dumi, opposite the Ste. Anne residence. The Consular Section of the Embassy may be reached at tel. 243-081-884-6859 or 243-081-884-4609; fax 243-081-301-0560 (do not dial the first zero when calling from abroad).
*

*

*
This replaces the Country Specific Information for the Democratic Republic of the Congo, dated April 29, 2008, to update sections on Entry/Exit Requirements and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Sun 16 Feb 2020, 5:00 PM
Source: WHO, Weekly Bulletin on Outbreaks and Other Emergencies, page 9 [abridged, edited]

During week 4 [week ending 26 Jan 2020], a total of 73 suspected cases including one death were reported across the country, compared to 46 suspected cases and no deaths in the previous week. The majority of cases in week 4 were reported from Sankuru province (78%).

In the past 4 weeks (weeks 1 to 4 of 2020) a total of 222 suspected cases with 4 deaths (CFR: 1.8%) were notified in the country, with the majority of cases being reported from the provinces of Sankuru (31%), Bas-Uele (18%), Equateur (15%) and Mai-Ndombe (9%). There has been an increase in the weekly case incidence since week 2 of 2020.

Between weeks 1 and 52 of 2019 a cumulative total of 5288 monkeypox cases, including 107 deaths (CFR 2%) were reported from 133 health zones in 19 provinces.
======================
[Monkeypox (MPX) virus is endemic and widespread geographically in the DR Congo, with cases occurring sporadically in several provinces. January 2020 is off to a similar start with 222 suspected cases and 4 deaths reported in 4 provinces. The 2% CFR is relatively low for the clade of MPX that occurs in the DRC, which can reach 10% or more. The 222 cases are suspected, and there is the possibility that without laboratory confirmation some of them may be varicella cases misdiagnosed as MPX. There is no additional information about the circumstances under which these cases acquired their infection. Monkeys are not the reservoirs of the virus, despite the name that the virus has received. Studies of prevalence of MPX virus in populations of rodent hosts are not mentioned in this or previous reports. The main reservoirs of MPX virus are suspected to be rodents, including rope squirrels (_Funisciurus_ spp., an arboreal rodent) and terrestrial rodents in the genera _Cricetomys_ and _Graphiurus_. Halting the bushmeat trade and consumption of wild animals to halt MPX virus exposure will be culturally and economically difficult, so continued occurrence of cases can be expected. MPX virus can be transmitted between people but not readily. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Wed, 12 Feb 2020 21:09:17 +0100 (MET)

Geneva, Feb 12, 2020 (AFP) - The UN health agency on Wednesday said it was extending its global emergency designation for the Ebola outbreak in the Democratic Republic of Congo but said the sharp decline in cases was "extremely positive".   The recent outbreak was first identified in August 2018 and has since killed more than 2,300 people in eastern DR Congo -- an area where several militia groups are operating.   "As long as there is a single case of Ebola in an area as insecure and unstable as eastern DRC, the potential remains for a much larger epidemic," WHO chief Tedros Adhanom Ghebreyesus told reporters in Geneva.

The WHO, however, said it was downgrading the national and regional risk of the disease from very high to high, while it kept the global risk at low.    Tedros also voiced hope that the emergency could be lifted within the next three months on the advice of the WHO's Emergency Committee of international experts.   The World Health Organization last July declared it a "public health emergency of international concern" -- a designation that gives the WHO greater powers to restrict travel and boost funding.   Tedros, who will be travelling to DRC on Thursday to meet President Felix Tshisekedi, on Tuesday said only three cases had been reported in the past week.

But for the epidemic to be declared over, there have to be no new cases reported for 42 days -- double the incubation period.   The health emergency designation last year came a few days after a patient was diagnosed with the virus in the provincial capital Goma -- the first case in a major urban hub.   More than a month before that, the WHO reported that the virus had spread to Uganda for the first time.   The Ebola virus is passed on by contact with the blood, body fluids, secretions or organs of an infected or recently deceased person.   The death rate is typically high, ranging up to 90 percent in some outbreaks, according to the WHO.

This is the second worst outbreak of the disease since 2014 when it killed about 11,000 people -- mostly in Guinea, Liberia and Sierra Leone.   Efforts to contain the current outbreak have been hindered by attacks on health workers and conflicts in the east.   The WHO said in November it had moved 49 staff out of the Beni region in eastern DRC because of the insecurity.   The Beni region, straddling the North Kivu and Ituri provinces, has been repeatedly attacked by the Allied Democratic Forces (ADF) rebel group, which activists say has massacred more than 300 people since October.
Date: Fri 31 Jan 2020
Source: MSF (Medecins Sans Frontiers) [abridged, edited]

Since mid-2018, a massive measles outbreak has been ravaging through the Democratic Republic of Congo (DRC). The outbreak has turned into the biggest measles outbreak of the past 10 years in DRC and the biggest currently active worldwide.

Over 310,000 people have been infected and more than 6000 have died over the past year alone; 3/4 of those who have died are children. All 26 provinces of the country have been affected by the outbreak.

MSF teams are working in various areas of DRC to participate to the response; at different times over the past 2 years, they have been active in patient care, vaccination campaigns to prevent the spread of the disease, and surveillance activities to identify new areas of the epidemic and start the intervention as early as possible.

Our teams have set up dedicated facilities such as the laboratory opened at the end of 2019 in Lumbubashi, southeastern DRC, in order to ensure a faster, more effective turnaround of lab analyses.

During the last year in the current measles outbreak in DRC:

- 310 000 people have been infected with measles
- 6000 people have died
- 75% of those who have died are children

[See video at URL: Tackling the world's biggest measles outbreak: MSF responds in Kongo Central; byline: Solen Mourlon/MSF]

An MSF team is currently working in the province of Kongo Central, one of the main hotspots of the epidemic today. Our response in this area began in December 2019 and has been targeting the health zones where the highest numbers of cases of measles have been reported.

The team is providing care for complicated cases in dedicated treatment centres, supporting local health centres to deal with non-complicated cases, contributing to surveillance, and facilitating transfers of patients to healthcare facilities.

Some of the main challenges we face are the complications linked with associated diseases (such as malaria or malnutrition), which increase the risk of mortality, and gaining access to remote, hard-to-reach areas.
Date: Fri, 24 Jan 2020 17:43:54 +0100 (MET)
By Albert Kambale with Samir Tounsi in Kinshasa

Masisi, DR Congo, Jan 24, 2020 (AFP) - In eastern DR Congo, thousands have fled violence to camps in the remote mountain forests where they battle cholera, hunger and misery in a forgotten humanitarian disaster.   Eastern Democratic Republic of Congo has long struggled with violence from several militia groups, a legacy of the 1990s Congo wars that dragged in neighbouring Uganda and Rwanda.   The region is now also the epicentre of the latest Ebola epidemic, which has killed more than 2,200 people since August 2018.

Away from the Ebola headlines, tens of thousands of people are scattered in squalid camps across the mountains around Masisi, where they have fled, traumatised by violence, starving and with no chance to return home.   "I fled my village after clashes broke out," said Gentille, a 26-year-old Hutu Congolese. "We could no longer go to the fields. Many people died because clashes broke out in the middle of the village, very early one morning."

That fighting broke out in November and December involving one of the so-called Mai-Mai militia, the Nduma Defense of the Congo-Renove (NDC-R) and a coalition of other armed rivals, according to UN experts.   Now Gentille, a mother of five lives in a camp of 8,000 displaced people.  Along with the unsanitary conditions, a lack of clean water and food, since late last year, a cholera and measles outbreak has worsened life in the camps.    Several anti-cholera treatment units have been opened by Doctors without Borders (MSF), which reports 520 cases and two deaths.    "Three of my children got cholera. One died," says Gentille. "Here in the camp, we do not have enough toilets. More than 180 people use the same toilet. Since it is always busy, the children defecate outside and all around."

Around 685,000 displaced people survive in the mountainous areas, estimates MSF, a figure the aid group hopes will draw attention of the donors.   A year after coming to power, President Felix Tshisekedi has promised far-reaching reforms and a crackdown on corruption. But militia violence and ethnic clashes still undermine security of populations in the east.
Date: Sat 18 Jan 2020 03:15 WAT
Source: Actualita [in French, machine trans., edited]
<https://actualite.cd/2020/01/18/rdc-une-maladie-inconnue-fauche-des-vies-kiri-5-morts>

An unknown disease has already killed 5 people at Kiri General Hospital, in the province of Mai-Ndombe, in the west of the Democratic Republic of the Congo (DRC), according to the authorities. The provincial minister of public health has said that all measures are underway to detect [diagnose?] the mysterious disease. "Admittedly, this was an abnormal situation; however, the situation is manageable because we have just gone into this health facility and we have tried to carry out investigations. My collaborators and I took some samples which have quickly been sent to the National Institute for Biomedical Research (INRB) in Kinshasa for the appropriate medical tests which can give us accurate [diagnosis] on this abnormal situation," declared the minister Jean Claude Bola. First, added the same official, "it is not an Ebola epidemic, contrary to the rumour circulating in the Kiri territory and in the social networks."

In an exclusive interview with actualita.cd, the provincial authority also confirmed the deaths. "However, I warn all those who broadcast through the various media and social networks that there is Ebola in Mai-Ndombe that they have neither qualification nor competence to do so, because the only authority having jurisdiction in the provinces to declare an epidemic is the provincial governor," declared Paul Mputu Boleilanga. "Severe and disciplinary sanctions will be reserved against usurpers of power," he threatened. According to provincial authorities, a team from the National Institute of Biomedical Research (INRB), a team is expected in the Kiri territory for "rapid" management of all patients and to determine the disease underlying deaths in this region.
=============================
[Other than the number of deaths and the geographical location of the cases there is no additional information to permit reasonable speculation as to the aetiology or dates of illnesses. ProMED Mod.MPP noted that Ebola denial leads one to suspect this is a viral haemorrhagic fever.

Laboratory tests should confirm or rule out diseases such as yellow fever or Lassa fever. However, there is no indication that these cases are due to a virus or other infectious agent. Toxicants should also be ruled out. Additional information about these or new cases would be appreciated. - ProMED Mod.TY]

[Maps of DR Congo: <http://goo.gl/DM2AT8> and
<http://healthmap.org/promed/p/194> and
<http://healthmap.org/promed/p/65284>]
More ...

Iraq

Iraq US Consular Information Sheet
2nd October 2008
COUNTRY DESCRIPTION:
In 2005, Iraqi citizens adopted a new constitution and participated in legislative elections to create a permanent, democratic government, and in May 2006, a new Gove
nment of Iraq (GOI), led by Prime Minister Nouri al-Maliki, was sworn in. Although the GOI has made political, economic and security progress, Iraq still faces many challenges, including overcoming three decades of war and government mismanagement that stunted Iraq's economy, sectarian and ethnic tensions that have slowed progress toward national reconciliation, and ongoing (even if abating) insurgent, sectarian, criminal, and terrorist violence. Conditions in Iraq are extremely dangerous. While Iraqi Security Forces now take the lead in providing security in most provinces, Multinational Force-Iraq (MNF-I) continues to assist the Iraqi government in providing security in many areas of the country. The workweek in Iraq is Sunday through Thursday. Visit the Department of State Background Notes on Iraq for the most current visa information.
ENTRY/EXIT REQUIREMENTS: Passports valid for at least six months and visas are required for most private American citizens. An Iraqi visa may be obtained through the Iraqi Embassy in Washington, D.C. Travelers should not rely on obtaining a visa upon arrival at an airport or port of entry in Iraq. Visitors to Iraq who plan to stay for more than 10 days must obtain a no-fee residency stamp. In Baghdad, the stamps are available for all visitors at the main Residency Office near the National Theater. Contractors in the International Zone may also obtain exit stamps at the Karadah Mariam Police Station (available Sunday and Wednesday, 10:00-14:00.). There is a 10,000 Iraqi dinar (USD 8) penalty for visitors who do not obtain the required residency stamp. In order to obtain a residency stamp, applicants must produce valid credentials or proof of employment, two passport-sized photos, and HIV test results. An American citizen who plans to stay longer than two months must apply at the Residency Office for an extension. Americans traveling to Iraq for the purpose of employment should check with their employers and with the Iraqi Embassy in Washington, D.C. for any special entry or exit requirements related to employment. American citizens whose passports reflect travel to Israel may be refused entry into Iraq or may be refused an Iraqi visa, although to date there are no reported cases of this occurring.
U.S. citizens who remain longer than 10 days must obtain an exit stamp at the main Residency Office before departing the country. In Baghdad, they are available for all visitors at the main Residency Office near the National Theater. Contractors in the International Zone may also obtain exit stamps at the Karadah Mariam Police Station (available Sunday and Wednesday, 10:00-14:00). Exit stamp fees vary from USD 20 to USD 200, depending on the length of stay, entry visa and other factors. Those staying fewer than 10 days do not need to get an exit stamp before passing through Iraqi immigration at the airport. Visitors who arrive via military aircraft but depart on commercial airlines must pay a USD 80 departure fee at the airport.
Note: For information on entry requirements for other countries, please go to the Entry/Exit Requirements section in the Country Specific Information Sheet for the country you are interested in at http://travel.state.gov/travel/cis_pa_tw/cis/cis_1765.html. You may also contact the U.S. embassy or consulate of that country for further information.
Visit the Iraqi Embassy web site at http://www.iraqiembassy.us for the most current visa information. The Embassy is located at 1801 P Street NW, Washington, DC 20036; phone number is 202-742-1600; the fax is 202-333-1129.
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 risk of terrorism directed against U.S. citizens in Iraq remains extremely high. The Department of State continues to strongly warn U.S. citizens against travel to Iraq, which remains very dangerous.

Remnants of the former Baath regime, transnational terrorists, criminal elements and numerous insurgent groups remain active throughout Iraq. Multinational Force-Iraq (MNF-I) and Iraqi Security Forces (ISF)-led military operations continue, and attacks persist against MNF-I and the ISF throughout the country. Turkish government forces have carried out operations against elements of the Kongra-Gel (KGK, formerly Kurdistan Worker’s Party, or Partiya Karkeren Kurdistan (PKK)) terrorist group that are located along Iraq’s northern border. Despite recent improvements in the security environment, Iraq remains dangerous, volatile and unpredictable. Attacks against military and civilian targets throughout Iraq continue, including in the International (or “Green”) Zone. Targets include hotels, restaurants, police stations, checkpoints, foreign diplomatic missions, and international organizations and other locations with expatriate personnel. Such attacks can occur at any time. Kidnappings still occur; the most recent kidnapping of an American citizen occurred in July 2008. Improvised Explosive Devices (IEDs), Explosively Formed Penetrators (EFPs), and mines often are placed on roads, concealed in plastic bags, boxes, soda cans, dead animals, and in other ways to blend with the road. Grenades and explosives have been thrown into vehicles from overpasses and placed on vehicles at intersections, particularly in crowded areas. Rockets and mortars have been fired at hotels, and vehicle-borne IEDs have been used against targets throughout the country. Occasionally, U.S. Government personnel are prohibited from traveling to certain areas depending on prevailing security conditions. In addition to terrorist and criminal attacks, sectarian violence occurs often. Detailed security information is available on the Embassy's web site at http://iraq.usembassy.gov and at http://www.centcom.mil.
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, including the Travel Warning for Iraq, and Travel Alerts, as well as the Worldwide Caution, can be found. Travelers are also referred to the U.S. Embassy Baghdad’s Warden Notices which are available on the Embassy web site at http://iraq.usembassy.gov.
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 and Tips for Traveling Abroad.
CRIME: The U.S. Embassy and MNF-I are working with Iraqi authorities to establish law enforcement and civil structures throughout the country. U.S. and British military personnel are providing police protection as well, as the security situation permits. Petty theft is common in Iraq, including thefts of money, jewelry, or valuable items left in hotel rooms and pick-pocketing in busy places such as markets. Carjacking by armed thieves is very common, even during daylight hours, and particularly on the highways from Jordan and Kuwait to Baghdad. Foreigners, primarily dual American-Iraqi citizens, and Iraqi citizens are targets of kidnapping. The kidnappers often demand money but have also carried out kidnappings for political/religious reasons.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to 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. While U.S. Consular Services in Iraq are limited due to security conditions, the Embassy/Consulate staff can, for example, assist you to contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.See our information on Victims of Crime.There is no 911-equivalent emergency telephone number in Iraq.
MEDICAL FACILITIES AND HEALTH INFORMATION: Basic modern medical care and medicines are not widely available in Iraq. The recent conflict in Iraq has left some medical facilities non-operational and medical stocks and supplies severely depleted. The facilities in operation do not meet U.S. standards, and the majority lack medicines, equipment and supplies. Because the Baghdad International Airport has limited operations for security reasons, it is unlikely that a private medical evacuation can be arranged.
Iraq does not allow visitors with HIV/AIDS to enter the country. At this time there is no waiver available for this ineligibility. However, please inquire directly with the Embassy of Iraq at http://www.iraqiembassy.org before you travel for any changes.

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://www.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.
AVIAN INFLUENZA: The WHO and Iraqi authorities have confirmed human cases of the H5NI strain of avian influenza, commonly known as the "bird flu." Travelers to Iraq and other countries affected by the virus are cautioned to avoid poultry farms, contact with animals in live food markets, and any surfaces that appear to be contaminated with feces from poultry or other animals. In addition, the CDC and WHO recommend eating only fully cooked poultry and eggs. For the most current information and links on avian influenza, see the State Department's Avian Influenza Fact Sheet.
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 as well as whether medical evacuation would be possible from Iraq. 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 Iraq is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
All vehicular travel in Iraq is extremely dangerous. There have been numerous attacks on civilian vehicles, as well as military convoys. Attacks occur throughout the day, but travel at night is exceptionally dangerous and should be avoided. There have been attacks on civilian vehicles as well as military convoys on Highways 1, 5, 10 and 15, even during daylight hours. Travelers are strongly urged to travel in convoys with at least four vehicles in daylight hours only. Travel in or through Ramadi and Fallujah, in and between al-Hillah, al-Basrah, Kirkuk, and Baghdad and between the International Zone and Baghdad International Airport, and from Baghdad to Mosul is particularly dangerous. Occasionally, U.S. Government personnel are prohibited from traveling to select areas depending on prevailing security conditions. There continues to be heavy use of Improvised Explosive Devices (IEDs) and/or mines on roads, particularly in plastic bags, soda cans, and dead animals. Grenades and explosives have been thrown into vehicles from overpasses, particularly in crowded areas. Travel should be undertaken only when absolutely necessary and with the appropriate security.
Buses run irregularly and frequently change routes. Poorly maintained city transit vehicles are often involved in accidents. Long distance buses are available, but are often in poor condition and drive at unsafe speeds. Jaywalking is common. Drivers usually do not yield to pedestrians at crosswalks and ignore traffic lights (if available), traffic rules and regulations. Roads are congested. Driving at night is extremely dangerous. Some cars do not use lights at night and urban street lights may not be functioning. Some motorists drive at excessive speeds, tailgate and force other drivers to yield the right of way. Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by air carriers registered in Iraq, the U.S. Federal Aviation Administration (FAA) has not assessed Iraq's Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
There is credible information that terrorists are targeting civil aviation. Military aircraft arriving and departing from Baghdad International Airport (ORBI) have been subjected to small arms and missile fire. Travelers choosing to utilize civilian aircraft to enter or depart Iraq should be aware that, although there have been no recent attacks on civilian aircraft, the potential threat still exists. Official U.S. Government (USG) personnel are strongly encouraged to use U.S. military or other USG aircraft when entering or departing Iraq. All personnel serving in Iraq under Chief of Mission (COM) authority are prohibited from entering or departing ORBI on commercial airlines unless they receive COM approval, which is granted on a case-by-case basis for emergency purposes only. Other personnel not under COM authority must be guided by their own agencies. Personnel under COM authority assigned to the Erbil and Sulaymaniyah areas are permitted to use commercial flights in and out of Erbil on a case-by-case basis.

SPECIAL CIRCUMSTANCES:
As of September 21, 2006, Iraqi law prohibits adult Iraqis and foreigners from holding and transporting more than U.S. $10,000 in cash out of Iraq. In addition, it permits adult Iraqi and resident foreigners to hold and transport no more than 200,000 Iraqi dinars to cover travel expenses. Iraqi law also prohibits taking more than 100 grams of gold out of the country. Iraqi customs personnel are taking action to enforce these laws and may pose related questions to travelers during immigration and customs exit procedures. (Civil customs personnel also will verify passport annotations related to any items such as foreign currency, gold jewelry, or merchandise that were declared by passengers upon entry into Iraq on Form-8.)
All U.S. citizens are reminded that it is their duty to respect Iraqi laws, including legal restrictions on the transfer of currency outside of Iraq. If you are detained at the airport or at any other point of exit regarding your attempt to transfer currency out of Iraq, you should contact – or ask that Iraqi authorities immediately contact -- the American Embassy.

Transporting large amounts of currency is not advisable. Almost all of the international companies working in Iraq have the capability to make payments to their employees and at least four Iraqi banks are also able to convert cash into an international wire transfer directed to a bank account outside Iraq. Branches of the Credit Bank of Iraq on Al-Sa’adoon St., Baghdad (creditbkiq@yahoo.com), Dar Es Salaam Bank (info@desiraq.com), Iraqi Middle East Investment Bank (coinvst@iraqimdlestbank.com) and Al-Warqaa Investment Bank (warkabank@hotmail.com) all have this capability. Please be aware that large wire transfers may require Central Bank of Iraq approval because of measures in place to combat money laundering. Such approvals can be obtained by the sending bank, if information on the origin of the funds and the reason for its transfer are provided. Additional information on banking in Iraq is available at the Central Bank of Iraq web site http://www.cbi.iq/.
Customs and MNF-I officers have the broad authority to search persons or vehicles at Iraq ports of entry. Officers may confiscate any goods that may pose a threat to the peace, security, health, environment, or good order of Iraq or any antiquities or cultural items suspected of being illegally exported. Goods that are not declared may be confiscated by an officer. Persons may also be ordered to return such goods, at their expense, to the jurisdiction from which they came. Please see our Customs Information.
The banking and financial infrastructure has been disrupted and is in the process of rebuilding. Hotels usually require payment in foreign currency. Automatic Teller Machines (ATMs) are extremely limited but the Trade Bank of Iraq (TBI) provides ATM services in dinars and U.S. dollars at the TBI head office in central Baghdad and two other locations (See http://www.tbiraq.com.)
Telecommunications are very poor. There is limited international phone service in Iraq at this time. Local calls are often limited to a neighborhood network. There are no public telephones in the cities; however, calls may be made from hotels, restaurants or shops. Limited cellular telephone service and Internet service are available in Iraq.
Due to security conditions, the Consular Section of the U.S. Embassy is able to provide only limited emergency services to U.S. citizens. Because police and civil structures are in the process of being rebuilt, emergency service and support will be limited.
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 Iraqi laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Iraq 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: The U.S. and international media have occasionally reported on the difficult situation faced by Iraq's children, and it is completely understandable that some American citizens want to respond to such stories by offering to open their homes and adopt these children in need. However Iraqi law does not permit full adoptions as they are generally understood in the United States. It is not possible to adopt Iraqi children at this time. For more information on this issue, please refer to our flyer Intercountry Adoptions – Iraq.
Iraq is not party to the Hague Convention on the Civil Aspects of International Child Abduction, nor are there any international or bilateral treaties in force between Iraq and the United States dealing with international parental child abduction. The security situation in Iraq limits consular access to children. For more information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.
REGISTRATION / EMBASSY LOCATION:
The Travel Warning on Iraq urges U.S. citizens to defer travel to Iraq. However, Americans living or traveling in Iraq despite that Warning 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 Iraq. 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. U.S. citizens may also contact the consular section of the U.S. Embassy in Baghdad, Iraq located in the International Zone via e-mail at baghdadacs@state.gov, via landline at 1-240-553-0581, extension 2413 (this number rings in Baghdad) or the U.S. Embassy's web site at http://iraq.usembassy.gov. The after-hours number in case of extreme emergency is GSM 1-914-822-1370 or Iraqna 07901-732-134.
* * * * * *
This replaces the Country Specific Information for Iraq dated January 22, 2008, to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Medical Facilities and Health Information, Aviation Safety Oversight, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Mon 6 Jan 2020
Source: Rudaw [in Kurdish, trans. ProMED Mod.NS, abridged, edited]

The number of patients infected with seasonal influenza H1N1 in Kurdistan region has reached 38. Khalis Qadir, director general at the Kurdistan Regional Ministry of Health, told Rudaw that 4 of these patients have died and only one is from Kurdistan region. Qadir indicated that most cases were from Erbil governorate as of the 38 patients, 17 were from Erbil, 11 were from Duhok and 10 were from Sulaymaniyah.
Date: Thu 5 Jul 2018
Source: IraqiNews.com [edited]

Mosul, Iraq's former Islamic State (IS) capital, is witnessing a growing rate of scabies infections in its western region, medical workers reported as the city struggles to overcome destruction resulting from the war against the extremist group. Moamen Shahwani, a doctor at the health department in Mosul, was quoted by the Iraqi website Sky Press in a press statement that western Mosul has recorded 150 scabies cases, warning that parasites causing the disease are spreading in the city.

He attributed the spread of the disease to several factors, most importantly the return of displaced families to the regions, which are still scarred by the war against Daesh (IS) and the resulting waste matter. "Garbage, debris and remains of corpses are almost at every corner; moreover, there is a shortage in water, electricity and other essential services," Shahwani said.

The doctor noted that, besides registered cases, there are other unregistered ones, with infected persons seeking treatment at outpatient clinics or resorting to herbal medicines. "The disease is highly dangerous and rapidly progressing, and it is difficult to contain it in a short period [in] an environment that lacks the simplest services," he added.

Mosul was IS's capital and base of operations in Iraq. It was from its Grand Nuri Mosque that IS founder, Abu Bakr al-Baghdadi, proclaimed the group's rule. Iraqi forces recaptured the city last July [2017] after an operation that lasted for more than 8 months. Most of the city's infrastructure was demolished due to battles, and authorities continue to extract dead bodies from under the debris.  [Byline: Mohamed Mostafa]
====================
[Scabies is found worldwide and is an indicator of poor hygienic conditions, including lack of personal hygiene and clean clothes, crowded sleeping conditions and inadequate water resources. Thus, it is not surprising that scabies is found in Mosul under the present circumstances. More importantly, scabies can be an indicator of infections transmitted by human lice, like _Borrelia recurrentis_, _Rickettsia prowazekii_ and _Bartonella quintana_. Thus, those treating persons with severe febrile illness in Mosul should consider these infections. - ProMED Mod.EP]

[HealthMap/ProMED-mail map:
Date: Tue 26 Jun 2018
Source: Rudaw [edited]
<http://www.rudaw.net/english/middleeast/iraq/26062018>

After 3 reported deaths caused by viral haemorrhagic fever in Iraq's Euphrates Valley, a rights group has called on the government to undertake measures to prevent the disease from spreading, while officials say: "The situation doesn't call for worry." "The Iraqi High Commission for Human Rights warns of spreading the viral haemorrhagic fever, which causes human deaths and has great dangers to public health and the economy of Iraq," read a statement from IHCHR on Tuesday [26 Jun 2018].

The virus is spread by mosquitoes, ticks, rodents, and bats into livestock and humans, or when humans butcher already-infected livestock. "We call on the Ministry of Health and Diwaniyah Health Department to fumigate animal sheds in the province and carry out rapid preventive measures to prevent the spreading of the disease to Iraq's provinces," added the rights group.

They call for butchers only to work at licensed locations and for the police and relevant administrations to issue instructions. Additionally, posters should be displayed, and seminars should be offered as part of an educational campaign. "After 2 people lost their lives due to the hemorrhagic fever in the Diwanyah province, our ministry has swiftly undertaken the necessary measures to prevent the disease and provide necessary medications," Sayf Badir, a spokesperson for the ministry, said in a statement.

A source from the Diwanyah Hospital told Baghdad Today of another death on Monday [25 Jun 2018], increasing the number to 3. The Provincial Council of Diwanyah held a meeting in the presence of the governor and the head of the province's police to discuss the issue. Dr. Sabah Mahdi, the director of the National Center for Containing and Preventing Diseases, said on Monday [25 Jun 2018] that the 1st recorded case of the disease in Iraq was in 1979. He revealed that there are continuous efforts by the veterinaries to spray pesticides on cattle fields.

"To prevent this disease, we advise all ranchers, laboratory employees, and veterinary employees to wear personal protection gear while dealing with animals," added Mahdi. "The preventive measures are continuous, and by following up on all the cases, the situation doesn't call for worry." The World Health Organization defines viral haemorrhagic fever as "a general term for a severe illness, sometimes associated with bleeding, that may be caused by a number of viruses." Symptoms are sudden and include fever, muscle ache, dizziness, neck pain, backache, headache, and sore eyes, among other symptoms. The mortality rate is 30 percent. There is no vaccine available for humans or animals. There have been no reported cases outside of Diwanyah.
======================
[If the virus is believed to be spread by mosquitoes, ticks, rodents, and bats into livestock and humans, the identity of the virus has not been determined. However, if it is transmitted to humans when they butcher livestock, that raises the possibility that the etiological agent is Congo-Crimean haemorrhagic fever (CCHF) virus.

Cases in Iraq would not be surprising because cases have occurred this year (2018) across the region, including Iran and Afghanistan, and was suspected in 2 fatal and 4 suspected cases in Iraq in 2010. Crimean-Congo hemorrhagic fever (CCHF) is caused by infection with a tick-borne Nairovirus in the family Bunyaviridae. It is a viral zoonosis (animal to human) caused by infection with a tick-borne virus.

The hosts of the CCHF virus are mostly wild and domestic animals, including cattle, sheep and goats. Human transmission may occur when human beings come into contact with infected ticks (through tick bites) or direct contact with blood or tissues of an infected animal. CCHF can be transmitted from one infected human to another by contact with infectious blood or body fluids. In humans, until the etiological agent is identified, effective prevention will be difficult. ProMED-mail would appreciate receiving the name of the virus involved and the laboratory tests used to identify it. - ProMED Mod.TY]

[HealthMap/ProMED-mail map: Qadisiyyah Governorate, Iraq:
<http://healthmap.org/promed/p/25538>]
Date: Mon 9 Oct 2017
Source: MedPage Today [edited]

US service members deployed to Iraq showed signs of having been infected with latent visceral leishmaniasis during their service, researchers said.

In one study, latent visceral leishmaniasis was identified in asymptomatic Operation Iraqi Freedom soldiers (10.2 percent of 88), potentially putting them at risk of activation of the disease if they are immunosuppressed, according to Edgie-Mark Co of the William Beaumont Army Medical Center in El Paso, Texas <https://academic.oup.com/ofid/article/4/suppl_1/S122/4295608/A-Stealth-Parasite-Prevalence-and-Characteristics>.

In another study, 20 veterans with asymptomatic latent visceral leishmaniasis had no active disease, although it was not clear how likely the condition was to resurface and cause serious health problems, reported Nate Copeland of the Clinical Trials Center at Walter Reed Army Institute in Bethesda, Maryland, and colleagues <https://academic.oup.com/ofid/article/4/suppl_1/S122/4295606/Clinical-Evaluation-of-Latent-Visceral>.

Both studies were presented at the annual ID Week meeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).

Leishmaniasis is spread by sand flies and is common in the Middle East. The zoonotic parasitic disease can cause chronic fever, weight loss, spleen problems, and pancytopenia. Bacterial infections, malnutrition, and severe bleeding can also occur. Researchers are concerned because visceral leishmaniasis, unlike the more common cutaneous form, can cause serious health problems.

"Visceral leishmaniasis can be severe, and even life-threatening if not recognized and treated appropriately," Copeland told MedPage Today.

He said that more than 20 cases of active visceral leishmaniasis were reported among US service members in the Iraq region from 2000-2013, along with hundreds of cutaneous cases.

The study by Copeland [et al.] checked 88 soldiers from the El Paso area who'd served in areas with endemic visceral leishmaniasis from 2002-2011 (86 percent male, median age 39). Via various tests, they found that 10.2 percent showed signs of asymptomatic visceral leishmaniasis.

"If you have a healthy immune system, it shouldn't be an issue. That's what your immune system does, it suppresses the disease," Co told MedPage Today. "But once you have conditions that weaken the system, that's when the disease reactivates." HIV, treatment with immunosuppressant drugs, and the use of steroids could put these soldiers at risk of emergence of active disease, he said.

"Reactivation has been reported in the literature among immunocompromised patients such as solid organ transplants patients and rheumatologic patients with immunosuppressive treatment," said Kanokporn Mongkolrattanothai of Children's Hospital of Los Angeles, who has treated leishmaniasis patients.

Mongkolrattanothai, who was not involved with the studies, told MedPage Today that the new studies are "useful" in light of the life-threatening nature of visceral leishmaniasis.

In the study of 20 soldiers with active visceral leishmaniasis (all male, median age 38.5), "the majority tested positive with a test showing a good cell-mediated immune response, which is essential for control of the _leishmania_ parasites," Copeland said. "These service members were all counseled on the clinical syndrome of visceral leishmaniasis as well as potential risk factors for activation based on what is known at this time."

These patients will be able to visit for re-checks every 1 or 2 years, Copeland said, "but if they remain asymptomatic they likely do not need further care in light of being a healthy and immune-competent group."

Tests revealed that another 2 service members showed signs of genetic material from leishmania parasites in their blood. "While they are also without symptoms, we are following them very closely, every 3-6 months, and monitoring their levels of parasite," Copeland said. "We have also been doing some evaluation as to whether these individuals have any evidence of an immunodeficiency allowing them to have parasites circulating in their blood stream."

"Neither service member is being treated at this point, " he said, "because there are definite known risks to treatment, but no clearly defined benefit to treating people without symptoms. [But] if they were to develop symptoms, there would be a very low threshold to treat them."

The next steps are to understand the risk to service members of latent visceral leishmaniasis infection and gain insight into risk factors for activation, he said.

"In tuberculosis, we have a very similar disease, conceptually," he said. "You have a parasite that most often causes no problems in healthy people exposed, but a certain subset go on to active disease early on after exposure, and others reactivate months to years later, often as a result of some risk factor."

"While we are not sure if the later reactivation is the case in leishmaniasis, we are concerned it may be," Copeland added. "In tuberculosis, there is clear evidence that if you treat those with latent infection, especially those with risk factors for reactivation, you can decrease the risk of future active disease. So that begs the question, would the same be true in leishmaniasis? In other words, can we treat these asymptomatic people now and prevent them from ever getting disease?"  [Byline: Randy Dotinga]
========================
[We know very little about latent Leishmaniasis in healthy subjects. There is no doubt that the exposure to leishmaniasis in the US armed forces in Iraq was extensive (see ProMED reports below from 2001 to 2004).

The tests described here respond with an Interferon-gamma response to stimulation with Leishmania antigens. The test may be false positive or negative and we have no data showing that even if the tests correctly identify people who have been exposed to Leishmania, they will eventually become ill with clinical visceral leishmaniasis.

The authors draw a comparison with tuberculosis. We know a lot more about latent tuberculosis but even here treating latent tuberculosis based on a positive quantiferon test in healthy, asymptomatic individuals is controversial. These people, if treated, are exposed to side effects and the benefit is not well quantified. It is a good rule in clinical medicine, that we treat patients and not laboratory results. Thus a sensible scenario would be to do follow up in Leishmania test positive, asymptomatic individuals.

For subjects with a confirmed (repeated) positive PCR for Leishmania in their blood or other samples like a bone marrow, the infection is no longer asymptomatic and should be treated accordingly, probably with liposomal amphotericin B. - ProMED Mod EP]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Sun 24 Sep 2017
Source: Alghad Press [in Arabic, trans. Mod.NS, edited]

The Parliamentary Health and Environment Committee revealed on [Sun 24 Sep 2017] the spread of plague and called for a national campaign against rodents that are causing the disease.

The deputy head of the Parliamentary Health and Environment Committee, Fares Al-Barefkani, told Alghad Press that "new cases of plague have been identified, and the causes of the disease are known and are related to the poor municipal, disease control, sewage, and landfill services, in addition to widespread residential slums."

Al-Barefkani indicated that "there are a lot of residential slums that have emerged and are not under the control of Baghdad municipality and lack health services." He called for "a serious national campaign to combat rodents in the residential neighbourhoods that cause plague and provide medicines that help to eliminate the disease" and stressed that "there is a need to support Baghdad municipality and the health and the environment directorates to educate people on how to combat plague."

Al-Barefkani added that "the Parliamentary Health and Environment Committee does not have accurate data on the number of cases because we are in the process of follow-up in all the governorates."

On Tuesday [12 Sep 2017], the Ministry of Health denied some social media and other media reports about the occurrence of plague cases.
===================
[ProMED would again appreciate more information regarding whether plague cases have occurred in Iraq as it had been previously denied. If plague is present there, a program to eradicate rodents alone will not be effective in preventing human cases as the infected flea vector will seek other blood sources, such as humans.

This publication regarding the history of _Yersinia pestis_ in Iran also reviews the history of plague in other countries in the Middle East including Iraq:

Hashemi Shahraki A, Carniel E, Mostafavi E: Plague in Iran: its history and current status. Epidemiol Health. 2016 Jul 24; 38: e2016033; available at

"Throughout its history, Iraq has experienced multiple epidemics of plague. In 716 and 717 CE, a large outbreak known as al-Ashraf (the Notables) was recorded in Iraq and Syria. In an epidemic of bubonic plague in 1772 and 1773, many victims died in cities such as Basra (with 250 000 deaths) and Mosul. In 1801 CE, a large plague epidemic occurred in Mosul and Baghdad. A plague epidemic occurred again in Baghdad in 1908. From 1923 to 1924, approximately 90 cases of pneumonic plague were reported in Baghdad, and some plague outbreaks were reported in Basra." - ProMED Mod.LL]

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

Uruguay

Uruguay - US Consular Information Sheet
May 01, 2008
COUNTRY DESCRIPTION:
Uruguay is a constitutional democracy with a large, educated middle class and a robust developing economy.
The capital city is Montevideo .
Tourist facilit
es are generally good with many 5-star accommodations at resort destinations such as Punta del Este and Colonia de Sacramento.
The quality of tourist facilities varies according to price and location.
Travelers are encouraged to seek travel agency assistance in making plans to visit Uruguay .
Read the Department of State Background Notes on Uruguay for additional information.

ENTRY/EXIT REQUIREMENTS:
All United States citizens entering Uruguay for business or pleasure must have a valid passport.
U.S. citizens traveling on a regular passport do not need a visa for a visit of less than three months.
U.S. citizens traveling on diplomatic or official passports require a visa.
Air travelers are required to pay an airport tax upon departure.
This fee may be paid in U.S. dollars or in Uruguayan pesos.
For further information on entry requirements, contact the Embassy of Uruguay at 1913 “Eye” Street NW, Washington, DC 20006, tel. (202) 331-4219; e-mail: conuruwashi@uruwashi.org.
Travelers may also contact the Consulate of Uruguay in New York, Miami, Chicago, Los Angeles, and Puerto Rico.
Visit the Embassy of Uruguay web site at http://www.uruwashi.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:
Regular protests, some with an anti-American flavor, take place outside Congress, City Hall and the “University of the Republic.”
U.S. citizens visiting or residing in Uruguay are advised to take common-sense precautions and avoid any large gatherings or any other event where crowds have congregated to demonstrate or protest.
If travelers encounter a protest they should walk the other way or enter a commercial establishment until the protest passes.
Taking pictures of protesters is not a good idea.

Although there have been no past instances of violence directed at U.S. citizens from cross-border extremist groups, U.S. citizens traveling or residing in the more remote areas of Uruguay near the border with Argentina and Brazil are urged to exercise caution.

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:
Petty street crime is prevalent in Montevideo .
The criminals tend to be non-violent.
However, criminals often resort to violence if the victims resist.
Travelers should exercise reasonable caution to minimize their exposure to crime.
Criminals prey on the unaware, particularly those carrying cameras, pocketbooks, laptops, or backpacks.
Travelers are advised to lock most valuables in secure hotel safes and to download their wallets of excess credit cards and cash.
If dining at an outdoor restaurant take extra care with pocketbooks or bags.
There are no “off limits” areas of the city and parts of “Ciudad Vieja” are popular tourist attractions.
However the only sections of Ciudad Vieja with continual police patrols are Plaza Independencia, the pedestrian street Sarandi, and the Mercado del Puerto.
Mugging is common in other parts of Ciudad Vieja - particularly for travelers walking alone, or couples walking at night.
A smart alternative is to call for a taxi for evening travel between restaurants, bars, and hotels.

Victims are usually foreign tourists, individuals openly carrying valuable items, and motorists in unlocked vehicles stopped at busy intersections, particularly on Montevideo 's riverfront road known as the Rambla. Drivers should keep all car doors locked, the driver's window open only one inch, and purses, bags, briefcases and other valuables out of sight on the floor or in the trunk. Parked cars, particularly in the Carrasco neighborhood, are also increasingly targeted for break-ins. During the summer months (December-March), beach resort areas such as Punta del Este attract tourists, and petty street crimes and residential burglaries--similar to those that occur in Montevideo --rise significantly. Visitors are advised to exercise common sense in the conduct of their activities around Montevideo and in Uruguayan resort areas. They should be very attentive to personal security and their surroundings in the aforementioned areas.

Those planning to live in Montevideo should note that burglaries and attempted burglaries seem to be on the rise in upscale neighborhoods.
The perpetrators are mostly non-confrontational but determined teenagers.
A combination of preventive measures including rigorous use of locks and alarms, strong grillwork on all windows, guard dogs, keeping a residence occupied as much as possible, and using a security service is highly recommended.

Montevideo continues to experience armed robberies of patrons at crowded restaurants in the Pocitos neighborhood.
Most of these crimes have occurred very late at night.
Restaurant patrons should exercise extreme caution for late night dining.

Uruguayan law enforcement authorities have increased the number of uniformed policemen on foot in areas where criminal activity is concentrated and the number of patrol cars in residential areas. The clearly marked patrol cars are equipped with cellular phones and the phone numbers are conspicuously painted on the vehicles.

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 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:
Facilities for medical care are considered adequate. Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost tens of thousands of dollars.


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

The Uruguayan Ministry of Transportation is responsible for maintaining safe road conditions countrywide. The Uruguayan Ministry of Interior highway police (tel. 1954) are responsible for traffic safety on highways and other roads beyond city limits. In urban and suburban areas, transit police and municipal employees share road safety responsibilities.

Driving is on the right-hand side of the road. Wearing seat belts and using headlights on highways and other inter-city roads 24 hours a day are mandatory. Children under 12 must ride in the back seat. Motorcyclists must wear helmets. The use of cellular phones while driving is prohibited. Right turns on red lights and left turns at most intersections marked with a stoplight are not permitted. Drivers approaching an intersection from the right or already in traffic circles have the right of way.
Flashing high beams indicate intent to pass or continue through unmarked intersections.
Many drivers ignore speed limits and traffic signs.
If you plan to drive, use extreme caution and drive defensively.

For driving under the influence, violators are fined and confiscated licenses may be retained for up to six months. In accidents causing injury or death, drivers are brought before a judge who decides if incarceration is warranted.

Inter-city travel is via bus, taxi, car service (remise), car, and motorcycle. Speed limits are posted on highways and some main roads. Most taxis have no seat belts in the back seat. Cycling outside the capital or small towns is hazardous due to a scarcity of bike paths, narrow road shoulders and unsafe driving practices.

Illumination, pavement markings, and road surfaces are sometimes poor. Route 1, which runs between Montevideo and Colonia or Punta del Este, and Route 2, between Rosario and Fray Bentos, are particularly accident-ridden because of heavy tourist traffic. Road accidents rise during the austral summer beach season (December to March), Carnaval (mid-to-late February), and Easter Week.

Within Montevideo , the emergency number to contact the police, fire department, rescue squad, or ambulance service is 911. In the rest of the country, dial 02-911 to connect with the Montevideo central emergency authority, which will then contact the local emergency service. The Automobile Club of Uruguay responds to emergency calls for roadside assistance at 1707, “Car Up” at 0800-1501 and the Automobile Center of Uruguay at 2-408-6131/2091. SEMM (tel. 159) and UCM (tel. 147), Montevideo-based ambulance services manned by doctors, have agreements with emergency medical units in other cities.

Please refer to our Road Safety page for more information.
You may also telephone Uruguay ’s national tourist office and national authority responsible for road safety in Miami at (305) 443-7431.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed Uruguay ’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Uruguay ’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Uruguay 's customs authorities may enforce strict regulations concerning temporary importation into or export from Uruguay of items such as precious jewels, gold, firearms, pornography, subversive literature, inflammable articles, acids, prohibited drugs (medications), plants, seeds, and foodstuffs as well as some antiquities and business equipment. It is advisable to contact the Embassy of Uruguay in Washington, D.C., or one of Uruguay 's consulates in the U.S. for specific information regarding customs requirements. Note: Travelers entering Uruguay with precious jewels or gold worth more than $500.00 ( U.S. ) must declare them to customs officers at the port of entry or face possible detention or seizure of the goods and charges of contraband or evasion of customs controls. Visitors are expected to comply with local law and regulations by approaching a customs officer before routine inspection of all incoming baggage, conducted on standard security equipment.
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 Uruguay ’s laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Uruguay 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.

The Uruguayan Ministry of Agriculture and Fishing strictly enforces all regulations regarding hunting permits, as well as seasonal and numerical limits on game. Visitors who contravene local law have been detained by the authorities and had valuable personal property (weapons) seized. Under Uruguayan law, seized weapons can only be returned after payment of a sum equivalent to the value of the property seized. Hunters are also subject to stiff fines for practicing the sport without all appropriate permits.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Uruguay 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 Uruguay .
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency. The U.S. Embassy is located at Lauro Muller 1776; telephone (598) (2) 418-7777; fax (598) (2) 418-4110 or -8611. Internet: http://uruguay.usembassy.gov/, email: MontevideoACS@state.gov. Consular Section hours for American Citizen Services are Monday to Thursday, 9:00 a.m. to 11:00 p.m. and 2:00 p.m. to 4:00 p.m., except U.S. and Uruguayan holidays.
* * *
This replaces the Consular Information Sheet dated August 28, 2007 to update Sections on Entry/Exit Requirements, Safety and Security, Crime, Aviation Safety Oversight, Children’s issues, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

20th June 2019
https://en.mercopress.com/2019/06/20/torrential-rains-in-uruguay-forces-7.400-to-abandon-their-homes
Troops will continue monitoring the situation because “there are many people who do not want to leave their homes due to fear of being looted” Bayardi said.Torrential rains in central and southern Uruguay in the past several days have caused massive floods and forced some 7,400 people to leave their homes, according to the latest update by the country's National Emergency System.  The central city of Durazno is the most affected, with 5,299 evacuees, according to official reports.

Defense Minister Jose Bayardi visited one of the camp sites managed by the military to help the displaced.  ”We have established a high level of experience (in the face of these catastrophes) which we have succeeded in institutionalizing,“ he told the media. Troops will continue monitoring the situation because ”there are many people who do not want to leave their homes due to fear of being robbed and looted” Bayardi said.

The National Highway Police also said that 12 national highways remain cut-off in different directions. Uruguay's National Meteorological Institute said that between June 11 and 16, some southern regions of the country received around 270 mm of rain.  On Wednesday morning, the Yi River, which had been 11.8 meters higher than its normal water level in the Durazno area, was falling at a rate of 11 cm per hour, according to local media reports.

Date: Tue 12 Mar 2019
Source: Carmelo Portal [in Spanish, trans. Mod. TY, edited]

The departmental health director, Dr Jorge Mota, confirmed for Carmelo Portal the death in our city of a young 17 year old girl from [a] hantavirus [infection]. "In Colonia department, there are on average 3 cases per year. The evolution of the disease is in thirds. One-third of the [infected] people do not have notable symptoms; another third have serious symptoms, especially respiratory symptoms and ones in all the systems, but with adequate treatment, [the infected people] survive, sometimes with sequelae. There is another third that die. It is those few with the virus that die with an evolution so drastic, such as is the case of this girl, sadly," Dr Mota stated.

The department health director said that hantaviruses are not contagious person-to-person. "It is transmitted from an intermediate animal, the field mouse. Only 3% of these mice have [a] hantavirus. To become infected, one must be in contact with an [infected] mouse's secretions that have dried, are mixed with dust, and are in a closed space, away from sunlight and ventilation. A spa, a shed, or a wood pile [are examples of such a space]. The person had to have been moving around there and inhaled the dust," he explained.

Dr Mota spoke about the epidemiological surveillance that is carried out. "We tracked places where the person was, even those that could be identified 2 months before contracting the virus; sometimes we found the place, but sometimes not." As a preventive measure, Mota stated that in these cases, ventilate these closed spaces for at least half an hour. Wet down floors and shelves with water [with 10% bleach]. Use masks [and gloves].
==========================
[The report above does not mention the circumstances under which the infection might have been acquired nor which hantavirus was responsible for this or earlier cases in Uruguay. Hantaviruses that cause hantavirus pulmonary syndrome (with rodent hosts found in Uruguay) include Laguna Negra virus (_Calomys laucha_), Maciel virus (_Necromys benefactus_), Central Plata virus, Lechiguanas virus (_Oligoryzomys flavescens_, complex of rodents), and Anajatuba virus and Juquitiba virus (_Ologoryzomys fornesi_).

The rodent reservoir hosts shed the virus in its saliva, urine, and faeces, contaminating the environment in which they live and breed.

A HealthMap/ProMED-mail map showing the location of Uruguay in South America can be accessed at
<http://healthmap.org/promed/p/28995>.

A map of Colonia department in southern Uruguay is available at
<https://en.wikipedia.org/wiki/Colonia_del_Sacramento>
and <http://healthmap.org/promed/p/27367>. - ProMED Mod.TY]
Date: Thu, 19 Jul 2018 03:23:55 +0200
By Lucia LACURCIA

Montevideo, July 19, 2018 (AFP) - Enrique Curbelo is delighted. Selling cannabis has allowed the affable 76-year-old to keep his privately owned pharmacy in Montevideo open in a market dominated by big chains.   "I had to sell what they didn't sell," he told AFP. "For me it's like selling aspirin."   It's been this way for a year now.   Every Wednesday, Ismael Fernandez receives a WhatsApp message from his local pharmacist telling him a new stock of cannabis has arrived.   After leaving work, he heads there and buys the 10 grams that Uruguayan law permits, costing 400 pesos, around $13.

Fernandez then heads home and rolls a joint "to relax" with his partner Stefania Fabricio.   No longer do they need to surreptitiously contact a dealer and pay more for Paraguayan or Brazilian marijuana that's been "pressed, mixed (and is) sometimes very bad and full of chemicals."   "Now it's much easier than when it started," Fernandez, a 31-year-old who works for a cleaning company, told AFP.   It has been four and a half years since marijuana use became legal in Uruguay and a year since it has been sold in pharmacies -- up to 40 grams a month per person.

Initially, there was insufficient supply, leaving people standing in long queues as stocks sometimes ran out. Pharmacies are better prepared now.   "They send you a message with a number which you use later to go and collect it, and in my pharmacy you can order it online," added Fernandez, the father of a three-year-old.   Hairdresser Fabricio, also 31, says "it's good quality," but not too strong.   "It doesn't send your head spinning, but it's not meant to. You get a hit but you can still do things perfectly."   - 'Privileged' -   She says she feels "privileged" to live in a country that enacted a law to "get tons of people out of the black market."   As a result, she said, the stigma attached to those who smoke pot is changing, "albeit slowly."

The system is simple: to buy cannabis in a pharmacy you must be at least 18, live in Uruguay and sign up as a "buyer" at the post office.   An initial stumbling block arose when banks refused to work with establishments selling cannabis due to international rules against drug-trafficking.   But the country plowed on, and last year it became the first in the world to fully legalize its sale.   But Enrique Curbelo had to get over his own prejudices before deciding to join the select band of pharmacies selling the plant.   There are 14, half of them in the capital, serving the 24,812 registered buyers.

- 'Normal people' -
Users can choose between two brands and two types of cannabis -- sativa and indica -- both provided by an official distributor.   Customers are generally not the stereotypical grubby-looking student or idle waster.    On this day in Curbelo's store they include two young women, a man in his 50s and an older lady -- "normal people," says the pharmacist.   Official statistics say 70 percent of buyers are male and 49 percent are between the ages of 18 and 29.

To keep anyone from exceeding their monthly allowance, a fingerprint machine is used to register every sale.   Along with the ability to purchase cannabis in a pharmacy, Uruguayans have the right to grow their own -- up to a six-plant maximum -- or to join a cannabis club, which can have up to 45 members and 99 plants.   Federico Corbo, a 41-year-old gardener, grows cannabis in his garden on the outskirts of Montevideo. He experiments by crossing species in an attempt to improve quality and optimize the flowering period.   Corbo is not impressed with the quality on offer in pharmacies.   "It's not the worst, but it's low," he said, insisting quality control needs to be improved.   "Marijuana that doesn't reach the minimum standards -- with crushed flowers, no aroma, low quality -- shouldn't be sold in the pharmacy.   "Maybe, as I'm a grower, I'm very demanding, but there is a cost associated to the product and it must be offered to the public in the best way possible."

According to the Institute of Cannabis Regulation and Control (Ircca), an average cultivator or club member supplies cannabis to two other people, while those who buy it in a pharmacy share it with one other.   "Approximately half of marijuana users have access to regulated cannabis," says Ircca.   The rest prefer to continue buying the drug on the black market, put off by the need to register as a user.   "It's wrong -- if they legalize it they have to do so in a way in which the state doesn't keep a paternalistic role in overseeing how much you smoke or stop smoking," one clandestine user, who wished to remain anonymous, told AFP.   This 48-year-old lawyer simply doesn't trust the authorities. He pointed to the danger a change of government could bring, or even the return of dictatorship.   "Right now that seems impossible," he said, "but you can never discount it."
Date: Thu 1 Feb 2018 23:02hs UYT
Source: LaRed 21 [in Spanish, machine trans. edited]

The Ministry of Public Health (MSP) issued a statement through which it reports that it has detected cases of infection by the bacterium _Vibrio vulnificus_ in Montevideo, Canelones, and Maldonado [departments]. The State Secretariat assured that every year there are cases of this bacterium, but so far in 2018, 4 serious cases have been reported, of which 3 died. All of them had underlying illnesses.

"90 percent of these cases, in the world, are associated with the consumption of undercooked or raw seafood. Infrequently, the infection can be acquired when entering the sea with open wounds, especially in elderly people or people with diseases that affect the immune system," explained the MSP. It is an event "extremely rare in our country," said the State Secretariat. It also indicated that fewer than 10 cases per year are registered per year for this bacterium.

It is an infection that "can be serious and in some cases fatal, so it is recommended to avoid the consumption of undercooked or raw sea products (as well as their handling without protection measures) and in the same way, avoid entering the sea with wounds or cuts on the skin." The bacteria can be found in coastal marine waters and estuaries in areas of tropical and subtropical climates that have a moderate degree of salinity and temperatures that usually exceed 18 C [64.4 F].
====================
[The following is extracted from the previous edition of the "Bad Bug Book," Center for Safety and Applied Nutrition, US FDA (Food and Drug Administration). The newest version is available at:  <https://www.fda.gov/downloads/Food/FoodborneIllnessContaminants/UCM297627.pdf>:

"_Vibrio vulnificus_, a lactose-fermenting, halophilic, Gram-negative, opportunistic pathogen, is found in estuarine environments and associated with various marine species such as plankton, shellfish (oysters, clams, and crabs), and finfish. Environmental factors responsible for controlling numbers of _V. vulnificus_ in seafood and in the environment include temperature, pH, salinity, and amounts of dissolved organics. It may be normal flora in salt water, and acquiring this organism from shellfish or water exposure does not imply that the water is contaminated by sewage.

"Wound infections result either from contaminating an open wound with sea water harbouring the organism, or by lacerating part of the body on coral, fish, etc., followed by contamination with the organism. The ingestion of _V. vulnificus_ by healthy individuals can result in gastroenteritis."

The "primary septicaemia" form of the disease follows consumption of raw seafood containing the organism by individuals with underlying chronic disease, particularly liver disease. The organism can also enter through damaged skin. In these individuals, the microorganism enters the blood stream, resulting in septic shock, rapidly followed by death in many cases (about 50 percent). Over 70 percent of infected individuals have distinctive bullous skin lesions (shown at <http://safeoysters.org/medical/diagnosis.html>).

There are 2 points to be emphasized: that vibrios are normal flora in warm saltwater (not indicative of any sewage contamination) and that most of the life-threatening illnesses occur in individuals with underlying medical illnesses, including immunocompromised states, chronic liver disease, and diabetes. So-called normal individuals often just develop gastroenteritis. The range of disease due to _V. vulnificus_ can involve more northern geographical areas as overall global warming takes effect. - ProMED Mod.LL]

Date: Mon 29 Jan 2018
Source: Monte Carlo [in Spanish, trans. ProMED Mod.TY, edited]

Personnel of the Ministry of Public Health are investigating the death of a young --28-years old -- agronomist caused by [a] hantavirus [infection]. After completion of the specific studies, which could take 48 hours, they will be able to determine if the young woman died as a consequence of the virus [infection].

The disease is contracted by the inhalation of excretions or secretions of rodents infected by the hantavirus.

As a preventive measure, personnel of the Department of Epidemiology of the Ministry of Health will go to the rural area in Canelones, where the young woman resided.  [Byline: Enrique Puig]
====================
[No information is given about the symptoms that the young woman experienced prior to her death, nor the date of her illness and death. Presumably, the diagnosis of a suspected hantavirus infection leading to death was hantavirus cardiopulmonary syndrome (HPS).

The report above does not mention which hantavirus was responsible for this or earlier cases in Uruguay. Central Plata hantavirus could be the etiological agent responsible (for this and previous HPS cases). Its rodent host is the yellow pygmy rice rat, _Oligoryzomys flavescens_, complex of rodents. This rodent reservoir host sheds the virus in its saliva, urine and faeces, contaminating the environment in which it lives and breeds.

An image of this rodent can be accessed at

A HealthMap/ProMED-mail map showing the location of Uruguay in South
America can be accessed at: <http://healthmap.org/promed/p/28995> and
Canelones department in southern Uruguay at
More ...

World Travel News Headlines

Date: Thu, 20 Feb 2020 16:20:39 +0100 (MET)

Damascus, Feb 20, 2020 (AFP) - A bomb explosion wounded two people in Damascus Thursday, the state news agency reported, the latest of several such attacks in the Syrian capital.   "An explosive device planted on a pickup truck went off in the Marjeh area" in central Damascus, SANA said, adding that two civilians were wounded by the blast.

The Syrian Observatory for Human Rights war monitor said the device was a "sticky bomb" planted on a military vehicle, although it was not immediately clear what the target was.   There was no immediate claim of responsibility for the blast, nor for a similar explosion that wounded five people in another neighbourhood of Damascus on Tuesday. The Syrian capital was routinely targeted by major car bomb attacks in the course of the nine-year-old conflict but blasts have been less frequent since regime forces reclaimed full control of the Damascus region in 2018.
Date: Thu, 20 Feb 2020 15:40:35 +0100 (MET)
By Laurent Thomet, with Miwa Suzuki in Tokyo

Beijing, Feb 20, 2020 (AFP) - China on Thursday touted a big drop in new virus infections as proof its epidemic control efforts are working, but the toll grew abroad with deaths in Japan and South Korea.   Fatalities in China hit 2,118 as 114 more people died, but health officials reported the lowest number of new cases in nearly a month, including in hardest-hit Hubei province.

More than 74,000 people have been infected by the new coronavirus in China, and hundreds more in over 25 countries.   The number of deaths outside mainland China climbed to 11.   Japan's toll rose to three as a man and a woman in their 80s who had been aboard a quarantined cruise ship died, while fears there mounted about other passengers who disembarked the Diamond Princess after testing negative.

South Korea reported its first death, and the number of infections in the country nearly doubled Thursday to 104 -- including 15 at a hospital in Cheongdo county.   The mayor of Daegu -- South Korea's fourth-largest, with 2.5 million people -- advised residents to stay indoors, while commanders at a major US military base in the area restricted access.   Iran reported two deaths on Wednesday, the first in the Middle East. Deaths have previously been confirmed in France, the Philippines, Taiwan and Hong Kong.

Chinese officials say their drastic containment efforts, including quarantining tens of millions of people in Hubei and restricting movements in cities nationwide, have started to pay off.   "Results show that our control efforts are working," Foreign Minister Wang Yi said at a special meeting on the virus with Southeast Asian counterparts in Laos, citing the latest data.   Wang said the situation was "significantly improving" in Hubei and Wuhan, but an official in a central government team dealing with the epidemic said it was still "very severe".

- 'Not turning point' -
Although more than 600 new infections were reported in Hubei's capital Wuhan, it was the lowest daily tally since late January and well down from the 1,749 new cases the day before.   The national figure has now fallen for three straight days.   Chinese authorities placed the city of 11 million under quarantine on January 23 and quickly locked down the rest of the province in the days that followed.

Wuhan authorities this week carried out a three-day, door-to-door check on residents, with the local Communist Party chief warning that officials would be "held accountable" if any infections were missed.   Cities far from the epicentre have limited the number of people who can leave their homes for groceries, while rural villages have sealed off access to outsiders.   Richard Brennan, a World Health Organization official, said in Cairo that China was making "tremendous progress" and "trends are very encouraging, but we are not at a turning point yet".

- 'Chaotic' cruise quarantine -
While China has boasted progress in its fight against the COVID-19 epidemic, Japan's government has been criticised for the quarantine measures it placed on the Diamond Princess.   The huge vessel moored in Yokohama is easily the biggest coronavirus cluster outside the Chinese epicentre, with 634 cases confirmed among passengers and crew.   Another 13 people on board the ship were diagnosed with the virus Thursday, Japan's health ministry said.   Still, passengers were disembarking after negative tests and having completed a 14-day quarantine period -- packing into yellow buses and leaving for stations and airports.

Questions were asked over the wisdom of allowing them to mingle in Japan's crowded cities.   "Is it really safe to get off?" screamed a headline in the Nikkan Sports tabloid.   The paper quoted one passenger who said he was tested on February 15, but only left four days later.   "I thought I could be infected during the four days. I thought 'Is it really OK'?"

A specialist in infectious diseases at Kobe University slammed as "completely chaotic" the quarantine procedures on board in rare criticism from a Japanese academic.   "The cruise ship was completely inadequate in terms of infection control," said Kentaro Iwata in videos he has since deleted.

South Korea, meanwhile, announced 51 new cases, with more than 40 in a cluster centred on the Shincheonji Church of Jesus, an entity often accused of being a cult.  The infections apparently came from a 61-year-old woman who first developed a fever on February 10 and attended at least four services before being diagnosed.   Local media said she had twice refused to be tested for the coronavirus on the grounds she had not recently travelled abroad.   Authorities were investigating whether she might have visited the hospital where a long-term patient contracted the virus and later died.

Some 15 other patients have now been found to have the virus.   Shincheonji claims its founder, Lee Man-hee, has donned the mantle of Jesus Christ and will take 144,000 people with him to heaven on the day of judgement.   A man in his 60s tested positive for the coronavirus after dying Wednesday following symptoms of pneumonia, South Korean authorities said.
Date: Thu, 20 Feb 2020 10:28:16 +0100 (MET)

Lagos, Feb 20, 2020 (AFP) - An outbreak of Lassa in Nigeria has killed 103 people this year, health authorities said, as the first confirmed case was reported in the economic hub Lagos.    "Cumulatively from week 1 to week 07, 2020, 103 deaths have been reported with a case fatality rate of 17.6%," said the Nigeria Centre for Disease Control (NCDC) in its latest statistics on the virus released on Wednesday.    The overall number of confirmed cases rose by 115 last week to a total of 586 across the country.

Separately, health authorities in Lagos, Nigeria's most populous city with 20 million inhabitants, said an infected person was diagnosed there on February 17 and being treated in isolation in hospital.    "Sixty-three people that may have been in contact with the patient and who may have been infected in the process have been identified and are being monitored," the state government wrote on Twitter on Thursday.

Endemic to Nigeria, Lassa fever belongs to the same family as the Ebola and Marburg viruses, but is much less deadly.   The disease is spread by contact with rat faeces or urine or the bodily fluids of an infected person.    The majority of those infected do not show symptoms but the disease can go on to cause severe bleeding and organ failure in about 20 percent of cases.

An outbreak of Lassa fever killed some 170 people around Nigeria last year.     The number of cases usually climbs around the start of the year linked to the dry season.   While the overall number of confirmed cases and deaths is up this year on the same period in 2019, the mortality rate is lower.    Twenty health workers across the country have been confirmed as contracting the disease so far in 2020.    The virus takes its name from the town of Lassa in northern Nigeria, where it was first identified in 1969.
Date: Thu, 20 Feb 2020 09:58:17 +0100 (MET)
By Nicolas DELAUNAY

Les Mamelles, Seychelles, Feb 20, 2020 (AFP) - On a plain suburban street in Seychelles, far from the idyllic coastline and luxury resorts pampering honeymooners and paradise-seekers, heroin addicts queue anxiously for their daily dose of methadone.   It is a scene few outsiders would associate with the tropical nirvana adrift in the Indian Ocean, and one rarely, if ever, glimpsed by tourists as they shuttle from the airport to five-star luxury on white-sand beaches.

But life for many Seychellois is far from picture perfect: the tiny archipelago nation is battling what officials say are the world's highest rates of heroin addiction.   Nearly 5,000 people are hooked, government figures show, equivalent to nearly 0 percent of the national workforce -- a statistic that has startled the government into action.

In comparison, 0.4 percent of the global population consumed opioids in 2016, half of them in Asia, according to a United Nations report that puts Seychelles among the top consumers alongside producing countries such as Afghanistan.   The Seychelles' heroin boom, which took off over the past decade, gripped young and old alike and cut across class lines.   Among those queueing in the town of Les Mamelles for methadone -- a substitute narcotic used to wean users off heroin -- are parents with young children, an old man leaning on a cane and a taxi driver between shifts.

Graham Moustache, a 29-year-old father of two, described how the arrival of affordable and high-quality heroin in Seychelles swept up his entire family.   "I have four brothers and two sisters, and we have all been heroin addicts at one point," he told AFP, tracing his fingers over the needle scars on his arms.   "I've been to prison twice," he said, adding his mother had turned him in as "she didn't know what to do any more".   "Sometimes, I didn't have enough to eat and I had to choose between eating and buying heroin. I chose heroin."

- Soaring addiction -
The rise of new trafficking routes through East Africa in the late 2000s, coupled with porous borders and relatively high purchasing power among Seychellois, flooded the paradisal islands with heroin.   The average salary in the archipelago is $420 (390) -- high compared to other African nations.   The World Bank considers the Seychelles the only high-income country on the continent, thanks to the growing tourism industry.    But around 40 percent of the population still lives in poverty.

By 2011, around 1,200 people were addicted, prompting a punitive crackdown.   "We did not make a difference between the victim and the trafficker," said Patrick Herminie, director of the state-run Agency for Drug Abuse Prevention and Rehabilitation (APDAR).   By 2017, addiction had risen four-fold, placing Seychelles among the world's most drug-dependent nations.   The government, realising its war on drugs had failed, changed tack and declared a public health emergency.   "The magnitude of the problem is simply because we reacted a bit late," Herminie said.

Money has poured into combating the scourge, with state funds for drug prevention and rehabilitation programmes soaring to 75 million Seychelles rupees ($5.5 million) in 2020 -- almost 10 times the 2016 budget.    APDAR, a specialist drug agency created in 2017 to tackle the problem, employs four times as many staff as the body that preceded it.   A state-run methadone programme has reached 2,500 people, with medical follow-ups helping to track their progress.    But the free availability of methadone has also prompted drug dealers to lower their prices.

Mobile clinics drive around offering methadone to addicts and providing free health checks and advice.    "I've been clean for more than a year. I found a job as a fisherman, and I can see my two kids," said Moustache proudly, as he queued at the white methadone van staffed with healthcare workers.   Others have struggled to stay the course.   "Methadone helps me a lot, but it's difficult not to take heroin at all," said Gisele Moumou, an emaciated 32-year-old addict, drawing ragged breaths and sweating as she waits for her small cup of methadone.

- Stopping the scourge  -
Schoolchildren are being taught about the damage done by drugs through awareness campaigns and billboards in classrooms.    But there is much work to be done, especially among children from families affected by drug use, says Noellie Gonthier from CARE, a local harm-reduction charity.   "Sometimes, four- or five-year-olds at school mimic injecting heroin," she said.   "Our challenge is to make them understand that what they consider normal -- because of their family context -- actually isn't at all."   On Mahe, a small, mountainous island with lush vegetation, most of the population lives near the water. Life is quiet here, without traffic, and the streets are mostly clean.

Poverty is largely hidden, concentrated in a few neighbourhoods behind faded walls or in the hills.   So why do so many Seychellois take drugs? The authorities admit they haven't quite figured it out, but say it appears that while poverty does not quite allow people to live well, it allows them enough money to buy drugs to forget their woes.   "The root of the cause, we're still working on it," said Herminie.   Early studies show that health and social problems associated with heroin use have declined since the government switched its response from punishment to prevention, officials say.

Crime has nearly halved and annual cases of new hepatitis C infections have fallen 60 percent.    Youth unemployment, meanwhile, has shrunk from 6.5 percent to 2.1 percent in recent years.   One recovering addict, a taxi driver who did not want to be named, offered a bleak assessment as he waited for his daily methadone in an empty car park in Les Mamelles.    "We're a small island in the middle of the ocean. What else is there to do here?" he said.
Date: Wed, 19 Feb 2020 16:12:54 +0100 (MET)
By Michael O'HAGAN

Otuke, Uganda, Feb 19, 2020 (AFP) - Under a warm morning sun scores of weary soldiers stare as millions of yellow locusts rise into the northern Ugandan sky, despite hours spent spraying vegetation with chemicals in an attempt to kill them.   From the tops of shea trees, fields of pea plants and tall grass savanna, the insects rise in a hypnotic murmuration, disappearing quickly to wreak devastation elsewhere.   The soldiers and agricultural officers will now have to hunt the elusive fast-moving swarms -- a sign of the challenge facing nine east African countries now battling huge swarms of hungry desert locusts.

They arrived in conflict-torn South Sudan this week, with concerns already high of a humanitarian crisis in a region where 12 million are going hungry, according to the UN's Food and Agriculture Organization (FAO).    "One swarm of 40 to 80 million can consume food" for over 35,000 people in a day, Priya Gujadhur, a senior FAO official in Uganda, told AFP.

In Atira -- a remote village of grass-thatched huts in northern Uganda -- some 160 soldiers wearing protective plastic overalls, masks and goggles sprayed trees and plants with pesticide from before dawn in a bid to kill the resting insects.   But even after hours of work they were mostly able to reach only lower parts of the vegetation.   Major General Kavuma sits in the shade of a Neem Tree alongside civilian officials as locusts sprayed with pesticide earlier that morning fall around them, convulsing as they die.   An intense chemical smell hangs in the air.

- 'They surrounded me' -
Zakaria Sagal, a 73-year-old subsistence farmer was weeding his field in Lopei village some 120 kilometres (75 miles) away, preparing to plant maize and sorghum, when without warning a swarm of locusts descended around him.   "From this side and this side and this side, they surrounded me," Sagal said, waving his arms in every direction.    "We have not yet planted our crops but if they return at harvest time they will destroy everything. We are not at all prepared."

East Africa's regional expert group, the Climate Prediction and Applications Centre (ICPAC), warned Tuesday that eggs laid across the migratory path will hatch in the next two months, and will continue breeding as the rainy season arrives in the region.   This will coincide with the main cropping season and could cause "significant crop losses... and could potentially worsen the food security situation", ICPAC said in a statement.

- 'Panic mode' -
Since 2018 a long period of dry weather followed by a series of cyclones that dumped water on the region created "excessively ideal conditions" for locusts to breed, says Gujadhur.    Nevertheless, governments in East Africa have been caught off guard and are currently in "panic mode" Gujadhur said.   The locusts arrived in South Sudan this week after hitting Ethiopia, Somalia, Kenya, Djibouti, Eritrea, Tanzania, Sudan and Uganda.   Desert locusts take over on a dizzying scale.

One swarm in Kenya reached around 2,400 square kilometres (about 930 square miles) -- an area almost the size of Moscow -- meaning it could contain up to 200 billion locusts.   "A swarm that size can consume food for 85 million people per day," said Gujadhur.   Ugandan authorities are aware that subsequent waves of locusts may pose problems in the weeks to come, but in the meantime they are attempting to control the current generation.

Gujadhur is quick to praise the "quite strong and very quick" response from the Ugandan government but is concerned that while the army can provide valuable personnel, a military-led response may not be as effective as is necessary.    "It needs to be the scientists and (agriculture officials) who take the lead about where the control operations need to be and how and when and what time," she said.

- 'They eat anything green' -
The soldiers have been working non-stop for two days, criss-crossing the plains on the few navigable roads, trying to keep up with the unpredictable swarms.    Major General Kavuma recognises that the biggest threat is from the eggs which are yet to hatch but is confident the army will be able to control this enemy.   "We have the chemicals to spray them, all we need is to map the places they have been landing and sleeping," he said.   "In two weeks time we will come back and by that time they will have hatched and that will be the time to destroy them by praying."

Back in Lopei village, Elizabeth Namoe, 40, a shopkeeper in nearby Moroto had been visiting family when the swarm arrived.   "When the locusts settle they eat anything green, the animals will die because they have nothing to feed on, then even the people (will suffer)," she said.   "The children will be affected by hunger and famine since all life comes from all that is green. I fear so much."
Date: Wed, 19 Feb 2020 12:55:06 +0100 (MET)

Beijing, Feb 19, 2020 (AFP) - China's President Xi Jinping called Wednesday for greater protection of medical staff fighting the new coronavirus after the deaths of prominent doctors sparked national anger at the government's handling of the outbreak.   At least seven medical workers have died from the virus, while 1,716 have been confirmed as infected, most at the epicentre of the epidemic in central Hubei province where hospitals have dealt with a huge influx of patients.

Staff have faced shortages of masks and protective bodysuits, with some even wearing makeshift suits and continuing to work despite showing respiratory symptoms, health workers have told AFP.   Xi said China must "strengthen efforts to relieve the stress of medical workers, provide them with daily necessities, arrange time for their rest and give them encouragement", the official Xinhua news agency reported.   Liu Zhiming, the director of Wuchang Hospital in Hubei's capital Wuhan, died Tuesday, more than a week after the death of whistleblowing ophthalmologist Li Wenliang in the same city prompted nationwide mourning and calls for political reforms.

- 'Majestic spirit' -
A paper published by China's Center for Disease Control and Prevention said an additional 1,300 health workers may have been infected but have yet to receive a diagnosis.   Xi said China must ensure medical teams in Hubei and Wuhan "carry out work in a safe, orderly, coordinated, effective and swift manner", Xinhua reported.   The deaths of frontline medical workers "reflected doctors' humane and majestic spirit", Xi said.   The death toll from the virus jumped past 2,000 on Wednesday, while 74,185 cases of infection have been confirmed in mainland China.
Date: Wed, 19 Feb 2020 12:19:59 +0100 (MET)

Tehran, Feb 19, 2020 (AFP) - Two people in Iran tested positive Wednesday for the deadly new coronavirus, the health ministry said, in the Islamic republic's first cases of the disease.   Kianoush Jahanpour, a ministry spokesman, said the cases were detected in the holy city of Qom, south of the Iranian capital.   "In the past two days, some suspect cases of the new coronavirus were observed in Qom city," he said, quoted by state news agency IRNA.

"Teams were dispatched after receiving the reports, and based on the existing protocols the suspect cases were isolated and tested," said Jahanpour.   "Out of the samples sent, a laboratory tested two of them as positive for coronavirus just minutes ago and some of the other samples were type B influenza."

The health ministry spokesman said additional tests were being done on the two cases and final results would be announced "as soon as possible".   The new coronavirus epidemic has killed more than 2,000 people in China and infected more than 74,000. It has spread to at least two dozen countries.   The United Arab Emirates was the first country in the Middle East to report cases of coronavirus last month.
Date: Tue 18 Feb 2020
Source: CIDRAP (Center for Infectious Disease Research & Policy) News [edited]

The WHO's African regional office said that both Chad and the Central African Republic (CAR) are in the midst of measles outbreaks, with both countries reporting increasing case counts since [1 Jan 2020].

In Chad, 1276 cases, including 14 deaths have been reported since 1 Jan 2020, with 352 suspected measles cases and 4 deaths reported in the week ending on 9 Feb 2020.  "Most, 78%, of the investigated cases never received any vaccination against measles," the WHO said. "60% of the investigated cases were under 5 years of age while 19% were between 5 and 14 years and 14% were 15 years and above."

In CAR, a total of 1498 suspected measles cases, including 15 deaths, have been recorded since [1 Jan 2020]. The outbreak has been ongoing since early 2019. From 1 Jan 2019, through 9 Feb 2020, a total of 5724 suspected measles cases, including 83 deaths (case fatality rate, 1.45%) have been reported in 13 health districts.  Almost 3/4 of the cases (72%) are in children under the age of 5.
=======================
[HealthMap/ProMED-mail maps
Central African Republic: <http://healthmap.org/promed/p/6>]
Date: Wed 19 Feb 2020
Source: Circular/News, Veterinary Services, Israel's Ministry of Agriculture [in Hebrew, trans. Mod.AS, edited]

Rabies, Case No. 6 for 2020, dog, Ramot Naftali, Upper Galilee. Reference: Kimron Vet Institute [KVI] Laboratory Test No. A00373420, dated 19 Feb 2020
---------------------------------------
On 17 Feb 2020, a dead dog was brought for examination to the KVI [at Beit-Dagan]. The dog died while being transported to a rabies observation kennel since, as reported, it had attacked grazing cattle and attempted to attack people.  It was also reported that the dog had bitten itself. The tested animal has been diagnosed rabies positive.  [Byline: Dr. Avi Wasserman Head, Field Veterinary Services (acting)]
====================
[The above and 5 earlier rabies cases in Israel since 1 Jan 2020 are located within a small region along the Lebanese border, facing Lebanon's governorate A-Nabatieh. See the rabies map (2020) at <https://moag.maps.arcgis.com/apps/webappviewer/index.html?id=a6d8aae5cbc04c958d5efefd2724318f>.

The 2019 map, presenting a total of 17 cases, is available at

The 6 cases during 2020 are: 3 jackals, 2 dogs, 1 cow. Most likely, rabies is currently circulating within the Lebanese side of the border.

It would be interesting to note whether the rabid dog was owned and, in case affirmative, whether and when this dog was last vaccinated against rabies, as prescribed by law. Israel's owned dogs are included in the national dog registry, currently counting more than 400,000 dogs. - ProMED Mod.AS]
Date: Tue 18 Feb 2020
Source: Qatari Ministry of Public Health [edited]

The Ministry of Public Health (MOPH) declared that a case of Middle East respiratory syndrome (MERS) has been confirmed. The case is a male citizen aged 65 years who has been suffering from several chronic diseases. The patient has been admitted to the hospital to receive the necessary medical care in accordance with the national protocol to deal with confirmed or suspected cases of the disease.

The Ministry of Public Health, in cooperation with the Ministry of Municipality and Environment, is taking all necessary preventive and precautionary measures to control the disease and prevent it from spreading.

MERS is a viral respiratory disease that is caused by one of the coronaviruses (MERS-CoV), but it differs from the novel coronavirus, known as COVID-19, which has recently spread in several countries. Both viruses differ in terms of the source of infection, mode of transmission, and the disease severity. The Ministry of Public Health confirms that no cases of the novel coronavirus (COVID-19) have been diagnosed in Qatar so far.

Only 3 cases of MERS-CoV were registered in Qatar during the past 2 years. The Ministry of Public Health calls on all members of public, and especially people with chronic diseases or those with immunodeficiency disorders, to adhere to public hygiene measures. This includes washing the hands regularly with water and soap, using hand sanitizers, as well as avoiding close contact with camels and seeking medical advice when experiencing symptoms of fever, cough, sore throat, or shortness of breath.

The Rapid Response Team of the Health Protection and Communicable Disease Control is available round-the-clock to receive notifications or inquiries related to communicable diseases on its hotline numbers 66740948 or 66740951.
======================
[In early December 2019, Qatar reported 3 cases of MERS-CoV infection, a fatal case and 2 asymptomatic contacts of the fatal case. The fatal case denied a history of contact with camels or recent travel. She did have a history of underlying medical conditions (which may have led to contact with the health sector in the 2 weeks prior to onset of illness). Prior to these cases, the most recent report of a case of MERS-CoV infection in Qatar was in 2017 when there were 3 cases reported (see prior ProMED-mail posts listed below.)

The location of residence of this patient was not available, nor were other epidemiological variables, including possible high risk exposures.

The HealthMap/ProMED-mail map of Qatar is available at