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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Mon, 12 Feb 2018 05:54:19 +0100

San Juan, Feb 12, 2018 (AFP) - Most of San Juan and a strip of northern Puerto Rico municipalities were plunged into darkness Sunday night after an explosion at a power station, five months after two hurricanes destroyed the island's electricity network.

The state electric power authority (AEE) said the blast was caused by a broken-down switch in Rio Piedras, resulting in a blackout in central San Juan and Palo Seco in the north.   "We have personnel working to restore the system as soon as possible," the AEE said.   San Juan's mayor, Carmen Yulin Cruz, said on Twitter that emergency services and local officials attended the scene in the neighbourhood of Monacillos, but no injuries were reported.

Meanwhile, the Puerto Rican capital's airport said it was maintaining its schedule using emergency generators.   The blackout comes as nearly 500,000 of AEE's 1.6 million customers remain without power since Hurricanes Irma and Maria struck the US territory in September 2017.   AEE engineer Jorge Bracero warned on Twitter that the outage was "serious," and advised those affected that power would not be restored until Monday.
Date: Wed, 13 Dec 2017 03:08:12 +0100
By Leila MACOR

Fajardo, Puerto Rico, Dec 13, 2017 (AFP) - Until Hurricane Maria hit Puerto Rico, Jose Figueroa did brisk business renting kayaks to tourists itching to see a lagoon that lights up by night thanks to millions of microorganisms.   Today, things are so dire he's considering selling water to motorists stopped at red lights.   "Now we are trying to survive," the 46-year-old tour guide said.

It used to be that visitors had to reserve a month in advance to get one of his kayaks and paddle around in the dark on the enchanting, bioluminescent body of water called Laguna Grande.   But tourists are scarce these days as the Caribbean island tries to recover from the ravages of the storm back in September.   "We do not know if we will have any work tonight," Figueroa said. "Last week, we worked only one day."    He and another employee of a company called Glass Bottom PR are cleaning kayaks on the seaside promenade of Fajardo, a tourist town in eastern Puerto Rico whose main attraction is the so-called Bio Bay.

The year started off well for Puerto Rico, with the global success of the song "Despacito" by local musicians Luis Fonsi and Daddy Yankee.   The catchy tune helped promote the US commonwealth island of 3.4 million people, which is saddled with huge debts and declared bankruptcy in May.    But the hurricane turned what should be an island bustling with tourists into one with deserted beaches, shuttered restaurants and hotels full of mainland US officials working on the rebuilding of the island.   "What few tourists we have are the federal officials themselves," said Figueroa.

- Locals only -
The grim outlook spreads up and down the seaside promenade of Fajardo, where many restaurants are closed because there is no electricity.   On this particular day around noon, the only restaurant open is one called Racar Seafood. It has its own emergency generator.   "We get by on local tourists," said its 61-year-old owner, Justino Cruz.   "Our clients are local -- those who have no electricity, no generator, cold food or no food."

Puerto Rico's once-devastated power grid is now back up to 70 percent capacity, but this is mainly concentrated in the capital San Juan.   So while inland towns that depend on tourism are struggling mightily, things are getting better in San Juan as cruise ships are once again docking.   On November 30, the first cruise ship since the storm arrived with thousands of vacationers on board. They were received with great fanfare -- quite literally, with trumpet blaring and cymbals crashing.

- Pitching in to help -
The World Travel & Tourism Council, based in London, says tourism accounted for about eight percent of Puerto Rico's GDP in 2016, or $8.1 billion.   Hurricane Maria's damage has been uneven. Although some tour guides now have no work and many eateries are shut down, hotels that have their own generators are doing just fine.   Thanks to the thousands of US government officials and reconstruction crew members that came in after the storm, the hotels that are open -- about 80 percent of the total -- are pretty much full.

These people are starting to leave the island this month but hotels may receive tourists around Christmas, at least in San Juan, where power has for the most part been restored.   The hurricane "undoubtedly cost billions in lost revenue," said Jose Izquierdo, executive director of the Puerto Rico Tourism Company.    But Izquierdo nevertheless says he is "optimistic" and suggests an alternative: put tourists to work as volunteers in the gargantuan reconstruction effort that the island needs.   "We want to look for travellers who want to travel with a purpose, who might have the commitment to help rebuild," said Izquierdo.

The program, called "Meaningful Travel" and launched in mid-November, organizes trips on which residents, Puerto Ricans living abroad and tourists are invited to help the island get back on its feet.   "The plan aims to create empathy with this tourist destination," said Izquierdo.    "We want to be like New Orleans after Katrina, where 10 years after the hurricane, tourism is the driving force of its economy. We want to build that narrative of recovery," he added.   "There are different ways in which the world wants to help Puerto Rico. The best way is to visit us."
Date: Thu, 9 Nov 2017 12:39:04 +0100
By Marcos PÉREZ RAMÍREZ

San Juan, Nov 9, 2017 (AFP) - Andrea Olivero, 11, consults her classmate Ada about an exercise during their daily English class at San Juan's Sotero Figueroa Elementary School. The task: list the positive and negative aspects of Hurricane Maria's passing almost two months ago.

The girls only have to look around. There is no electricity and they "roast" in the heat, Andrea says. At the back of the room, computers and televisions collect dust.   "We would like to move past the topic of the hurricane a bit. It is already getting repetitive," Andrea told AFP.   She is one of more than 300,000 pupils in the public education system, although only half of schools are functioning. Barely 42 per cent of Puerto Ricans have electricity seven weeks after Maria struck, killing at least 51 in the American territory.

The lack of power has prompted disorienting timetable changes on the tropical island, to avoid both the hottest hours of the day and the use of dining facilities.   "The children are very anxious. We manage to make progress in lessons and they change the hours again. Everything is messed up and we fall behind," English teacher Joan Rodriguez explained.   "We can't use the computers to illustrate classes," she said. "They are reading the novel "Charlotte's Web," and we wanted to do exercises comparing it to the film version. But we cannot use the television.

- Suspicions -
From October 23, some directors reopened their schools in the western region of Mayaguez and San Juan.   But last Thursday, the Department of Education ordered their closure, insisting they must be evaluated by engineering and architectural firms, then certified by the US Army Corps of Engineers.   One of those schools was Vila Mayo, also in San Juan. The community presumed it would open, as it had been used as a shelter, its electrical infrastructure had been inspected and it had not suffered structural damage.

But Luis Orengo, the education department's director in San Juan, told protesters outside the school it was closed as inspectors' findings had not reached the central government.   "This is unacceptable! The school is ready to give classes but they don't want to open it. Our children cannot lose a year," fumed Enid Guzman, who protested with her 11-year-old son, Reanny De la Cruz.   There are suspicions the stalled reopening of schools is, in part, related to the prior closure of 240 schools over the past year during Puerto Rico's long-running financial crisis.   The fiscal difficulties have seen the island's population drop over the past decade by 14 percent, leading in turn to a fall in school enrolment.

Before the storms, 300 schools were at risk of closure -- and for the president of Puerto Rico's federation of teachers, Mercedes Martinez, the government's aim is clear.   "Secretary (Julia) Keleher seems to have an orchestrated plan to close schools," she said, referring to the education secretary. "Why do you have to wait 30 days to get a certification so a school can open?"   Keleher has announced she expects most schools to be open by the middle of November.
Date: Tue 24 Oct 2017
Source: KFOR Oklahoma News4 [edited]

Puerto Rico has reported at least 76 cases of suspected and confirmed leptospirosis, including a handful of deaths, in the month after Hurricane Maria, said Dr. Carmen Deseda, the state epidemiologist for Puerto Rico.

Two deaths involved leptospirosis confirmed through laboratory testing, and "several other" deaths are pending test results, Deseda said. The 76 cases, up from 74 last week, also include one patient with confirmed leptospirosis who is currently hospitalized.

The island typically sees between 63 and 95 cases per year, she said. Health officials had expected that there would be a jump after the hurricane. "It's neither an epidemic nor a confirmed outbreak," Public Affairs Secretary Ramon Rosario Cortes said at a news conference Sunday [22 Oct 2017]. "But obviously, we are making all the announcements as though it were a health emergency."

Leptospirosis may be treated with antibiotics, but many people recover on their own. "The majority of leptospirosis cases is a mild, subclinical disease with no complications," Deseda said. "But one out of 10 people who have leptospirosis develop severe illness." In the 1st stage of leptospirosis, symptoms vary widely from fever and headache to red eyes and rashes. Some people may have no symptoms at all. But a small number will develop dire complications: meningitis, kidney and liver damage, bleeding in the lungs and even death.

Doctors are required to report any potential leptospirosis cases to health authorities, Deseda said. Those cases must then be tested to confirm the bacteria, since the symptoms can be difficult to tell apart from other illnesses. After that, health officials may look for patterns or clusters and determine whether there is an outbreak.

The lab tests on the suspected cases have been sent to the US Centers for Disease Control and Prevention, Deseda said. The turnaround time is about 5-6 days.

Doctors on the island have expressed concerns about burgeoning health crises amid hospitals that are overwhelmed, undersupplied and sometimes burning hot. Influenza is another concern on the horizon, Deseda said. Drinking water is also hard to come by on many parts of the island.

Dr. Raul Hernandez, an internist in San Juan, told CNN that people were drinking water from whatever sources they could find, such as rivers and creeks. If that water contains urine from a [leptospirosis-infected rat], those people will be at risk, he said.

Deseda said people should be discouraged from walking barefoot, drinking or swimming in potentially leptospirosis-contaminated waters.

"These diseases are everywhere, and there's a way to prevent them," she said.
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[Leptospirosis is a zoonotic, spirochetal infection that occurs worldwide and is transmitted to humans by exposure to soil or fresh water contaminated with the urine of wild and domestic animals (including dogs, cattle, swine, and especially rodents) that are chronically infected with pathogenic _Leptospira_. _Leptospira_ may survive in contaminated fresh water or moist soil for weeks to months. Outbreaks of leptospirosis frequently follow heavy rainfall, flooding with fresh water, and increasing rodent numbers.

Parts of Puerto Rico saw more than 30 inches of rain and consequent flooding with recent Hurricane Maria. A map showing the estimated rainfall across Puerto Rico with this hurricane is available at <https://twitter.com/NWSSanJuan/status/910983698597777409/photo/1?ref_src=twsrc%5Etfw&ref_url>.

With continued absence of potable water, inadequate sanitation, and flooding in the streets for a large proportion of the population in Puerto Rico, food- and water-borne diseases, like leptospirosis, will be a major problem. - ProMED Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Thu, 19 Oct 2017 16:37:27 +0200
By Ricardo ARDUENGO, con Nelson DEL CASTILLO en San Juan y Leila MACOR en Miami

Utuado, Puerto Rico, Oct 19, 2017 (AFP) - It's been a month since Hurricane Maria ripped through Puerto Rico and Samuel de Jesus still can't drive out of his isolated, blacked-out town.   In fact, much of the US territory in the Caribbean is still a crippled mess four weeks after that fierce Category Four storm.

The bridge connecting Rio Abajo to the rest of the island was swept away when Maria slammed the island on September 20. For two weeks Rio Abajo, located in a mountainous region in central-western Puerto Rico, was cut off and forgotten, without power or phone service.   "We didn't know what to do. We were literally going crazy," said de Jesus, 35.   "Those were difficult, desperate days. We could not find a way out, and the hurricane caused extensive damage," he told AFP.

During the two long weeks following Maria, the 27 families living in Rio Abajo saw their supplies quickly deplete.   De Jesus, who has diabetes, needed to keep his insulin refrigerated. The storm blew away the island's already decrepit power grid, so people resorted to emergency generators.   "But I was running out of gasoline to run the generator," he said.   A helicopter now makes regular deliveries of food, water and medicine because with the bridge washed out, there is no other way in or out of town.

People can't wade across the river because it is contaminated with human waste after a pipe broke when the bridge went.   Some brave souls use a precarious ladder rigged to get across the water, but for most people it is too dangerous.   We need a bridge "to take out our vehicles and leave in case of emergency, or if there is a landslide," he said.   Where the bridge once stood, residents set up a system of ropes, pulleys and buckets to move supplies over the river, which has been contaminated with sewer water since the hurricane.   Over the remains of the bridge locals hung the single-star, red, white and blue flag of Puerto Rico and a sign that reads "the campsite of the forgotten."

- Desperate need for electricity -
Puerto Rico Governor Ricardo Rossello visited the surrounding municipality of Utuado on Wednesday to deliver supplies, but he did not stop in Rio Abajo.   "Utuado is certainly one of the most severely affected municipalities in all of Puerto Rico," Rossello said.   "Our commitment is to give it support and aid during the whole road to recovery."   Eighty-one percent of Puerto Rico remains blacked out one month after Maria struck. Clean water for drinking, cooking and bathing is scarce, too.

Puerto Ricans' main obstacle to getting back to some semblance of normality is the slowness of the Puerto Rico Electric Power Authority in getting the power grid back up and running.   The lack of power has paralyzed a key industry -- pharmaceutical production -- and most businesses including restaurants are closed or operating at great cost through the use of diesel powered generators.

This nightmare comes about a year after the US government established an external fiscal control board for the island after it declared bankruptcy because of 73 billion dollars in debt.   Economist Joaquin Villamil told AFP that damage from Hurricane Maria is estimated at 20 billion dollars -- four times that of Hurricane Georges in 1998, when measured in 2016 dollars.

Villamil said reconstruction money provided by the Federal Emergency Management Agency and from insurance companies will have a positive impact on the island's economy in the second half of fiscal 2018 and in fiscal 2019, but this boost will just be temporary.   "From an economic point of view there is not much net gain," said Villamil, who works for a consulting firm called Estudios Tecnicos.   He said the economy has been shrinking since 2006 and Maria will delay any prospect of recovery.   It will take at least until 2026 to get back to the GDP level of 2006, he added.

Making things worse, people are leaving the island for the mainland US. Forecasts are that the population now at 3.4 million will go down to 3.1 million or even less by 2026, said Villamil.   The government of Florida estimates that since October 3 -- the day a state of emergency to deal with an influx of Puerto Ricans was declared -- more than 36,000 people from the island have poured in.
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Benin

Benin - US Consular Information Sheet
April 28, 2008

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

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

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

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

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

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

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

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

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

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

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

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

See our information on Victims of Crime.

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

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

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Malta

Malta US Consular Information Sheet
November 26, 2008

COUNTRY DESCRIPTION:
Malta is a small, developed, democratic Mediterranean island nation, positioned as a cultural stepping-stone between Europe and North Africa.
Malta became
a member of the European Union with nine other new member states on May 1, 2004, and became a full member of the Schengen area in March 2008.
Tourist facilities of all categories are widely available.
Read the Department of State Background Notes on Malta for additional information.

ENTRY/EXIT REQUIREMENTS:
Malta is a party to the Schengen agreement.
As such, U.S. citizens may enter Malta for up to 90 days for tourist or business purposes without a visa.
The passport should be valid for at least three months beyond the period of stay.
For further details about travel into and within Schengen countries, please see our fact sheet.
For further information concerning entry requirements for Malta, travelers should contact the Embassy of Malta at 2017 Connecticut Avenue, NW, Washington DC
20008, tel.: (202) 462-3611, web site: http://www.foreign.gov.mt/default.aspx?MLEV=47&MDIS=505, or the Maltese Consulate in New York City, tel.: (212) 725-2345.

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:
Malta remains largely free of terrorist incidents. No indigenous terrorist or extremist groups are known to be active in Malta, and no foreign terrorist organization has carried out an attack against U.S. interests in Malta in recent years.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s web site at http://travel.state.gov 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. and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

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

CRIME:
Malta has a low rate of violent crime.
Theft of unattended personal property and car stereos from vehicles is a common problem.
Visitors are strongly encouraged to secure their valuables, and be aware of pickpockets and purse snatchers.
Such criminals focus on areas and establishments frequented by tourists.
Caution is particularly urged in the Paceville nightclub area, where excessive drinking and poor crowd control have led to instances of violent behavior.
Poverty, homelessness, and panhandling are almost non-existent in Malta.
All visitors to Malta should practice the same good, common sense personal security precautions that are part of everyday life in urban areas within the U.S., particularly when spending time in areas frequented by tourists.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. The crime victim’s assistance agency is ‘APPOGG’- Support Line, tel: 179;
web site: www.appogg.gov.mt.
To learn about resources in the U.S. if you are the victim of a violent crime overseas, please also see our information on Victims of Crime.

The local equivalents to the “911” emergency line in Malta are: Police 191; Ambulance 196; Fire 199.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is available through public and private hospitals.
The quality of medical care in Malta is excellent.
Private hospitals generally offer a higher standard of service than the public hospitals, and the majority of the best doctors practice in private medical facilities.

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
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Malta.
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 Malta is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Traffic in Malta flows on the left, requiring attentiveness and caution from visitors from right-hand drive countries such as the United States.
In addition, drivers may be erratic or undisciplined. Roads flood easily, and are often narrow, winding, and congested, with poor visibility around curves.
Traffic arteries are prone to bottlenecks and accidents.
Buses are the primary means of public transportation.
Though the bus fleet is being modernized, most buses are old, cramped, and not air-conditioned.
Taxis are safe but expensive and are not metered; it is a good practice to agree with the driver in advance on the charge.

Please refer to our Road Safety page for more information.
There is a Malta Tourist Information Office located at Freedom Square Valletta, tel. 21-237-747, web site: http://www.visitmalta.com/getting-around
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Malta’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Malta’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:
Malta customs authorities may enforce strict regulations concerning currency restrictions and temporary importation into or export from Malta of items such as firearms, antiquities, and any item that might be deemed to have resalable value.
It is advisable to contact the Embassy of Malta in Washington or the Consulate of Malta in New York City for specific information regarding customs requirements.
Malta’s customs authorities encourage the use of an ATA (Admission Temporaire/Temporary Admission) Carnet for the temporary admission of professional equipment, commercial samples, and/or goods for exhibitions and fair purposes.
ATA Carnet Headquarters located at U.S. Council for International Business, 1212 Avenue of the Americas, New York, N.Y. 10036, issues and guarantees the ATA Carnet in the United States.
For additional information call (212) 354-4480, send an e-mail to atacarnet@uscib.org or visit http://uscib.org for details.

For more 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 Malta’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Malta are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in illicit 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 Malta 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 Malta.
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 on the third floor of the Development House, St. Anne Street, Floriana, Valletta, telephone (356) 2561-4000.
The Consular Section’s telephone number is (356) 2156-4115, fax: (356) 2124-3229, web site: http://malta.usembassy.gov/uscit_intro.html.
The Consular Section is open to the public Monday, Wednesday, and Friday from 8:00 a.m. to 11:00 a.m.
* * *
This replaces the Country Specific Information for Malta dated April 29, 2008, to update sections on Safety and Security and Exit and Entry Requirements.

Travel News Headlines WORLD NEWS

Date: Fri 16 Aug 2019
Source: Times of Malta [abridged, edited]

The number of measles cases in Malta has soared to an unprecedented level this year [2019], with 30 cases reported in the 1st 6 months, according to the World Health Organisation.

Data recently published by the health body showed that the figures until June 2019 are in stark contrast to those for the previous years. According to the WHO data, between 2011 and 2018, there were only 11 cases reported. There were no cases reported in a number of these years, and, between 2012 and 2017, there were only 2 cases reported, one in 2013 and another 2 years later.

Earlier this year [2019], the WHO had flagged the issue [slipping vaccine rates] with a rapid increase in measles cases on a global level. At the time, preliminary figures had shown that measles cases rose 300% worldwide through the 1st 3 months of 2019 when compared to the same period last year [2018].

According to the Superintendent of Public Health, Charmaine Gauci, after a number of years with no cases of the disease, in 2018, there were 5 imported cases and one local transmission.

Most of the cases occurred in adults who were not vaccinated. "This year [2019], we have already seen over 15 locally acquired cases. Most of the cases occurred in adults who were not vaccinated," Dr Gauci said when the preliminary figures came out.

In its report on this year's [2019] data, the WHO noted a "dramatic resurgence of measles compared to previous years" in the European region, with 49 of the 53 countries in the region together having reported over 160 000 measles cases and over 100 measles-related deaths by the end of May 2019.

"High national-level coverage can mask pockets of low coverage at the local level, resulting in an accumulation of susceptible individuals that often goes unrecognised until outbreaks occur. An enhanced response is needed to protect all populations in the region from this dangerous disease," WHO said. It has set the ambitious goal of achieving measles and rubella elimination in at least 5 of its regions by 2020.  [Byline: Claire Caruana]
Date: Sun 29 Jul 2018 17:28 CEST
Source: Times of Malta [summ., edited]

The number of salmonellosis cases reported to the health authorities so far in July 2018 has surpassed that in previous years, peaking at 20 cases in July alone.

Figures supplied to The Sunday Times of Malta by the health authorities showed that so far this month [July 2018], 20 cases of the food poisoning infection have been reported, up from 11 in 2017. Since the beginning of 2018, 67 cases have been brought to the authorities' attention.

Salmonellosis is a type of foodborne illness caused by bacteria and is often more common in summer. The infection is contracted when food contaminated with the bacteria is consumed, with young children, older adults, and those with impaired immune systems being more susceptible to severe infection. Symptoms include diarrhoea, fever, and abdominal cramps and usually develop 12 to 72 hours after the infection is contracted. It usually lasts 4 to 7 days.

Just this week, the health authorities confirmed _Salmonella_ had been found in eggs from St Joseph Farm [Southern region] during sampling by the veterinary authorities as part of the Veterinary National Control programme for _Salmonella_. Eggs packed by this farm have since been recalled, with the public being advised not to consume them. The Superintendent of Public Health warned that food that has been listed as recalled should not be consumed, while the general handling of eggs should also be done with caution.

Eggs, she said, should always be cooked until both the yolk and the white are firm, while egg dishes should be cooked to an internal temperature of 71 deg C [160 deg F] or hotter. The eggs used in sauces or any other items that contain raw or lightly-cooked eggs should be pasteurized, Dr Gauci said. Hands, and any implements that come in direct contact with raw eggs, should always be thoroughly washed.  [Byline: Claire Caruana]
============================
[While undercooked eggs are a common source for human salmonellosis, it is not unclear if the finding of contaminated eggs on Malta is related to the upswing of human cases. No information is given regarding the human and egg isolates to assess if they are related. - ProMED Mod. LL]

[HealthMap/ProMED-mail map of Il-Hamrun, Malta:
Date: Mon 13 Mar 2018
From: Christian Lenart <christian@lenart.at> [edited]

We report a case of _Leishmania donovani_/_L. infantum_ in a 56-year-old man from Austria. He travelled to Malta in June 2017 and complained about itchy, partly exulcerated papules in November 2017. His wife too was suffering from the same lesions but did not consult a dermatologist, since the lesions regressed spontaneously.

The patient first contacted a dermatologist, who performed an excision showing _Leishmania_ negative granulomatous inflammation as a histological result. He was then referred to the dermatological ward of the municipal hospital. The lesions were up to 2 cm [0.8 in] in size, disseminated on all extremities.

Another excision was performed, showing plenty of amastigotes affected macrophages. He then was checked for signs of visceral manifestation, but showed no hepatosplenomegaly. The blood sample showed no conspicuity with normal haematological results and normal CRP [C-reactive protein]. The PCR test for _Leishmania_ sp. DNA was positive.

The Western blot (IgG) was positive as well, whilst immunoaffinity chromatography was negative. Skin biopsy genotyping proved a diagnosis of _Leishmania infantum_/_L.donovani_. Since the patient had multiple lesions treatment with miltefosine was initiated.

Leishmania in Malta
-----------------------------------------
While especially leishmaniasis was quite common in the early 20th century in Malta, there were hardly any cases of cutaneous leishmaniasis at the end of the century. For the last years the incidence has been stable with about 3 to 4 cases of visceral leishmaniasis, VL, per year (1).  In 2012, 3 VL and no CL cases were reported (2). All cases of leishmaniasis are caused by _L. infantum_ in Malta, transmitted from dogs to humans by _Phlebotomus perniciosus_. The 2 identified zymodemes in Malta are MON 1, causing visceral and MON 78, causing cutaneous leishmaniasis (3).

References
---------------------------------------
1. Alvar J, Vélez ID, Bern C, et al and the WHO Leishmaniasis Control Team. Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012; 7(5): e35671. doi: 10.1371/journal.pone.0035671; available at <http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035671>.
2. Government of Malta, Ministry for Health, the Elderly and Community Care: Annual report 2012; p. 46; available at <https://www.gov.mt/en/Government/Publications/Documents/Annual%20Reports/MHEC.pdf>.
3. Pace D, Williams TN, Grochowska A, et al. Manifestations of paediatric _Leishmania infantum_ infections in Malta. Travel Med Infect Dis. 2011; 9(1):37-46. doi: 10.1016/j.tmaid.2010.11.005; available at <http://www.travelmedicinejournal.com/article/S1477-8939(10)00196-1/fulltext>.
--------------------------------------
Dr Christian Lenart
Department of Emergency Medicine
Krankenhaus Hietzing (Municipal Hospital Vienna-Hietzing)
Austria
christian@lenart.at
===============================
[Leishmaniasis is endemic in Malta and cases imported from Malta to other countries are not unusual. _Leishmania infantum_ usually results in visceral leishmaniasis and the genotyping in this case could not distinguish between _L. donovani_/_L. infantum_. Miltefosine is the drug of choice for cutaneous leishmaniasis. - ProMED Mod.EP]

[HealthMap/ProMED-mail maps: Austria: <http://healthmap.org/promed/p/63886> Malta: <http://healthmap.org/promed/p/77>]
Date: Tue, 20 Feb 2018 18:18:07 +0100

Valletta, Feb 20, 2018 (AFP) - Malta International Airport was brought to a standstill on Tuesday by a fire that left flights suspended and hundreds of passengers stranded.   Passengers were evacuated from the airport as smoke billowed through the arrivals and departure lounges, an AFP reporter at the scene said.   Firefighters worked for two hours to put out the small blaze, which began at around 1:15 pm and caused no injuries.

Airport operators said 10 outbound international flights were delayed. They added later in an online statement that operations at the terminal were resuming.   The airport said the blaze broke out in the pump room for the airport's small aquarium, located in the arrivals concourse.   "Terminal operations are now resuming, and Malta International Airport's recovery plan has been activated," it said in a statement in the late afternoon.

Hundreds of passengers were left standing outside the airport and some even on the apron.   One flight to nearby Catania in Sicily was expected to take off 11 hours later than scheduled, according to the departures timetable.   Flights to Stockholm, Cyprus, Krakow, London Gatwick and Dublin were also delayed.   Flights from British airports Heathrow and Gatwick were diverted to Catania.
Date: Fri 24 Feb 2017
Source: Times of Malta [edited]

The meningitis B vaccine shortage [is] likely to persist. Malta will have to wait its turn, manufacturers say. Global demand for the vaccine outstrips supply, manufacturers say.

A one-year-old baby died of [meningococcal] meningitis [serogroup] B, a disease against which vaccines are currently unavailable, this newspaper is informed. Sources said the baby died last month [January 2017] after contracting the disease that affects the lining around the brain and spinal cord. The Central Procurement and Supplies Unit (CPSU) was informed that the local agent for the meningitis B vaccine had a stock of vaccines available in a number of local pharmacies, a Health Ministry spokeswoman said.

The representatives of international pharmaceutical company GlaxoSmithKline (GSK) in Malta were in liaison with their suppliers to hasten further delivery, and the CPSU was in liaison with both companies to monitor the situation, the spokeswoman added.

The ministry was also asked about the baby's death, but no reference was made to it in its reply late yesterday [23 Feb 2017] evening.

The government does not supply the vaccine against the specific strain that affected the infant, which can, however, be purchased from private hospitals and pharmacies. Paediatricians said private hospitals had purchased the vaccine from pharmacies abroad, but these too had since run out.

According to one paediatrician, the unavailability of such a vaccine in light of the baby's death was very worrying, particularly to parents. Another paediatrician, however, warned against the matter getting out of hand, saying the issue was not as worrying as parents were making it out to be. Babies who were not vaccinated were not in any immediate danger, he said.

A spokeswoman for the local representative of GSK confirmed that the vaccine was not available and it would not be for some time. She said no fixed date had yet been given as to when a supply would be made available to the local market. According to the spokeswoman, the vaccine was in high demand all over the world, and as GSK [GlaxoSmithKline] had agreements with a number of governments abroad, supplies would be shipped to these countries 1st. At present, demand exceeded the quantity manufactured.

"It's important to understand that, in these cases, we need to stock enough for boosters, so before sufficient doses are available, this will not be made available," the GSK spokeswoman said.

According to the Maltese Paediatric Association, about 10 cases of meningitis have been reported among children. The signs of meningitis are fever, severe headache, neck stiffness, vomiting, dislike of bright light and drowsiness. Infants and younger children may not always show such symptoms but, instead, feed poorly or become very lethargic.  [Byline: Claire Caruana]
===================
[Although there are at least 13 _ Neisseria meningitidis_ serogroups, based on the antigenic specificity of their capsular polysaccharides, disease due to serogroups A, B, C, Y, and W is most common. Meningococcal vaccines contain capsular polysaccharide for _Neisseria meningitidis_ serogroups A, C, Y, and W, either alone or conjugated to protein. The conjugate capsular polysaccharide vaccines are preferable, because, unlike the polysaccharide vaccines, conjugate vaccines immunize infants, reduce the carriage of meningococci in the throat and thus its transmission, as well as confer a more sustained immune response, and, therefore, longer-term protection than the polysaccharide vaccines.

Serogroup B vaccines are based upon meningococcal B outer membrane vesicle protein antigens, because group B polysaccharide is poorly immunogenic in humans and is a potential auto-antigen. At least 2 serogroup B meningococcal vaccines -- Bexsero (GlaxoSmithKline, GSK) and Trumenba (Pfizer) -- are available.

Meningococcal disease often occurs without warning and frequently progresses rapidly to death, even when it is treated appropriately. In addition, about 10-20 percent of survivors of meningococcal disease will suffer disabilities such as hearing loss, brain damage, and amputations. Vaccines are used to prevent meningococcal disease, not treat someone already ill from the disease. Immunity following use of a meningococcal vaccine is specific for the type of capsular polysaccharide the vaccine contains regarding the A, C, Y, and W polysaccharide or conjugate vaccines or the surface proteins regarding serogroup B vaccines, with no cross-protection against infection due to other meningococcal groups.

Vaccines are frequently used to prevent spread of meningococcal disease in the face of an institutional or community outbreak (<https://www.cdc.gov/meningococcal/downloads/interim-guidance.pdf>). Antibiotics are also used to prevent spread of meningococcal disease in persons who are at high risk because they have been in close contact (coughing or kissing) or lengthy contact, especially among people living in the same household.

According to the 2017 Malta National Immunization Schedule, meningococcal vaccines are not included in the series of vaccines for infants and children (<https://health.gov.mt/en/phc/pchyhi/Pages/National-Immunisation-Schedule.aspx>). In the U.S., vaccination against meningococcal disease due to serogroups A, C, Y, and W is only recommended for children aged 2 months through 10 years who are at increased risk for meningococcal disease, i.e., have complement component deficiencies, have functional or anatomic asplenia (including sickle cell disease), are in the risk group for an outbreak for which vaccination is recommended, or are traveling to or residing in regions where meningitis is epidemic or hyper-endemic (for specifics, see Table at <https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6324a2.htm#Tab>). The serogroup B vaccines Bexsero and Trumenba have been licensed by the U.S. Food and Drug Administration (FDA) only for individuals aged 10 through 25 years. However, the European Medicines Agency has approved Bexsero for use in individuals of 2 months of age and older, and Bexsero has been added to the routine childhood immunization schedule in the UK and Ireland (<http://www.meningitis.org/menb-vaccine>).

Malta, a member of the EU, is a southern European island country consisting of an archipelago in the Mediterranean Sea, 80 km (50 miles) south of Italy, with a population of just under 450,000 residents (<https://en.wikipedia.org/wiki/Malta>). - ProMED Mod.ML]

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

Trinidad and Tobago

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

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

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

SAFETY AND SECURITY:
American citizens traveling to or residing in Trinidad and Tobago should avoid large crowds and demonstrations.
While non-violent demonstrations occur on occasion, widespread civil disorder is not typical.
The downtown area of Port of Spain experienced four bombings in 2005.
While no similar incidents have occurred since that time, the perpetrator(s) have not been arrested and their identities and motive remain unknown.
Americans visiting or residing in Port of Spain are advised to exercise caution, especially in crowded urban areas.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

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

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

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

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

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
We strongly recommend that you obtain comprehensive travel and medical insurance before traveling.
Medical care is limited compared to that in the United States.
Care at public health facilities is significantly below U.S. standards for treatment of serious injuries and illness, with limited access to supplies and medications.
While care at some private facilities is better than at most public health facilities, patients may be expected to prove their ability to pay before assistance is given, even in emergency situations.
Patients requiring blood transfusions are expected to arrange for at least the same amount to be donated on their behalf.
Physicians and nurses may go on strike, causing serious strain on both public and private medical resources.
Ambulance service is extremely limited both in the quality of emergency care and in the availability of vehicles in many parts of the country.
According to the Trinidad & Tobago Ministry of Health, recent monkey deaths on the island of Trinidad have been laboratory confirmed as due to yellow fever.
Although no human cases have been reported since 1979, the virus appears to be permanently embedded in forested areas of the central/south region of the island of Trinidad.
Evident outbreaks among monkeys may appear every 10-20 years after long periods of epidemiologic silence.
CDC continues to recommend yellow fever vaccine for travel to Trinidad & Tobago.
Dengue fever presents significant risk in urban and rural areas.
Precautions against insect bites are recommended such as wearing long sleeved shorts/trousers, the use of bed nets and insect repellants which contain DEET, picaridin (KBR 3023), Oil of Eucalyptus/PMD, or IR 3535.
Ciguatera poisoning is prevalent and results from eating reef fish such as grouper, snapper, amberjack, and barracuda.
The toxin remains even when fish is well cooked.
Marine hazards include corals, jellyfish, sharks, and sea urchins.
Heed posted warnings at organized beaches, and do not bathe at unmarked, unpatrolled beaches.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Trinidad and Tobago.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site.
For information about outbreaks of infectious diseases abroad, consult the World Health Organization’s (WHO) web site.
Further health information for travelers is available from the WHO.
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

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

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

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

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

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

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

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

Please see our Customs Information.

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

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

Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Trinidad and Tobago are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Trinidad and Tobago.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

The U.S. Embassy is located at 15 Queen's Park West, telephone 868-622-6371, Consular Section fax 868-822-5555.
American Citizen Services public hours of operation are 8:00 AM – 11:30 AM, and 1:00 PM through 3:00 PM, Monday - Friday, except U.S. and Trinidad and Tobago national holidays.
For additional information, you may send email inquiries.
*

*

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

Travel News Headlines WORLD NEWS

Date: Mon 10 Jun 2019
Source: Saturday Express [edited]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[HealthMap/ProMED-mail map:
Trinidad & Tobago: <http://healthmap.org/promed/p/28>]
Date: Fri 10 Nov 2017
Source: Loop [edited]

Agricultural economist Omardath Maharaj is calling for Government to be more proactive regarding post-flooding food safety policies after a number of leptospirosis cases were reported in South Trinidad. According to media reports, 13 cases of leptospirosis were reported at the San Fernando General Hospital.

It is thought the cases connected to unhygienic conditions due to recent flooding in parts of South Trinidad.

Newsday reported that 2 people have since died from the disease.

Maharaj, who represents the Tableland Pineapple Farmers Association and the Felicity Charlieville Fishing Association, is asking what extra measures are being put in place for testing of local produce, meat and shellfish to ensure that the disease is not being spread.

"There has been minimal, if any, information being distributed to the national community as it relates to flooding, food security, diseases (leptospirosis, cholera, meningitis etc) and bacteria (_Salmonella_, _E. coli_, etc)."

"Certainly, I am not aware of any national lessons learnt post-Tropical Storm Bret and the more recent flooding disaster towards mitigating the unsustainability and vulnerability of the local food system as it relates to preserving national food and nutrition security."

"Research suggests that the lack of important information and active surveillance compounds the fact that the level of awareness of these issues is low in the country."

"Leptospirosis, particularly, is still under-reported, and considered to be of significant public health importance. The recent food poisoning of young Tobagonian students in receipt of meals from the School Nutrition Programme is a living case study of our vulnerability," Maharaj said. Maharaj is asking the Ministry to update the public as to whether that has been an increase in the number of persons seeking medical aid for infections or diseases related to recent flooding, such as leptospirosis.

He is also asking what public awareness messages are being conveyed to the public in order to take extra precautions. He added that vendors and farmers should also be advised as to sanitary and safety protocols to ensure their harvests are not tainted. Maharaj is also asking for an update on the planned National Public Health Laboratory, which was recently announced by Health Minister Terrence Deyalsingh.

"There is a vacuum in the national conversation...these issues and inherent discussions are of national importance and every individual, family, and organization should participate in the dialogue contributing to our national development agenda," Maharaj said.
=============
[Leptospirosis is a zoonotic spirochetal infection that occurs worldwide and is transmitted to humans by exposure to soil, fresh water or food contaminated with the urine of wild and domestic animals (including dogs, cattle, swine, and especially rodents) that are chronically infected with pathogenic _Leptospira_. _Leptospira_ may survive in contaminated fresh water or moist soil for weeks to months. Outbreaks of leptospirosis frequently follow heavy rainfall, flooding with fresh water, and increasing rodent numbers.

Though the CDC considers leptospirosis can be a foodborne disease, estimating an actual percentage of cases that can be attributed to food is complicated since this disease has various ways of transmission, such as contact with contaminated flood water following heavy rains that may also be simultaneously operative (<https://wwwnc.cdc.gov/eid/article/17/9/10-1766-techapp1.pdf>). - ProMED Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at:
Monday 6th August 2012
A ProMED-mail post
<http://www.promedmail.org>

- Trinidad & Tobago. 3 Aug 2012. There are more than 200 reported cases of dengue in Trinidad. The mayor of Chaguanas says half of that number is in his borough.
=====================
[A HealthMap/ProMED-mail interactive map showing the location of Trinidad can be accessed at <http://healthmap.org/r/1OyH>. - ProMed Mod.TY]
More ...

Gambia

General
*******************************
The Gambia is situated on the coast of West Africa and is a common tourist destination. It enjoys a tropical climate with a rainy season between May to October each year. Harmattan winds can be experienced
during the dry season.
Stability throughout the country has been in question since a coup in 1994 but generally tourists remain unaware of any particular difficulty in this regard. Civilian rule has been in place since 1996. There is a successful tourist industry and the majority of travellers will remain in the resort regions along the coast.
Safety & Security
*******************************
It is uncommon to hear of attacks against tourists but it is considered unwise to flaunt personal wealth. Thus wearing valuable jewellery or watches should be avoided. Use the hotel safety deposit boxes for storing items of value and keep an eye on personal belongings while on the beach, on ferries or walking through market places. Many of the main tourist beaches have police or hotel security but there would be a risk if visiting some of the more isolated areas along the coast.

Road Transport
*******************************
In the main tourist regions road transport is perfectly reasonable but travelling throughout the country, particularly during the rainy season, is much more difficult. Paved roads exist in the capital, Banjul, but pedestrians still need to take care while out walking. If leaving the main tourists resorts it is essential to travel with a recognised guide. If driving, take care to stop at all check points and never reverse to avoid a road checkpoint. It is safer to use a taxi where possible (green ones for tourists). Avoid travelling to the Casamance region in Senegal (close to Gambia border), as this area is quite unstable at present. The region around Ziguinchor has also unexploded mines and armed bandits and so it would be wise to avoid.
Ferry Risks
*******************************
Taking the Banjul to Barra ferry may involve safety risks as the boat is frequently overcrowded and does not carry enough life belts etc for the number of passengers. All the engines for the ferry do not always work and it may be wiser to consider travelling 150km upriver and use the Yelitenda to Bambatenda ferry.
Health Facilities
*******************************
The level of medical facilities varies greatly throughout the country. The Medical Research Council facility in Banjul offers excellent healthcare but travellers are advised to carry sufficient supplies of any personal medication they may require while abroad.
Food & Water Facilities
*******************************
The main tourist resorts offer a good standard of food for tourists. However, it is wise to ensure that all food is fresh and well cooked. Avoiding bivalve shell fish (oysters, mussels, clams etc) is essential as these foods are frequently associated with illness among those who partake. The tap water supply may not always be regularly maintained and so it is safer to use sealed mineral water for both drinking and brushing your teeth while in The Gambia. Ice in drinks will be made from tap water and so best avoided. Food and fluids should not be purchased from street vendors except in the case of fruit, which you will then peel yourself. Tinned drinks may be safe but be careful to clean the lip before drinking straight from the can.
Malaria & Mosquitoes
*******************************
The risk of malaria in The Gambia is generally between June to December each year. Tourists have seldom been at significant risk up until recently when there has been a significant increase in the numbers of cases returning to Europe with the disease. Malaria prophylaxis should be used throughout the year. Mosquitoes mainly bite between dusk and dawn but other species can bite at any time of the day.
Rabies Risk
*******************************
There is an ever-present risk of Rabies in Africa and The Gambia is no exception. The disease is mainly transmitted to humans through the bite of an infected dog but other animals also pose a risk including cats and monkeys. The disease can also be transmitted through licks and scratches’ so avoiding all contact with animals is a wise precaution.
Sun Exposure & Dehydration
************************************
The heat and radiation from sunlight in The Gambia can be very significant especially for fair skinned Irish travellers. Make sure you use a wide brimmed hat and keep covered from the suns rays. Dehydration and salt depletion are also common and you will need to increase the amount of fluid (and salt, unless there is a contraindication) while in this climate.
Local Laws & Customs
*******************************
The Gambian authorities take strong action against those involved in any drug trade and so take care not to carry any item for another person at any time. It is a predominantly Muslim country and so care should be taken to respect their customs for example by dressing modestly particularly when away from the main tourist regions. Never take photographs or videos of any police or military installations.
Vaccinations
*******************************
If travelling to The Gambia you are advised to consider vaccination cover against the following;
*
Yellow Fever (mosquito borne viral disease)
*
Poliomyelitis (childhood booster)
*
Tetanus (childhood booster)
*
Typhoid (food & water borne disease)
*
Hepatitis A (food & water borne disease)
Occasionally travellers are advised to also consider protection against diseases like Hepatitis B, Rabies and Meningitis.
Malaria prophylaxis is essential at all times of the year for your personal protection.
Summary
*******************************
Tourist holidays to The Gambia are increasing after a lull following the unrest of the mid 90’s. However, the recent increase in malaria during December 2000 among European tourists shows how travel to tropical Africa must be treated with the respect it deserves. The majority of travellers who follow sensible guidelines will travel healthy and well.

Travel News Headlines WORLD NEWS

Date: Thu 22 Nov 2018
From: Vanessa Field vanessa.field@nhs.net

Dr. Bram Goorhuis and Dr Martin Grobusch of the GeoSentinel Surveillance Network site, Center for Tropical & Travel Medicine, AMC, Amsterdam, have reported a patient with confirmed yellow fever (YF) after travel to the Gambia and Senegal. The patient is a 26-year-old male, with no significant medical history, and previously unvaccinated against YF, who had travelled, together with his girlfriend, to the Gambian coastal region, Mansa Konko (14 days) and the Niokolo Park game reserve, Senegal (3 days). He had exposure to insect bites, but not tick bites, and did not have contact with fresh water or animals. He did not take malaria chemoprophylaxis.

On 17 Nov [2018], whilst on his flight home to Amsterdam, Netherlands, he developed a fever, chills, photophobia, and some transient gastrointestinal complaints (frequent liquid stools and abdominal discomfort). On 20 Nov [2018], he was transferred to the Center for Tropical and Travel Medicine, Amsterdam, from a peripheral hospital, with fulminant hepatitis (AST 22,000 U/L; ALT 12,500 U/L) and signs of liver failure. He tested negative for malaria and dengue; yellow fever PCR showed a very high viral load of 3.82 x 109/L. Due to an evolving encephalopathy, and a potential need for liver transplantation, the patient has now been transferred to the Erasmus Medical Center, a GeoSentinel site (Dr. Jan Nouwen and Dr. Perry van Genderen), Rotterdam, Netherlands. More follow-up is pending.

The last reported case of yellow fever in a traveller from the Gambia was in 2001 in a 47-year-old unvaccinated Belgian woman, who acquired yellow fever during a one-week vacation and subsequently died. Ref. Colebunders R et al.: A Belgian Traveler Who Acquired Yellow Fever in the Gambia. Clinical Infectious Diseases. 2002. 35(10): e113-e116. doi: <https://doi.org/10.1086/344180>.

The Ministry of Health in Senegal last notified the WHO in 2001 of 3 cases of yellow fever in K'dougou and Saraya Health districts, near the border with Mali and Guinea Conakry. A mass vaccination campaign followed. There have been no official reports to the WHO from the Gambia.

Ref: WHO Disease Outbreak News

In 2017, there were major yellow fever (YF) outbreaks in Brazil and Nigeria. These outbreaks were not marked by the rapid urban spread seen in 2016 in Angola and the Democratic Republic of the Congo (DRC), yet they illustrate the increased risk of YF and urban outbreaks with international spread. The "Eliminate Yellow Fever Epidemics" (EYE1) strategy was developed with the goal to reduce the risk of YF through a continuum ranging from outbreak detection and response to prevention. The YF surveillance network also identified suspected cases in several other high-risk countries including Congo, DRC, and Liberia.
Ref: World Health Organization (WHO) Weekly epidemiological record, 10 Aug 2018, No. 32, 2018, 93, 409-416; Yellow fever in Africa and the Americas, 2017.
<http://apps.who.int/iris/bitstream/handle/10665/273782/WER9332.pdf?ua=1>.

World Health Organization (WHO) data suggest that the rate of yellow fever transmission is increasing, especially in sub-Saharan Africa. The WHO estimates that, after adjustment for underreporting, about 200 000 cases of yellow fever occur each year. In most of west Africa, with the exception of the Gambia, yellow fever vaccination coverage is low, and there are regular epidemics of yellow fever that fluctuate according to the sylvatic cycle. Since the mid-1990s, epidemics have been reported from Ghana, Gabon, Liberia, Senegal, Benin, and Ivory Coast.

Yellow fever remains endemic in west Africa. Even urban yellow fever has recently been detected in Abidjan, Ivory Coast. Many countries in areas of endemicity in Africa (such as the Gambia) and South America (such as Venezuela) do not require travelers to undergo yellow fever vaccination. International guidelines for travellers recommend vaccination against yellow fever for persons traveling to these countries, but vaccination is not required by the countries themselves.
-----------------------------------------
Communicated by:
Davidson Hamer, MD (GeoSentinel PI)
Professor of Global Health and Medicine
Boston University School of Public Health and School of Medicine
Boston, MA USA
and
Vanessa Field, MD
Chair, GeoSentinel Tracking and Communication Working Group
International Society of Travel Medicine
=======================
[Drs. Hamer and Field are thanked for this report of the Netherlands case and the overview of the YF situation in endemic countries. The Netherlands case is another example of failure of travellers to receive YF vaccination at least 10 days prior to arrival in an endemic country. Although the Netherlands case presents no risk of initiation of ongoing YF virus transmission, it does illustrate the fact that viremic individuals can travel long distances and, should their destination be an area that could support transmission, such as Central America or south/southeast Asia, can initiate an outbreak in a population that is overwhelmingly unvaccinated. - ProMED Mod.TY]

[Map of the Netherlands:

Maps of Senegal and the Gambia:
Date: Wed, 18 Jan 2017 17:50:39 +0100

Banjul, Gambia, Jan 18, 2017 (AFP) - Gambian President Yahya Jammeh looked determined to cling to power on Wednesday as his mandate came to an end, prompting neighbouring Senegal asking the UN to back regional actions against him.   Jammeh has announced a state of emergency which he said was necessary due to interference of foreign powers in the West African country's December 1 election, which the president of 22 years lost to opponent Adama Barrow.

Barrow, who is currently sheltering in Senegal, maintains his inauguration will go ahead on Thursday on Gambian soil, putting the country on a collision course.   Senegal on Wednesday presented a draft resolution to the UN Security Council seeking support for west African efforts to press Jammeh to step down, diplomats said in New York.   But the text does not explicitly seek council authorisation to deploy troops to The Gambia, they added.   Jammeh's declaration immediately triggered travel advisory warnings by Britain and the Netherlands, with around 1,000 British tourists expected to leave on special flights on Wednesday alone.   The 15-nation Economic Community Of West African States (ECOWAS) has repeatedly urged Jammeh to respect the outcome of the vote and step aside, a call backed unanimously by the international community.

The exact location of the inauguration was "in the hands of ECOWAS," said James Gomez, the inauguration's head organiser who said he had spoken with Barrow twice on Tuesday.   Gomez said that plans for the transfer of power in a huge stadium outside the capital Banjul were now cancelled, but added "there will be a big celebration" despite the state of emergency.   A source at Nigeria's military HQ told AFP a deployment to Senegal, whose territory surrounds The Gambia, would happen "very soon", ramping up expectations of a possible military intervention.   Under the Gambian constitution a state of emergency lasts up to 90 days if the national assembly confirms it -- which the legislature did late Tuesday.   The country's vice-president Isatou Njie-Saidy resigned Wednesday, family sources said, along with environment minister Pa Ousman Jarju, the latest in a mass string of cabinet members deserting Jammeh's government.

- Tourist disappointment -
Tourists were streaming out of the country, leaving the small airport near Banjul struggling to handle extra flights.   Brian and Yvonne Souch, a couple from Witney in southern England, told AFP they were unaware of the potential risk of flying to the country 10 days ago and felt tour company Thomas Cook should have kept them better informed.   "We didn't know anything until we came down for breakfast,"  Brian Souch said, sitting in shorts and sleeveless T-shirt in the lobby of a hotel in the Kololi tourist strip as he awaited a bus to the airport.

Thomas Cook said in a statement Wednesday a programme of additional flights into Banjul airport would bring home the 1,000 package holidaymakers it has in The Gambia, followed by up 2,500 more at the "earliest possible flight availability".   Holidaymakers were told that Thomas Cook flights would stop completely in a few days time, leaving them at risk of being stranded.   The Dutch travel firm TUI Nederland told AFP Tuesday it would repatriate "about 800" clients.   Some tourists were unfazed by the news as the state of emergency, however, as their countries have not issued travel alerts.   "We have over two weeks left and we are staying," said Mariann Lundvall, who flew into Banjul to escape Finland's freezing winter.   "If the Finnish government decides we go, then we go," she added, but with a pained face added "the climate in Helsinki... it is so cold now!"   The panic caused by the state of emergency could prove devastating for the country's economy, which experts say relies on tourism for up to 20 percent of the economy.

- Stockpiling -
Gambians were taking precautions and stocking up on food and supplies in the few shops that remained open in districts near the capital, with roads quiet and street hawkers notably absent.   A source told AFP that patients at Banjul's Edward Francis Small Teaching Hospital, which sits opposite Jammeh's seat of power, were removed for security reasons. Only those in intensive care remained.   Fatou Sarr, a resident of the fishing community of Old Jeshwang, said: "Only a few shops had bread this morning and they ran out of stock very early. If this stalemate drags on for a week or two, the country will run out."   Citizens continue to pack their bags and stream out of Gambia -- a small, narrow enclave of Senegal except for its coast -- by road and ferry heading for Senegal, Guinea-Bissau and Guinea, taking as many possessions as they could carry.   "My two children and I are staying with my aunt. We don't know what will happen tomorrow," said a 50-year-old woman who recently took shelter in Senegal, adding that she hoped to return home soon.
Date: Wed, 18 Jan 2017 04:45:54 +0100

Banjul, Gambia, Jan 18, 2017 (AFP) - Gambia's Yahya Jammeh declared a state of emergency just days before he was due to step down, with British and Dutch travel agencies scrambling to evacuate thousands of tourists Wednesday.   Jammeh, who has ruled The Gambia with an iron fist for 22 years, initially acknowledged opponent Adama Barrow as the victor in December elections, but later rejected the ballot count as flawed and lodged a complaint with the country's Supreme Court.   He declared a state of emergency on Tuesday due to the "unprecedented and extraordinary amount of foreign interference in the December 1 presidential elections and also in the internal affairs of The Gambia," Jammeh announced on state TV.

Citizens were henceforth "banned from any acts of disobedience to the laws of The Gambia, incitement to violence and acts intended to disturb public order and peace," Jammeh said, asking security forces to maintain law and order.   Under the Gambian constitution a state of emergency lasts up to 90 days if the national assembly confirms it -- which the legislature did late Tuesday, a parliamentary source told AFP.   In Washington, the US State Department urged Jammeh to "peacefully hand over power" to Barrow -- who is in Senegal, where he plans to remain until his planned inauguration Thursday.   "Doing so would allow him to leave office with his head held high and to protect the Gambian people from potential chaos," spokesman John Kirby said. "Failure to do so will put his legacy, and more importantly The Gambia, in peril."

The 15-nation Economic Community Of West African States (ECOWAS) has also repeatedly urged Jammeh to respect the outcome of the vote and step aside, a call backed by the UN Security Council, African Union and others.   Jammeh has rebuffed two high-level delegations by west African leaders pleading with him to go.   "The potential for military intervention and civil disturbance is high," the British foreign ministry said on its website, a warning echoed on social media by its Dutch counterpart, who both urged citizens to avoid all but essential travel.   British travel agency Thomas Cook said it had "implemented our contingency plans to bring all our UK customers home," and was trying to arrange evacuation of up to 3,500 tourists from Banjul airport as soon as possible.    "We will operate a programme of additional flights into Banjul airport over the next 48 hours," the company said in a statement, adding this included four extra flights on Wednesday.   The Dutch travel firm TUI Nederland told AFP it would repatriate "about 800" clients.

- String of resignations -
Four more cabinet ministers in Jammeh's government defected, a source close to the regime told AFP on Tuesday.   Foreign minister Neneh Macdouall-Gaye, finance minister Abdou Kolley, trade minister Abdou Jobe and tourism minister Benjamin Roberts all resigned, the source said, requesting anonymity for safety reasons.   They follow the high-profile defection last week of information minister Sheriff Bojang, who is now in neighbouring Senegal.   Citizens continued to pack their bags and stream out of Gambia -- a small, narrow enclave of Senegal except for its coast -- by road and ferry heading for Senegal, Guinea-Bissau and Guinea, taking as many possessions as they could carry.   One traveller told AFP that those arriving at 10:00 am would have to wait until the following day to board a ferry at Banjul port to cross the river headed for Senegal, unless they bribed officials, due to huge numbers exiting the city.

- Military deployment? -
Military intervention in The Gambia seems closer than ever, following declarations by the UN and African Union that boots on the ground could get the green light without a rapid resolution to the crisis.   In Nigeria -- the regional power of west Africa -- a source at the country's military HQ said, "We are deploying to Dakar, Senegal, very soon."   "We are deploying platforms, a few personnel, pilots, technicians and the maintenance crew," said the source, speaking on condition of anonymity.   "You already know that this deployment is in connection with the unfolding development in The Gambia."   In Rabat, it was reported that Morocco had offered Jammeh asylum for accepting the election defeat and stepping down "in return for a golden retirement", but Banjul sources were reluctant to confirm the claim.   Seven journalists -- from Sweden and Senegal, plus four from Kenya and South Africa who were working for a Chinese TV channel -- were expelled late Monday soon after they arrived at Banjul airport to cover the ongoing crisis.
Date: Tue, 13 Dec 2016 05:39:37 +0100
By Jennifer O'MAHONY

Banjul, Gambia, Dec 13, 2016 (AFP) - The cocktails keep flowing by the pool on the tourist strip, but in The Gambia's markets many African migrant traders are packing up their businesses and heading home.   The international community is piling pressure on President Yahya Jammeh to leave power after 22 years and hand over to opposition leader Adama Barrow, who won an election two weeks ago only for Jammeh to later reverse his original concession of defeat.

Of the economy's two main sources of investment from abroad, tourism appears to be weathering the country's political storm far better than the thousands of petty traders who move to The Gambia from the rest of west Africa.   President-elect Barrow told AFP on Monday claims that tourist numbers could be hit were "exaggerated", and with hotels and restaurants full, for the moment he appears to be right.   Flights from Brussels and London are still arriving like clockwork for the peak winter sun season, with many holidaymakers telling AFP they return to the country year after year -- and aren't changing their minds.

"I did think there were more checkpoints," said Elly Preston, a returning retired schoolteacher spending three and a half months in Kololi, the Gambian heartland of full English breakfasts and karaoke bars stuffed with crooning pensioners.   Preston had seen alarming posts on the Tripadvisor tourism website, but with hotel prices as low as £40 a night (48 euros) she stuck with her instinct and left behind the cold and rain of Cleckheaton in northern England.   "I feel safe here. I know everybody and we come together," she said from her sunlounger, waving at a friend she met while on holiday here a few years ago.

Reading a thriller while taking in some rays in the late afternoon, Joseph Fowlis from Liverpool is well aware that Jammeh has refused to stand down, and supports Barrow's fight for change.   "Taxi drivers told me they want a democracy," he told AFP. "And why shouldn't they have one?"   But that hasn't affected his budget break. Apart from a higher than usual level of political conversation in the back of cabs, he said, little had changed from the previous years he has been here.   "If you didn't know about it you wouldn't think anything of it," he said.   Hotel owners are slightly more nervous, but as long as the tour operators keep the flights up, business will boom, they told AFP.

- Trader panic -
The tiny west African state relies on largely British and Scandinavian tourists for 20 percent of its GDP.   Meanwhile Guineans, Mauritanians and Senegalese are well known for importing goods and selling them to the local population.   In a recent speech, Jammeh said 100,000 foreigners were working in The Gambia's markets, but did not specify a source for that figure.   Fifteen minutes down the road from Kololi, the hawkers and fruit sellers of Serekunda market have a very different interpretation of the events unfolding.

Amadou Wurri Jallow, a Guinean shopkeeper, spoke of his fear of soldiers being stationed on the streets of his neighbourhood.   "I do not understand why soldiers armed with machine guns would be deployed every night in built-up areas of Serekunda," Jallow said.   "This is really frightening and disturbing. I am leaving for my country until this political stalemate is resolved peacefully."   Fallou Diop, a Senegalese hawker who has lived and worked in The Gambia for the past few years, told AFP shortly before his departure to the city of Touba in central Senegal that the uncertainty was too much.   "Since no one can tell how this problem would come to an end, I am going back to Touba until the dust settles," he said.
Date: Fri 14 Nov 2014
Source: StarAfrica, APA (Agence Africaine de Presse) report [edited]

The head of disease control in the Gambia, Sanna Sambou, has confirmed the reopening of the country's border to countries affected by the deadly Ebola virus, APA reported on Friday [14 Nov 2014]. Mr Sambou noted that border closure was not the best solution to contain the virus, hence the need to reopen borders to allow in and out movement of people between the Gambia and countries affected by Ebola. According to media reports, the issue of border closure, as a result of the outbreak of the disease, was deemed discriminatory and unworthy by the World Health Organisation (WHO), adding that it should be considered a global pandemic.

Despite the restoration of the border crossing, however, Sambou said the health authorities are poised to continue on the thorough screening of people moving into the country from Ebola hit nations. It could be recalled the Gambia in September [2014] announced that it would no longer be granting entrance to Guineans, Liberians, Nigerians or Sierra Leoneans, due to fear of the disease getting into the country.
More ...

Travel News Headlines WORLD NEWS

More ...

World Travel News Headlines

Date: Tue, 20 Aug 2019 05:21:07 +0200 (METDST)

Bangkok, Aug 20, 2019 (AFP) - At least 13 Chinese tourists were killed and dozens injured when their bus skidded off the road and plunged 30 metres into a ravine in Laos, a police officer said Tuesday.   The bus was carrying more than 40 Chinese nationals heading towards the tourist town of Luang Prabang when the accident occurred late on Monday.   "At this moment, 13 bodies have been recovered... while two are still missing," police officer Xaiyaphon Chitavong told AFP, blaming brake failure for the accident.   He added that 31 people were receiving medical treatment.    Chinese state media showed photos of rescuers wading through ankle-deep floodwaters.

Traffic accidents in Laos, Thailand, Cambodia and Myanmar are common, with safety regulations often flouted and law enforcement low.    The monsoon season from June to October also drenches rural roads with heavy rains creating slippery conditions.   Tourism to communist-run Laos has grown in recent years, and visitors from China increased by 13 percent in the first half of 2019 compared to the year before, according to the state-backed Vientiane Times.
Date: Mon, 19 Aug 2019 20:57:15 +0200 (METDST)

Bukavu, DR Congo, Aug 19, 2019 (AFP) - A child has died from Ebola in DR Congo's South Kivu, health authorities said Monday, the second person to succumb to the virus since the epidemic spread to the eastern province.   The announcement last week of the first confirmed cases in South Kivu revived concerns that the highly contagious disease could cross the porous borders of the central African country, where it has claimed more than 1,900 lives since August last year.   "A seven-year-old child died yesterday (Sunday) of Ebola" in South Kivu's Mwenga region, said Claude Bahizire, communication officer of South Kivu's provincial health division.

The first death in South Kivu was a woman in her twenties who evaded movement controls to travel from the North Kivu town of Beni, the epicentre of the outbreak, to South Kivu's capital Bukavu and then Mwenga.    She died on Wednesday, and her seven-month-old son has been diagnosed with the virus and is receiving treatment.   Bahizire said that "two other suspected cases, two women, have been detected and admitted to Bukavu's transit centre".   The two women "were in contact with the woman who died last week while she was staying in Bukavu on the way to Mwenga," he added.

The outbreak of the haemorrhagic virus began in North Kivu on August 1, 2018 and spread to Ituri province.   The health ministry also announced that "a new health zone had been assigned in North Kivu".   A confirmed case of Ebola has been recorded in North Kivu's Pinga region, in Walikale territory, a source said without providing further details.   According to the latest numbers published on Sunday, 1,934 people have since died, while 862 have been cured.

The latest outbreak is the second-deadliest on record after more than 11,000 people were killed in Guinea, Sierra Leone and Liberia between 2014-2016.   Also on Monday, World Health Organization (WHO) chief Tedros Adhanom Ghebreyesus called on the nine countries that share a border with DR Congo to show solidarity to stop the spread of Ebola.   "We now have an Ebola vaccine that is more than 97 percent effective and treatments that are more than 90 per cent effective if used early enough," he said in Republic of Congo capital Brazzaville.
Date: Mon, 19 Aug 2019 19:48:07 +0200 (METDST)
By Alain JEAN-ROBERT

Paris, Aug 19, 2019 (AFP) - French construction workers wearing protective masks returned to the site of stricken Notre-Dame cathedral on Monday after a three-week pause due to the risk of lead contamination.   Labour Minister Muriel Penicaud was given a tour of the scorched monumet wearing a white protective suit while workers could again be seen surveying the structure which was left damaged and weakened in a massive fire in April.

Restoration of the cathedral has yet to begin with efforts focused entirely on securing the building. The culture ministry has warned it is still at risk of collapse.   Efforts to remove lead from the area around Notre-Dame began last week after alarm grew over the presence of the toxic metal.   Hundreds of tonnes of lead in the roof and steeple melted during the April 15 blaze that nearly destroyed the gothic masterpiece, with winds spreading the particles well beyond the church grounds.

Residents have accused the Paris authorities of underplaying the risk from the lead although the culture ministry insists safety is the top priority.   But prefect Michel Cadot, the government's top official for the Paris region, approved the resumption of the works after visiting the site.   "I saw that the different recommendations of the labour inspectors had been implemented," he said, adding the decontamination work would help keep contractors safe.   Securing the structure is required before the restoration work can start.    The culture ministry said that stones had fallen from the nave vault during a heatwave in July.   "It is only the urgency linked to the persistent risk of a collapse that justifies the rhythm of work undertaken" since the fire, it said in a statement Wednesday.

President Emmanuel Macron has set an ambitious target of five years for the restoration to be finished. But the ministry said the work would not even begin until next year.   Paris prosecutors said in June that a poorly stubbed-out cigarette or an electrical fault could have started the fire and opened an investigation into criminal negligence, without targeting any individual.

French investigative news site Mediapart published a report this week accusing the ministry of repeatedly ignoring warnings by labour inspectors about the dangers posed by the lead until work was finally suspended on July 25.   Critics have accused the city of failing to notify the public about the test results, while an environmental group has filed a lawsuit alleging that officials failed to sufficiently contain the contamination.   The ministry rejected Mediapart's allegations it had failed to pay attention to the risks encountered by workers on the site.
Date: Mon, 19 Aug 2019 13:26:06 +0200 (METDST)

Jalalabad, Afghanistan, Aug 19, 2019 (AFP) - Scores of people including children were wounded Monday after a series of explosions shook the eastern Afghan city of Jalalabad, as the country's independence day was marred by bloodshed.

As many as 10 blasts were reported in and around the city in Nangarhar province, authorities said, and casualty numbers rose as the day wore on.   "The explosions were caused by IEDs in different parts of the city and as groups of people were celebrating independence day," the Nangarhar governor's spokesman Attaullah Khogyani said, referring to improvised explosive devices.   Jalalabad is the scene of frequent bomb attacks, and the surrounding terrain is home to both Taliban fighters and the Islamic State group's local affiliate.

At least 52 people were wounded, Khogyani said. Zaher Adel, a spokesman for a local hospital, said 66 wounded people had been brought in. An AFP correspondent saw children among the victims.   This year's August 19 celebrations mark 100 years of Afghan independence from British influence.   The day was supposed to be one of national pride and unity, but was overshadowed by an IS suicide attack Saturday on a crowded Kabul wedding hall that killed at least 63 people.

In Kabul, locals took to the streets to wave the black-red-and-green Afghan flag, but several public events to commemorate the date were scrapped as Kabul mourns and due to fears of a fresh attack.    "We postponed the celebrations to honour the victims, but we will definitely take revenge for our people," Afghan President Ahraf Ghani said.   "We will avenge the blood of our people, every drop of it."

Mayhem from Afghanistan's war continues to wreak havoc on Afghans every day, even though the US and the Taliban are in final negotiations for a deal that would see US troops begin to quit Afghanistan and could potentially lead to a reduction in violence.
Date: Wed 14 Aug 2019
Source: Universitat Hohenheim [in German, trans. Britta Lassmann, edited]

The University of Hohenheim and the Bundeswehr Institute of Microbiology [IMB] have detected spotted fever in a hyalomma tick, the 1st time such a tick is suspected to have caused disease in a human in Germany.

This tick feeds on humans and can transmit a form of spotted fever in Germany. What were still unanswered questions about the tropical giant tick hyalomma is now certainty. At the beginning of August [2019], it was suspected that for the 1st time, a human in Germany had contracted a disease with the typical symptoms of rickettsiosis from the bite of a hyalomma tick. Experts from the University of Hohenheim in Stuttgart and the IMB in Munich were able to detect the pathogen _Rickettsia aeschlimannii_ in the tick. The number of hyalomma ticks in Germany increased significantly in 2019 compared to the previous year [2018]. In nearly half of the hyalomma ticks, _R. aeschlimannii_ can be detected. The tick researchers continue to ask the population to send them suspicious ticks.

It was probably no coincidence that this 1st case was in a horse owner. Tropical ticks of the genus _Hyalomma_ feed on large mammals. For several years, these ticks have been on the rise in Germany. Now tick researchers report the 1st suspected case of spotted fever transmitted in Germany. "Not only do we now know for sure that the hyalomma tick is also targeting humans," says Prof Dr Med Ute Mackenstedt, a parasitologist at the University of Hohenheim, "but also that there is the urgent suspicion that the transmission of spotted fever by these ticks is actually possible here in Germany."

The case: At the end of July [2019], the horse owner from near Siegen was bitten by a hyalomma tick. He sent the tick to the tick researcher in Hohenheim. He then presented to the hospital only a few days later with severe symptoms. Spotted fever caused by the bacterium _R. aeschlimannii_ was suspected. The tick was sent by courier service to the IMB in Munich, where the pathogen was detected in the tick. Thereafter, the patient received targeted antibiotic therapy, and his symptoms rapidly improved.

"We are talking about a suspected case, because direct detection of the pathogen from the patient was not possible," explains PD Dr Med Gerhard Dobler, medical doctor at the IMB. "The treatment of the patient came 1st. But the preceding tick bite, the typical symptoms
and, above all, the proof of the pathogen in the tick suggest that the case was spotted fever. The fact that the patient responded to targeted antibiotic therapy further supports this."

_R. aeschlimannii_ causes a feverish infection with headache and muscle pain, extreme joint pain, and a burning sensation. Typical for the disease, however, is the rash that gave the disease its name. This classic sign shows mainly on the extremities. The incubation period is about one week.

"If spotted fever is suspected after a hyalomma bite, a swab should be taken from the bite site and sent for examination," advises PD Dobler. "If there are questions, you are welcome to contact us. Ideally, we would also like to examine the tick."

About half of the hyalomma ticks, the researchers say, are infected with rickettsia. Transmission takes place exclusively via tick bite. "The number of hyalomma ticks in Germany is significantly higher this year [2019] than in the previous year [2018]," reports Prof Dr Med Mackenstedt, referencing the publication in which the situation was presented in 2018. The Hohenheim parasitologist not only cooperates closely with the IMB in Munich, but also with the working group of Prof Dr Med Christina Strube at the Veterinary University (TiHo) Hannover. "Together they already have found 50 such ticks in Germany in 2019. Last year [2018] there were a total of 35." Last year, these ticks had survived the winter in Germany for the 1st time.

"Rickettsia are the only pathogens that we have been able to detect so far," explains PD Dr. Dobler. "We have not found the virus that causes the dangerous Crimean Congo hemorrhagic fever, nor the pathogens _Theileria equi_ and _Babesia caballi_, both of which can be transmitted from ticks to horses."

The research team continues to ask the population for support to further explore the spread and potential dangers. In case of a tick bite, it's best to remove the tick with a tick remover, TickCard, or tweezers. Then send the animal in a small, tightly closed container to:
University of Hohenheim
Prof. Dr. Ute Mackenstedt
Department of Parasitology
Emil-Wolff-Strasse 34
70599 Stuttgart

Background: Tick genus _Hyalomma_
_Hyalomma marginatum_ and _Hyalomma rufipes_ are native to the dry and semi-arid areas of Africa, Asia, and southern Europe. Until recently, they did not occur in central and northern Europe. Their striped legs are striking, and they are much larger than the native ixodes ticks.

The adult ticks feed on large animals. They are active hunters and move quickly towards their host. They cover a distance of up to 100 m [328 ft]. Humans can serve as hosts. In contrast, tick larvae and nymphs mainly infest birds and small mammals and can stay up to 28 days with their hosts. Migratory birds can introduce larvae and nymphs to Germany.

In Eurasia, both _Hyalomma_ species are considered transmitters of the Crimean Congo hemorrhagic fever virus and the Arabic hemorrhagic fever virus (Alkhumra virus). They also transmit the bacterium _Rickettsia aeschlimannii_, which causes a form of spotted fever.

Reference:
Chitimia-Dobler L, et al. Imported _Hyalomma_ ticks in Germany in 2018. Parasites & Vectors. 2019; 12 (134).

More information:
Picture and video material [in German]
Press release: Tropical ticks in Germany: University of Hohenheim asks to send conspicuous tick finds [in German]
Press release: Tropical ticks: New immigrant species winters in Germany for the 1st time [in German]
-----------------------------------
communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
====================
[Given that the ticks were found last year (2018) and that they overwintered and were found again this year (2019), it is likely that this genus of tick is becoming established in Germany. Although the species of _Hyalomma_ that infected the man with _Rickettsia aeschlimannii_ was not determined, there is a clear association of this rickettsia with the 2 species of _Hyalomma_ that were tested. The published report cited above states, "35 ticks with an unusual appearance or behaviour were reported to us during summer-autumn 2018. For 17 of them, the description or photos implied that they belong to the hard tick genus _Hyalomma_. The remaining 18 ticks were sent to us and were identified as adult _Hyalomma marginatum_ (10 specimens) or adult _Hyalomma rufipes_ (8 specimens). All ticks tested negative for CCHF virus, _Coxiella burnetii_, _Coxiella_-like organisms, _Babesia_ spp. and _Theileria_ spp. The screening for rickettsiae gave positive results in 9 specimens. The _Rickettsia_ species in all cases was identified as _R. aeschlimannii_." Given that these ticks can be transported by birds migrating from Africa, continued surveillance in Germany for the rickettsia and the other pathogens that were not found currently is prudent. - ProMED Mod.TY]

The first human case of _R. aeschlimannii_ infection was identified in a patient who had fever, rash, and an eschar similar to _R. conori_ infection (Mediaterrian spotted fever) after travel in Morocco (1). _R. aeschlimannii_ infections in humans have been previously confirmed in South Africa, in Algeria, and in Tunisia (2). To our knowledge, the first human case of _R. aeschlimannii_ infection reported in Europe occurred in Greece and was reported in 2013 (3).

1. Raoult D, Fournier PE, Abboud P, Caron F. First documented human Rickettsia aeschlimannii infection. Emerg Infect Dis. 2002; 8: 748-9. doi: 10.3201/eid0807.010480
2. Demoncheaux JP, Socolovschi C, Davoust B, Haddad S, Raoult D, Parola P. First detection of _Rickettsia aeschlimanii_ in _Hyalomma dromedarii_ ticks in Tunisia. Ticks Tick Borne Dis. 2012; 3: 398-402.
3. Germanakis A, Chochlakis D, Angelakis E, Tselentis Y, Psaroulaki A. _Rickettsia aeschlimannii_ infection in a man, Greece. Emerg Infect Dis. 2013; 19: 1176-7.  - ProMED Mod. LL]

[HealthMap/ProMED-mail map of Germany:
Date: Wed 19 Aug 2019, 12:48 PM
Source: Kazakh Telegraph Agency [edited]

A total of 4 anthrax cases have been confirmed in the Akmola region, reports the health care department. "Up to [now] 5 [suspected cases of] anthrax have been recorded; lab tests have confirmed 4. The cause of contamination was cow butchering without a veterinary certificate in a private yard," said the interlocutor.

"Epidemiological situation in the Akmola region and Nur-Sultan is stable," said the department. "The situation is being constantly monitored by the committee," said Ludmila Burabekova, chairfigure of the committee of quality control and goods safety. "Anti-epidemic and anti-epizootic arrangements have been organized in the area," she added.
*****************************
Date: Wed 19 Aug 2019, 12:04 PM GMT
Source: Radio Free Europe [edited]

A village near the Kazakh capital, Nur-Sultan, is under quarantine after lab tests confirmed anthrax infections in several people.

The Health Ministry said on [19 Aug 2019] that 5 residents of the village of Olginka, 100 km [about 62 mi] east of Nur-Sultan, have been hospitalized in recent days with anthrax symptoms, 4 of whom tested positive for _Bacillus anthracis_ -- the bacterium that causes the infectious disease. According to the statement, the situation in the village in the Aqmola region is under the control of the authorities and all necessary measures are being taken to prevent the possible spread of the disease.

In 2016, in nearby Qaraghandy Oblast, 2 people died as a result of anthrax infections.

According to the United States Centers for Disease Control and Prevention (CDC), domestic and wild animals -- such as cattle, sheep, goats, antelope, and deer -- can become infected by inhaling or ingesting spores in contaminated soil, plants, or water. CDC says all types of anthrax infections can cause death if they are not treated with antibiotics.
========================
[Olginka is in north-central Kazajhstan; see:

There is a measure of rural poverty in northern half of Kazakhstan, with the result that sick and moribund animals get butchered and eaten. Fortunately, as this village is within 100 Km [about 62 mi] of the Kazakh capital the affected have had the advantage of hospital care and proper laboratory confirmation. The coincident 5th person may have just shown a fever when the medical authorities were looking for clinical cases or it may be a false negative.

Folk have a habit of self-treating with antibiotics and this would have reduced the number of circulating vegetative cells available to testing. My friend Benyamin Cherkasskyi, the Soviet anthrax expert, used to tell me that only some 30%-40% of cutaneous cases would test positive. You have to know to insert your needle in under the lesion to draw out the fluid there which will contain cells, blood, and toxins. - ProMED Mod.MHJ]

[HealthMap/ProMED map available at:
Date: Mon, 19 Aug 2019 03:45:54 +0200 (METDST)

Lomo del Pino, Spain, Aug 19, 2019 (AFP) - A raging wildfire on the Spanish holiday island of Gran Canaria forced the evacuation of some 5,000 people, authorities said Sunday, warning it could take days for the blaze to be brought under control.   The fire, which has spread to the mountainous Cruz de Tejeda region popular with tourists for its breathtaking views, is "extremely fierce" and "unstable", said Canary Islands president Angel Victor Torres in a statement.   No fatalities have been reported.

More than 600 firefighters and 14 aircraft battled to contain the flames, hampered by strong winds and high temperatures.   With the temperature set to rise Monday, authorities estimate it could take days before the blaze is brought under control.   "The next few hours will be very important because the weather forecast for the night is not good," Torres said.   The fire broke out days after another wildfire in the same region forced the evacuation of hundreds.

Gran Canaria is the second most populous of the Canary Islands in the Atlantic off the northwest coast of Africa.   The Canary Islands received 13.7 million foreign visitors last year, over half of them from Britain and Germany.   Spain is frequently plagued by huge forest fires because of its arid summer climate.
Date: Sun, 18 Aug 2019 23:01:00 +0200 (METDST)

Lisbon, Aug 18, 2019 (AFP) - Portuguese fuel tanker drivers whose strike has caused fuel shortages at the summer holiday season on Sunday ended their industrial action.   Drivers have been staging a strike since Monday to demand further wage increases in 2021 and 2022, prompting the government to declare an energy crisis.   "Since all the conditions are now in place to negotiate, we decided to end the strike," Pedro Pardal Henriques, spokesman for the National Union of Dangerous Goods Carriers (SNMMP), told reporters.

A meeting is scheduled for Tuesday, the union President Francisco Sao Bento said, adding that the union did not "rule out new strikes being called if Antram (the employers association) adopts an uncompromising attitude".   Police had launched an operation to escort fuel tankers with extra supplies and Portugal also mobilised about 500 members of the security forces to replace the strikers and drive the trucks.   Despite the shortages, Energy Minister Joao Pedro Matos Fernandes said about two-thirds of the country's 3,000 or so petrol stations had not run dry.
Date: Sun, 18 Aug 2019 11:47:26 +0200 (METDST)
By By Emal Haidary and Mushtaq Mojaddidi

Kabul, Aug 18, 2019 (AFP) - Joy and celebration turned into horror and carnage when a suicide bomber targeted a packed Afghan wedding hall, killing at least 63 people in the deadliest attack to rock Kabul in months, officials and witnesses said Sunday.   The massive blast, which took place late Saturday in west Kabul, came as Washington and the Taliban finalise a deal to reduce the US military presence in Afghanistan and hopefully build a roadmap to a ceasefire.   The groom recalled greeting smiling guests in the afternoon, before seeing their bodies being carried out hours later.

The attack "changed my happiness to sorrow", the young man, who gave his name as Mirwais, told local TV station Tolo News.   "My family, my bride are in shock, they cannot even speak. My bride keeps fainting," he said.   "I lost my brother, I lost my friends, I lost my relatives. I will never see happiness in my life again."   Interior ministry spokesman Nasrat Rahimi said at least 63 people had been killed and 182 injured.   "Among the wounded are women and children," Rahimi said. Earlier he stated a suicide bomber carried out the attack.

Afghan weddings are epic and vibrant affairs, with hundreds or often thousands of guests celebrating for hours inside industrial-scale wedding halls where the men are usually segregated from the women and children.   "The wedding guests were dancing and celebrating the party when the blast happened," recounted Munir Ahmad, 23, who was seriously injured and whose cousin was among the dead.   "Following the explosion, there was total chaos. Everyone was screaming and crying for their loved ones," he told AFP from his bed in a local hospital, where he is being treated for shrapnel wounds.

Images from inside the hall showed blood-stained bodies on the ground along with pieces of flesh and torn clothes, hats, sandals and bottles of mineral water. The huge blast ripped parts of the ceiling off.   The wedding was believed to be a Shia gathering. Shia Muslims are frequently targeted in Sunni-majority Afghanistan, particularly by the so-called Islamic State group, which is also active in Kabul but did not immediately issue any claim of responsibility.

Wedding guest Hameed Quresh told AFP the young couple were saying their vows when the bomb went off.    "We fainted following the blast, and we don't know who brought us to the hospital," sobbed Quresh, who lost one brother and was himself wounded.   Another guest told Tolo that some 1,200 people had been invited. With low security, weddings are seen as easy targets.   The attack sent a wave of grief through a city grimly accustomed to atrocities. President Ashraf Ghani called it "barbaric", while Afghanistan's chief executive Abdullah Abdullah described it as a "crime against humanity".

- Withdrawal deal expected -
The attack underscores both the inadequacy of Afghanistan's security forces and the scale of the problem they face. While the police and army claim they prevent most bombings from ever happening, the fact remains that insurgents pull off horrific attacks with chilling regularity.   On July 28, at least 20 people were killed when attackers targeted Ghani's running mate Amrullah Saleh as he campaigned in presidential elections.    The incident showed how even amid tight security and known threats, insurgents can conduct brazen attacks.   The issue also goes to the heart of a prospective deal between the US and the Taliban that would see Washington begin to withdraw its approximately 14,000 soldiers from Afghanistan.

The deal relies on the Taliban providing guarantees they will stop jihadist groups such as Al-Qaeda and IS from using Afghanistan as a safe haven. Saturday's attack suggests any such promise would be tough to keep.   The "Taliban cannot absolve themselves of blame, for they provide platform for terrorists," Ghani said.   Few believe such a deal will bring quick peace.

Many Afghans fear the Taliban could return, eroding hard-won rights for women in particular and leading to a spiralling civil war.   Meanwhile, in the northern province of Balkh, 11 members of the same family were killed when their car hit a roadside bomb, officials said. The provincial governor blamed the Taliban for planting the device.
Date: Sun, 18 Aug 2019 05:28:47 +0200 (METDST)
By Amélie BOTTOLLIER-DEPOIS

Paris, Aug 18, 2019 (AFP) - Seafood lovers who prize the mussel for its earthy taste and succulent flesh may be unaware of its growing potential in the fight against water pollution.   The mussel is the hoover of the sea, taking in phytoplankton for nourishment along with microplastics, pesticides and other pollutants -- which makes it an excellent gauge.

One day, it may also be pressed into service to cleanse water.   "It's a super-filter in the marine world, filtering up to 25 litres of water a day," says marine biologist Leila Meistertzheim.   "It's a real model of bioaccumulation of pollutants generally speaking."   As they pump and filter the water through their gills in order to feed and breathe, mussels store almost everything else that passes through -- which is why strict health rules apply for those destined for human consumption.

Like canaries in a coal mine, mussels have long been used as "bio-indicators" of the health of the seas, lakes and rivers they inhabit.   Little-known pollutants can turn up to join the usual suspects, with increasing attention paid to microplastics containing bisphenol A and phthalates, both thought to be endocrine disruptors.

Meistertzheim heads a study for France's Tara Ocean Foundation using mussels to gauge the health of the estuaries of the Thames, Elba and Seine rivers.   The mussels, placed in fish traps, are submerged in the waters for a month before researchers dissect them to determine what chemical substances lurk in their tissues.   The idea of deploying mussels across the oceans to absorb ubiquitous microplastics is just a dream for now, but for other pollutants, the bivalves are already at work.   "In some places, mussels are used, as well as oysters, to cleanse the sea of pesticides, for example," Meistertzheim notes.

- E. coli busters -
Richard Luthy, an environmental engineer from California's Stanford University, says that, in most cases, mussels harvested from contaminated waters should not be eaten.   But if the contaminant is E. coli, mussels can be thanked for the "removal and inactivation" of the faecal material, he says, calling the service a "public health benefit".   The mussels are edible because they "excrete the bacteria as faeces or mucus," he says.   Mussels living in waterways affected by eutrophication -- often marked by abundant algae -- are also fit for human consumption, researchers say.   The phenomenon is often the result of waste dumped into the waterway containing phosphates and nitrites, such as detergents, fertilisers and sewage.   The nutrients in these substances encourage the proliferation of algae, which in turn starves the water of oxygen, upsetting the ecosystem.

Mussels "recycle" these nutrients by feeding on the algae, says Eve Galimany, a researcher of the US National Oceanic and Atmospheric Administration's Milford Laboratory who has experimented with mussels in the Bronx River in New York.   The recycling principle is already at work in a pilot project titled Baltic Blue Growth in Sweden, Denmark and the Baltic countries which grows mussels to be fed to animals such as poultry, fish and pigs.   "Eutrophication... is the biggest problem of the Baltic Sea, the most urgent one," says project head Lena Tasse. Mussels "could be part of a solution".   Why feed them to animals if they are safe for humans? Because Baltic mussels are too small to be of interest to seafood lovers, says Tasse, adding: "Swedes like big mussels."

Meanwhile, the jury is still out on the effects of microplastics on human health.   A recent report by WWF said that humans ingest an average of five grammes of microplastics a week -- about the weight of a credit card.   A 2018 study published in the journal Environmental Pollution, based on samples from British coastlines and supermarkets, estimated that every 100 grammes (3.5 ounces) of mussels contained 70 tiny pieces of plastic.   Should we be worried? Meistertzheim thinks not.   "I eat them," she says. "A dish of mussels is not necessarily worse than organic hamburger meat wrapped in plastic."