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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: Tue, 24 Sep 2019 07:27:34 +0200 (METDST)

Miami, Sept 24, 2019 (AFP) - A strong 6.0 magnitude struck off the northwest coast of Puerto Rico late Monday, the United States Geological Survey said, although no casualties or damage were reported.   The quake struck 62km northwest of San Antonio at 11:23 pm local time (03:20 GMT) at a depth of 10km, the agency said.  San Antonio is home to Rafael Hernandez Airport, a key air link to the mainland US.    In 2010 nearby Haiti was struck by a devastating 7.0 magnitude earthquake that killed more than 250,000 people and crippled the nation's infrastructure.
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:
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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 ...

Qatar

Qatar - US Consular Information Sheet
February 26, 2008
COUNTRY DESCRIPTION:
Qatar is a monarchy governed by the ruling Al Thani family in consultation with a council of ministers, an appointed advisory council and an elected municipal cou
cil.
Islamic ideals and beliefs provide the foundation of the country’s customs, laws and practices.
Located in the heart of the Persian Gulf, Qatar is a dynamic, modernizing, rapidly developing country that is among the wealthiest per capita in the world.
The capital is Doha.
Tourist facilities are available.
Read the Department of State Background Notes on Qatar for additional information.
ENTRY/EXIT REQUIREMENTS:
Passports and visas are required.
U.S. citizens may obtain a single-entry tourist or business visa at Doha International Airport upon arrival.
Single entry visas cost $28 and must be paid by credit card only.
Cash is not accepted.
Visas are valid for 30 days and may be extended for an additional 30 days for a $28 fee through the Airport Visas Section of the Immigration Department located next to Doha International Airport.
However, U.S.-citizen travelers will be able to clear Qatari immigration more quickly and be granted a longer stay in country by obtaining visas prior to arrival.
If planning to arrive at another port of entry in Qatar, travelers should obtain a tourist or business visa in advance of their arrival from a Qatari embassy or consulate abroad.
Travelers should also note that the Qatari Government charges $55 for each day that an individual overstays a visa, up to a maximum amount of $3,300.

For further information on visas, residence permits and entry requirements, please visit the Qatari Ministry of Interior’s web site at www.moi.gov.qa/English/index.htm.
Travelers may also contact the Embassy of the State of Qatar (www.qatarembassy.net) at 2555 M Street NW, Washington, DC
20037, tel. (202) 274-1600, fax (202) 237-0061.
They may also contact the Consulate General of the State of Qatar, 1990 Post Oak Blvd. Suite 810, Houston TX 77056, telephone (713) 355-8221, fax (713) 355-8184, send email inquiries to info@qatarembassy.org.

Military personnel are subject to different entry/exit requirements and should refer to www.fcg.pentagon.mil for specific information pertaining to their travel requirements.
NOTE FOR DUAL NATIONALS:
Qatari law requires that Qatari citizens only hold Qatari citizenship and enter and exit on a Qatari passport.
Qatari authorities have confiscated the passports of U.S. citizens who acquired Qatari citizenship through marriage to a Qatari national or by virtue of birth in the U.S.
In several cases, Qatari authorities informed U.S. citizens that their U.S. citizenship had been revoked and was no longer valid.
However, foreign governments have no authority to revoke the citizenship of a U.S. citizen.
If this occurs, please contact the U.S. Embassy in Doha immediately.
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:
Incidents of violence are rare in Qatar, although attacks against Western targets have occurred.
To provide for public security, a large police presence is deployed throughout the country.
American citizens in Qatar are strongly encouraged to maintain a high level of vigilance, be aware of local events and take the appropriate steps to bolster their personal security at all times.

The Department of State remains concerned about the possibility of terrorist attacks against U.S. interests worldwide, including the Middle East.
Both historical and recurring information suggests that al-Qa’ida and affiliated organizations continue to plan strikes against Western targets; these attacks may employ a wide variety of tactics to include assassination, kidnapping, hijacking and bombing.
On March 19, 2005, a suicide bomber detonated a vehicle-borne improvised explosive device (VBIED) at a theater in Doha regularly frequented by westerners; a citizen of the United Kingdom was killed, and several other individuals were injured.

Increased security at official facilities has led terrorists and their sympathizers to seek softer, less fortified targets; the March 2005 theater attack in Doha is one such example.
Other locations of potential concern include any venue where U.S. citizens and other foreigners are known to congregate in large numbers such as public assemblies, sporting events, restaurants, residential areas, clubs, places of worship, schools, hotels, etc.
The Government of Qatar occasionally provides security for such locations and events, but to varying degrees.
In most instances, the Embassy cannot gauge the appropriateness of security for a given event prior to its commencement.
The Embassy strongly encourages American citizens to avoid large crowds and demonstrations whenever possible.
For the latest security information, Americans traveling abroad should regularly monitor the Department’s Internet web site, where the current Worldwide Caution, Travel Warnings and other Travel Alerts and additional resources 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:
The crime rate in Qatar is generally low.
A large police presence is apparent to travelers throughout the country.
Incidents of violence are rare but have occurred more frequently as Doha’s population and economic pressures on expatriate workers have increased substantially during the past few years.
Local and third country national young men have been known to verbally and physically harass unaccompanied, expatriate women.
Reports of petty theft have been growing, including ATM and credit card theft, purse snatching and pickpocketing.
Travelers are cautioned not to leave valuables such as cash, jewelry, and electronic items unsecured in hotel rooms or unattended in public places.

The Qatari Police can be contacted for emergency assistance by dialing 999 from any telephone in Qatar.
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 U.S. Embassy in Doha.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the U.S. Embassy for assistance.
The Embassy 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:
Good modern medical care and medicines are available in Doha, although only basic or no medical care may be available in Qatar’s smaller cities or outlying areas.
Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars.
Doctors and hospitals expect immediate cash payment for health services.
Information about the Qatari national healthcare system is available at http://www.hmc.org.qa.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Qatar is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Short-term visitors should obtain a valid International Driving Permit prior to arrival and should not drive in Qatar on a U.S. driver’s license.
Short-term visitors and business travelers can also obtain a Temporary Qatari Driving License by presenting their U.S. driver’s license at any branch of Qatar’s Traffic Police.
New and prospective residents should obtain a permanent Qatari Driving License immediately after arrival.
Once an American citizen holds a valid Qatari residence permit, they are no longer permitted to drive in Qatar with an International Driving Permit or a Temporary Qatar Driving License.

Traffic accidents are among Qatar’s leading causes of death.
Safety regulations in Qatar are improving thanks to a more stringent traffic law adopted in October 2007 and a country-wide traffic safety campaign.
However, informal rules of the road and the combination of local and third-country-national driving customs often prove frustrating for first-time drivers in Qatar.
The combination of Qatar’s extensive use of roundabouts, many road construction projects and the high speeds at which drivers may travel can prove challenging.
The rate of automobile accidents due to driver error and excessive speed is declining but remains higher than in the United States.
In rural areas, poor lighting, wandering camels and un-shouldered roads are other hazards.
Despite aggressive driving on Qatar’s roads, drivers should avoid altercations or arguments over traffic incidents, particularly with Qatari citizens who, if insulted, have filed complaints with local police that resulted in the arrest and overnight detention of U.S. citizens.
Drivers can be held liable for injuries to other persons involved in a vehicular accident, and local police have detained U.S. citizens overnight until the extent of the person’s injuries were known.
Due to its conservative Islamic norms, Qatar maintains a zero-tolerance policy against drinking and driving.
Qatar’s Traffic Police have arrested Americans for driving after consuming amounts of alcohol at even smaller levels normally accepted in the U.S.
Any motor vehicle over five years old cannot be imported into the country.
For specific information concerning Qatari driver’s permits, vehicle inspection, road tax and mandatory insurance, please contact either the Embassy of the State of Qatar in Washington, DC or the Consulate General of the State of Qatar in Houston, Texas.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Qatar’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Qatar’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: Qatari customs authorities enforce strict regulations concerning importation into Qatar of items such as alcohol, narcotics, pork products, firearms, or anything deemed pornographic by Qatari authorities.
While importation of religious material for personal use is acceptable, importation of religious material for the purpose of proselytizing is not.
It is advisable to contact the Embassy of the State of Qatar in Washington, DC, or the Consulate General of the State of Qatar in Houston for specific information regarding customs requirements.

Please see our Customs Information.

Pets entering Qatar require an import permit from the Ministry of Agriculture.
Cats with proper documentation are allowed to enter with no difficulty, but some breeds of dogs, especially large dogs, are not admitted.
Application forms for import permits may be obtained from the Ministry of Agriculture through a sponsoring employer.
A copy of the pet's health certificate and vaccination record must be submitted with the application.

Qatari law does not recognize dual nationality.
Persons who possess Qatari citizenship in addition to U.S. citizenship are considered Qatari citizens by the State of Qatar and are subject to Qatar’s laws.
Qatari citizenship imposes special obligations, particularly with regard to child custody and exiting or entering the country.
For additional information, please refer to our dual nationality flyer
or contact the U.S. Embassy in Doha.

All U.S. citizens are encouraged to carry a copy of their passports with them at all times so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available.
Qatari employers/sponsors customarily hold passports of foreign (i.e., non-Qatari) employees during the terms of their employment in Qatar.
Residents carry a Qatari Identification Card (Iqama) for identification in place of a passport.
Foreign nationals, including U.S. citizens, may not leave Qatar without permission in the form of exit visas obtained by their employer/sponsor.
The U.S. Embassy in Doha cannot assist U.S. citizens in Qatar to obtain third country visas for unofficial travel.
Islam provides the foundation of Qatar’s customs, laws and practices.
Foreign visitors are expected to remain sensitive to the Islamic culture and not dress in a revealing or provocative manner, including the wearing of sleeveless shirts and blouses, halter-tops and shorts.
Western bathing attire is worn at hotel pools and beaches.
BUSINESS AND EMPLOYMENT CONTRACTS:
The written, Arabic text of a contract governs employment and business arrangements under Qatari law.
Before signing a contract, U.S. citizens and companies should obtain an independent English translation of the original Arabic to ensure a full understanding of the contract's terms, limits, and agreements.
No U.S. citizen should work in Qatar or make a business arrangement without having seen and understood the full, written contract.
Verbal assurances or side letters are not binding in Qatar.

In the event of a contract or employment dispute, Qatari authorities refer to the Arabic language of a contract.
Since a Qatari sponsor holds the employee's passport and controls the issuance of exit visas, U.S. citizens cannot simply leave Qatar in the event of an employment or business dispute.
Any U.S. citizen who breaks an employment or business contract may have to pay substantial penalties before being allowed to depart Qatar.
Qatari law favors employers over employees, and Qatari sponsors have substantial leverage in any negotiations and may block the departure of the employee or bar future employment in Qatar.

Transferring employment in Qatar requires the permission of the previous employer, which is discretionary, and is subject to approval by the Ministry of the Interior.
The Ministry of the Interior has denied employment transfers in the past, including ordering U.S. citizens deported and barred from re-entry to Qatar for two years.
The U.S. Embassy has no standing in Qatar’s courts, cannot sponsor visas, and cannot adjudicate labor or business disputes.
U.S. consular officers can provide lists of local attorneys to help U.S. citizens settle disputes, but ultimate responsibility for the resolution of disputes through Qatar’s legal system lies with the parties involved.
To obtain a residence permit in Qatar, the Government of Qatar usually requires foreign citizens to provide a police clearance certificate from their home countries.
Prospective residents can obtain a U.S. police clearance certificate two ways: through a local or state law enforcement agency or through the Federal Bureau of Investigations (FBI).
In both cases, the clearance will run against the National Crime Information Center, which contains all federal, state and local criminal records.
This process requires several weeks, and the U.S. Embassy in Doha strongly recommends that prospective residents obtain a U.S. police clearance before they arrive in Qatar.

For more information on business opportunities and practices in Qatar, please visit the Foreign Commercial Service’s Country Commercial Guide for Qatar at http://www.buyusa.gov/qatar.
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.
Criminal offenses are punished according to Qatari laws, which in some cases are based on Islamic law and sometimes more severe than in the United States for similar offenses.
Persons violating Qatari laws, even unknowingly, may be arrested, imprisoned, deported, or subject to a ban from departing Qatar.
Travel bans are not lifted until both parties resolve a dispute and the case is abandoned or, if not, until the matter is resolved by a court, which may require months to process the case.
Qatari law enforcement authorities have detained potential witnesses or relatives without charges or access to legal counsel during the investigation of a crime.
The U.S. Embassy in Doha cautions American citizens that Qatari police can and have arrested American citizens suspected of or witness to a crime, including traffic accidents involving injuries to pedestrians or the occupants of other cars, traffic arguments, slander, and a variety of lesser offenses.
Once arrested, the Qatari Police have no independent authority to grant a release, an authority reserved solely for Qatar’s Public Prosecution and Courts.
As a result, arrested Americans, regardless of the charges, often spend one night in jail awaiting a hearing with Qatar’s Public Prosecution or the appropriate court.
Qatari law enforcement authorities do not routinely notify the U.S. Embassy in Doha of a U.S. citizen’s arrest and, for more serious crimes, may not allow a U.S. Embassy official to visit an arrested U.S. citizen until the initial interrogation is completed.
Upon arrest, U.S. citizens should ask to speak to the U.S. Embassy immediately, and if not allowed, request a friend or family member notify the U.S. Embassy through the contact information below.
Incidents involving insults or obscene language/gestures often result in arrest, overnight imprisonment and/or fines whether the incident occurs between private parties or involves officers of the law.
Drunk driving, public intoxication and other alcohol-related offenses are treated with severity and will result in arrest, heavy fines, imprisonment, or expulsion from the country.
Penalties for possession, use, or trafficking in illegal drugs in Qatar are severe, and convicted offenders can expect long jail sentences and heavy fines.
Homosexual activity is considered to be a criminal offense, and those convicted may be sentenced to lashing and/or a prison sentence, and/or deportation.
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 Qatar are encouraged to register with the U.S. Embassy in Doha through the State Department’s travel registration web site to obtain updated information on travel and security within Qatar.
Americans without Internet access may register directly with the U.S. Embassy in Doha.
By registering, American citizens make it easier for the U.S. Embassy in Doha to contact them in case of emergency.
The U.S. Embassy is located in the Al-Luqta District on 22nd February Street, PO Box 2399, Doha; phone (974) 488-4101, extension 0 or 6500.
For after-hours emergencies, U.S. citizens may call (974) 488-4101, extension 0 or 6600, to reach the duty officer.
On the Internet, you may reach the Embassy web site at http://qatar.usembassy.gov for additional information and operating hours.
The embassy observes a Sunday through Thursday workweek.
Government offices and most businesses in Qatar also observe a Sunday through Thursday workweek.
*

*

*
This replaces the Country Specific Information for Qatar dated November 26, 2007, to update the sections on Entry/Exit Requirements, Medical Facilities and Health Information, Traffic Safety and Road Conditions, Special Circumstances, and Criminal Penalties.

Travel News Headlines WORLD NEWS

Date: Wed 24 May 2017
Source: State of Qatar, Ministry of Public Health - News [edited]

Ministry of Public Health (MOPH) has announced that a new Middle East Respiratory Syndrome Corona Virus (MERS-CoV) case has been confirmed for a 29-years-old, resident in Qatar, marking the 3rd MERS-CoV case to be confirmed in the country this year [2017] and bringing the cumulative number of confirmed MERS-CoV cases since 2012 to 21 cases among whom 7 have died.

The patient is a camel worker and had complaints of fever and dry cough for several days. He sought medical attention in Hamad General Hospital where an X-Ray investigation suggested a severe pneumonia. Consequently and as he reported an occupational frequent contact with camels, further samples were withdrawn from the patient. He ultimately tested positive for MERS-CoV according to Hamad Medical Corporation laboratories.

Despite his stable condition, the patient was admitted to hospital; in consistence with the national infection prevention and control protocol for confirmed and suspected MERS-CoV cases to ensure the appropriate medical attention. However, neither a history of contact with similar cases nor a recent travel outside the country was reported for the patient who has no comorbidities.

Once the case has been confirmed, the rapid response team of the Health Protection and Communicable disease Control (HP & CDC) department at the MOPH, accompanied with the team from Animal Health Department, Ministry of Municipality and Environment, have started a field investigation to assess the possible source of the infection and to verify whether any of the patient contacts has suspected symptoms according to the WHO standard case definition. Consequently, all traced contacts will be monitored over a period of 2 weeks, while those who develop suspected symptoms will then be subjected to confirmatory laboratory investigation.

The Ministry of Public Health advices citizens and residents, in particular those with comorbidities or low immunity, to abide to cough etiquette and handwashing with soap and water thoroughly and avoid unnecessary contact with sick animals.

MOPH proclaimed that Health Protection & CDC Hotlines 66740948 & 66740951 are accessible 24/7 to respond to any notification or enquiry related to infectious diseases.
==================
[The above press release mentioned the participation of animal health experts in the investigation of the described case. Information on their observations and findings, including results of laboratory tests (in case animal samples were taken), will be appreciated.

Qatar officially notified the OIE about its 1st event of MERS-CoV in camels, as an emerging disease, on 28 Nov 2013. The start of the event was, reportedly, dated 14 Oct 2013. The 'affected population' was kept on a "small farm with 14 camels, one sheep, one pigeon cage and some chicken" in Al-Shahanya, Ar Rayyan district. The diagnostic laboratory, given as "the Erasmus Medical Center (Rotterdam) and National Institute for Public Health and the Environment (Bilthoven), the Netherlands (OIE Reference Laboratory)", established the diagnosis of MERS-CoV in camels by PCR, on 26 Nov 2013. The report included the following epidemiological comment: "The health authority in Qatar notified the presence of a confirmed human MERS-CoV case. A joint team from both health and veterinary authorities was sent to the patient farm to investigate the health status of animals and the contact person. A farm worker proved to be positive for MERS-CoV and samples were collected from the 14 existing camels in addition to one sheep, some pigeons and chickens and some environmental samples (water, soil, animal food and grass) and all were sent to the Netherlands for testing. All animals were kept under observation and quarantine and all were apparently healthy". The above immediate notification was followed by 3 follow-up reports (29 Dec 2013, 22 Apr 2014 and 09 Jun 2014).

Follow-up report No 1, submitted a month later, namely on 29 Dec 2013, informed: "There are no new outbreaks in this report". The report, however, included the following epidemiological comments: "The samples from the same herd tested, using the same technique were negative and this may show that MERS-CoV infection in camels is a self-limiting disease. The planned massive survey for MERS-CoV in animals is under implementation and the same herd is under systematic retesting. Follow-up reports will be submitted when there will be new data".

Follow-up report No 2, submitted 22 Apr 2014, addressed "A single barn of 26 camels of different ages" in the same location (Al-Shahanyain), Qatar. The diagnostic laboratory was named as "Department of Viroscience, Erasmus Medical Center, Rotterdam (The Netherlands) (Foreign laboratory)"; the tests were performed on 19 Apr 2014, applying PCR and virus isolation, both positive. The report included the following epidemiological comments: "During an existing survey (pilot phase of the survey), nasal swabs were collected from an 8-month-old camel among healthy dromedary camels. The sample was inoculated on Vero cells and cytopathic changes were observed in cells at 48h post-infection. Human hepatoma cells (Huh-7 cells) were inoculated with MERS-CoV to further functionally characterize this viral isolate. After 2 days, virus-induced cytopathic effects were observed in the inoculated cell cultures. Virus production in Huh-7 cells was blocked by pre-incubating MERS-CoV with a 1/200 dilution of serum from MERS-CoV antibody positive camels. Conclusion: these data demonstrate that the MERS-CoV obtained from a dromedary camel is able to replicate in human cells and uses DPP4 as entry receptor, similar as isolates obtained from MERS patients".

Follow-up report No 3, submitted 9 Jun 2014, involved 3 barns with a total number of 12 camels of different ages, similarly in Al-Shahanya. Of the 12 susceptible camels, there were 5 "cases", indicated as an apparent morbidity rate of 41.67 percent. The diagnostic laboratory was "Erasmus Medical Center (Rotterdam) and National Institute for Public Health and the Environment (Bilthoven), The Netherlands (Foreign laboratory)", which applied SNT. This report included the following epidemiological comment: "Milk was collected according to local customs; cria's (dromedary calves) were not weaned after delivery but kept at the farm in paddocks adjacent to their dams throughout lactation. Dams were reunited with their cria to trigger milk production. Once milk production was initiated, the milk samples were collected by the camel owner or caretaker without specific hygienic precautions". The named follow-up report No 3 was the last report of MERS-CoV in camels submitted so far by Qatar to the OIE. It included the statement "continuing". No additional MERS-CoV reports from Qatar have become available since June 2014.

According to WAHID's archive data, the summary of the event since its start, as of June 2014, was:
Total outbreaks = 3 (Submitted)
Species/ Susceptible/ Cases/ Deaths/ Destroyed/ Slaughtered
Camelidae/ 52/ 9/ 0/ 0/ 0
(see at <http://www.oie.int/wahis_2/temp/reports/en_fup_0000015380_20140610_175414.pdf>).

In May 2017, the OIE updated its case definition for the reporting of MERS-CoV, as follows:

"1. Introduction
Dromedary camels have been confirmed by several studies to be the reservoir of the MERS-CoV infection in humans. Zoonotic transmissions of MERS-CoV from dromedary camels to humans were reported in multiple occasions. MERS-CoV has never been reported as a disease in camels though in experimental infections MERS-CoV has been associated with mild upper respiratory signs. Positive PCR results for MERS-CoV or isolation of the virus from camels is notifiable to the OIE because MERS is an emerging disease with a significant public health impact.

2. Confirmed case:
A dromedary camel with laboratory confirmation (*note 1) of MERS-CoV infection, with or without clinical signs.

3. Suspected case:
a) Observed clinical signs of mild respiratory infection (rhinitis in young dromedaries); and
b) Direct epidemiologic link (*note 2) with a confirmed human or camel MERS-CoV case; and
c) Testing for MERS-CoV is unavailable, negative or inconclusive (*note 4) on a single inadequate specimen (*note 3).

Notes
1 A case may be laboratory confirmed by virus isolation or detection of viral nucleic acid. The presence of viral nucleic acid can be confirmed by 1) a positive RT-PCR result on at least 2 specific genomic targets,
2) a single positive target with sequencing of a 2nd target or
3) a single positive target with positive result in a rapid MERS-CoV Ag Test. Serological investigations are of little value as high percentage of tested dromedaries possess antibodies to MERS-CoV.

2. A direct epidemiological link with a confirmed MERS-CoV dromedary camel may include living or traveling together in close proximity or sharing the same environment with individual dromedaries infected with MERS-CoV.

3. An inadequate specimen would include a specimen that has had improper handling, is judged to be of poor quality by the testing laboratory, or was taken too late in the course of illness.

4. Inconclusive tests may include a positive screening test on a single rRT-PCR target without further confirmation. Animals with an inconclusive initial test should undergo additional sampling and testing to determine if the animal can be classified as a confirmed MERS-CoV case. At herd level, having positive single target PCRs in more than one animal could constitute confirmation. Preference should be a repeat nasopharyngeal specimen. Other types of clinical specimens could also be considered for molecular testing if necessary, including blood/serum, and stool/rectal swab. These generally have lower titers of virus than respiratory tract specimens but have been used to confirm cases when other specimens were inadequate or unobtainable".

As commented by Mod.MPP (see http://promedmail.org/post/20170524.5059234), according to a review of cases reported by Saudi Arabia and classified as "primary" cases (N=560), 27.3 percent had a history of camel exposure, and 72.7 percent were reported as still under investigation for high risk exposures at the time of initial confirmation report. The 85th General Session of the World Assembly of OIE Delegates has been held in Paris during this week (21 to 26 May 2017). According to WHO updated information, MERS-CoV has caused, since its initial detection in Sep 2012, at least 1952 human cases, of which at least 693 deaths in 27 countries. It will be interesting to note if the reporting of this disease, according to the OIE criteria, and its possible control in the animal reservoir have been discussed during the General Session.

Subscribers are referred to a recent review paper (Ref 1), and in particular to figure 3 "Hypothesis of MERS-CoV transmission to humans".

A One Health approach to the MERS-CoV issue, its epidemiology and control, will require the active involvement of the 3 relevant international authorities, namely the FAO, OIE and WHO.

References
M. G. Hemida, A. Elmoslemany, F. Al-Hizab, A. Alnaeem, F. Almathen, B. Faye, D. K. W. Chu, R. A. P. M. Perera & M. Peiris. Dromedary Camels and the Transmission of Middle East. Transboundary & Emerging Diseases 64 (2017) 344-353.  <http://agritrop.cirad.fr/580073/7/Hemida_et_al-2017-Transboundary_and_Emerging_Diseases.pdf>. - ProMED Mod.AS]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Sat, 26 Nov 2016 20:00:07 +0100

Doha, Nov 26, 2016 (AFP) - Rainfall caused widespread flooding in Qatar on Saturday, potentially raising fresh concerns about infrastructure in the Gulf country due to host the 2022 football World Cup.   Several major roads were flooded, prompting official warnings.   "As the rain continues to pour in most parts of the country, motorists are advised to be cautious," the interior ministry tweeted after earlier calling the rainfall "medium to heavy".   Some apartment buildings on the Pearl Qatar, an artificial island in Doha, estimated to have cost $15 billion (13.5 billion euros) to build, suffered flooding, as did the nearby suburb of Qanat Quartier, built to resemble Venice.

The Doha News website reported that the Qatar Animal Welfare Society pleaded urgently for foster homes to take care of its dogs because of the conditions.   The Peninsula English-language newspaper reported that rain caused leaks at major Doha shopping centre the Landmark Mall.   Many people used social media to post videos and pictures, with some questioning how a relatively small amount of rain -- the first of the winter -- could cause such problems.   The wet weather had been predicted and the government "Rain Emergency Team" had already convened to discuss potential problems.

Last November, the government began an inquiry after rain damaged Doha's Hamad international airport, which opened in 2014, flooded roads and streets and caused some schools to close.   Gas-rich Qatar is spending more than $200 billion on major infrastructure such as roads, the airport, a metro system and a new city ahead of the 2022 World Cup, which will be played at this time of year -- from November 21 to December 18.   World Bank figures show Qatar's average annual rainfall is around 75 millimetres.
Date: Mon 13 Jun 2016 01:58 AM (Qatar)
Source: Gulf Times [edited]

The Ministry of Public Health has announced that a new Middle East Respiratory Syndrome Corona Virus (MERS-CoV) case has been confirmed in a 23-year-old male resident, marking it the 3rd to be confirmed in the country this year [2016].

The person was not in contact with a confirmed case and does not suffer from any chronic diseases that usually cause immunity suppression. The patient was admitted to Hamad General Hospital as he reported fever, cough, runny nose, and backache where he tested positive for Mers-CoV. The patient is now stable and receives medical care in the isolation ward.

The ministry said that Health Protection and Communicable Disease Control Hotlines, 66740948 and 66740951, are accessible round-the-clock to respond to any notification or query related to infectious diseases.

MERS-CoV was 1st identified in Saudi Arabia in 2012.

According to the World Health Organization (WHO), globally, since September 2012, it has been notified of 1652 laboratory-confirmed cases of infection with MERS-CoV, including at least 591 related deaths [the most recent report from WHO on 16 May 2016 gives a global tally of 1733 laboratory-confirmed cases of infection with MERS-CoV, including at least 628 related deaths (<http://www.who.int/csr/don/16-may-2016-mers-saudi-arabia/en/>) - ProMED Mod.MPP].

Mers-CoV is a zoonotic virus that is transmitted from animals to humans.
==================
[As mentioned in the above report, this is now the 3rd case of MERS-CoV infection reported in Qatar in 2016. The 1st case was reported in February 2016 in a 66 year old Qatari male who had been, for 2 months preceding onset of illness, in Saudi Arabia where he had a camel farm (see MERS-CoV (35): Saudi Arabia, Qatar ex Saudi Arabia, WHO http://promedmail.org/post/20160311.4085518 and MERS-CoV (24): Qatar ex Saudi Arabia, Saudi Arabia (RI) RFI http://promedmail.org/post/20160222.4041719). The 2nd case was a 40 year old Qatari national camel worker with non-specific, non-respiratory symptoms (see MERS-CoV (56): Qatar, Saudi Arabia, WHO http://promedmail.org/post/20160503.4198200).

According to the most recent ECDC Communicable Disease Threats Report, as of 9 June 2016, there have been a total of 1753 cases of MERS-CoV infection, including 680 deaths reported by health authorities worldwide. Besides, there have been a total of 15 cases of MERS-CoV infection including 5 deaths reported by Qatar as of 9 Jun 2016, making this current case the 16th case reported by Qatar since April 2012.  (<http://ecdc.europa.eu/en/publications/Publications/Communicable-disease-threats-report-11-june-2016.pdf>).

In addition to the 16 cases reported by Qatar, there have been 2 additional cases reported in Qatari nationals treated in Europe (see Novel coronavirus - Saudi Arabia (03): UK HPA, WHO, Qatar
East. Med. (07): Saudi Arabia, UK, Germany

We await further information on possible high risk transmission exposures.

The HealthMap/ProMED map of Qatar can be found at:
Date: Mon 2 May 2016
Source: Gulf Times

A 40-year old camel worker has tested positive for the Middle East respiratory syndrome coronavirus (MERS-CoV), the Ministry of Public Health (MoPH) announced.

It is the 2nd case confirmed in Qatar so far this year [2016].

The worker, who was neither in contact with a suspected patient nor abroad during the last 2 weeks, is free from chronic diseases that usually cause immunity suppression. He was admitted to Hamad General Hospital [in Doha] with general symptoms where routine investigations tested positive for MERS-CoV, despite him not exhibiting any respiratory related symptoms.

The patient is currently in stable condition and receiving the necessary medical care in the isolation ward, according to the national protocol for infection prevention and control, the ministry said in a statement.

After the tests proved positive, the rapid response team of MoPH carried out extensive search to list all potential contacts to check for their possible consistence with the standard case definition of the suspected cases, based on the World Health Organisation guidelines. All traced contacts will be monitored over a period of 2 weeks, while those who develop suspected symptoms will then be subjected to confirmatory laboratory investigation, the ministry added.

While research efforts continue on a global and local level to determine the modes of transmission of MERS-CoV infection, the MoPH has advised citizens and residents who suffer from chronic diseases to avoid direct contact with camels and to wash hands with soap and water thoroughly. Also recommended are implementing respiratory hygiene and cough etiquette and the need to boil camel milk before drinking.

MoPH added that Health Protection & CDC Hotlines 66740948 and 66740951 are accessible 24/7 to respond to any notification or inquiry related to infectious diseases.
==================
[The text of the media report above is almost verbatim from the MoPH announcement, also released today (2 May 2016 and available at <https://www.moph.gov.qa/news/moph-announces-the-second-mers-cov-case-in-2016?backArt=326&page=2>). On 22 Feb 2016, there was a report of a case of MERS-CoV infection in a 66 year old Qatari male who had a farm (with camels and sheep) in Saudi Arabia. The addition of this newly confirmed case brings the total number of cases of MERS-CoV infection reported by Qatar to 15 since 2012. It is noteworthy that in the absence of respiratory symptoms, the history of camel contact most probably led to testing for MERS-CoV infection in this patient, suggesting a high index of suspicion on the part of the medical community treating this patient.

The HealthMap/ProMED map of Qatar can be found at
Date: Thu, 10 Mar 2016 14:54:28 +0100

Doha, March 10, 2016 (AFP) - A 66-year-old Qatari man has died after contracting the MERS virus, in the first fatal case in the Gulf state for 10 months, health officials announced Thursday.   The public health ministry, quoted by the official Qatar News Agency, said the man "had been suffering from several chronic diseases and died of complications from the disease".

This was the first such case of Middle East Respiratory Syndrome reported in Qatar since May 2015 when it claimed the life of a 73-year-old man, the ministry added in a statement.   The ministry "continues to monitor acute respiratory diseases and is working in cooperation with all the health institutions in the public and private sectors to monitor any suspected case," it said.   The latest victim had been diagnosed with the virus in February. He was hospitalised after returning from a "neighbouring country", according to an official statement last month.

MERS is a viral respiratory illness and considered a deadlier but less infectious cousin of the SARS virus that appeared in Asia in 2003, infecting more than 8,000 people and killing hundreds.   Like SARS, it appears to cause a lung infection, with patients suffering coughing, breathing difficulties and a temperature.

MERS differs in that it also causes rapid kidney failure.   It first appeared five years ago in neighbouring Saudi Arabia, which has been the country worst hit by the virus, with 1,286 cases of infection and 551 deaths, according to official figures.   Globally, there have been 1,644 confirmed MERS cases and 590 deaths, according to the World Health Organization.
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 ...

Congo, Democratic Republic

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

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

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

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

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for overseas callers, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
In the DRC, poor economic conditions continue to foster crime, especially in urban areas. Travel in many sections of Kinshasa, Kisangani, Lubumbashi and most other major cities, is generally safe during daylight hours, but travelers are urged to be vigilant against criminal activity which targets non-Congolese, particularly in highly congested traffic and areas surrounding hotels and stores. Outlying, remote areas are less secure due to high levels of criminal activity and the lack of adequate training, supervision, and salary payments to the security forces present.

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

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

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

Travelers using public transportation or visiting high pedestrian traffic areas of any type are advised to be vigilant against robbery and pick-pocketing which is a persistent problem in all major cities in the DRC. The presence of “street children”, who can be persistent and sometimes aggressive, remains a problem particularly in Kinshasa.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
In the DRC, medical facilities are severely limited, and medical materials are in short supply. Travelers should carry properly labeled prescription drugs and other medications with them and should not expect to find an adequate supply of prescription or over-the-counter drugs in local stores or pharmacies. Payment for any medical services required is expected in cash, in advance of treatment.

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

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en
MEDICAL INSURANCE:
For planning purposes, the minimum estimated cost of medical air evacuation to the nearest suitable health care facility (in South Africa) is $35,000.

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

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning the DRC is provided for general reference only, and may vary according to location or circumstance.

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

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

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

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

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

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

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

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

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

CRIMINAL PENALTIES:
While in any foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.

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

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in the DRC are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site, so that they can obtain updated information on travel and security within the Congo. Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency. The U.S. Embassy is located at 310 Avenue des Aviateurs; tel. 243-081-225-5872 (do not dial the zero when calling from abroad). Entrance to the Consular Section of the Embassy is on Avenue Dumi, opposite the Ste. Anne residence. The Consular Section of the Embassy may be reached at tel. 243-081-884-6859 or 243-081-884-4609; fax 243-081-301-0560 (do not dial the first zero when calling from abroad).
*

*

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

Travel News Headlines WORLD NEWS

Date: Mon 14 Oct 2019 17:11
Source: Africa News [edited]

Bat consumption is still a vibrant culture among Congolese despite numerous warnings by health practitioners against the practice.  Several homes do serve bats, also locally known as "ngembo" in Lingala language, as part of their meals.

The process of preparing a bat is not hectic as elaborated by one of the consumers.  "We start by cutting its wings after burning the hair in the fire. It is then cleaned with warm water, then cut into 2 and everything is put into the pot in which we add a little salt, oil, and other ingredients", [EM] told Africanews correspondent Rosie Pioth in Brazzaville. After one hour of cooking, someone has to taste just to be sure if it's delicious enough to be served. It is then served with cooked cassava.  To get bat meat, one has to go to the market. On the shelves, prices vary between USD 1 to USD 2.5.

Several health practitioners have warned against dangers of consuming bat meat. They have consistently claimed that bats can act as hosts to Ebola virus. "Today, we can say that a bat is a frugivore. A bat can keep a certain number of viruses, today the most dangerous virus is the Ebola. So bat meat can contain this virus and therefore transmit it to human", explained Josaphat Depaget, a nutritionist in Brazzaville.  "You have a very delicious meat, which is very good but by consuming it, you have the risks of being contaminated with the Ebola virus. Therefore, it is not good for consumption."

Cheap and highly appreciated for its meat, the debate on the consumption of bat meat is still raging in Congo. Those who defend it see it as a source of nutrition, while others see it as a contaminant.  [Byline: Michael Oduor]
====================
[Bats are well-recognized reservoirs of zoonotic pathogens, in particular viruses. Agents that can spill over from bats to humans caused emerging zoonoses that affected humans and domestic animals -- such as filoviruses (Ebola and Marburg virus), henipaviruses (Hendra and Nipah virus) and coronaviruses (including severe acute respiratory syndrome coronavirus, SARS-CoV). In DRC the pathogen of main concern is Ebola virus. Ebola outbreaks there have been linked to bat consumption (for example, <http://dx.doi.org/10.1089/vbz.2008.0167>). It has to be taken into account that although the cooking procedures can inactivate the virus, there is inevitable exposure to viral particles before it happens. - ProMED Mod.PMB]

[Bushmeat comes from a variety of wild animals of which bats are just one prized example. Nonhuman primates, cane rats (grasscutters), and duiker (antelope) are also favored, according to the CDC. Generally, Ebola is not spread during the act of eating these animals following roasting. Rather, human infections have been associated with hunting, butchering, and processing meat from infected animals. Also see ProMED-mail 16 Oct 2019 regarding danger of eating dead gorillas. - ProMED Mod.LK]

[HealthMap/ProMED-mail map of DR Congo:
Date: Tue 15 Oct 2019
Source: Outbreak News Today [edited]

In an update on the plague cluster in Ituri Province in the north-eastern Democratic Republic of the Congo (DRC), UN officials report a total of 31 cases and 8 deaths since the beginning of 2019.

The 1st 5 cases were reported during week 10 in the Aungba health zone, which is in an endemic area. Two other cases were reported during week 13 (Aru health zone) and 14 (Aungba health zone). The latest cluster of cases was reported between week 39 (7 cases and 3 deaths) and 40 (14 cases) from Aru health zone in Ituri Province.

Plague is an infectious disease caused by the bacterium, _Yersinia pestis_. It is found in animals throughout the world, most commonly in rats but also in other rodents like ground squirrels, prairie dogs, chipmunks, rabbits and voles. Fleas typically serve as the vector of plague.

People can also get infected through direct contact with an infected animal, through inhalation and, in the case of pneumonic plague, person to person.  _Y. pestis_is treatable with antimicrobials if started early enough.  There are 3 forms of human plague; bubonic, septicemic and pneumonic.
======================
[Most cases are due to bubonic plague following the bite of an infected rodent flea causing a swollen and very tender lymph gland. The swollen gland is called a bubo. Bubonic plague should be suspected when a person develops a swollen gland, fever, chills, headache, and extreme exhaustion, and has a history of possible exposure to infected rodents, rabbits, or fleas. A person usually becomes ill with bubonic plague 2 to 6 days after being bitten.

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

[HealthMap/ProMED map available at:
Date: Fri 11 Oct 2019
Source: WHO AFRO [abridged, edited]

HM and his wife, NM, were among the 1st parents to arrive for the measles vaccination at Nzombi Health Centre in Masi Manimba, a village 400 km [approx. 250 mi] south of Kinshasa. They brought their 3-year-old triplet girls. The children had missed out on being vaccinated for measles at the designated age of 6 months and are in serious danger of infection.

HM and his wife are among the hundreds of thousands of parents across the Democratic Republic of the Congo who rushed to have their children vaccinated following the launch of a measles campaign by the Government, the World Health Organization (WHO) and partners.

A few streets from the health centre, community mobilizer Mundumusi Lipsa bellows through his megaphone, calling on parents to take children who are not vaccinated to the health centres offering the vaccination. His colleague, Lula Pwati, and a WHO epidemiologist are going from house to house to make sure no child is left behind.

According to preliminary reporting on coverage, the 9-day vaccination campaign that reached the triplets of HM and NM most likely will go beyond the targeted 825 000 children in what has become the world's largest and fastest-moving outbreak. To date, the number of suspected cases has gone beyond 203 000 (6276 confirmed), with more than 4000 deaths, nearly all of them children. This vaccination campaign is the 3rd emergency intervention targeting children aged 6--59 months.

"Measles is a disease that not only kills but also has very serious complications. Health workers must always remind parents to take the children for the shot on time," says Dr. Helene Chenge, a WHO epidemiologist.

The campaign is funded by the United Nations Humanitarian Pooled Fund, with contributions from the WHO Contingency Fund for Emergencies and from the Measles and Rubella Initiative.

A 5-day follow-up immunization campaign in 7 provinces is slated to begin on [22 Oct 2019] to provide supplemental doses to children aged 9-59 months and thus reach those who were not vaccinated through the routine immunization programme.
Date: Sun, 13 Oct 2019 23:31:57 +0200 (METDST)

Kinshasa, Oct 13, 2019 (AFP) - Doctors will use a second Ebola vaccine from November in three eastern provinces in the Democratic Republic of Congo to fight the deadly virus, medical officials said Sunday.   "It's time to use the new Ad26-ZEBOV-GP vaccine, manufactured by Johnson & Johnson's Belgian subsidiary," said Dr. Jean-Jacques Muyembe, who leads the national anti-Ebola operation in the DRC.    It will arrive in the eastern city of Goma, in North Kivu province, on October 18 and be used from the beginning of next month, he added.   DRC's latest Ebola epidemic, which began in August 2018, has killed 2,144 people, making it the second deadliest outbreak of the virus, after the West Africa pandemic of 2014-2016.

Muyembe said the communes of Majingo and Kahembe had been selected to receive the vaccine as they were considered the epicentres of the epidemic.   "We will extend this vaccination to our small traders who often go to Rwanda to protect our neighbours," he added.   "If it works well, we will expand vaccination in South Kivu and Ituri."   DR Congo's eastern provinces of Ituri, North Kivu and South Kivu sit on the borders with Uganda, Rwanda and Burundi.   The Belgian laboratory will send a batch of 200,000 doses to neighbouring Rwanda and 500,000 doses in the DRC, Muyembe said.   More than 237,000 people living in active Ebola transmission zones have received a vaccination produced by the pharma company Merck Sharpe and Dohme since August 8, 2018. 

The J&J vaccine had been rejected by DRC's former health minister Oly Ilunga, who cited the risks of introducing a new product in communities where mistrust of Ebola responders is already high.   But Ilunga's resignation in July appears to have paved the way for approval of the second vaccine. He currently faces charges that he embezzled funds intended for the fight against Ebola.   In his letter of resignation Ilunga said "actors who have demonstrated a lack of ethics" want to introduce a second vaccine, but did not elaborate.    Muyembe, who took over the Ebola fight in the DRC in July, said "The Johnson & Johnson vaccine has the most science-based data."
Date: Wed, 9 Oct 2019 22:01:17 +0200 (METDST)

Kinshasa, Oct 9, 2019 (AFP) - Six people were killed in the Democratic Republic of Congo after torrential rains hit the capital Kinshasa, flooding several neighbourhoods. a local official said.    The bodies were found between Tuesday night and Wednesday morning.    Five people were killed in the capital's Selembao municipality where around 30 houses collapsed, local mayor Augustin Mankesi told Top Congo radio station.   One woman died in the Pelende district after she was electrocuted, he added.    "Our community is stricken," Mankesi added, calling on the Congolese authorities for help.   Fatal floods and rains are frequent in Kinshasa. In January last year 48 people were killed in landslides, floods and after houses collapsed, according to authorities.    Residents told AFP the road from the sea port district of Matadi to the Kinshasa turnoff has been closed due to erosion caused by the rain.    The passage is Kinshasa's main supply route for imported goods and also serves as an exit point for exports.
More ...

Sweden

Sweden - US Consular Information Sheet
14th October 2008
COUNTRY DESCRIPTION:
Sweden is a highly developed, stable democracy with a modern economy.
Read the Department of State Background Notes on Sweden for additional information.
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ENTRY/EXIT REQUIREMENTS:
Sweden is a party to the Schengen agreement.
As such, U.S. citizens may enter Sweden 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 Schengen Fact Sheet.
Contact the Swedish Embassy at 901 30th Street, NW, Washington, DC
20007, tel: (202) 467-2600 (mailing address 2900 K Street, N.W., Washington, DC), or the Swedish Consulate General in New York at (212) 583-2550. Visit the Sweden Abroad web site at www.swedenabroad.com for the most current visa information.
Sweden’s immigration authorities (Migrationsverket) also maintain a home page at http://www.migrationsverket.se/english.jsp.

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:
Sweden remains largely free of terrorist incidents.
However, like other countries in the Schengen area, Sweden’s open borders with its Western European neighbors allow the possibility of terrorist groups entering/exiting the country with anonymity.
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 of State, Bureau of Consular Affairs’ 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 security can also be obtained by calling 1-888-407-4747 toll free in the United States, or, for callers outside the United States 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:
Sweden has a low crime rate with rare, but increasing, instances of violent crime.
Most crimes involve the theft of personal property from cars or residences or in public areas. Pickpockets and purse-snatchers are becoming more prevalent. Many American citizens fall victim to these highly skilled thieves, especially at the main train stations in Stockholm and Gothenburg and during bus or train transit to and from airports. Do not put any bags containing valuables, such as your passport, down on the ground. Computer bags are particularly desirable.
Pickpockets and purse-snatchers often work in pairs or groups with one distracting the victim while another grabs valuables.
Often they operate in or near major tourist attractions such as Stockholm’s Old Town, restaurants, amusement parks, museums, bars, buses, long distance trains, subway trains, train and bus stations, and airports.
Hotel breakfast rooms and lobbies attract professional, well-dressed thieves who blend in with guests and target purses and briefcases left unguarded by unsuspecting tourists and business travelers.
Valuables should not be left in parked vehicles.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to both 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, contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you in finding appropriate medical care, contacting family members or friends, and explaining how funds can be transferred.
Although the investigation and prosecution of a crime abroad 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.

Sweden has a limited criminal injuries compensation program for victims of violent, personal, and property crime.
Foreign citizens who are victims of crime on Swedish territory are eligible to apply for compensation, but if the victim and offender’s affiliation to Sweden is transitory in nature, compensation may not be awarded even though the crime occurred on Swedish soil.
Application forms in English are available at local police stations and other government agencies as well as on the Internet at
http://www.brottsoffermyndigheten.se/default.asp?id=1345.
Claimants are generally notified of the program’s decision within four months.

The local equivalent to the “911” emergency line in Sweden is 112.
See our information for Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care is comparable to that found in the United States.
The Swedish medical system is a state-run system, so instead of visiting a local private general practitioner, travelers can visit a local medical center or clinic, called an “Akutmottagning” or “Vardcentral.”
Patients should be prepared to present their passports.
In case of a medical emergency, use the emergency telephone number “112” (see above) to contact the appropriate emergency service.

Travelers with special medical needs should consult with their personal physician and take appropriate precautions, including bringing adequate supplies of necessary medication.
Medicines may be brought into the country as long as they are intended for the traveler’s personal use.
Medications categorized as narcotics may only be brought into the country to cover the traveler's personal use for a maximum of five days and must be accompanied by a medical certificate stating why the traveler needs them.
In addition, stringent Swedish customs regulations prohibit travelers from receiving drugs from abroad after having arrived in the country.
Travelers may also find local physicians reluctant to prescribe equivalent quantities or dosages.
Prescriptions are dispensed at state-run pharmacies called “Apotek” in Swedish.
Most pharmacies are open during normal shopping hours but major cities have a 24-hour pharmacy.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Sweden.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
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 Sweden is provided for general reference only, and may not be totally accurate in a particular location or circumstance.


A valid U.S. driver’s license may be used while visiting Sweden, but drivers must be at least 18 years of age.
Driving in Sweden is on the right.
Road signs use standard international symbols and Swedish text.
Many urban streets have traffic lanes reserved for public transportation only.

Swedish roads are comparable to those in the U.S., though secondary roads may be less heavily traveled.
These secondary routes often narrow to two lanes with a wider shoulder.
Slower vehicles are expected to move onto the shoulder to allow faster moving vehicles to pass.
All vehicles must have headlights lit when on the road, no matter what time of day.
The use of snow tires is mandatory between December 1 and March 31 and, experience in driving on ice and snow is recommended before navigating Sweden’s winter roads.

Public transport in Sweden is of good quality and is the recommended method of travel.
Passenger trains, intercity buses, and plane flights provide regular service over longer distances.
Public transportation in urban centers includes buses, subways, trams, suburban trains, and taxis.
Taxis are more expensive than in major U.S. cities.
Most local residents use public transport in Stockholm as parking can be hard to find and expensive.
The bus, train, and subway systems are relatively safe.

Use of seat belts is mandatory for drivers and all passengers, and children under the age of seven must be seated in approved child or booster seats.
The maximum speed limit is 110 kilometers per hour.
Driving under the influence of alcohol or drugs, including prescription drugs, is considered a very serious offense.
The rules are stringently enforced and fines can be severe.
Violations can result in severe fines and possible jail sentences.

Emergency services for traffic accidents can be reached by calling 112 (the equivalent to 911 in the U.S.).
Please refer to our Road Safety page for more information.
Visit the website of the country’s national tourist office and national authority responsible for road safety at www.visitsweden.se and at http://www.vv.se/templates/page2_2____13172.aspx?epslanguage=EN
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Sweden’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Sweden’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:
Please see our information on Customs Information and the Swedish web site www.tullverket.se/en for customs information specific to Sweden.
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 Sweden’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Sweden are severe, and convicted offenders can expect long jail sentences and heavy fines.
There is no bail system in Sweden and non-resident Americans who are arrested may be held in custody until the trial is complete.
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 Sweden are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, https://travelregistration.state.gov, so that they can obtain updated information on travel and security within Sweden.
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
Dag Hammarskjoldsvag 31, telephone: (46) (8) 783-5300, fax:
(46) (8) 783-5480, and after-hours telephone: (46) (8) 783-5310.
The Embassy’s web site is http://stockholm.usembassy.gov/
* * *
This replaces the Consular Information Sheet dated March 4, 2008 to update the sections on Entry Requirements, Information for Victims of Crime and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: 10 Oct 2019
Source: Food Safety News [edited]

Livsmedelsverket has warned people to correctly soak and cook dried legumes such as beans, peas and lentils after they were linked to a large food poisoning outbreak at a school.

Dried legumes naturally contain lectins which can cause nausea, vomiting and diarrhea around 1-7 hours after consumption.

Illness occurred in the canteen at lunchtime in early September 2019 at Baldergymnasiet school in Skelleftea, a city in Vasterbotten County. Swedish media reported that almost 280 people were affected, and samples were sent to a laboratory in the United Kingdom.

Sandra Wallstrom, a food inspector at Skelleftea municipality, said it was thought to be the 1st time elevated levels of lectin have been shown to have caused food poisoning in Sweden.

Follow-up checks will be made at the school to ensure the handling of beans and similar foods is safe in the future.

Swedish officials urged people to follow instructions on the packaging and in recipes. They should be soaked for at least 12 hours, rinsed and cooked for at least half an hour. Canned beans are already cooked and can be eaten directly without soaking and boiling.  [Byline: Joe Whitworth]
=======================
["Lectins are proteins selectively binding carbohydrates and, importantly, the carbohydrate moieties of the glycoproteins decorating the surface of most animal [and mammal] cells. They are found in a wide range of vegetables (29 out of 88 tested; [1]). Plant lectins not efficiently degraded by digestive enzymes, and that have an affinity for the surface of gut epithelial cells, such as those present in the Leguminosae family, can be poisonous [2]. Acute symptoms following ingestion include nausea, vomiting and diarrhea.

"Ingestion of the lectins present in certain improperly cooked vegetables [especially beans and lentils] can result in acute gastrointestinal (GI) tract distress, but the mechanism of toxicity is unknown. _In vivo_, gut epithelial cells are constantly exposed to mechanical and other stresses and consequently individual cells frequently experience plasma membrane disruptions. Repair of these cell surface disruptions allows the wounded cell to survive: failure results in necrotic cell death. Plasma membrane repair is mediated, in part, by an exocytotic event that adds a patch of internal membrane to the defect site. Lectins are known to inhibit exocytosis.

"Repair of plasma membrane disruptions and exocytosis of mucus was assessed after treatment of cultured cell models and excised segments of the GI tract with lectins. Plasma membrane disruptions were produced by focal irradiation of individual cells, using a microscope-based laser, or by mechanical abrasion of multiple cells, using a syringe needle. Repair was then assessed by monitoring the cytosolic penetration of dyes incapable of crossing the intact plasma membrane. We found cell surface-bound lectins potently inhibited plasma membrane repair, and the exocytosis of mucus normally accompanies the repair response."

1. Nachbar MS, Oppenheim JD. Lectins in the United States diet: a survey of lectins in commonly consumed foods and a review of the literature. Am J Clin Nutr. 1980;33:2338-2345.
2. Vasconcelos IM, Oliveira JT. Antinutritional properties of plant lectins. Toxicon. 2004;44:385-403.

The full article may be found at:

One note: Be sure to discard the water the lentils or beans were soaked in. Fresh water should be added for cooking the lentils/beans. The taste of soaked vs. unsoaked beans may not vary much, but apparently the effect on the GI tract is much different. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
Date: Wed 25 Sep 2019
Source: Food Safety News [edited]

Authorities in Sweden are investigating a national outbreak of monophasic _Salmonella_ Typhimurium, which has affected almost 40 people.

Folkhalsomyndigheten (Public Health Agency of Sweden) reported that the source of the infections is still unknown. During September [2019], there was an increase in the number of cases of salmonellosis. The outbreak was identified, thanks to Folkhalsomyndigheten's microbial surveillance program. The latest date of illness onset is 6 Sep [2019].

To date, 36 illnesses from 10 counties have been linked by whole-genome sequencing. Most patients live in Vastra Gotaland, Jonkoping, Halland, and Dalarna. Those ill come from all age groups, including children and the elderly. More women, 22, than men, 14, have become ill.

Local authorities, Livsmedelsverket (Swedish Food Agency) and Folkhalsomyndigheten are investigating the outbreak to identify the source of infection that is suspected to be a food widely distributed in Sweden. People are being interviewed about what they ate the week before illness, with the aim of identifying common suspect foods.

The outbreak strain has multilocus variable-number tandem-repeat analysis (MLVA) pattern 3-12-11-N-211.

In 2018, isolates from 864 _Salmonella_ infections were typed; 91% were infected in Sweden, and 18% had been infected abroad. Among cases infected in Sweden, Enteritidis, Typhimurium, and monophasic Typhimurium were the most common serotypes.  [Byline: Joe Whitworth]
==========================
[The source of this outbreak is as yet unknown. By monophasic, it is meant that the organism does not have the complete set of flagellar serotypes. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Date: Fri 6 Sep 2019
Source: Rikard Dryselius rikard.dryselius@folkhalsomyndigheten.se
[edited] [re: ProMED-mail Tularemia - Sweden (04): further increase, RFI
http://promedmail.org/post/20190905.6659382]
--------------------------------------------------------------------------------
According to clinical reports, a majority (over 70%) of the reported cases during the ongoing outbreak of tularemia in Sweden appear to have contracted the infection through insect bites, mainly mosquito bites. For about 1/4 of the disease cases no path of infection is indicated, while mainly animal contact and in some cases drinking water is indicated as route of infection for the remaining cases. -- Rikard Dryselius Folkhalsomyndigheten rikard.dryselius@folkhalsomyndigheten.se
=====================
[ProMED thanks Rikard Dryselius for this clinical information. - ProMED Mod.LL]
 
[HealthMap/ProMED-mail map of Sweden: <http://healthmap.org/promed/p/108>]
Date: Wed 28 Aug 2019
Source: Outbreak News Today [edited]
-------------------------------------
As of [Mon 26 Aug 2019], about 560 human cases have been reported, much more this time of year than usual and even more than 2015 when 859 people across the country suffered from the illness. Most cases of illness are reported from central Sweden (the Dalarna region, Gavleborg and Orebro), but an increasing number of reports are also starting to come in from other regions, especially in northern Sweden.

Since the number of illness cases is usually highest in September in Sweden, the outbreak is expected to grow further in the coming weeks.

Infections in Sweden are mainly seen in forest and field hares and rodents, but the disease has been reported in several other species, including other mammals, birds, amphibians, insects, and ticks.

Tularemia, or harpest as it is known as in Sweden, is one of the most common native zoonoses in people in Sweden. People are infected mainly through mosquitoes, but also through direct contact with sick or dead animals and by inhalation of, for example, infectious dust.

The number of reported cases of harpest in humans varies from year to year, in recent years there have been reported between about 100 to over 800 cases per year. More than 90 percent of reported human cases have fallen ill in Sweden.
=========================
[This outbreak, primarily in central Sweden, continues to increase in size.  _Francisella tularensis_ subsp. _tularensis_ (type A) is associated with lagomorphs (rabbits and hares). Wild rodents are also frequently infected, and occurrence of human cases is usually linked to these host species. _F. tularensis_ is transmitted primarily by ticks and biting flies, and is highly virulent for humans and domestic rabbits.

Tularemia is largely confined to the Northern Hemisphere and is not normally found in the tropics or the Southern Hemisphere. _F. tularensis_ subspecies _holarctica_ naturally infects several mammalian wildlife species in northern Europe, in particular, mice, rabbits, hares, beavers, voles, lemmings, and muskrats. The ticks _Dermacentor reticularis_ and _Ixodes ricinus_ are vectors for the bacterium, although previous research has suggested that mosquito bites are the most frequent route of transmission to humans in Sweden.

In addition to vector transmission, tularemia may be spread via contact with infected animals or environmental fomites by inhalation, or by ingestion of the poorly cooked flesh of infected animals or contaminated water.

Tularemia can be transmitted by aerosol, direct contact, ingestion, or arthropods. Inhalation of aerosolized organisms (in the laboratory or as an airborne agent in an act of bioterrorism) can produce a pneumonic form. Direct contact with, or ingestion of, infected carcasses of wild animals (such as cottontail rabbit) can produce the ulceroglandular, oculoglandular, oropharyngeal (local lesion with regional lymphadenitis), or typhoidal form. Immersion in or ingestion of contaminated water can result in infection in aquatic animals. Ticks can maintain infection transstadially [pathogen remains with the vector from one life stage ("stadium") to the next] and transovarially [transmission of a pathogen from an organism (as a tick) to its offspring by infection of eggs in its ovary], making them efficient reservoirs and vectors.

The manifestations of infection in this growing outbreak in parts of Sweden are not stated. If vector borne, the most common form would be ulceroglandular with an ulcer at the introduction site and enlarged lymph nodes in that area. If waterborne, oropharyngeal would be most common. Among flying vectors, deer flies are often brought up but mosquitoes are also relevant as shown in this Swedish publication:

Reference
---------
Thelaus J, Andersson A, Broman T, et al: _Francisella tularensis_ subspecies _holarctica_ occurs in Swedish mosquitoes, persists through the developmental stages of laboratory-infected mosquitoes and is transmissible during blood feeding. Microb Ecol. 2014; 67(1): 96-107;  <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3907667/>

"Abstract
--------
In Sweden, mosquitoes are considered the major vectors of the bacterium _Francisella tularensis_ subsp. _holarctica_, which causes tularemia. The aim of this study was to investigate whether mosquitoes acquire the bacterium as aquatic larvae and transmit the disease as adults. Mosquitoes sampled in a Swedish area where tularemia is endemic (Orebro) were positive for the presence of _F. tularensis_ deoxyribonucleic acid throughout the summer. Presence of the clinically relevant _F. tularensis_ subsp. _holarctica_ was confirmed in 11 out of the 14 mosquito species sampled. Experiments performed using laboratory-reared _Aedes aegypti_ confirmed that _F. tularensis_ subsp. _holarctica_ was transstadially maintained from orally infected larvae to adult mosquitoes and that 25% of the adults exposed as larvae were positive for the presence of _F. tularensis_-specific sequences for at least 2 weeks. In addition, we found that _F. tularensis_ subsp. _holarctica_ was transmitted to 58% of the adult mosquitoes feeding on diseased mice. In a small-scale in vivo transmission experiment with _F. tularensis_ subsp. _holarctica_-positive adult mosquitoes and susceptible mice, none of the animals developed tularemia. However, we confirmed that there was transmission of the bacterium to blood vials by mosquitoes that had been exposed to the bacterium in the larval stage. Taken together, these results provide evidence that mosquitoes play a role in disease transmission in part of Sweden where tularemia recurs."  - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Sweden:
Date: Mon 12 Aug 2019 16:01 CEST +02:00
Source: The Local [edited]

Swedish health authorities have warned an outbreak of rabbit fever (tularemia) is expected to grow, with hundreds of people affected so far.

A total of 212 confirmed cases have been reported to The Public Health Agency of Sweden (Folkhallsomyndigheten) so far in 2019, sharply increasing from late July 2019. That is twice as many as in a normal year.

But Sweden has not yet seen the end of it, the authority warned on [Mon 12 Aug 2019]. "Since the number of cases (of rabbit fever) is usually at its highest in September, the outbreak is expected to grow further in the coming weeks," it wrote in a statement.

Most cases have been reported in Dalarna, Gavleborg, and Orebro counties in central Sweden, but in the past week Vasterbotten and Norrbotten have also seen an increase, often limited to a specific area.

Many of those affected by the disease have been infected via mosquito bites.  [Byline: Emma Loefgren]
=========================
[_Francisella tularensis_ subsp. _tularensis_ (type A) is associated with lagomorphs (rabbits and hares). Wild rodents are also frequently infected, and occurrence of human cases is usually linked to these host species. _F. tularensis_ is transmitted primarily by ticks and biting flies, and is highly virulent for humans and domestic rabbits.

Tularemia is largely confined to the Northern Hemisphere and is not normally found in the tropics or the Southern Hemisphere. _F. tularensis_ subspecies _holarctica_ naturally infects several mammalian wildlife species in northern Europe, in particular, mice, rabbits, hares, beavers, voles, lemmings, and muskrats. The ticks _Dermacentor reticularis_ and _Ixodes ricinus_ are vectors for the bacterium, although previous research has suggested that mosquito bites are the most frequent route of transmission to humans in Sweden.

In addition to vector transmission, tularemia may be spread via contact with infected animals or environmental fomites by inhalation, or by ingestion of the poorly cooked flesh of infected animals or contaminated water.

Tularemia can be transmitted by aerosol, direct contact, ingestion, or arthropods. Inhalation of aerosolized organisms (in the laboratory or as an airborne agent in an act of bioterrorism) can produce a pneumonic form. Direct contact with, or ingestion of, infected carcasses of wild animals (such as cottontail rabbit) can produce the ulceroglandular, oculoglandular, oropharyngeal (local lesion with regional lymphadenitis), or typhoidal form. Immersion in or ingestion of contaminated water can result in infection in aquatic animals. Ticks can maintain infection transstadially [pathogen remains with the vector from one life stage ("stadium") to the next] and transovarially [transmission of a pathogen from an organism (as a tick) to its offspring by infection of eggs in its ovary], making them efficient reservoirs and vectors.

The manifestations of infection in this growing outbreak in parts of Sweden are not stated. If vector borne, the most common form would be ulceroglandular with an ulcer at the introduction site and enlarged lymph nodes in that area. If waterborne, oropharyngeal would be most common. Among flying vectors, deer flies are often brought up but mosquitoes are also relevant as shown in this Swedish publication:

Thelaus J, Andersson A, Broman T, et al: _Francisella tularensis_ subspecies holarctica occurs in Swedish mosquitoes, persists through the developmental stages of laboratory-infected mosquitoes and is transmissible during blood feeding. Microb Ecol. 2014; 67(1): 96-107; <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3907667/>

"Abstract
--------
In Sweden, mosquitoes are considered the major vectors of the bacterium _Francisella tularensis_ subsp. _holarctica_, which causes tularemia. The aim of this study was to investigate whether mosquitoes acquire the bacterium as aquatic larvae and transmit the disease as adults. Mosquitoes sampled in a Swedish area where tularemia is endemic (Orebro) were positive for the presence of _F. tularensis_ deoxyribonucleic acid throughout the summer. Presence of the clinically relevant _F. tularensis_ subsp. _holarctica_ was confirmed in 11 out of the 14 mosquito species sampled. Experiments performed using laboratory-reared _Aedes aegypti_ confirmed that _F. tularensis_ subsp. _holarctica_ was transstadially maintained from orally infected larvae to adult mosquitoes and that 25% of the adults exposed as larvae were positive for the presence of _F. tularensis_-specific sequences for at least 2 weeks. In addition, we found that _F. tularensis_ subsp. _holarctica_ was transmitted to 58% of the adult mosquitoes feeding on diseased mice. In a small-scale in vivo transmission experiment with _F. tularensis_ subsp. _holarctica_-positive adult mosquitoes and susceptible mice, none of the animals developed tularemia. However, we confirmed that there was transmission of the bacterium to blood vials by mosquitoes that had been exposed to the bacterium in the larval stage. Taken together, these results provide evidence that mosquitoes play a role in disease transmission in part of Sweden where tularemia recurs."  - ProMED Mod.LL]

[Maps of Sweden:
More ...

World Travel News Headlines

Date: Tue, 22 Oct 2019 13:43:23 +0200 (METDST)

Capriata d'Orba, Italy, Oct 22, 2019 (AFP) - A taxi driver has drowned in Italy during violent storms in the north which flooded towns and destroyed a bridge, the fire service said Tuesday.   Farmers in the sweltering south meanwhile sounded the alarm over a draught expected to hit crops hard.   Over 100 people were evacuated Monday across the Alessandria province in the Liguria region, while firefighters carried out 900 operations across the north from Milan to Genoa, as rising waters surged across roads and railways.

The taxi was swept away in the town of Capriata d'Orba, where a bridge had also given way as the river burst its banks.   "There's water everywhere", driver Fabrizio Torre, 52, told his bosses before his phone line cut out, media reported.   His passenger managed to escape the vehicle and survived by clinging to a tree, the reports said.   Two men, aged 61 and 84, were found alive by firefighters after going missing in another part of the storm-hit region.   Rescue workers also pulled young children, their grandmother and the family's dog out of a house submerged by a landslide.   The Po river rose by more than 3.5 metres (11 feet) over a 24-hour period, according to Coldiretti, Italy's main agricultural association.   Lake Maggiore was also nearing a historic level.

Italy has seen "over three storms a day since the start of autumn, 18 percent more than the same period last year," it said.   "And while the north is under rain clouds... in the south, record heat and lack of rainfall has triggered a drought alarm."   Italy was seeing "the effects of climate change, with exceptional weather events becoming the norm".   It noted a "clear endency to tropicalisation" in the Mediterranean country, which was experiencing "a crazy autumn that ranks in the top ten of the hottest since 1800, with a temperature of 1.27 degrees above the average".   The high frequency of violent events was expected to continue, with the north pummelled by rains while farmers in the south risk losing crops.
Date: Tue, 22 Oct 2019 09:57:15 +0200 (METDST)
By Tupad POINTU

La Paz, Oct 22, 2019 (AFP) - Bolivia braced for a general strike on Tuesday hours after violence broke out in several cities when the main opposition candidate rejected presidential election results that seemed set to hand a controversial victory to long-time incumbent Evo Morales.   Opposition supporters reacted with fury, torching electoral offices in the southwestern cities of Sucre and Potosi, while rival supporters clashed in the capital La Paz.    Incidents were reported in cities across the South American country.   Carlos Mesa, who came a close second to Morales in Sunday's polls -- forcing a run-off, according to preliminary results -- denounced revised results released by election authorities as a "fraud."   "We are not going to recognize those results that are part of a shameful, consumated fraud, that is putting Bolivian society in a situation of unnecessary tension," said Mesa.

International monitors from the Organization of American States voiced "deep concern" at sudden changes to the election count to show Morales closing in on an outright victory in the first round.   Preliminary results released late Sunday showed neither Morales, 59, nor 66-year-old Mesa with a majority and "clearly indicated a second round," the OAS mission said.   The partial results put Morales in the lead with 45 percent of the votes, with Mesa on 38 percent, meaning Morales would have to contest a run-off for the first time.   But results released late Monday, after a long and unexplained delay, showed Morales edging towards an outright victory with 95 percent of the votes counted.   Mesa, a former president of the country between 2001-2005, accused Morales of colluding with the Supreme Electoral Tribunal (TSE) to tweak delayed results and avoid a run-off.

- Opposition call general strike -
The call for a general strike was issued by Fernando Camacho, head of an influential civil society organization in Bolivia's biggest city, Santa Cruz, where transport and businesses were expected to shut down from noon.   "Tomorrow we start at 12:00 to block this country," Camacho told opposition demonstrators late Monday, before holding talks with leaders from other regions.   Long lines formed at gas stations amid fears of shortages.   Riot-police dispersed a crowd who tried to storm the electoral offices in the Andean city of Oruro, south of La Paz.    Clashes were also reported in Tarija in the south, Cochabamba in the center and Cobija in the north.

- 'Subverting democracy' -
The United States' top diplomat for Latin America said the Electoral Tribunal was attempting "to subvert Bolivia's democracy by delaying the vote count and taking actions that undermine the credibility of Bolivia's elections."   "We call on the TSE to immediately act to restore credibility in the vote counting process," the official, Michael Kozak, said on Twitter.   The OAS observer mission in the country expressed "surprise at the drastic and hard-to-explain change in the trend of the preliminary results revealed after the closing of the polls," it said in a statement.   It urged the election authority to "firmly defend the will of the Bolivian people" and called for calm on the streets.   "It is extremely important that calm is maintained and any form of violence is avoided in this delicate situation."

- Longest serving president -
Morales, Latin America's longest-serving president, is controversially seeking a fourth term.   He obtained Constitutional Court permission in 2017 to run again for president even though the constitution allows only two consecutive terms.   The former coca farmer and leftist union leader has led the poor but resource-rich Latin American country for the past 13 years, though his popularity has waned amid allegations of corruption and authoritarianism.   He has led the country since taking office in 2006, when he became its first indigenous president.

A new mandate would keep him in power until 2025.   As leader of his Movement for Socialism Party (MAS), Morales points to a decade of economic stability and considerable industrialization as his achievements, while insisting he has brought "dignity" to Bolivia's indigenous population, the largest in Latin America.   He has come under severe criticism this year as wildfires in August and September ravaged Bolivia's forests and grasslands, with activists saying his policies encouraged the use of blazes to clear farmland.
Date: Tue, 22 Oct 2019 06:44:29 +0200 (METDST)

Papeete, Oct 22, 2019 (AFP) - A French tourist has been seriously injured in a rare shark attack in the palm-fringed Pacific islands of Polynesia, emergency services said Tuesday.   The 35-year-old woman was swimming during a whale-watching trip on Monday in the French overseas territory when the oceanic whitetip shark tore into her chest and arms.   "Luckily for her, there were two nurses on the scene who could deliver first aid," firefighter Jean-Jacques Riveta told AFP.   The woman lost both hands and a lot of blood in the attack and was airlifted to hospital, he said.
Date: Tue, 22 Oct 2019 05:13:16 +0200 (METDST)

Wellington, Oct 22, 2019 (AFP) - A huge fire at a construction site sent clouds of acrid black smoke billowing over Auckland on Tuesday, forcing large parts of the downtown area to be cordoned off as firefighters battled the blaze.   The fire broke out on the roof of the SkyCity convention centre site shortly after 1:10pm (0010 GMT) and quickly spread, Fire and Emergency NZ said.   Office workers were warned to stay inside and turn off air conditioning as a thick pall of smoke engulfed the centre of New Zealand's largest city, but there were no reports on injuries.   Unconfirmed reports said the fire was started by a construction worker using a blowtorch on the building, which is one of the venues for the 2021 APEC summit being held in Auckland.
Date: Mon, 21 Oct 2019 18:48:23 +0200 (METDST)

Harare, Oct 21, 2019 (AFP) - At least 55 elephants have died in a month in Zimbabwe  due to a lack of food and water, its wildlife agency said Monday, as the country faces one of the worst droughts in its history.   More than five million rural Zimbabweans -- nearly a third of the population -- are at risk of food shortages before the next harvest in 2020, the United Nations has warned.

The shortages have been caused by the combined effects of an economic downturn and a drought blamed on the El Nino weather cycle.   The impact is being felt at Hwange National Park, Zimbabwe's largest game reserve.   "Since September, we have lost at least 55 elephants in Hwange National Park due to starvation and lack of water," Zimbabwe National Parks spokesman Tinashe Farawo told AFP.   Farawo said the park was overpopulated and that food and water was scarce "due to drought".

Africa's elephant numbers have dropped from around 415,000 to 111,000 over the past decade, mainly due to poaching for ivory, according to the International Union for Conservation of Nature (IUCN).   But Zimbabwe, like other countries in the southern African region, is struggling with overpopulation.   "Hwange was meant for 15,000 elephants but at the moment we are talking of more than 50,000," Farawo said.   "The situation is dire. We are desperately waiting for the rains."   An adult elephant drinks 680 litres (180 gallons) of water per day on average and consumes 450 kilogrammes (990 pounds) of food.

Hungry elephants have been breaking out of Zimbabwe's game reserves and raiding human settlements in search for food, posing a threat to surrounding communities.   Farawo said 200 people have died in "human-and-animal conflict" in the past five years, and "at least 7,000 hectares (17,300 acres) of crop have been destroyed by elephants".   The authorities took action earlier this year by selling nearly 100 elephants to China and Dubai for $2.7 million.   Farawo said the money had been allocated to anti-poaching and conservation projects.   Botswana, Namibia, Zambia and Zimbabwe have called for a global ban on elephant ivory trade to be relaxed in order to cull numbers and ease pressure on their territories.
Date: Mon, 21 Oct 2019 13:34:35 +0200 (METDST)

Santiago, Oct 21, 2019 (AFP) - Chile, reeling from its worst social unrest in decades, has since the 1990s been considered a Latin American hub of political stability and economic growth after 17 years of dictatorship.   Here is some background.

- From dictatorship to democracy -
In 1973 General Augusto Pinochet toppled Socialist President Salvador Allende in a military coup. Allende committed suicide in the presidential palace as troops closed in.   Pinochet imposed a right-wing dictatorship that lasted for 17 years, during which at least 3,200 people were killed or disappeared as a result of political repression. Around 38,000 were tortured.   In 1988 he lost a plebiscite on remaining in power and handed over to democratically elected Patricio Aylwin in 1990, remaining head of the armed forces until 1998.    Pinochet died in 2006 without standing trial for atrocities under his regime.   In 2006 Socialist Michelle Bachelet became Chile's first female president. Re-elected in 2013, she was barred constitutionally from standing again immediately and appointed UN right commissioner in 2018.   The 2017 elections were won by conservative billionaire Sebastian Pinera, who had already been president in 2010-2014.

- Model economy -
Pinochet applied neo-liberal free-market methods, privatising healthcare, education and pensions.   Chile turned to exports and in the 1980s became the preferred Latin American host for foreign investors.   With this economic model still largely in place, growth reached a strong 4% in 2018. The country of 18 million people also has the highest per capita income of Latin America at $20,000.   GDP, however, fell to 1.8% in the first half of 2019 -- due to a challenging external context, adverse climatic conditions and a delay in reforms -- and is expected at 2.5 percent for the year.   Despite slashing poverty from 30% in 2000 to 8.6% in 2019, the country has high social inequalities including in healthcare, education and pensions.   It is the world's biggest producer of copper, with lithium, timber, fisheries, gold, silver, avocados and oil also driving exports.

- Paedophile priests scandal -
The staunchly Roman Catholic country has been rocked by allegations of sexual abuse within the church going back decades.   In May 2018 Pope Francis summoned all 34 Chilean bishops to Rome over the crisis and all tendered their resignations, although only a handful have been accepted.   Since 2000 about 80 priests have been reported to authorities in Chile for alleged sexual abuse, including of children and adolescents.   Prosecutors said in August 2018 they were investigating 158 members of the church, both priests and lay people.   Ultra-conservative Chile allowed divorce only from 2004 and legalised abortion in certain cases in 2017.

- World's most seismic -
Bordered by the Pacific Ocean to the west and the Andes mountain range to the east, long and narrow Chile is the world's most seismic country.   In 1960 it was struck by the most powerful earthquake ever registered which measured 9.5 and struck at Valdivia. More than 5,700 people were killed.   In 2010 a 8.8-magnitude quake in the south and centre unleashed a tsunami that swept away entire villages, leaving around 520 people dead.

- Astronomy heaven -
Benefitting from a totally clear sky for most of the year, northern Chile is home to some of the world's most powerful telescopes.   The construction of the planet's biggest telescope was launched in May 2017 in the Atacama desert by ESO, the European Organisation for Astronomical Research in the Southern Hemisphere.
Date: Sun 20 Oct 2019
Source: Pakistan today [edited]

The death toll from a mysterious throat virus has reached 9 children in Seerani and its surrounding localities in Badin district as one more child infected by the virus died, affected people said on [Sun 20 Oct 2019].

A child, R, son of RM, died after contracting the disease. The most affected areas are reported to be Seerani and its surrounding localities. Teams of the health department and other organizations reached Seerani and took blood samples of at least 30 children who were infected by the virus. The blood samples will be sent to Islamabad for the tests.

The people of the area are worried about this new throat viral disease and have demanded authorities to provide immediate health cover to them.
====================
[There is little information to go on other than the throats of children are affected and the case fatality rate is high (10 of at least 30). No other symptoms are provided, nor is the basis for concluding that a virus is involved or what the epidemiological data are (dates, ages, sex of children involved, and local conditions). ProMED-mail would welcome additional information. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: 21 Oct 2019
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/polio-cases-reported-in-zambia-chad-and-togo-73820/>

Circulating vaccine-derived polio virus (cVDPV) type cases have been confirmed in 10 African countries through [16 Oct 2019] this year [2019]. Now, the World Health Organization (WHO) is reporting 3 additional countries from the continent that more recently reported circulating vaccine-derived polio virus type 2 (cVDPV2) cases: Zambia, Chad and Togo.

Zambia
The Ministry of Health of Zambia reported last week on a confirmed case of circulating vaccine-derived polio virus type 2 (cVDPV2) in a 2-year-old child in Chienge district, Luapula province on the border with Democratic Republic of the Congo. This is the 1st case of cVDPV2 reported from Zambia in 2019. [Date of onset of paralysis reported to be 16 Jul 2019 according to another media report <https://www.lusakatimes.com/2019/10/21/polio-case-has-been-recorded-in-zambias-luapula-province/>.

In addition to the initial case-patient, 34 stool samples were collected from healthy contacts, and 2 samples tested positive for VDPV2, which were genetically linked to the case-patient. No established links have so far been found with the ongoing outbreak of cVDPV2 in Democratic Republic of the Congo, where 37 cases have been reported in 2019. The last recorded case of indigenous polio in Zambia was in 1995, while between 2001 and 2002, 5 cases of wild polio virus were identified among Angolan refugees in the Western province of the country.

Chad
Last week, WHO was informed about cVDPV2 in Chad. A cVDPV2 was isolated from a 13-month-old case of acute flaccid paralysis (AFP), with onset of paralysis on [9 Sep 2019] in Chari Baguirmi province, bordering Cameroon. The isolated virus has 32 nucleotide changes from Sabin 2, and is genetically linked to a cVDPV2 detected in Borno, Nigeria and is part of the Jigawa emergence. The last indigenous wild poliovirus cases were reported in 2000 in Chad.

Togo
In addition, last week WHO was informed about cVDPV2 in Togo. A cVDPV2 was isolated from a 30-month-old case of AFP with onset of paralysis on [13 Sep 2019] in Plateaux province, bordering Benin and Ghana. The isolated virus has 32 nucleotide changes from Sabin 2 and is genetically linked to a cVDPV2 detected in Irewole state, Nigeria and is part of the Jigawa emergence as well. The last indigenous wild poliovirus case was reported in 1999 in Togo.
======================
[Three more countries are joining the list of cVDPV outbreak countries, all with cVDPV2 isolates. Two of the 3 countries (Togo and Chad) have viruses related to the Jigawa, Nigeria cVDPV2 outbreak. The case in Zambia is suspected to be associated with the ongoing cVDPV2 transmission in the Democratic Republic of the Congo (DR Congo), but genetic testing is presumably still pending or has been negative. See my comments below after the following section, as they are relevant to what is ongoing globally with respect to cVDPVs.

Below are the HealthMap/ProMED map links to countries where cVDPV cases/outbreaks have occurred in the past 12 months, a total of 20 countries.

Angola: <http://healthmap.org/promed/p/165>
Benin: <http://healthmap.org/promed/p/59>
Cameroon: <http://healthmap.org/promed/p/65>
Central African Republic: <http://healthmap.org/promed/p/66>
Chad: <http://healthmap.org/promed/p/57>
China: <http://healthmap.org/promed/p/155>
Democratic Republic of the Congo: <http://healthmap.org/promed/p/194>
Ethiopia: <http://healthmap.org/promed/p/95>
Ghana: <http://healthmap.org/promed/p/53>
Indonesia: <http://healthmap.org/promed/p/184>
Kenya: <http://healthmap.org/promed/p/174>
Mozambique: <http://healthmap.org/promed/p/177>
Myanmar: <http://healthmap.org/promed/p/148>
Niger: <http://healthmap.org/promed/p/58>
Nigeria: <http://healthmap.org/promed/p/62>
Papua New Guinea: <http://healthmap.org/promed/p/188>
Philippines: <http://healthmap.org/promed/p/158>
Somalia: <http://healthmap.org/promed/p/125>
Togo: <http://healthmap.org/promed/p/64>
Zambia: <http://healthmap.org/promed/p/170> - ProMED Mod.MPP]
Date: Fri 18 Oct 2019 07:32 PM EDT
Source: WSPA [edited]

North Carolina health officials say a 4th person has died from an outbreak of legionnaires' disease linked to a hot tub display at the North Carolina Mountain State Fair, which is held at the Western North Carolina Agricultural Center.

We've also learned another person, who did not attend the NC Mountain State Fair, was diagnosed with legionnaires' after attending a quilt show that was held inside the same building as the hot tub exhibit. That building is the Davis Event Center.

7 News spoke with folks who have been impacted by the outbreak. "We were like 'Oh no, I hope nobody gets sick,'" [LP] said. He attended the North Carolina Mountain State Fair-an event tied to at least 140 cases of legionnaires'. He said 2 people he knows, including his uncle, got sick after the fair. "They didn't actually have legionnaires', but they had respiratory problems that did come out of it," he said. [Perhaps Pontiac fever?] Even so, [LP] was back at the WNC Agricultural Center on [Fri 18 Oct 2019] to help host his club's annual Antique Tractor Show.

And while everything appeared to be business as usual, [LP] was concerned as another person was just diagnosed with the disease and didn't attend the fair. Instead, they were at a quilt show held at the WNC Agricultural Center 2 weeks later. "Anytime there's an outbreak of something, it's always going to have a thing in the back of your mind that says, 'I don't know if I want to do this or not,'" he said.

The Davis Event Center has since been closed; but health officials say it's possible the source for the newest case of legionnaires' may not have been at the WNC Agricultural Center. "There are other possible exposures that this person had, so it's hard. At this point, we can't pinpoint," Jennifer Mullendore with Buncombe County Health and Human Services said.

According to a statement by the WNC Agricultural Center, the hot water system in the Davis Event Center, and every other building on the grounds, went through a disinfecting process as a precautionary measure. "They did some cleaning and doing some real hot high-powered water through the water system here, and so we do have a clean bill of health," Phillips said.  It's unclear at this time when the Davis Event Center will re-open.  [Byline: Scottie Kay]
========================
[The latest status, as of 18 Oct 2019, of the legionellosis outbreak associated with the Mountain State Fair that was held in western North Carolina between 6 and 15 Sep 2019 at the Western North Carolina Agricultural Center (WNC Ag Center) in Fletcher, a town in Henderson County, can be found at <https://epi.dph.ncdhhs.gov/cd/legionellosis/outbreak.html>.

The source of the outbreak has still not as yet been confirmed. However, hot tub displays in one of the buildings (Davis Event Center) has been linked to the outbreak. A site map of the WNC Ag Center that shows the location of the Davis Event Center building can be found at <https://www.wncagcenter.org/p/mountainstatefair/competitions/map>.

One more case and an additional death have been reported since the last ProMED-mail post on this outbreak, but no cases linked to the outbreak had a symptom onset date more than 2 weeks after the end of the fair, that is, within the incubation period for legionnaires' disease (<https://www.cdc.gov/legionella/clinicians/clinical-features.html>). The latest case of legionnaires' disease didn't attend the fair, but instead attended a quilt show held 2 weeks later at the Davis Event Center, but the source for this case is thought possibly to have not been at the WNC Agricultural Center. The Davis Event Center has since been closed.

The number of confirmed cases of legionellosis by county are as follows: Buncombe, 49; Burke, 1; Caswell, 1; Cherokee, 1; Gaston, 1; Granville, 1; Haywood, 12; Henderson, 34; Jackson, 3; Madison, 6; McDowell, 5; Mecklenburg, 5; Mitchell, 2; Polk, 1; Rutherford, 3; Transylvania, 3; Union, 1; Watauga, 1; and Yancey, 1. 10 cases occurred out of state (in South Carolina). Total cases: 141. A map showing the location of the North Carolina counties can be found at <https://geology.com/county-map/north-carolina.shtml>.

Male, 82 (59%)*; female, 58 (41%)*. Median age in years (range): 61 (24-91). Hospitalizations: 94 (69%)*; deaths 4. *Some cases reported with unknown gender or hospitalization status.

A total of 133 (94%) have legionnaires' disease, the pneumonic form of the infection, and 8 (6%) have Pontiac fever, the non-pneumonic form of the infection.

The species of _Legionella_ detected in patients is not specified; however, the usual pathogen in the USA is _L. pneumophila_ serogroup 1 and one sample of water collected from the women's restroom in the Davis Event Center was previously reported to be positive for _L. pneumophila_. Genotyping clinical and environmental isolates will help identify clusters of cases with a common source and identify the source responsible for infection in these clusters. - ProMED Mod.ML]
 
[HealthMap/ProMED-mail map of North Carolina, United States:
Date: Sun 20 Oct 2019 12:52 AM IST
Source: Deccan Chronicle [edited]

The respite from cases of dengue, notwithstanding, the city [Hyderabad] is now caught in the grip of viral encephalitis, or brain fever. There is an alarming increase in the number of viral encephalitis cases being reported across city hospitals. This is ironic as October is medically termed as 'fair-weather' season. The rise in the number of cases has been worrisome and those getting inflicted include children and elders.

Many are complaining of fever of the brain with body temperature touching [106-107 deg F/41.1-41.6 deg C].

According to doctors, at least 3 cases are reported each week in the tertiary hospitals of which 7 major ones are in the city.

Dr Shyam Jaiswal, neurologist at Care Hospitals, explains, "Of late, we have been admitting viral encephalitis-affected children in the hospital. Most fall sick because of the body's low immunity. Immediate hospital care is a must as most complain of severe headache, delirium, and in some cases even loss of memory. The treatment takes between 2-3 days."

It is a medical nightmare that some elders are suffering from both chikungunya and viral encephalitis.

Dr Hari Kishan B, general physician with Apollo Hospitals, explains, "The combination of chikungunya and viral encephalitis has been noted earlier too. These are rare cases but do occur from time to time. The viral infections have been very high this year [2019] and those suffering from diabetes, hypertension, and other cardiovascular ailments, will suffer more when infected with these viruses."  [Byline: Kaniza Garari]
=====================
[This report does not provide total case numbers, nor indicate how long 2-3 cases per week have been occurring. The virus suspected or confirmed as the etiology of these cases is not mentioned, but the comment that October is termed "a fair weather season" suggests that Japanese encephalitis virus may be involved with the usual transmission season declining in October. No mention is made of acute encephalitis syndrome, a clinical designation with a variety of suggested Aetiologies in other cases in north-eastern India. - ProMED Mod.TY]

[Maps of India: