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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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Cook Islands

No Profile is available at present

Travel News Headlines WORLD NEWS

8 Aug 2019

Dengue-type1 outbreak was declared on the 27 Feb 2019 following a laboratory (NZLabPlus) confirmation of 7 dengue type 1 cases. From 28 Jan-4 Aug 2019, a cumulative number of 78 dengue cases have been reported (22 confirmed, and 56 probable-NS1Ag positives). Rarotonga and Aitutaki are the only islands affected and most of the cases have been from the main island of Rarotonga. Aitutaki has managed to contain its number of cases to 3. The last case was reported on 18 Apr 2019. A total of 42 cases have been hospitalised and given free mosquito nets to take and use at home. Apart from some severe cases, the hospitalisation was also an effort to contain and minimise the spread of the infection into the community. Unfortunately, some cases refused to be admitted but were given some health advice and mosquito precautionary measures. No deaths reported.

- Cook Islands. 17 Aug 2019. 78 dengue cases have been reported in Cook Islands since the outbreak began early in the year [2019]. The Cook Islands News reports the Ministry of Health saying 22 were confirmed cases while 56 have been deemed probable positives.

HealthMap/ProMED-mail map of Cook Islands:
- Cook Islands. 12 Apr 2019

As of Wednesday [10 Apr 2019], the Ministry for Health has 18 confirmed and 12 probable dengue fever cases. This is a total of 30 cases compared to 24 previously identified.
Date: Thu, 2 Jul 2015 05:34:35 +0200 (METDST)

Wellington, July 2, 2015 (AFP) - Airport authorities in the Cook Islands on Thursday warned thrill seekers to stay away from their runway's jet blast zone after three tourists were injured when a plane was taking off.   The main road in the tiny Pacific nation passes by the bottom of the runway and daring plane-spotters often stand in the wash of jet engines, clinging to the airport's fence as aircraft hit maximum thrust for ascent.   "If you don't hang onto anything, you'll be knocked over," Cook Islands Airport Authority chief executive Joe Ngamata told AFP.   "You get the young people and tourists looking for thrills going down there."

Ngamata said three tourists were blown over by the power of the jet blast last Thursday and were lucky to only receive cuts and bruises.   "It can be dangerous," he said, adding that the area was clearly marked with red danger signs to deter the practice.    "We might need to look at extra barriers or fences to keep people away."   However, stopping it may be difficult, with the national tourism authority including the jet blast in a recent marketing video showing "the top 10 reasons to come to the Cook Islands".
Date: Tue 1 Apr 2014
From: Dr Alyssa Pyke <Alyssa.Pyke@health.qld.gov.au> [edited]

A female patient in Townsville, Queensland, Australia has been diagnosed with Zika virus infection following a recent trip to the Cook Islands, where the virus is currently circulating. A serum sample collected in March 2014 was positive by 2 separate Zika virus TaqMan real-time RT-PCRs and a pan-Flavivirus RT-PCR. Nucleotide sequencing and phylogenetics revealed 99.1 per cent homology with a previous Cambodia 2010 sequence within the Asian lineage. Flavivirus IgG and IgM antibodies were also detected in the serum sample.

This is the 1st known imported case of Zika virus infection into northern Queensland, where the potential mosquito vector _Aedes aegypti_ is present, and only the 2nd such case diagnosed within Australia.
----------------------------------------------------
Dr Alyssa Pyke
Public Health Virology
Forensic and Scientific Services
Coopers Plains, Queensland
Australia
==============================
[As of 25 Mar 2014, there were 49 confirmed cases of Zika virus infection in the Cook Islands, the source of the virus in the case above. Concern for Zika virus introduction into northern Queensland where vector mosquitoes are present is a serious concern. Transport of this virus by viremic individuals has been the mechanism for its introduction into several Pacific islands. Dengue viruses have been introduced into Townsville, northern Queensland, by infected individuals and started small outbreaks there. Since that has happened with dengue viruses, it can happen with Zika virus as well.

ProMED thanks Alyssa Pyke for sending in this report.

A HealthMap showing the location of Queensland state can be accessed
at <http://healthmap.org/promed/p/285>, and the Cook Islands at
<http://healthmap.org/promed/p/4035>. - ProMed Mod.TY]
Date: Tue 25 Mar 2014
Source: Radio New Zealand [edited]

There are now 49 confirmed cases of Zika virus [infection] in the Cook Islands, and as many as 630 people are believed to have suffered from the mosquito-borne disease.

Last month [February 2014], health authorities 1st thought they were dealing with dengue fever, but the 1st batch of test results confirmed 18 cases of Zika [virus infection].

The Director of Community Health Services, Dr Rangi Fariu, says further results from French Polynesia, where the disease 1st broke out in the region, take the number to 49.

He says scientists there are still determining the exact nature of the strain. "Tahiti just asked for those who were already shown positive; they wanted more samples to find out if the Zika [virus] strain that we have here is similar to the one that they have in Tahiti."

Dr Rangi Fariu says doctors have reported about 630 cases of suspected Zika virus [infection] in the Cook Islands and says the real number would be much higher.
========================
[This is the 1st report of Zika virus infections in the Cook Islands. The virus has been circulating in the islands of French Polynesia, New Caledonia and Easter Island. Although the distances between these islands is significant, the virus is being moved by viraemic people who travel between them. One can expect further spread to localities where there are populations of vector mosquitoes that can initiate new outbreaks. Zika virus is a flavivirus. Symptoms of Zika fever may include fever, headache, red eyes, rash, muscle aches, and joint pains. The illness is usually mild and lasts 4-7 days. No fatalities caused by Zika virus infection have been reported.

A HealthMap/ProMED-mail map showing the location of the Cook Islands in the Pacific can be accessed at
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Eritrea

Eritrea US Consular Information Sheet
November 26, 2008
COUNTRY DESCRIPTION:
Eritrea is a poor but developing East African country, the capital of which is Asmara. Formerly a province of Ethiopia, Eritrea became an independent country on M
y 24, 1993, following a 30-year struggle that culminated in an overwhelming referendum vote for independence. Tourism facilities are very limited. Read the Department of State Background Notes on Eritrea for additional information.

ENTRY/EXIT REQUIREMENTS:
All travelers should have a passport and valid visa prior to arrival; visas are not available at the airport unless specifically pre-authorized by the Eritrean government.
Travelers visiting Eritrea using a foreign passport do not need an exit visa, provided they leave before their entrance visa expiration date.
Persons staying beyond their entrance visa expiration date may be subject to fines or imprisonment, or be required to remain in Eritrea for an extended period while their case is reviewed in court.
All long-term residents, regardless of citizenship, must obtain an exit visa 30 days prior to departure, unless they hold a difficult-to-obtain multiple entry visa.
Upon entry and exit, visitors must declare all foreign currency, and may be asked to declare electronic equipment such as cameras, computers and video equipment.
Visitors must save all receipts for foreign exchange and present these upon departure to account for all foreign currency spent in Eritrea.
Failure to report foreign currency or meet customs requirements usually results in both a fine and imprisonment.
There is also a $20 airport departure tax.
Information about the airport tax and entry/exit requirements is available from the Embassy of Eritrea, 1708 New Hampshire Avenue NW, Washington, DC 20009; telephone (202) 319-1991; fax (202) 319-1304.
Overseas, inquiries may be made at the nearest Eritrean embassy or consulate.

U.S. citizens born in Eritrea, to Eritrean parents, or who in any other way appear to have Eritrean origins, are required to register with the Immigration and Nationality office in Asmara within seven business days of their entry into the country.
The Eritrean government sometimes subjects U.S. citizens of Eritrean heritage to the same entry/exit requirements as Eritrean citizens.
See the “Special Circumstances” section below for more information about dual nationality.

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:
Eritrea and Ethiopia fought a border war from 1998-2000.
United Nations peacekeepers patrolled the border until March 2008, when Government of Eritrea diesel fuel restrictions resulted in the peacekeepers’ withdrawal.
Both Eritrea and Ethiopia maintain large military presences along the border and currently all border crossings into Ethiopia from Eritrea remain closed.
U.S. citizens are strongly advised to avoid travel near the Eritrean-Ethiopian border and to register their presence in Eritrea with the U.S. Embassy in Asmara.

Since April 2008, large numbers of Eritrean troops have been deployed along the northeastern border of Djibouti.
U.S. citizens are strongly advised to avoid non-essential travel to the Southern Red Sea region of Eritrea, including the port of Assab.

Landmines and unexploded ordnance remain a serious problem throughout the country.
There are reports of accidents and numerous incidents where vehicles and people occasionally detonate mines.
Many detonations occurred on relatively well-traveled roads in and near the Gash Barka region of western Eritrea; subsequent investigations indicated that several mines had been recently laid.
Vast areas of the country still have not been certified free of mines and unexploded ordnance left over from both the 30-year war for independence and the subsequent 1998-2000 conflict with Ethiopia.
Americans should avoid walking alone and hiking in riverbeds or areas that local government officials have not certified as safe.

Although Eritrea and Sudan have diplomatic relations, the procedures for crossing their common border are not clear and subject to change.
Overland travel between the two countries is dangerous and ill advised.
Travelers crossing from Eritrea to Sudan north and west of the Keren-Barentu road risk becoming victims of banditry or Islamic extremist insurgent activity.
Several incidents were reported in 2007, apparently involving insurgents or criminals in this area.
The U.S. Embassy also received reports of sporadic bombings of vehicles and government facilities in the Gash Barka region near Sudan in 2007 and 2008.
If travel near the Eritrean-Sudanese border is essential, travelers should consult both the Eritrean authorities and the U.S. Embassy in advance.
Foreign travelers who wish to visit any area outside of Asmara must apply at least ten days in advance for a travel permit from the Eritrean government.

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

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphletA Safe Trip Abroad.
CRIME:
Although still a safe city by many measures, Asmara reported significant increases of street crime, such as theft, robbery, and assault in 2008.
Travelers should exercise vigilance in their personal security and safety precautions regarding what valuables they carry and which areas they visit.

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 Eritrea are extremely limited.
Travelers must carry their own supplies of prescription drugs and preventative medicines because pharmaceuticals are in short supply.
Food and water-borne illnesses are very common among travelers, so drink only bottled or purified water and eat foods that are cooked or peeled.
Malaria is a serious risk to travelers in the lowlands of Eritrea, but Asmara is generally considered free of the disease.

There is no HIV testing requirement for temporary or permanent entry into Eritrea.
Please verify this information with the Embassy of Eritrea before you travel.

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) website 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 Eritrea is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

The roads between major cities (Asmara, Massawa, Mendefera, Dekemhare, Barentu, and Keren) are paved and in relatively good condition.
However, secondary roads and those in remote areas are usually unpaved and in poor condition.
U.S. citizens should avoid traveling on these roads, especially at night.
Bad weather can also make the condition of poor roads worse.
If you must take unpaved roads, check first with local government and village officials as new minefields continue to be discovered.

Landmines and unexploded ordnance litter the countryside in many areas, occasionally causing injuries and deaths.
Although the UN conducted de-mining efforts until late 2007, evidence of new mines has been reported, particularly in areas near the Ethiopian border.
All areas that are not well traveled are potentially dangerous due to live mines, especially north and west of Keren.
There are also minefields near Massawa, Ghinda, Agordat, Barentu, south of Tessenae, Nakfa, Adi Keih, Arezza, Dekemhare, and in a roughly 40-kilometer wide region just west of the Eritrean-Ethiopian border between the Setit and Mereb Rivers.

Many Eritreans use inexpensive public transportation, especially bus service.
Travelers should avoid taking buses due to extreme over-crowding.
Taxis are plentiful and inexpensive in Asmara, but usually carry multiple passengers along pre-defined routes.
If an empty taxi is available, a customer may request a "contract" taxi, which accepts no additional passengers, for a significantly higher fixed price.
Drivers should be aware of heavy and erratic pedestrian and bicycle traffic obstructing vehicle flow.
Occasionally horse-drawn carts, cattle, or goats add to the obstacles.
Other hazards are children and the elderly, who sometimes wander into the path of moving traffic, as well as small, slow, motorized carts.
Elderly or disabled people usually drive these carts and do not always yield to faster moving traffic.
When parallel parking on city streets, watch for pedestrians as you back into the space.
Please refer to our Road Safetypage for more information.

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

SPECIAL CIRCUMSTANCES:
Due to Eritrean government restrictions impacting Embassy operations, the consular section of the U.S. Embassy in Asmara does not provide routine services to American citizens in Eritrea, including reports of birth, passports, and notaries.
Americans traveling or residing in Eritrea who require such services must travel to a U.S. Embassy or Consulate outside Eritrea, and should plan accordingly.

American citizens should also be aware that U.S. diplomatic personnel are subject to travel restrictions.
The Government of Eritrea requires resident diplomats to apply 10 days in advance for travel outside of Asmara city limits; often travel permission is not given.
This restriction can delay or prevent U.S. Embassy emergency assistance to American citizens outside of Asmara.

The consular section of the U.S. Embassy in Asmara has been closed for visa services since January 2007.
Eritrea has complicated citizenship laws and does not recognize renunciation of Eritrean citizenship.
Dual nationals who enter the country on Eritrean documents are treated as Eritrean citizens, regardless of their other citizenship.
U.S. citizens born in Eritrea, or who otherwise are considered to have acquired Eritrean citizenship, may be subject to certain obligations, including being drafted into national service, regardless of the documents they present at entry.
(National service is approximately six months of military training, followed by an often unspecified number of years in military or other government service.)

U.S.-Eritrean dual nationals who enter the country on an Eritrean passport or national ID card must obtain an exit visa prior to departure.
Exit visa applications can significantly delay travel plans or be denied, even for persons who entered Eritrea legally.
Eritrean dual nationals are also required to pay a 2% income tax on overseas earnings to the Eritrean Government prior to being granted an exit visa.
Additionally, Eritrean authorities sometimes to not allow Eritreans who left the country after 1993 to depart Eritrea after visiting the country, even if they have a U.S. passport and a valid Eritrean visa.

The government of Eritrea does not inform the U.S. Embassy of the detention of American citizens, and does not allow Embassy officials to visit incarcerated Americans.

Visitors are advised to exercise caution when taking photographs in Eritrea.
Foreigners in Asmara have been harassed and detained by local police and plain clothes security officials for taking photographs of street scenes in the city.
No law has been cited, but the arresting officials' justifications have been that (unmarked) government buildings are in the background and/or that the pictures are being taken (illegally) for commercial reasons.

All foreign nationals in Eritrea are required to apply for permits to travel outside of Asmara.
Travel permits must be presented at all checkpoints.
Checkpoints are found on major roads through Eritrea, but locations may change without notice.
Applications for travel permits are available at the Ministry of Tourism located on Harnet Avenue.
There is a high risk of earthquakes in Eritrea.
General information about natural disaster preparedness is available on the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov.
Please see our information on Customs Regulations.

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 Eritrean laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Eritrea 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 Eritrea 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 Eritrea.
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 179 Alaa Street, PO Box 211, Asmara; telephone (291-1) 12-00-04; fax (291-1) 124-255 and (291-1) 127-584; the Embassy’s web site is located at http://eritrea.usembassy.gov/
*

*

*
This replaces the Country Specific Information for Eritrea dated April 28, 2008, to update sections on Entry/Exit Requirements, Safety and Security, Crime,
Medical Facilities and Health Information, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Sat 10 Sep 2016
Source: Asmarino Independent [edited]

Activists have reported a serious cholera outbreak in the Upper Gash-Barka Region of Eritrea, which is proving difficult to control. The outbreak was 1st observed at Barentu Referral Hospital 2 weeks ago when people who had travelled from the upper Gash region were reported to be suffering from an illness that was not diagnosed easily. However, as a result of the extended time taken for accurate diagnosis of cholera due to a severe shortage of expertise and infrastructure, the outbreak spread widely, affecting areas of the Gash-Barka Region.

It has now been a week since the Ministry of Health acknowledged the outbreak as being a potential national epidemic and has briefed health professionals in the region to that effect.

So far, the effort to curb the spread is proving futile, and the impact of the outbreak is being felt across the region. Markets were deserted as a result of the spread, and even cattle markets in small villages outside Barentu have been cordoned off to prevent the spread. An expert at the Ministry of Health's public health section for preventing such epidemics stated: "There is currently no national emergency response team to prevent and control such outbreaks; we are, therefore, prone to such epidemics, as it always takes time to pull such a team together to both control the outbreak and treat victims."

Already, the current epidemic is said to have spread from the Upper Gash Region to the Southern Region and particularly to the area of Mai Dima, where an epidemic control team has been dispatched.

According to health experts in the region, when such an outbreak occurs, even able-bodied adults find it impossible to cope with the acute loss of bodily fluids. Without appropriate medical assistance, it is impossible for patients to recover, and the situation is considerably worse for pregnant women and children.

Given the lack of public health awareness, Arbi Harnet calls on the people to take preventive actions by strictly adhering to personal and public hygiene practices.
======================
[A HealthMap/ProMED-mail map showing Eritrea is available at
Date: Sat, 23 Jan 2016 12:14:06 +0100

Nairobi, Jan 23, 2016 (AFP) - Eritrean President Isaias Afwerki on Saturday dismissed fears the Horn of African nation faces a food crisis, despite sweeping drought across the wider region leaving millions in need of aid.   Floods and failed rains caused by the El Nino weather phenomenon have sparked a dramatic rise in the number of people going hungry in east Africa.

But authoritarian and isolated Eritrea has long rejected UN food aid in favour of a policy of self reliance, and Isaias said he was not worried.    "In view of the harvest shortfall that has affected the whole Horn of Africa region, President Isaias stated that the country will not face any crisis in spite of reduced agricultural output," the information ministry said, after he was interviewed by state-run media.   Isaias praised the government's "judicious policy and approaches of bolstering its strategic food reserves."

In November, the UN warned that Eritrea was among the countries at risk, like all the other nations in the wider region. "The current El Nino pattern, being the strongest ever recorded, has caused severe drought in the Horn of Africa nation, resulting in crop reduction by 50 to 90 percent; even failure in some regions," the United Nations said earlier this month.   In Ethiopia, over 10 million people need food aid, it added.    In Eritrea, few if any major foreign aid agencies are allowed operate, while the UN has limited access across the country, and most assessments are dependent on government reports.

Thousands of Eritreans flee the county each month, saying they are escaping conscription and rampant rights abuses.   Refugees from the repressive Red Sea state make up the third-largest number of people risking the dangerous journey to Europe after Syrians and Afghans, running a gauntlet of ruthless people smugglers to make the treacherous Mediterranean crossing.
Date: Thu 30 Jul 2015
Source: Eurosurveillance edition 2015; 20(30) [edited]

Louse-borne relapsing fever (_Borrelia recurrentis_) in asylum seekers from Eritrea, the Netherlands, July 2015
----------------------------------------------------------------------
[Authors: Wilting KR, Stienstra Y, Sinha B, Braks M, Cornish D, Grundmann H]

Two patients from Eritrea, recently arrived in the Netherlands, presented with fever and were investigated for malaria. Bloodfilms showed spirochetes but no blood parasites. Louse-borne relapsing fever caused by _Borrelia recurrentis_ was diagnosed. Treatment was complicated by severe Jarisch-Herxheimer reactions [inflammatory reaction observed after antimicrobial treatment of several infectious diseases] in both patients. Physicians should be aware of the possibility of _B. recurrentis_ infection in migrant populations who travel under crowded conditions, especially after passing through endemic areas such as Ethiopia and neighbouring countries.

_Borrelia recurrentis_ has for many centuries caused infections of often epidemic proportions known as relapsing fever. Since the infection is exclusively transmitted by body lice and humans are their only host, large scale outbreaks are only expected under circumstances conducive to louse infestation. We here report the 1st introduction of louse-borne relapsing fever into the Netherlands after World War II.

Case descriptions
-----------------
Patient 1
On 4 Jul 2015, a young adult from Eritrea was referred from the National Reception Centre for Asylum Seekers (Asielzoekercentrum, AZC) to a regional hospital in the northern Netherlands with a 5-day history of headache, dizziness, right upper quadrant pain, myalgia, and fever (39.3 deg C [102.7 deg F]). Malaria was suspected. The patient had been in the Netherlands for only 2 days after arriving in Europe 14 days earlier. En route to Europe, they travelled through Ethiopia, Sudan, and Libya. Previously, they had noticed chills while sheltering in an unofficial street camp in Rome where they stayed with a small group of fellow Eritreans before travelling to the Netherlands.

Thick and thin bloodfilms did not show malaria parasites and commercial malaria antigen tests were negative. However, filamentous unidentified structures were reported in the thick film by the laboratory of the peripheral hospital. The patient received empirical treatment with a single dose of ceftriaxone (2000 mg intravenously) for suspected bacterial septicaemia. After administration, their condition deteriorated and the patient was transferred within the next 2 hours to the University Medical Center Groningen (UMCG) where they arrived at the emergency department with headache, peripheral hypothermia (35.3 deg C [95.5 deg F]), hypotension (systolic/diastolic blood pressure 78/52 mmHg, heart rate of 106 beats per minute), abdominal pain but no hepatosplenomegaly, and shortness of breath (respiratory rate 23 breaths/min). Laboratory analysis showed leucocytopenia (leucocytes: 1.6 x 10(9)/L, norm: 4.5-10 x 10(9)/L), anaemia (haemoglobin: 6.5mmol/L, norm: 8.6-11.2 mmol/L) and thrombocytopenia (thrombocytes: 16x10(9)/L, norm: 150-450x10(9)/L). C-reactive protein (CRP) was 254 mg/L (norm: less than 1 mg/L). Kidney function was normal. The patient's liver function tests showed mildly elevated transaminases (alanine transaminase: 58 U/L, norm: 7-56 U/L; aspartate transaminase: 108 U/L, norm: 10-40 U/L; alkaline phosphatase: 124 U/L, norm 20-140 U/L; gamma-glutamyl transferase: 93 U/L, norm 0-51 U/L) and total bilirubin levels of 38 micromole/L (norm: less than 26 micromol/L) and direct bilirubin 35 micromol/L (norm: less than 7 micromol/L). Oxygen saturation was 91 percent (norm: 95-100 percent). Giemsa-stained thick and thin films revealed spirochetes in large numbers (Figure 1 [available at the source URL]) and no malaria parasites.

Given the patient's travel history, louse-borne relapsing fever was suspected. The clinical deterioration was provoked by the ceftriaxone administration leading to a severe Jarisch-Herxheimer reaction [1]. Treatment was switched to doxycyline 200 mg per day intravenously intravenously to reduce the risk of relapse [2]. The patient was transferred to the intensive care unit (ICU) for fluid resuscitation, cardiac support with noradrenalin, and supportive oxygen delivery via high flow nose mask.

_B. recurrentis_ was confirmed by 16S rDNA PCR and sequencing directly from blood 2 days later. The patient stayed at the ICU for 2 days, made a full recovery and was discharged after 6 days. The body louse _Pediculus humanus humanus_ was recovered from [the patient's clothing (Figure 2 [available at the source URL]).

Patient 2
In 9 Jul 2015, a 2nd young adult from Eritrea was directly referred by the responsible physician at the AZC to the UMCG. On arrival, the patient presented with general malaise, headache, fever (38.5 deg C [101.3 deg F]) and cough. Blood tests showed elevated inflammatory parameters (leucocytes: leucocytes: 12.7 x 10(9)/L, CRP: 320 mg/L), normal kidney function and slightly elevated transaminases, but the blood sample was haemolytic. Thick and thin films showed spirochetes and treatment was started with doxycyline 200 mg orally. 2 hours later the patient developed a severe Jarisch-Herxheimer reaction [that] required admission to intensive care where they received fluid resuscitation, inotropic treatment with noradrenalin, and oxygen via a face-mask. _B. recurrentis_ was confirmed by 16S rDNA sequencing.

The patient reported symptoms of chills and fever 2 weeks before presentation at our hospital. Their journey through North Africa followed the same route as that of Patient 1, but Patient 2 had arrived in Europe a week earlier. Patient 2 had camped out in the streets for 5 days in Rome (as had Patient 1). Patient 2 arrived in the Netherlands 2 weeks before presenting at our hospitals after travelling through Austria and Germany. The patient made a full recovery and was discharged after 5 days. Lice could not be recovered from the clothing.

Discussion
----------
_B. recurrentis_ should be suspected in patients presenting with fever and a recent history of migration from or through endemic countries (Ethiopia, Sudan, Eritrea, and Somalia). The infection is transmitted through body lice (_P. humanus humanus_, formally known as _P. humanus corporis_), which typically lives and breeds in the seams of clothes but can occasionally also be found in bed linens. Immigrants may share their clothing and that can pose an additional risk of transmission. The incubation period for relapsing fever is usually 4 to 8 days with a range of 2 to 15 days [3]. It should be noted that head lice (_P. humanus capitis_), which are not uncommon in Northern Europe, are incompetent vectors and cannot transmit _B. recurrentis_. The spirochetes are easily visible under a microscope in a Giemsa-stained thick or thin blood film as used for the diagnosis of _Plasmodium_ spp [4]. In our patients, the diagnosis was confirmed in both cases by 16S rDNA PCR and sequencing from blood.

Published evidence supports a single dose of tetracycline 500 mg intravenously as the conventional treatment, but considering the limited availability of this drug, doxycycline 200 mg can be used as an effective alternative [2,5]. In young children, pregnant women, or patients with a tetracycline allergy, erythromycin 500 mg can be used instead [6].

Both patients had travelled independently along a similar route before arriving in the Netherlands. Given the incubation period, it cannot be ruled out that the infection was acquired within Europe. Crucial information about risk factors such as exact travel history, recollection of louse infestation or bites and onset of symptoms was, however, impossible to obtain from our patients. Apart from being very sick and the fact that communication required an interpreter versed in Tigre our patients appeared to be traumatised and intimidated and not eager to volunteer information for fear of legal consequences.

Both patients developed a severe Jarisch-Herxheimer reaction after starting antibiotic treatment. _B. recurrentis_ evades host immune defences, resulting in very high bacterial loads (10(6)-10(8)/microl), and effective antibiotic therapy is followed by severe reactions characterised by sudden rigors, fever, and hypotension in virtually all treated patients [3]. Clinical symptoms are associated with increased plasma concentrations of tumour necrosis factor alpha (TNF-alpha), interleukin-6 and interleukin-8 [7]. Treating physicians should be aware of this complication and the chances that ICU admission may be warranted. It is advised that patients receive 2 well-placed intravenous lines for rapid fluid resuscitation. Treatment of Jarisch-Herxheimer reaction consists mainly of supportive care. Corticosteroids seem to have limited beneficial effect but studies suggests that TNF-alpha blockers may be useful [8].

An ad hoc survey at the AZC on [16 Jul 2015] found body lice on 2 newly arrived Eritreans. Since then, all asylum seekers arriving from endemic countries to the AZC have been segregated into a different compound, where they turn over all of their personal clothes in exchange for disposable overalls. Personal clothes are then washed and returned on the next day. Used overalls and bed linen are subsequently destroyed. In addition to delousing, all arrivals receive a single dose of ivermectin as pre-emptive treatment against scabies and Eritreans who arrive with clinically manifest scabies (about 80 percent of all new arrivals) receive a 2nd dose a week later. No new cases of _B. recurrentis_ infection have been identified since mandatory delousing was implemented.

Conclusion
----------
Because infections with _B. recurrentis_ pose a significant health risk to other migrants, aid workers, healthcare personnel, and arguably to the general population, screening and delousing should be considered for arriving migrants already at ports of entry into the European Union. Our patients may have acquired body lice before arriving in Europe but transmission of infected lice between migrants after arrival in Europe cannot be ruled out and could pose an additional public health challenge.

[Figures and references are available at the source URL above.]
======================
[Relapsing fever is a bacterial infection caused certain species of the spirochete _Borrelia_. These organisms are able to periodically change their surface protein molecules to evade the host's immune response, thus causing a relapsing illness. Following an incubation period of about 7 days, the illness is characterized by recurring episodes of high fever, headache, muscle and joint pain, nausea and vomiting, each episode lasting several days, followed by a several-day asymptomatic interval. There may be up to 3-4 recurrences. Complications may include involvement of the lungs (ARDS; acute respiratory distress syndrome), central nervous system, spinal cord, eyes, heart, and liver. The bacteremia is intense (more than 10,000 organisms per ml of blood) during febrile episodes, which allows detection of organisms on a Wright-Giemsa stained blood smear. Thick blood smears are more sensitive than thin smears.

There are 2 types of relapsing fever: Tick-borne relapsing fever (TBRF) and louse-borne relapsing fever (LBRF). LBRF is more severe than TBRF, with case-fatality rates without antimicrobial treatment of 30 to 70 percent in outbreaks. TBRF occurs in the Western hemisphere, Africa, Asia, the Mediterranean region and the Middle East. In the western United States, TBRF is usually associated with sleeping in rustic, rodent-infested cabins in mountainous areas. In the United States, 3 species, _Borrelia hermsii_, _B. parkerii_, and _B. turicatae_, transmitted by the bite of soft-bodied ticks (genus _Ornithodoros_) cause TBRF. A recently discovered _Borrelia_ species, _Borrelia miyamotoi_, has been found in hard-bodied ticks (_Ixodes_) in regions where Lyme disease is endemic.

LBRF is caused by a single species, _Borrelia recurrentis_, transmitted through abraded skin when the body louse is crushed during scratching. LBRF is endemic in Ethiopia, Sudan, Eritrea, and Somalia. Outbreaks are found in developing regions affected by war and in refugee camps characterized by overcrowding and poor personal hygiene. While mammals and reptiles may serve as a reservoir for tick-borne _Borrelia_ species, humans are the only host of _B. recurrentis_.

Treatment of relapsing fever consists of either a tetracycline (such as, doxycycline), a macrolide (such as, erythromycin), penicillin, or other beta-lactam antibiotics (such as, ceftriaxone). LBRF can be treated effectively with a single dose of the antibiotic (<http://jid.oxfordjournals.org/content/137/5/573.abstract>), whereas treatment of TBRF requires 7-10 days to prevent relapse. When initiating antibiotic therapy, all patients should be observed for a Jarisch-Herxheimer reaction. The reaction, caused by massive release of tumor necrosis factor alpha (TNF-alpha), interleukin-6, interleukin-8, and other cytokines, is manifest by a worsening of symptoms with rigors, tachycardia, sweating, hypotension, and high ever, occurs in over 50 percent of cases. The Jarisch-Herxheimer reaction can be fatal. Pretreatment with anti TNF-alpha antibody has been found to suppress Jarisch-Herxheimer reactions (<http://www.nejm.org/doi/full/10.1056/NEJM199608013350503>).

Corticosteroids and antipyretic agents have little or no effect (<http://jid.oxfordjournals.org/content/137/5/573.abstract> and <http://www.ncbi.nlm.nih.gov/pubmed/6132178?dopt=Abstract>), whereas meptazinol, an opioid agonist-antagonist, has been reported to reduce the severity of the reaction (<http://www.ncbi.nlm.nih.gov/pubmed/6132178?dopt=Abstract>). Treatment with intravenous fluids and vasopressors to maintain adequate blood pressure may be required. - ProMed Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Fri, 20 Jan 2012 13:40:00 +0100 (MET)

ADDIS ABABA, Jan 20, 2012 (AFP) - Addis Ababa said Friday that two Germans kidnapped during a deadly attack by unidentified gunmen on a group of tourists in northern Ethiopia had been taken to neighbouring Ethiopia. Germany said it was still investigating the pair's whereabouts. "There is news that they are in Eritrea by now," foreign ministry spokesman Dina Mufti told AFP.

The Germans are believed to have been abducted when gunmen attacked a group of tourists in Ethiopia's remote Afar region earlier this week. Five people were killed in the attack: two Germans, two Hungarians and one Austrian. The German foreign ministry said three members of Germany's Federal Crime Agency were dispatched to Ethiopia to assist search efforts.  "The Federal Crime Agency (has) sent staff to Ethiopia in order to support the Embassy," a spokeswoman for Germany's foreign ministry told AFP from Berlin.  "They are trying to investigate where the two missing Germans could be." Six other Germans were among twelve survivors, some of them wounded, who were flown back to Addis Ababa on Wednesday. A Belgian citizen with gunshot wounds remains in hospital in Mekele in northern Ethiopia. The five bodies have been flown to the capital.

The attack took place near the famed Erte Ale volcano in Ethiopia's sparsely populated Danakil desert, close to the tense Ethiopia-Eritrea border.  The area, which boasts spectacular moon-like landscapes and is famed to be the hottest place on earth, is popular among travellers.  No group has claimed responsibility for the killings, but Ethiopia blamed arch-foe Eritrea for carrying out the attack. Eritrea vehemently denied being behind the incident, calling Ethiopia's claim "ludicrous" and a "smear campaign." The two Horn of Africa countries fought a bloody border war from 1998 to 2000 which killed 70,000 people. The border remains contested, with Ethiopian troops occupying land that international courts say belongs to Eritrea.
Date: Tue, 30 Aug 2011 12:41:08 +0200 (METDST)
by Jenny Vaughan

Shire, Ethiopia, Aug 30, 2011 (AFP) - In Ethiopias Endabaguna refugee camp, rows of gaunt Eritreans clad in rubber sandals give vent to their exasperation after days of trekking and dodging soldiers in an attempt to escape failed crops, hunger and an autocratic government. Over 12 million people across the Horn of Africa are struggling from the region's worst drought in decades, but secretive Eritrea is the only country to deny it has been affected by the crisis. "This year I farmed, but there was lack of rain. I dont know whats going to happen, only God knows," said Mehreteab, a refugee. He escaped from the army, risking death or jail if caught crossing the heavily militarized border, leaving his wife and three children behind. "There is no food and no grain in the home," he said. "I dont have any idea whats going to happen to them." Camps in northern Ethiopia receive about 900 refugees every month from Eritrea, one of the regions most isolated countries. A former colony of Italy and then part of Ethiopia, Eritrea fought a 30-year war with Ethiopia and only gained independence in 1991. A subsequent border conflict with Ethiopia from 1998-2000 still simmers.  Former rebel leader Issaias Afewoki, who has been in power since 1991 without elections, has cracked down on all dissidents and severely restricted press and religious freedom.

The majority of those arriving in the Ethiopian camps are young men escaping conscription, which forces men above 16 to serve in the military for decades on minimal pay. The UN recently called for tighter economic sanctions after releasing a report linking Eritrea to a failed bomb plot at the African Union. According to satellite imagery from the weather monitoring group FEWSNET, rainfall in parts of Eritrea this year has been "below average" - less than 10 percent of normal levels in some areas. Aid workers admit it is nearly impossible to know just how gravely the Eritrea is affected because access to information is so limited in the country where the only media is state-run. "Its been a black hole for us, we dont know whats going on there," said Matthew Conway, spokesman for the UN humanitarian coordination office in Nairobi. "But thats not to say its not happening."

The US ambassador to the United Nations has said she is "deeply concerned" that Eritrea is facing extreme hunger, and urged the government to allow humanitarian access. "The people of Eritrea who most likely are suffering the very same food shortages that were seeing throughout the region are being left to starve," Susan Rice told reporters in New York. And much like other countries in the region, such as Ethiopia and Kenya, Eritrea is vulnerable to increased food prices, exacerbating the crisis. According to the UN agriculture agency, global food prices jumped 33 percent in the last year. "High international prices affected every country in the world, so from that you can assume Eritrea is affected," said Shukri Ahmed, an economist at the Food and Agriculture Organization. Fiercely self-reliant Eritrea stopped sending market information to FAO about three years ago, Ahmed said, so it is impossible to know how much food prices have risen in the country. "Unfortunately, we dont have any information on the ground," he told AFP by phone from Rome.

Over half of Eritrea's food is imported, the FAO estimate, leaving it vulnerable to market fluctuations for staples such as sorghum and maize. Eritrean refugee Berhane, 35, said the cost of food has surged in recent years, though wages have remained the same. Intermittent work as a labourer earned him about $5 per day. But the cost of grain is about $3 per kilo and a sheep is about $170, more than he could make in a month, he told AFP. "How is someone with no money or daily work supposed to buy this?" he asked. "It is too expensive." Facing steep food costs, he relied on a small plot of land to feed his family. But the rains were two months late this year and his harvest failed. "The government doesnt do anything. Nothing. There are no rations," he told AFP.

The Eritrean authorities deny the country is facing food scarcity. "This nonsense about a hidden famine in Eritrea is utterly false," the Eritrea's information ministry said in an online statement last week. Instead, Asmara claims last year's harvest was the best in a decade, while state run media heap praise on government-run food security programs. But refugee Gebrielxavier, 25, said this is not true. He left Eritrea last November because his crop failed, he could not find work and his family went hungry. "We couldnt live. We were famished," he said. "And the government? It did nothing." He is now running a café in the refugee camp, where he earns less than $2 a  day and relies on UN food rations, but says he is still better off. "I got my freedom," he said.
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Egypt

Geographical Information:
Egypt has a total area of about 385,000 sq. miles and sits on the North Eastern corner of Africa. It is bounded by the Mediterranean Sea and on the East by Israel and the Red Sea. The Southern border is with Sudan (the large
t country in Africa) and on the West it shares a border with Libya. The country extends about 675 miles from north to south and is widest at its southern border where it covers 780 miles. Egypt is well known for the great Nile river which courses throughout its length. It is the longest river in the world and has historic links stretching back to at least 3200BC.
Climate:
The hot season in Egypt is from May to September. During this time temperatures can easily reach 370C though northern winds can provide a very necessary respite. November to March is the cooler time of the year and typical temperatures reach 140C though, during the evenings, temperatures can occasionally fall to near freezing. The humidity is mainly along the Mediterranean coastline and the average rainfall here is only about 8".
Medical Facilities:
In the main towns and cities the level of medical care is very adequate for the tourist. English speaking doctors will be associated with all the larger hotels but nevertheless care should always before being admitted to a ‘clinic’ for further treatment should this ever become necessary. Travellers are encouraged to contact the Irish Embassy in Cairo for emergency assistance should the need ever arise.
Food & Water Hygiene:
A significant number of tourists visiting Egypt suffer stomach complaints. In many cases this is due to eating food from the market places or using the hotel tap water supply for drinking or brushing teeth. The hotter climate of the country and the poorer level of food hygiene leave the unwary tourist at particular risk. Salads and shellfish meals should particularly be avoided.
Cruising along the Nile:
Over the past number of years many Irish holiday makers have enjoyed themselves cruising along the Nile for a week and then visiting Luxor in the southern part of the country. In most cases these travellers remain very well with no particular health problems. Nevertheless, in a small number they appear to forget the basic rules of food and water hygiene and will sample the local foods in the market places on shore. This practice is frequently associated with a ruined second half of the holiday. Commonsense rules of looking but not touching are much wiser.
Sun Stroke:
The ambient temperatures in Egypt can be very high and tourists are frequently exposed to the strong sunlight during their time in Egypt. It is essential that an adequate fluid intake is maintained (much higher than at home) and that travellers remember they may need to increase their salt intake (if this is not contraindicated because of heart disease or blood pressure). Small children and the elderly are at special risk.
Malaria risk in Egypt:
The risk of malaria in Egypt is small. The disease is usually only found during the warmer summer months (June to October) in the El Faiyûm area. Travellers may require prophylaxis but they should continuously remember to use adequate protection against mosquitoes and other insects.
Swimming in Egypt:
The fresh water rivers of Egypt are commonly infected with a disease called Schistosomiasis (Bilharzia). This parasite penetrates through intact skin and can cause significant health problems. Travellers are encouraged to swim only in the Mediterranean, the Red Sea or in well maintained swimming pools to avoid exposure.
Health Care while Diving:
Many of the world's most beautiful sites for diving are situated along the Red Sea. These are common tourist destinations and generally the risk of significant health worries will be small. However, check out the professionalism of the diving company before you develop too close a relationship. Make sure their equipment is in good working order and that their instructors are insisting on standard safety procedures for any proposed dive. Never dive after a large meal or following alcohol intake. Remember that you can get significantly sunburnt while snorkeling so take care to cover your back and shoulders with either a suit or sufficient water repellent cream.
Diving at night may be a beautiful experience but take extra care. Never dive beyond your personal limits and ensure that the 'buddy system' is fully operational at all times. Even the most experienced divers can have problems at times so never let you guard down and stay alert.
Rabies:
This disease is widespread in Egypt and is normally transmitted through the bite of warm blooded animals. Any bites, licks or scratches from these animals should be treated seriously by washing out the wound, applying an antiseptic and the seeking urgent competent medical attention.
Vaccines for Egypt:
All Irish travellers to Egypt should ensure that their vaccines against Poliomyelitis, Typhoid, Tetanus and Hepatitis A are in date. Those staying for longer periods or trekking through the country may require further protection against diseases like Rabies, Meningitis and Hepatitis B.
Further Information:
Further general health information on staying healthy while travelling abroad may be obtained free-of-charge from the Tropical Medical Bureau at either of our centres. Please always remember that each traveller is distinct and so individual specific information will require a medical consultation.

Travel News Headlines WORLD NEWS

Date: Tue 30 Jul 2019
Source: Food Safety News [edited]

The public health institute in Germany has reported more than 30 people have been sick with _E. coli_ in 2019 after going to Egypt. The Robert Koch Institute (RKI) noted increased reports of enterohemorrhagic _E. coli_ (EHEC) related to or after staying in Egypt. Earlier in July 2019, Public Health England (PHE) also reported an increase in adults and children ill after coming back from Hurghada in Egypt.

In Germany, there are 31 cases of EHEC and 5 people with haemolytic uremic syndrome (HUS), a type of kidney failure associated with this form of _E. coli_ infection. This is significantly more than in the same period of previous years. In 2018, there were 21 EHEC and one HUS case. In 2017, 9 EHEC and 1 HUS case were recorded. The rise cannot be explained by the increase in travel to Egypt alone, according to RKI.

It follows a warning by PHE after 18 people fell ill with EHEC infection and one person developed HUS after returning from Egypt in 2019. 4 people needed hospital treatment. A PHE spokeswoman previously told Food Safety News that it was not a single outbreak as a variety of different EHEC strains had been detected in visitors to Egypt with EHEC O157 and EHEC O26 among them. The agency has told the European Centre for Disease Prevention and Control (ECDC) about the cases.

What caused the German cases is unknown and sick people have stayed at different hotels in separate places, according to RKI, which has informed Egyptian authorities about the increase.

Dr Nick Phin, deputy director of the National Infection Service at PHE, said there are precautions that travellers can take. "These include ensuring meat is cooked thoroughly, not drinking tap water or ice made from tap water and trying to avoid swallowing water when swimming. Anyone suffering from diarrhoea and vomiting should ensure they keep well hydrated and seek medical advice if their symptoms don't improve within 48 hours. They should also avoid preparing or serving food while they have symptoms and thoroughly wash their hands after using the toilet to stop the bug being passed to others" he said.  [Byline: Joe Whitworth]
=======================
[This is the 2nd European country to report a spike to travel-related cases of EHEC related to Egypt. The German report does not specifically relate the cases to the Red Sea area of the country.

As a review, the classical enterohaemorrhagic _E. coli_ is the O157:H7 serotype although some are non-motile, that is, H-. Most O157 strains do not ferment sorbitol and that characteristic was used to screen for the strain using a sorbitol MacConkey agar. However, since non-O157 EHEC strains such as O26, O45, O103, O111, O121, and O145 do ferment sorbitol and, as seen here, some O157 also ferment sorbitol, laboratories now look for these isolates using genetic assays for the Shiga toxin genes.

Around 1903 Smith and Reagh reported on the different behaviour of salmonella strains. Their work was mostly ignored until Weil and Felix, working on _Proteus_ cultures, noted 2 forms, the swarming form called the H form (_mit Hauch_, in English: "with breath") and the non-swarming form, called the O form (_ohne Hauch_, in English: "without breath"). The H form contained both O and H antigens (correctly termed the OH form). These parallels were transposed to other Enterobacteriaceae.

If O antiserum is added to a culture, motility is preserved, whereas if H antiserum is added the culture does not move. Therefore, H antigen was involved with swarming in the agar plate (breathing might have been used to imply the ability to move). (_E. coli_, of course, do not swarm on certain agar plates like _Proteus_ bacteria do). - ProMED Mod.LL]

[HealthMap/ProMED-mail maps:
Date: Wed 17 Jul 2019
Source: Food Safety News [edited]

Public Health England has issued a warning after almost 20 cases of Shiga toxin-producing _Escherichia coli_ infection [also called enterohemorrhagic _E. coli (EHEC)] were found in people returning from Egypt in 2019.

All travellers had been to the Hurghada region [Red Sea governorate] of Egypt. A variety of different EHEC strains have been detected in visitors to Egypt with serotypes O157 and O26 identified among them. One person developed haemolytic uremic syndrome (HUS), a type of kidney failure associated with _E. coli_ infection.

Public Health England (PHE) scientists are investigating to understand the cause of the infections. The agency has given advice to those going to Egypt after 18 people, including children, returned with serious illnesses caused by EHEC infections. In 2018, there were 22 cases of EHEC in the whole year, and 11 infections in 2017. A PHE spokeswoman told Food Safety News that it cannot provide any further information about patients when asked about onset dates and the demographics of those affected.

"So far this year [2019], 4 cases have been hospitalized and 1 case has developed HUS. In 2018, 5 of 22 cases were hospitalized. We use whole genome sequencing to type all strains of EHEC in England, and the results do not indicate this is an outbreak, as multiple different strains of EHEC have been detected," she said. "Each case is individually followed up. We do not know the specific source of these infections in Egypt. However, the most common ways people get infected with EHEC is through eating contaminated food or water, through person to person spread or through contact with animal faeces."

The spokeswoman added the agency has told the European Centre for Disease Prevention and Control (ECDC) about the cases and notified the Egyptian public health authorities to provide them with information for their investigations.

There have been 16 cases of HUS in people, including children, who have been to the Hurghada region of Egypt between 2009 and 2019.

Dr Nick Phin, deputy director of the National Infection Service at PHE, said it was aware of people returning from Egypt with _E. coli_ infections. "We are gathering information about those affected to better understand the cause. There are simple precautions that travellers can take. These include ensuring meat is cooked thoroughly, not drinking tap water or ice made from tap water and trying to avoid swallowing water when swimming," he said. "Anyone suffering from diarrhoea and vomiting should ensure they keep well hydrated and seek medical advice if their symptoms don't improve within 48 hours. They should also avoid preparing or serving food while they have symptoms and thoroughly wash their hands after using the toilet to stop the bug being passed to others."

PHE recommendations to travelers include:
- where possible, avoid eating salads and uncooked vegetables and only eat fruit they can peel;
- avoid unpasteurized milk, cheese and ice cream;
- avoid food left uncovered in warm environments and exposed to flies;
- ensure all meat is cooked thoroughly before eating, avoid meat that is pink or cold;
- only drink bottled water or use ice made from bottled/filtered water;
- wash hands thoroughly after visiting the toilet, and always before preparing or eating food. Alcohol gel can be helpful but not entirely effective when hand washing facilities are not available

The advice also applies to other countries where _E. coli_ infections are common such as Turkey and Spain.
=======================
[Clearly this is not one organism as multiple serotypes of the EHEC have been found. It is not clear what factors involving the tourists have put them at risk for this potentially fatal infection. ProMED-mail previously posted about a case in the UK from this region of Egypt in 2016 (E. coli EHEC - UK (02): (England) ex Egypt http://promedmail.org/post/20160707.4330782).

Hurghada is a beach resort town stretching some 40km along Egypt's Red Sea coast. It is renowned for scuba diving, and has numerous dive shops and schools in its modern Sekalla district. - ProMED Mod.LL]

[HealthMap/ProMED-mail maps
England, United Kingdom: <http://healthmap.org/promed/p/279>
Date: Sun, 19 May 2019 21:55:33 +0200

Giza, Egypt, May 19, 2019 (AFP) - A bomb blast hit a tourist bus near Egypt's famed Giza pyramids on Sunday, wounding some of them, including South Africans, in the latest blow to the country's tourism industry.   The roadside bomb went off as the bus was being driven in Giza, also causing injuries to Egyptians in a nearby car, medical and security sources said.   Security and medical sources in Egypt said 17 people were injured, without giving a breakdown of their nationalities. No deaths were reported.   South Africa said in a statement that the "bus explosion" injured three of its 28 citizens who were part of the tourist group.   They would remain in hospital while the rest would return home on Monday, said the statement from the department of international relations.   "A device exploded and smashed the windows of a bus carrying 25 people from South Africa and a private car carrying four Egyptians," the security source said.

Video footage captured by AFP showed the bus and car with broken windows on the side of the road.   According to the security source, the wounded were being treated for scratches caused by the broken glass.   Sunday's incident comes after three Vietnamese holidaymakers and their Egyptian guide were killed when a roadside bomb hit their bus as it travelled near the Giza pyramids outside Cairo in December.   It also comes just little more than a month before the African Cup of Nations hosted by Egypt is to kick off.   Egypt has been battling an insurgency that surged especially in the turbulent North Sinai region following the 2013 military ouster of Islamist president Mohamed Morsi, who was replaced by former army general Abdel Fattah al-Sisi.   In February 2018, the army launched a nationwide operation against militants, focusing mainly on the North Sinai region.

- Tourism recovery -
Some 650 militants and around 45 soldiers have been killed since the start of the offensive, according to separate statements by the armed forces.   Since first being elected in 2014, Sisi has presented himself as a bulwark against terrorism, promising stability and increased security.   Recently, the country's vital tourism industry has started to slowly rebound after suffering strong blows due to deadly attacks targeting tourists following the turmoil of the 2011 uprising that toppled longtime ruler Hosni Mubarak.   Figures by the official statistics agency showed that tourist arrivals reached 8.3 million in 2017, compared with 5.3 million the previous year.    Authorities have gone at great lengths to lure tourists back, touting a series of archaeological finds and a new museum next to the pyramids, as well as enhanced security at airports and around ancient sites.    But that figure was still far short of the record influx of 2010 when more than 14 million visitors flocked to see the country's sites.
Date: Fri 10 May 2019
Source: ABC News [edited]

The Centers for Disease Control and Prevention (CDC) announced a temporary ban on dogs imported to the USA from Egypt on Friday [10 May 2019], citing multiple instances of dogs that contracted rabies in Egypt being brought to the USA in recent years.

Officials say Americans' appetite for adopting puppies has fuelled what regulators call an international smuggling operation that skirts US regulations. "The motives behind illegal puppy importation are not immediately obvious. However, a closer look reveals a big business driven by profit at the expense of the health and welfare of the underage puppies," the CDC says in a blog post.

"Importers aim to get around these regulations because customers demand puppies as young as 8 weeks. Profits decline by the thousands with each month a puppy ages. The puppy-loving public creating the demand is part of the problem."

The CDC estimates 100,000 dogs are imported from countries at high risk for rabies every year, some of the 1.06 million dogs entering the country through airports or ports of entry according to the agency. Three rabid dogs have been imported to the USA from Egypt since 2015, some with falsified health paperwork.

Animal rescue organization throughout the USA have worked with groups in Egypt and other countries to re-home animals, but federal officials have become increasingly concerned about the accuracy of information provided from overseas. The CDC and animal welfare groups say there's no single database to track what happens to dogs brought into the USA from Egypt once they're in the country.

In 2017, "Operation Dog Catcher" was launched after agents from Customs and Border Protection, the CDC, and USDA veterinarians identified more frequent large shipments of puppies at JFK [airport in New York]. The operation discovered smuggling operations where dogs from overseas "puppy mills" are shipped to the USA as rescue dogs valued at USD 0, then sold to the public online or on social media under false or misleading information claiming they were bred in the USA.

The most recent recorded incident was in February of this year [2019], according to the CDC, when 26 dogs imported from Egypt were adopted or placed in foster homes through a rescue in the Kansas City area. One of the dogs bit a technician and [the dog] tested positive for rabies.

The USA has been free of canine rabies since 2007, according to the CDC, but the agency says even one imported dog with the virus could create a public health threat if they interact with people or other animals that go untreated.

"The importation of just one dog infected with CRVV [canine rabies virus variant] risks the re-introduction of the virus into the United States," the CDC says in a draft of its public notice, which will be officially posted Friday [10 May 2019] (<https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-09654.pdf>).

The CDC says it has worked with international health organizations to try to clear up the problem, but officials in Egypt have not provided enough information to guarantee the health of imported dogs. Imports will be suspended until the CDC and other federal agencies determine appropriate controls are in place in Egypt to prevent exports of rabid dogs.

While US law says dogs coming into the USA have to be healthy and at least 6 months old, Operation Dog Catcher found animals with fraudulent health documents and vaccination records. In addition to rabies, dogs can spread other diseases capable of spreading to humans and other animals, such as parasites or skin infections.

The CDC and animal advocacy groups say members of the public should research breeders and ask to visit facilities or see inspection reports, even though the full records are not publicly available online. The CDC says adopting from credible animal shelters in the USA also helps decrease demand for puppies sold through fraudulent operations.  [Byline: Stephanie Ebbs]
=========================
[Laramie County, Wyoming, is wise to recommend livestock be vaccinated. It is cheap insurance for your other animals and for your help, your family and yourself. Most often our curious livestock want to see what the odd shuffling animal is crossing their pasture domain, so they stick their noses down, only to get bitten by a rabid animal, frequently a skunk. This is a usually unobserved situation until the bovine animal begins to act odd, even aggressive to its pen-mates or those feeding it. Rabid bovine animals have attacked pen-mates, people, feeding trucks and other objects. In the situation when a rabid bovine attacks a human or dog, it usually does not end well for the one attacked. If more than one animal encounters the skunk or raccoon or other source of rabies, there may be multiple herd animals affected with rabies. I have long advocated vaccinating your stock, so it is wonderful to see an official office promoting this. Also vaccinate your pet, whether they are your dog or cat or horse, or your pet steer. Rabies is a fatal disease. While there is a lifesaving post-exposure prophylaxis in humans, one should not procrastinate if bitten, but rather seek treatment immediately. Such a life-saving treatment is not available to our pets or livestock. Therefore, protect your pets and livestock and vaccinate against rabies.

Rabies is a very serious disease, often resulting in death of the animal victim and often expensive treatment for a human. There are several variants of the rabies virus. Some variants are the skunk variant or the racoon variant. The article about dogs from Egypt mentions the canine variant. This is a specific variant of the disease that has not been in the USA for over 10 years. Dogs can still be infected with the skunk variant or the racoon variant or other variants if bitten by one of those animals carrying a particular strain of rabies. The strain of rabies is one issue. The other issues the article addresses are people unexpectedly being exposed to rabies in an animal touted as having its appropriate vaccines. This is a very serious issue to adopt a pet from another country where the paperwork is fraudulent and thus expose yourself/family to a fatal disease that you believed had been prevented.

The article is correct to say investigate the breeder and where the animals are coming from. Let the buyer beware. - ProMED Mod.TG]

[HealthMap/ProMED-mail maps:
Laramie County, Wyoming, United States:
Date: Tue, 29 Jan 2019 12:22:15 +0100
By Bassem ABOUALABASS

Cairo, Jan 29, 2019 (AFP) - Alaa Hilal was out shopping in Cairo when she was attacked by a stray dog in broad daylight -- an increasing problem of daily life in Egypt which is stirring debate.   "I got out of my car and saw an exceptionally large street dog," the 38-year-old housewife told AFP at her home, northeast of Cairo.   "He approached me and bit me without barking or doing anything else," said Hilal, adding that she had been injured in the thigh.     An overpopulated mega-city of more than 20 million people, Cairo is already plagued by monster traffic jams, widespread waste problems and rampant pollution. Packs of stray dogs are only adding to the city's challenges.   Complaints about dog attacks, exposure to rabies and in some cases even deaths over the years have triggered calls for the animals to be brought under control.

- Hounds unleashed -
Commonly referred to as "baladi dogs", strays are widely viewed as unsanitary and dirty. They are typically seen running around the streets and scavenging garbage for food.   According to the agriculture ministry, there were around 400,000 cases of dog bites in 2017, up from 300,000 in 2014.    And 231 people died over the past four years from the wounds they received, mainly as a result of rabies.

A bite from a dog carrying the rabies virus can be fatal within 24 hours as it damages the human's nervous system, said Shehab Abdel-Hamid, the head of Egypt's society for the prevention of cruelty to animals (SPCA).    Hilal, who had never feared dogs having had several pets when growing up, was rushed to a nearby hospital only to discover that she was the ninth person to be bitten by the same dog.   "Due to the trauma caused by this incident, I became worried and I no longer want to be in the same place with them," she said.   There are no official data on the numbers of stray dogs, but activists say they are running loose in their millions.

A survey by the SPCA showed that the number of stray dogs "may reach up to more than 15 million", Abdel-Hamid said.   And though street dogs appear to fear the most crowded areas, they can be loud and aggressive in poorly lit and rubbish-strewn suburbs.    In November, a video widely circulated on social media showed a car hitting a teenager who was being chased by two stray dogs.   "Garbage is the main reason behind the stray dogs' crisis in Egypt," said Abdel-Hamid, highlighting how the problem was exacerbated when the rubbish men stopped working during the 2011 uprising.

- Government mauled -
The SPCA, however, lacks resources. Its headquarters in downtown Cairo was looted during the uprising and has not been renovated since, Abdel-Hamid added.    And Egyptian authorities say they can only intervene on a case by case basis.    "We do not go around the streets looking for dogs to kill them," said the agriculture ministry spokesman Hamed Abdel-Dayem. "We only take measures following complaints."   He didn't specify what measures are taken to bring the stray dog population under control.    But animal rights advocates often lambast the government, accusing it of mass culls.

In 2017, authorities killed more than 17,000 stray dogs following multiple complaints of dog "disturbances" and "biting" in Beni Sueif, south of Cairo, according to an August report by the governorate's veterinary directorate.    The Red Sea governor even offered a 100 Egyptian pounds ($5.58) award to those who capture and hand over at least five strays.   Animal rights defenders also accuse the government of killing dogs using a drug, known as "strychnine", a chemical substance listed as "unacceptable on animal welfare grounds" for euthanasia by the World Organisation for Animal Health.     But Abdel-Dayem denied that the government imported banned substances.   "Is it logical that we (the ministry) allow internationally prohibited substances to enter the country?" he told AFP when asked about the strychnine claim.

- 'Shelter of Hope' -
Animal rights advocates have sought to offer solutions, actively removing dogs from the streets and giving them homes.   Ahmed al-Shorbagi, 35, opened two dog shelters in a desert area west of Cairo, near the famed Giza pyramids.    The buildings with sheer concrete walls have kept more than 250 dogs safe for the past three years. Shorbagi contributes 40 percent to the funding of the shelters while the rest comes from donations.    "At first I followed the animal rescue pages on Facebook," Shorbagi told AFP, rubbing one dog's belly as she wagged her tail in joy.   "I saved a dog that I called 'Hope' and when I opened the shelter, I named it after her."

Shorbagi believes the solution lies in dog sterilisation programmes, providing rabies vaccinations and removing the garbage.    "Instead of the government paying millions of dollars to import poison, it should consider sterilisation," he said.    "We, as associations, proposed to the ministry of agriculture to solve the problem but it refused."   The ministry's spokesman denied however refusing to cooperate with private entities and hailed their work to help resolve the crisis.
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World Travel News Headlines

6th December 2019
https://www.theguardian.com/world/2019/dec/06/flooding-hits-new-zealand-tourist-hubs-of-wanaka-and-queenstown

Heavy rain has led to rivers bursting their banks, forcing the closure of shops and restaurants

Streets in the South Island tourist towns of Wanaka and Queenstown were slowly going under water on Friday, after Lake Wanaka and Lake Wakatipu burst their banks earlier in the week, flooding businesses and sewerage systems.

Water and large debris closed the main street of Wanaka, a popular spot with Instagrammers thanks to its famous tree that appears to have grown out of the lake. On Friday businesses were sandbagging as heavy rain continued to fall.

Sewerage systems in the town were also at risk of contaminating the lake, with the Queenstown Lakes District council taking the precautionary measure of shutting down the sewer connection to a handful of premises.

Wanaka residents were told to be on “high alert” with heavy rain predicted all weekend.

The streets of the usually bustling tourist town were largely empty, and the popular cafes and restaurants on the lake shore were closed.

3rd December 2019
https://watchers.news/2019/12/03/at-least-25-dead-as-days-of-heavy-rain-hit-tamil-nadu-india/

At least 25 people were killed in various rain-related incidents in Tamil Nadu, India since November 29, 2019. 17 of the victims died after a wall collapsed following a continuous heavy downpour in Coimbatore on Monday morning, December 2.

Among the fatalities were 10 women. Around 1 305 huts and 465 tiled-roof houses were damaged, while 1,000 people were evacuated to government relief centers in Tuticorin, Cuddalore, and Tirunelveli districts as the north-east monsoon intensifies.

Schools remain closed on Monday including those in the districts of Chennai, Chengalpet, Kancheepuram, Tiruvallur, Cuddalore, and Tuticorin, as the areas received 90 mm (3 inches) rain in the past 36 hours.

A flood alert has been issued to residents near the banks of Bhavani River in this western district of Tamil Nadu as a dam built across it has burst in the wake of torrential rains in catchment areas, officials said on Monday.

6th December 2019
https://erccportal.jrc.ec.europa.eu/ECHO-Flash/ECHO-Flash-Item/oid/17835

  • Southern Angola has been affected by widespread floods, triggered by heavy rains on 2-4 December.
  • According to the Government of Angola, 60 people have been displaced in the city of Ondjiva (Cunene Province), while several houses are damaged, roads are flooded, and power outages have been reported across areas of Ondjiva.
  • In Kalepi Municipality (Huila Province, southern Angola), a lightning event killed five people, and injured one on 2 December.
  • Moderate to heavy rains will persist over central, southern and eastern Angola on 6-8 December.
6th December, 2019
HSE Health Protection Surveillance Centre

There is a case of human rabies in Latvia. The case has been clinically and laboratory confirmed (immunofluorescence and PCR). The case is 55 years old female from city Daugavpils, located 35 km from Belarus and Lithuania borders. Symptoms appeared on November, 22, she died on November, 28. 
 
Possible exposures: 
• In May, 2018 she was bitten in both legs (ankles) by puppy travelling in India;
• She worked as volunteer in animal shelter in Daugavpils, in April this year she was bitten/scratched there by a dog, and the dog is healthy now;
• She fed stray cats and dogs in the courtyard of the house in Daugavpils, as well as in a country house outside the city near the forest. Information about bites or other possible exposures is not known.

In none of these cases the person received PEP. Now 61 contacts receive post-exposure treatment (vaccination), mostly as precautions: staff of two hospitals and medical emergency service, and close contacts, including household. In Latvia the last cases of rabies in wild animals were registered in 2010, in 2012 was registered the last case in domestic animals. In 2014, Latvia received the status of a country free of rabies. Latvia continues to implement wild animal’s vaccination progamme. Neighbour countries Belarus and Russian Federation is not rabies free and animals can cross the border.
 
A test report has been received on the results of the rabies virus genotype identification and sequencing reaction (EURL-Rabies Protocol, (AFSSA) P. Meyer, 2009). The rabies virus genotype 1 was detected in the sample. According to the GenBank database, the virus sequence has 99.17% identity to the RV2924 isolate of rabies virus from Nepal. Information and evidence obtained during an epidemiological investigation demonstrated that the human rabies case had a dog bites during her travel in India (Naggar and Manali, state Himachal Pradesh – close to Nepal), in May 2018. No post exposure treatment was received.

No cases of illegally exported pets as the potential source of infection were identified in the relation to this rabies case. According to the literature in rare cases a long (more than one year) incubation period of rabies is observed. Taking into account the epidemiological data and the result of the rabies virus sequencing, the Center for Disease Prevention and Control of Latvia believes that this human rabies case is not epidemiologically linked to Latvia.
6th December, 2019
HSE Health Protection Surveillance Centre

On 27/11/2019, a possible case of diphtheria was reported to the Department of Epidemiological Surveillance and Intervention through the Mandatory Notification System in Greece. It concerned an 8 years old boy of Greek nationality, who was hospitalized in the ICU of General Children's Hospital  where he died.  This child had underlying conditions (severe pulmonary hypertension) and was admitted to ICU  on 22/11/2019 with clinical presentation of laryngitis (without the presence of characteristic pseudo membranes) and pneumonia, immediately intubated, covered with double antibiotic regimen and died due to deterioration of his clinical presentation on 26/11/2019.
 
According to the epidemiological data given , there is no travel history, group living, no connection to another case and the child does not belong to a specific population group. Regarding his immunization status, the child was vaccinated with at least 3 doses against diphtheria-tetanus-pertussis.
 
Laboratory investigation of bronchial exudate isolated Corynebacterium diphtheriae via VITEK. Further laboratory testing was performed by the Public Health England  reference Laboratory for Corynebacteria. On Thursday 5/12/2019, the National Public Health Organization was informed that multiplex PCR testing was positive for C. Diphtheriae and positive for the diphtheria toxin gene. The Elek test was also positive for toxin production. The results of the child's post-mortem exam are pending.

Contact tracing and management is ongoing and has identified most of the close contacts of the patient. The National Public Health Organization provided recommendations on obtaining nasopharyngeal cultures in close contacts to evaluate carriage as well as the necessary preventive measures to protect the child's close contacts as well as the medical staff involved in direct patient care (i.e. awareness for potential compatible with diphtheria symptoms and administration of antibiotic prophylaxis together with booster or complete vaccination series as appropriate) according to the WHO’s Diphtheria Surveillance Standards (September 2018). In addition we have initiated the procedure for the procurement of a limited stockpile of DAT.
Date: Mon, 9 Dec 2019 11:12:25 +0100 (MET)
By Clare BYRNE

Paris, Dec 9, 2019 (AFP) - France's transport chaos deepened Monday on the fifth day of a nationwide strike over pension reforms, ramping up tensions at the start of a crucial week in President Emmanuel Macron's battle with trade unions.   With only two of the Paris metro's 16 lines running as normal and suburban trains also heavily disrupted, many commuters slipped behind the wheel to try to get to work in torrential rain, causing major gridlock.

By 9 am, the tailbacks in the Paris area ran to 600 kilometres (370 miles), twice the normal level, the Sytadin monitoring website said.   Large queues formed at bus stops following an announcement that one out of two buses would be running but striking workers blocked seven out of 25 bus depots, leaving more travellers stranded.   With many having opted to work from home last week and only now returning to the workplace, this week will test public support for the strike.

A poll Sunday in the Journal du Dimanche newspaper showed 53 percent of the French supporting the strike or expressing sympathy for their demands, up six points in a week.   Unions have called a second day of mass protests for Tuesday, a day before the government unveils the full details of its plans for a single points-based pension scheme that does away with dozens of more advantageous plans enjoyed by train drivers, sailors, lawyers and other professions.

- 'A monstrosity' -
Critics argue that the shake-up will require people in both the public and private sector to work longer for a smaller retirement payout.   Teachers are expected to walk out again for the second time in a week Tuesday, leading to widespread school closures.

Firefighters, electricity workers and "yellow vest" anti-government demonstrators have also joined railway workers in the streets in recent days.   The government's pensions envoy Jean-Paul Delevoye, who drafted the reforms, and Health Minister Agnes Buzyn will meet with trade unions on Monday to try to negotiate an end to the deadlock.   But the unions have sounded an uncompromising note.   "I will not negotiate over the implementation of what I describe as a monstrosity which endangers tomorrow's pensioners," said Yves Veyrier, the head of the militant Force Ouvriere union.

The strike has squeezed retailers in the run-up to Christmas, raising the prospect of another bleak year-end after the unrest caused by the yellow vests in late 2018.   The first day of the stoppage already caused an average 30 percent drop in sales, according to the Alliance of Commerce, which represents 27,000 supermarkets and clothing and shoe stores with almost 200,000 workers.   A hotel association said reservations in the larger Paris region dropped by 30 to 40 percent on the first day of the strike.    Regional and international trains, including the Eurostar to London and Thalys to Brussels, have also been hobbled by the unrest, and several flights were cancelled on the first days of the strike.

- Fairer system for all? -
Over 800,000 people took to the streets when the strike was launched on December 5, many accusing Macron of trying to weaken France's generous social safety net.   The president, Prime Minister Edouard Philippe and senior cabinet ministers met late Sunday to discuss the changes, which they argue will ensure a fairer and more sustainable system for all.   "If we do not carry out a far-reaching, serious and progressive reform today, someone else will do a really brutal one tomorrow," Philippe told Le Journal du Dimanche.

The strike has drawn comparisons with late 1995 when three weeks of strikes forced the then centre-right government to withdraw its pension reforms.   Adrien Quatennens, a lawmaker from the far-left France Unbowed party, acknowledged on LCI radio that the strike was hard on businesses and commuters, but said: "It's better to endure a few weeks of hassle than... years of hardship" in retirement.
Date: Mon, 9 Dec 2019 10:20:33 +0100 (MET)
By Neil SANDS, with Holly Robertson in Sydney

Wellington, Dec 9, 2019 (AFP) - Five people were killed, 18 were injured and several more were left stranded after an island volcano popular with tourists erupted unexpectedly in New Zealand on Monday.   Police said some 50 people were visiting White Island when it exploded suddenly in the early afternoon -- hurling ash and rock high into the air.   Two dozen people made it off the island, five of whom have since died. The rest are being treated for injuries, including severe burns.

Nothing is yet known about a group -- now estimated to number in the double digits -- who are still trapped on the island.   "We're unsure of the exact numbers on there and we're unsure of their wellbeing," said deputy commissioner John Tims.   As night fell, he said volcanic activity made a rescue attempt too dangerous.   "The island is unstable, there's a danger of further eruptions, it is physically unsafe for us to return to the island"   "I've got to consider the safety of our people and emergency services staff."   The eruption occurred at 2:11pm (0111 GMT), thrusting a thick plume of white ash 3.6 kilometres (12,000 feet) into the sky.   Seconds before, live camera feeds showed a group of more than a half dozen people walking on the crater floor. Then the images went black.

A "considerable number" of those caught up in the disaster are believed to be Australian, according to officials in Canberra.   As many as 30 people are also believed to be cruise passengers on a day trip from the vessel Ovation of the Seas, Kevin O'Sullivan, chief executive officer of industry body the New Zealand Cruise Association told AFP.   The ship's operator Royal Caribbean -- who had billed the trip to White Island as "an unforgettable guided tour of New Zealand's most active volcano" -- said "a number of our guests were touring the island" but did not confirm that number.   The ship has a capacity of around 4,000 people and set sail from Sydney last week on a 12 day voyage.

- Scene of terror -
Tourist Michael Schade, made it off the island just in time and was able to capture footage of the devastation.   His videos showed groups of startled tourists clustered by the shoreline, waiting to be evacuated as the ground around them smouldered, the sky filled with white debris. An ash-caked helicopter lies damaged nearby.   As his ship hurtled away, the caldera became virtually invisible, shrouded by a thick bank of ash.   Volcanic Air said they had landed a helicopter on the island shortly before the eruption carrying four visitors and one pilot. All were now accounted for.   "It had landed on the island. What happened after that we don't know, but we know that all five made it back to Whakatane on one of the tourist boats," a company spokesman told AFP.

Guillaume Calmelet, the co-director of Skydive Tauranga, saw the eruption from above as he took a customer on a tandem skydive from a plane 12,000 feet above the Bay of Plenty.   "As soon as the parachute opened there was this huge cloud that was really different to whatever we've seen before," he told AFP. "I could see it coming out in freefall, so probably about 30 seconds for the whole cloud to form, if that. It was pretty quick."   The country's National Emergency Management Agency described the eruption as "moderate", although the plume of ash was clearly visible from the mainland and from satellites flying overhead.    "We have seen a steady decline in activity since the eruption. There remains significant uncertainty as to future changes but currently, there are no signs of escalation."

White Island -- - also known as Whakaari -- is about 50 kilometres (30 miles) offshore in the picturesque Bay of Plenty and is popular with adventurous tourists willing to don hard hats and gas masks.   It is New Zealand's most active volcano cone and about 70 percent of it is underwater, according to government-backed agency GeoNet.   Around 10,000 people visit the volcano every year. It has erupted frequently over the last half-century, most recently in 2016.

In August of that year the New Zealand Defence Force airlifted a 2.4-tonne shipping container onto the island to serve as an emergency shelter in case of an eruption.   "Sudden, unheralded eruptions from volcanoes such as White Island can be expected at any time," said University of Auckland volcanologist Shane Cronin.   "The hazards expected from such events are the violent ejection of hot blocks and ash, and formation of 'hurricane-like' currents of wet ash and coarse particles that radiate from the explosion vent."   "These can be deadly in terms of causing impact trauma, burns and respiratory problems. The eruptions are short-lived, but once one occurs, there are high chances for further, generally smaller ones as the system re-equilibrates."
Date: Mon, 9 Dec 2019 09:54:20 +0100 (MET)

Rome, Dec 9, 2019 (AFP) - A 4.5 magnitude earthquake hit the central Italian region of Mugello on Monday, sending panicked residents into the streets but causing minimal damage to buildings.   The quake, centred some 31 km (19 miles) northeast of Florence in Tuscany, hit at 4:37 am (0330 GMT), after a series of smaller quakes, according to the national institute for geophysics and vulcanology (INGV).

Residents fled their buildings in the rain,  congregating outside or in their cars to await authorities.    "The quake went on for awhile, especially the first one, things fell down at a supermarket but for the moment we haven't seen any damage to people or things," said Filippo Carla' Campa, mayor of the town of Vicchio.   A resident of Barberino del Mugello said his neighbours were panicking getting out of the building.    "Paintings fell off the walls, bookcases fell over," he told Rai 24.    In Barberino del Mugello, the 17th century church suffered a crack in one side, television images showed.

Schools were closed in the region and some trains through Florence were cancelled or delayed.    Italy is frequently struck by seismic activity, often devastating. Most recently, a series of strong quakes hit central Italy in late 2016 and early 2017, killing 300 people.   In 1919, the area was hit by an earthquake that killed 100 people.
Date: Mon, 9 Dec 2019 03:52:15 +0100 (MET)

Mount Hutt, New Zealand, Dec 9, 2019 (AFP) - Almost 1,000 tourists were stranded in New Zealand's South Island Monday after wild storms cut highways, washed away bridges and flooded the rugged landscape.   Meteorologists said up to 400 millimetres (16 inches) of rain was dumped on the South Island over 24 hours by a severe weather system that unleashed gale-force winds and 230,000 lightning strikes.   The main highway through the island was closed after the Rangitata river burst its banks. Townships near the popular Franz Josef glacier were isolated when landslips blocked road access.

With New Zealand entering its peak tourist season, some 970 travellers at Franz Josef were left facing the prospect of taking an expensive helicopter ride to get out or hunkering down until Friday, when the road is expected to be cleared.   "Between the community, the hotels and motels and our welfare centre we've managed to billet out most people overnight," Civil Defence spokesman Stephen Doran told TVNZ.   "We'd just ask people to stay put at the moment. We want to keep the work site clear so we can get supplies in there... and try to get the road into some sort of shape."

Another landslip on the island's west coast will take an estimated six weeks to clear.   The worst of the weather hit over the weekend and it is forecast to deteriorate again later in the week, leaving authorities scrambling during a brief respite to complete as much repair work as possible.
Date: Sun, 8 Dec 2019 17:30:45 +0100 (MET)

Kigali, Dec 8, 2019 (AFP) - Rwanda on Sunday started a voluntary Ebola vaccination programme at its border with the Democratic Republic of Congo in a bid to prevent the spread of the deadly virus from its neighbour.   All countries in high-risk areas, even if not hit by Ebola, had been advised by the WHO to use a new vaccine developed by US group Johnson & Johnson, the country's health minister, Diane Gashumba, told journalists.   The idea was "to protect those with high chances of getting in contact with people living in areas where Ebola has been reported to be active", she said.

The vaccine, Ad26-ZEBOV-GP, is an experimental drug produced by US pharmaceuticals giant, Johnson & Johnson. It was used for the first time in mid-November in Goma in DR Congo, on the other side of the border.    So far, there have no confirmed cases of Ebola in Rwanda.   The epicentre of the outbreak in DR Congo, which has killed more than 2,200 people since August 2018, is located 350 kilometres (217 miles) north of Goma, in the Beni-Butembo region.   That region sits on the DR Congo border with Uganda.   More than 250,000 people in DR Congo have already been vaccinated using another product, rVSV-ZEBOV, made by US drug company, Merck Shape and Dohme.

- Ebola in Goma -
People working in the health sector, at border crossings, police officers, and business executives who frequently travel between the two countries are being given priority in the vaccination campaign.   But all residents in the border districts can ask to be vaccinated if they wish.    The first volunteers expressed relief at the measure.    "We lived in a life of worry because of what was going on in DR Congo," Joel Ntwari Murihe, one of the first Rwandans to be vaccinated, told AFP.   "It caused a lot of border disruptions as we were restricted to buying or selling with DR Congo residents who live in Goma.    "The vaccine is an assurance to the safety for our lives and our children's lives."

The head of DR Congo's anti-Ebola efforts, Jean-Jacques Muyembe, and the WHO's representative in Rwanda, Kasonde Mwinga, were present at the campaign launch.    In August, Rwanda briefly closed its border with DR Congo and ordered its citizens not to visit the country when the first Ebola cases were recorded in Goma.   The city, which is the regional capital of the Congolese province of North Kivu, sits on the border with Rwanda.    The border has since been reopened, but strict medical checks are being enforced.