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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Haiti US Consular Information Sheet
June 02, 2008
COUNTRY DESCRIPTION:
Haiti is one of the least developed and least stable countries in the Western Hemisphere. The availability of consumer goods and services is barely adequate in the capi
al, Port-au-Prince, but other parts of the country experience chronic shortages. Most consumer products are imported and expensive. Some tourism facilities in the large cities and resort areas are satisfactory, but many are rudimentary at best, and are difficult to find in most rural areas and small towns. Read the Department of State Background Notes on Haiti for additional information.
ENTRY/EXIT REQUIREMENTS: All Americans traveling by air outside of the United States are required to present a passport or other valid travel document to enter or re-enter the United States. Haitian law requires U.S. citizens to have a passport to enter and exit Haiti. Once in Haiti, an undocumented U.S. citizen can experience delays of several weeks for the issuance of a passport, as it is often more difficult to establish identity and citizenship overseas than in the United States. The Haitian government requires foreigners to pay a departure fee. U.S. citizens are encouraged to contact the Embassy of the Republic of Haiti for more details regarding current entry, departure and customs requirements for Haiti. The Embassy of the Republic of Haiti is located at 2311 Massachusetts Avenue NW, Washington, DC 20008; the telephone number is (202) 332-4090, and the Internet address is http://www.haiti.org/. There are Haitian consulates in Miami and Orlando, Florida; Boston, Massachusetts; New York, NY; Chicago, Illinois and San Juan, Puerto Rico.

Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
U.S. citizens should exercise extreme caution and are strongly encouraged to register online at https://travelregistration.state.gov prior to travel.
Travel in Haiti can be dangerous and all visitors are urged to exercise vigilance and caution. In some cities and towns ordinary services such as water, electricity, police protection and government services are either very limited or unavailable. While U.N. personnel from several countries have been in Haiti since 2004, their presence does not guarantee absolute security for residents or visitors.
During 2007 and early April 2008, the Embassy issued several security related messages warning U.S. citizens in Haiti of violent or unstable conditions. On occasion, the U.S. mission in Haiti was forced to suspend service to the public or close because of security concerns. These concerns have also prevented Embassy personnel from traveling to or through some areas. Since October 2004 Embassy personnel have been prohibited from entering central Port-au-Prince after dark due to security concerns. The Embassy has also imposed a curfew on its officers from time to time. If situations occur where the Embassy must suspend operations or when officers are unable to travel freely, the Embassy will continue to be available by telephone to offer emergency services to U.S. citizens.
In early April 2008, there were violent demonstrations, looting, transportation disruptions, and up to seven reported deaths in Les Cayes and Port-au-Prince. Some American citizens were temporarily stranded in isolated locations and could not safely travel until calm was restored. Because political and economic conditions precipitating the civil unrest have not been entirely resolved, American citizens should defer non-essential travel to Haiti.
U.S. citizens in Haiti should avoid all large gatherings, as crowd behavior can be unpredictable. Visitors encountering roadblocks, demonstrations, or large crowds should remain calm and depart the area quickly and without confrontation. Assistance from Haitian officials, such as the police, is often unavailable. Overseas visitors must be particularly cautious on the days of planned political activities. U.S. citizens are urged to take common-sense precautions and avoid any event where crowds may congregate.

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

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

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

CRIME: There are no "safe areas" in Haiti. Crime, a chronic problem over the years, has increased in recent years and can be subject to periodic surges sometimes not obviously explained by other events or conditions. The U.S. estimates that up to 8% of the cocaine entering the United States passes through Haiti. The state of law and order has steadily deteriorated as a result. Reports of kidnapping, death threats, murders, drug-related shootouts, armed robberies, break-ins or carjackings are common. These crimes are primarily Haitian against Haitian, though several foreigners and U.S. citizens have been victimized. In 2007, there were 29 reported kidnappings of American citizens, including two victims who were killed. Many American citizens reported that they were beaten and or raped by their hostage takers. Kidnapping remains the most critical security concern; kidnappers frequently target children.
U.S. citizens who travel to Haiti should exercise extreme caution throughout the country. Travelers should keep valuables well hidden, ensure possessions are not left in parked vehicles, use private transportation, alternate travel routes, and keep doors and windows in homes and vehicles closed and locked. U.S. citizens should avoid all night-time travel due to poor road conditions and increased criminal activity after dark. They should be alert for suspicious onlookers when entering and exiting banks, as criminals often watch and subsequently attack bank customers. Withdrawals of large amounts of cash should be avoided.
Criminal perpetrators often operate in groups of two to four individuals, and are disposed occasionally to be confrontational and gratuitously violent. Criminals sometimes will seriously injure or kill those who resist their attempts to commit crime. In robberies or home invasions, it is not uncommon for the assailants to beat or shoot the victim in order to limit the victim's ability to resist. If an armed individual demands the surrender of a vehicle or other valuables, the U.S. Embassy recommends compliance without resistance. This recommendation also applies in the event of a kidnapping. Visitors to Haiti should exercise caution at all times and review basic personal security procedures frequently.
U.S. citizens in Haiti must be particularly alert when arriving from overseas at the Port-au-Prince airport, as criminals have often targeted arriving passengers for later assaults and robberies. Some recent incidents have resulted in death. The use of public transportation, including "tap-taps" (private transportation used for commercial purposes), is not recommended. Visitors to Haiti should arrange for someone known to them to meet them at the airport.
U.S. citizens should decline all requests to carry items for others to or from Haiti. Traffickers of illegal drugs have duped unsuspecting travelers into helping transport narcotics aboard commercial airlines.
Certain high-crime zones in the Port-au-Prince area should be avoided, including Croix-des-Bouquets, Carrefour, Martissant, the port road (Boulevard La Saline), urban route Nationale #1, the airport road (Boulevard Toussaint L'Ouverture) and its adjoining connectors to the New ("American") Road via Route Nationale #1 (which should also be avoided). This latter area in particular has been the scene of numerous robberies, carjackings, and murders. Embassy employees are prohibited from remaining in the downtown area after dark or entering Cite Soleil and La Saline and their surrounding environs due to significant criminal activity. Neighborhoods in Port-au-Prince once considered relatively safe, such as the Delmas road area and Petionville, have been the scenes of an increasing number of violent crimes.
Cameras and video cameras should only be used with the permission of the subjects; violent incidents have followed unwelcome photography. Their use should be avoided altogether in high-crime areas.
Holiday periods, especially Christmas and Carnival, often bring a significant increase in criminal activity. Haiti's Carnival season is marked by street celebrations in the days leading up to Ash Wednesday. In recent years, Carnival has been accompanied by civil disturbances, altercations and severe traffic disruptions. People attending Carnival events or simply caught in the resulting celebrations have been injured and killed. Random stabbings during Carnival season are frequent. Roving musical bands called “rah-rahs” operate during the period from New Year's Day through Carnival. Being caught in a rah-rah event may begin as an enjoyable experience, but the potential for injury and the destruction of property is high. A mob mentality can develop unexpectedly leaving people and cars engulfed and at risk. During Carnival, rah-rahs continuously form without warning; some rah-rahs have identified themselves with political entities, lending further potential for violence.
The Haitian police are understaffed, poorly equipped and unable to respond to most calls for assistance. There are continued allegations of police complicity in criminal activity. The unsatisfactory response and enforcement capabilities of the Haitian national police and the weakness of the judiciary frustrate many victims of crime in Haiti. In the past, U.S. citizens involved in business and property disputes in Haiti have been arrested and detained without charge, and have been released only after intervention at high levels of the Haitian Government.

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 Haiti are scarce and for the most part sub-standard; outside the capital standards are even lower. Medical care in Port-au-Prince is limited, and the level of community sanitation is extremely low. Life-threatening emergencies often require evacuation by air ambulance at the patient's expense. Doctors and hospitals often expect immediate cash payment for health services.

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

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

TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Haiti is provided for general reference only, and may not be totally accurate in a particular location or circumstance. Cars are supposed to be driven on the right side of the road in Haiti, but few roads have lane indicators and drivers use whatever part of the road is open to them, even if it is not the correct side of the road. Traffic is extremely congested in urban areas, and hours-long traffic jams develop throughout the country.
Driving in Haiti must be undertaken with extreme caution. The situation on the roads can be described as chaotic at best, and it is advisable for those with no knowledge of Haitian roads and traffic customs to hire a driver through a local hotel. Roads are generally unmarked, and detailed and accurate maps are not widely available. Lanes are not marked and signs indicating the direction of traffic flow seldom exist. This lack of organization, along with huge potholes that occur without warning, may cause drivers to execute unpredictable and dangerous maneuvers in heavy traffic. The Haitian government lacks adequate resources to assist drivers in distress or to clear the road of accidents or broken-down vehicles blocking the flow of traffic. Drinking and driving is illegal in Haiti, but people frequently drive after drinking, especially at night.
Public transportation as it is usually defined does not exist in Haiti. While Haitians use buses, "tap-taps" and taxis, which may observe regular routes, much like public transportation, none of these should be considered reliable. The Embassy strongly discourages their use.
Those who drive in Haiti should do so defensively and conservatively, avoid confrontations such as jockeying for position, and remain aware of the vehicles around them. Drivers should carry the phone numbers of people to call for assistance in an emergency, as Haitian authorities are unlikely to respond to requests for assistance. When traveling outside of Port-au-Prince, drivers should caravan with other vehicles to avoid being stranded in the event of an accident or breakdown.
Although written and driving tests are required to qualify for driver's licenses, road laws are not generally known or applied. Signaling imminent actions is not widely practiced, and not all drivers use turn indicators or international hand signals properly. For instance, many drivers use their left blinker for all actions, including turning right and stopping in the road, and others flap their left arm out the window to indicate that they will be taking an unspecified action. Drivers do not always verify that the road is clear before switching lanes, turning, or merging.
Speed limits are seldom posted and are generally ignored. Speeding is the cause of many of the fatal traffic accidents in Haiti, as are overloaded vehicles on winding, mountainous roads and vehicles without brakes. Poor maintenance and mechanical failures often cause accidents as well. Drivers should be particularly cautious at night, as unlighted vehicles can appear without warning.
Right of way is not widely observed in Haiti, and there are few operational traffic lights or traffic signs. It is advisable at most intersections to stop and verify that there is no oncoming traffic even if it appears that you have the right of way. Drivers can be quite aggressive and will seldom yield. Walls built to the edge of roads frequently make it impossible to see around corners, forcing drivers to edge their cars into the road at intersections to check for oncoming traffic.
In addition to vehicles, a variety of other objects may appear on the road in Haiti, such as wooden carts dragged by people, small ice cream carts, animals, mechanics working on vehicles parked on the street, and even vendors and their wares. Vehicles are often abandoned in the road or by the side of the road. There are few marked crosswalks and sidewalks, and pedestrians often wend their way through traffic in urban areas. Please refer to our Road Safety page for more information.

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

SPECIAL CIRCUMSTANCES:
The official currency of Haiti is the gourde, which has a variable exchange rate. Visitors will notice that most establishments in Haiti price items in an unofficial currency known as the “Haitian dollar.” (One Haitian dollar is equivalent to five gourdes.) Others give prices in gourdes or even in U.S. dollars. It is always a good idea to clarify with vendors which currency -- the gourde, Haitian dollar, or U.S. dollar -- is being used in a given transaction, as price tags often bear a number without indicating currency. The currency itself shows a value in gourdes. U.S. dollars are the currency of choice at the Labadee Beach cruise ship port-of-call.
Travelers' checks are often difficult to change in Haiti, but credit cards are widely accepted and some establishments accept or cash personal checks. At least one local bank chain has ATMs around Port-au-Prince that are compatible with some U.S. ATM cards. These ATMs are frequently out-of-order, and there have been reports of over-charging accounts.
Haiti, like most Caribbean countries, can be affected by hurricanes and other storms. Hurricane season runs from approximately June 1 - November 30 each year. Extensive flooding as a result of heavy rainfall has occurred in the past. Daily weather information in Haiti is available from national and international media. The Haitian meteorological service provides hurricane warnings via national radio. Both media and government information is only in Kreyol and/or French. Warnings are also available on the internet from many sources among which is the National Oceanic and Atmospheric Administration (NOAA) at hurricanes.noaa.gov. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.
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 offences. Persons violating Haiti's laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Haiti are severe, and convicted offenders can expect long jail sentences and heavy fines. The judicial process in Haiti can be extremely long; progress is often dependent on considerations not related to the specific case. Detainees may wait months or years for their cases to be heard before a judge or to have legal decisions acted upon by the authorities. Bond is not usually available to those arrested for serious crimes with the result that often suspects remain in custody for many months before formal indictment. Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Haiti are encouraged to register with the nearest U.S. Embassy or Consulate through the State Departments travel registration web site so that they can obtain updated information on travel and security within Haiti. 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 Consular Section of the U.S. Embassy is located at Boulevard du 15 October, Tabarre 41, Tabarre, Haiti. The main Embassy switchboard number is: (509) (2) 229-8000. The America Citizens Services (ACS) Unit fax number is (509) (2) 229-8027, the email address is acspap@hotmail.com. Web site: http://haiti.usembassy.gov/. ACS Unit office hours are 7:00 a.m. to 3:30 p.m., Monday through Friday. The Consular Section is closed on U.S. and local holidays.
* * *
This replaces the Country Specific Information for Haiti dated April 27, 2007 to update sections on Exit/Entry Requirements, Safety and Security, Crime, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Thu, 4 Jul 2019 01:08:12 +0200

Port-au-Prince, July 3, 2019 (AFP) - At least five people were killed and three are missing in Haiti after a torrential downpour buffeted the capital of Port-au-Prince, the country's civil protection agency said Wednesday.   Three people were found dead in the city's impoverished Cite Soleil neighbourhood, while two others were killed elsewhere in Port-au-Prince.   In the busy hillside neighbourhood of Petionville, three people went missing and five were seriously injured when a wall collapsed under the weight of the downpour.

On Wednesday, heavy equipment was rolled out across the capital to clear mud and debris, while officials warned residents in flood-prone areas to remain on alert.   "There are unstable weather conditions prevailing in the Caribbean basin, and rain and thunderstorm activity could hit the country over the next two days," Haiti's civil protection agency said.

Heavy rain causes unusual damage in Haiti's main cities due to a lack of proper drainage infrastructure.   Some of the country's poorest residents also build flimsy homes along canals and gullies that easily become clogged with waste when it rains.   Every year Haiti has to prepare for potentially catastrophic storms during the Atlantic hurricane season, which runs from June 1 through November 30. However due to a complete lack of urban planning, even heavy rain is enough to threaten lives across the country.
Date: Wed, 22 May 2019 02:06:35 +0200
By Amelie BARON

Port-au-Prince, May 22, 2019 (AFP) - With no oxygen in intensive care or gloves in the emergency room, residents at Haiti's largest hospital have gone on strike to protest the filthy environment and demand six months of back pay.   "We have almost nothing when we talk about emergency services," said Emmanuel Desrosiers, 24, one of the doctors-in-training at the State University of Haiti Hospital (HUEH) that began the work stoppage Monday.    "When a patient arrives, when we should immediately take charge, we start by listing the things they or their family need to go buy."   The HUEH, known as the "general hospital," is where the most disadvantaged families in this impoverished Caribbean country crowd. Buying the medical supplies themselves is a financial headache, but private clinics are far too expensive.   In crumbling buildings in the center of Port-au-Prince, male and female patients are crowded together in tiny rooms, while trash cans overflow.   "We feel ridiculous when we give hygienic advice to patients," one resident said of the situation.

The residents' selflessness as they work in an unsanitary environment is compounded by the fact that they have not been paid since the start of their residency, nearly six months ago.   After five years of medical studies, the state is required to pay them 9,000 Haitian gourdes (HTG) per month -- only about $100, due to the devaluation of the national currency.   Nothing is being done about the hospital's disrepair, with those in charge waiting for a new building to be completed, according to resident Yveline Michel.   The new HUEH will have two floors and more than 530 beds once it's finished -- but it's unclear when that will be.   The project began after the January 2010 earthquake, which destroyed more than half the hospital. The United States, France and Haiti invested $83 million in a new hospital, which should have been completed by 2016.   Instead, there is little visible activity on the construction site, which can be seen through the windows of the current building.

Due to the heat, the windows are always open, letting in noise and dust from the street. There are only a few fans in the hospital rooms, which do little to combat the humidity or the flies.   "At any moment we could lose patients, but the state isn't doing anything to save their lives," said Michel, 25.   "We're striking for the population, since it should make these demands."   But some locals question the residents' position because the strike prevents the already struggling hospital from functioning.   Since the strike began, the poorest families in the area no longer know where to go for medical emergencies, as the residents are in charge of admitting patients.   "Due to the lack of resources and the unsanitary environment, there are always people dying in the hospital, so it's not the strike causing that," said Michel in response.
Date: Thu, 21 Feb 2019 07:52:47 +0100
By Amelie BARON

Port-au-Prince, Feb 21, 2019 (AFP) - With flaming barricades and widespread looting, 10 days of street violence in Haiti have all but buried a tourism industry that managed to resurrect itself after a devastating earthquake in 2010.   Ugly, violent footage beamed around the world has again sent the message that this impoverished Caribbean country is politically unstable and no place to go on vacation.

The final straw was the helicopter evacuation last week of 100-odd Canadian tourists trapped as angry protesters demanded the resignation of the president, whom they accuse of corruption.   "We have been through 12 days of hell. We managed the crisis but today we are suffering from the aftershocks," said Tourism Minister Marie-Christine Stephenson.

- Blacklist -
Beside the direct effects of the demonstrations, the United States delivered another crushing blow on February 14 when it urged its citizens not to travel to Haiti, which thus joined a no-go list with war-torn countries like Syria, Yemen and Afghanistan.

The minister said the US travel alert for Haiti was too harsh, calling the riots something that flared up unexpectedly and are now over.   "OK, they lasted 12 days but I am not sure that other Caribbean countries, which have had riots of their own, have been punished as severely and quickly as we have," said Stephenson.   Overnight, the decision by the US State Department hit the tourism industry hard. Travel web sites simply stopped offering flights to Haiti's two international airports.   Hotels are reporting cancellation of reservations and many empty rooms.

Officials in the industry have yet to tally up the damage but say that for the second time in less than a year, they will have to lay off workers.   In July of last year, three days of riots over a government attempt to raise fuel prices ruined the summer vacation season for Haiti's tourism industry.   It is not just hotels that will suffer again, said Beatrice Nadal-Mevs, president of the Haitian Tourism Association.   "This is going to affect everyday people because these are direct jobs that are going to be lost and supply chains will be threatened: farming, fishing, crafts, transport," Nadal-Mevs said.

- Mardi Gras cancelled -
With the opposition planning more demonstrations to seek the resignation of President Jovenel Moise, the sector got yet more bad news with word that Carnival celebrations have been called off in the Haitian capital, Port-au-Prince.   City Hall said it could not guarantee revelers' safety.   The festivities, which this year were planned for March 3-5, usually draw many Haitians living abroad and fleeing the winter cold in Canada and the eastern US.

Another major Carnival celebration is scheduled to take place in the city of Gonaives, but the government has not said if it will go ahead.   As grim as things are, some foreign tourists have gone ahead with visits to Haiti.   On Wednesday, a group of Australians under police escort visited a square featuring statues of heros of Haiti's independence from France. Days ago, demonstrators at the same plaza were throwing rocks at police, who responded with volleys of tear gas grenades.

A woman named Carole, who did not want to give her last name, said, "I trust the company we're traveling with. They not only want to take us but they want to bring us back."   Kevin McCue, another of the people in the group of 20, said he was glad that their tour operator had not opted for Plan B, which would have meant skipping Haiti and spending the whole week in the neighboring Dominican Republic.   "Tourism is alive and well here. People should come. The more they come, the better they spread some money among people who need it and the better for Haiti," said McCue.
Date: Sun, 17 Feb 2019 23:37:22 +0100

Ottawa, Feb 17, 2019 (AFP) - A group of 25 school students from Quebec and three chaperones were able to leave Haiti on Sunday, where they had been stuck due to violent anti-government protests.   "We are on the plane" back to Montreal, one of the chaperones confirmed in a message to AFP.   Canadian tour operator Transat also confirmed that the group of students was aboard flight TS663, which departed at 3:59 pm (2059 GMT) from Port-au-Prince.   In addition to the students, employees of Canada's temporarily-shuttered embassy were also heading home aboard the aircraft.   The day before, a group of 131 Canadian tourists were evacuated via helicopter from their beachside resort in Haiti after being trapped for one week at the site due to the ongoing unrest.   The tourists were ferried in shifts to the Port-au-Prince international airport, where they boarded a flight to Canada, Transat said.

On Friday, Canada officially warned its citizens against all travel to Haiti, an advisory issued after the temporary closure of its embassy in Port-au-Prince.   Since February 7, at least seven people have died as Haiti has been plunged into political crisis, with everyday life paralyzed by protests and barricades in the largest towns.   The protesters, angry at soaring inflation and the alleged theft of nearly $2 billion in Venezuelan oil relief, are demanding President Jovenel Moise's resignation.   Canada is one of Haiti's largest international donors and is home to a large Haitian diaspora, located mostly in French-speaking Quebec.
Date: Thu, 14 Feb 2019 20:37:05 +0100

Ottawa, Feb 14, 2019 (AFP) - Canada on Thursday temporarily closed its embassy in Haiti as violent protests against President Jovenel Moise's government trapped hundreds of Canadian tourists in the Caribbean island nation.   "Due to the current volatility, the Port-au-Prince embassy is closed today and we will continue to assess the situation in the coming days to ensure that our diplomats and their families are safe," Canada's foreign ministry said in a statement.   Clashes between police and protesters left at least one dead on Wednesday in Port-au-Prince, bringing to at least seven the number of people killed since protests began a week earlier.   The protesters, angry about skyrocketing inflation and the alleged theft of nearly $2 billion in Venezuelan oil relief to the island, are demanding Moise's resignation.

Gun violence and blocked roads prevented about 100 Canadian tourists staying at the all-inclusive Royal Decameron Indigo Beach resort to get to the airport on Sunday.   "At present, it is not safe to organize a trip to the airport, so for the moment our customers are at the hotel, they are perfectly safe," said Christophe Hennebelle, vice president of tour operator Transat.   "We are in constant contact with the Canadian embassy in Haiti and with the government authorities to assess the situation," he said, adding that he hoped that "in the coming days" the Canadians would be repatriated. An airplane remains on standby in Canada to go pick them up.   Ottawa, meanwhile, is urging Canadians to avoid all non-essential travel to Haiti.
More ...

World Travel News Headlines

Date: Fri, 24 Jan 2020 12:26:57 +0100 (MET)

Beijing, Jan 24, 2020 (AFP) - China has quarantined cities and shut major tourist attractions from Disneyland to the Forbidden City and a section of the Great Wall as it scrambles to stop a deadly SARS-like virus from spreading further.   The drastic moves come as hundreds of millions of people criss-crossed the country in recent days to celebrate the Lunar New Year holiday, which officially started Friday and is typically a joyous time of gatherings and public celebration.   Here is a rundown of the measures taken so far in an unprecedented quarantine effort:

- Cities under lockdown -
Public transport has been stopped in 13 cities in central Hubei province, with train stations shut, events cancelled and theatres, libraries and karaoke bars closed in some locations.   The epicentre of the outbreak is provincial capital Wuhan, the biggest city on lockdown, where the government has halted all travel out of the Yangtze River metropolis of 11 million.   Wuhan residents have been told to stay home and authorities are limiting the number of taxis allowed on roads. There are few flights available to the city, deepening the isolation.   Similar quarantine measures are being taken in the other, smaller cities. These include strict controls on weddings and funerals, temperature screening of people as they arrive and the suspension of online taxi services.   More than 41 million people in total are affected by the city shutdowns.

- Festivities cancelled -
Wuhan and Beijing have cancelled public events that usually attract hundreds of thousands of people to temples during the New Year holiday.   Gao Fu, head of the Chinese Center for Disease Control and Prevention, has asked China's 1.4 billion citizens to forego New Year gatherings and confine themselves at home until all is clear.   To discourage nationwide travel, the government also said all tickets for rail, air, road, or water transport could be refunded.

- Attractions closed -
The historic Forbidden City, a sprawling imperial palace in Beijing that is one of the country's most revered cultural sites, will temporarily close from Saturday.   Other famous landmarks including a section of the Great Wall, the Ming Tombs and Yinshan Pagoda are also not open to visitors.   Shanghai Disneyland said it would shut for an indefinite period "to ensure the health and safety of our guests and cast".   Women's Olympics football qualifiers scheduled for February 3-9 in Wuhan have been moved to the eastern city of Nanjing.

- Temperature checks -
Staff in full body protective suits were seen checking the temperatures of people entering a subway station in Beijing on Friday.   The country has ordered sterilisation and ventilation at airports and bus stations, as well as inside planes and trains, while travellers are being screened for fever.   Health authorities are urging people to wash their hands regularly, avoid crowded places, get plenty of fresh air and wear a mask if they have a cough.   In Wuhan, city authorities have made it mandatory to wear a mask in public places.   In response to skyrocketing demand for masks -- starting to sell out at pharmacies and on some popular websites -- China's industry and information technology ministry said it would "spare no effort in increasing supply".

- A new hospital -
In Wuhan, authorities are rushing to build a new hospital in a staggering 10 days as a rising number of patients are infected by the new coronavirus.   The facility is expected to be in use by February 3 and will have a capacity of 1,000 beds spread over 25,000 square metres, according to state media.   Dozens of excavators and trucks were filmed working on the site by state broadcaster CCTV.   Its construction began after reports surfaced of bed shortages in hospitals designated as dealing with the outbreak, which has now infected 830 people across China.
Date: Fri, 24 Jan 2020 11:22:00 +0100 (MET)

Beijing, Jan 24, 2020 (AFP) - China announced Friday it will close a section of the Great Wall and other famous Beijing landmarks to control the spread of a deadly virus that has infected hundreds of people across the country.   A range of Lunar New Year festivities have been cancelled to try to contain the virus, and Beijing's Forbidden City and Shanghai's Disneyland have also been closed temporarily.

The Ming Tombs and Yinshan Pagoda will also be closed from Saturday, the authority that oversees the sites said, while the Bird's Nest stadium -- the site of the 2008 Olympic Games -- was shuttered from Friday.   The Great Wall attracts around 10 million tourists a year and is a popular destination for visitors during the New Year holiday.   The Juyongguan section will close, while the Great Wall temple fair was cancelled at the Simatai section of the famous landmark.

Tourists at the Gubei water town by the Simatai section will have their temperature tested, the authority said in a statement on the WeChat social media app.   The Bird's Nest will be closed until January 30 in order to "prevent and control" the spread of the virus, authorities said. An ice and snow show taking place on the pitch will be closed.   The measures in the capital are the latest to try and control the outbreak of the new coronavirus, after authorities rapidly expanded a mammoth
quarantine effort that affected 41 million people in central Hubei province.

The previously unknown virus has caused alarm because of its similarity to SARS (Severe Acute Respiratory Syndrome), which killed hundreds across mainland China and Hong Kong in 2002-2003.   Although there have only been 29 confirmed cases in Beijing, city authorities have cancelled large-scaled Lunar New Year events this week.   The city government said it would call off events including two popular temple fairs, which have attracted massive crowds of tourists in past years.   Beijing's Forbidden City -- which saw 19 million visitors last year -- is usually packed with tourists during the Lunar New Year festival, when hundreds of millions of people travel across China.
Date: Fri, 24 Jan 2020 10:40:12 +0100 (MET)
By Sébastien RICCI

Wuhan, China, Jan 24, 2020 (AFP) - Chinese authorities rapidly expanded a mammoth quarantine effort aimed at containing a deadly contagion on Friday to 13 cities and a staggering 41 million people, as nervous residents were checked for fevers and the death toll climbed to 26.

While the World Health Organization (WHO) held off on declaring a global emergency despite confirmed cases in half a dozen other countries, China expanded its lockdown to cover an area with a total population greater than Canada's.   A range of Lunar New Year festivities have been cancelled, while temporary closures of Beijing's Forbidden City, Shanghai's Disneyland and a section of the Great Wall were announced to prevent the disease from spreading further.   The previously unknown virus habeis caused alarm because of its similarity to SARS (Severe Acute Respiratory Syndrome), which killed hundreds across mainland China and Hong Kong in 2002-2003.

The WHO said China faced a national emergency but stopped short of making a declaration that would have prompted greater global cooperation, including possible trade and travel restrictions.   The outbreak emerged in late December in Wuhan, an industrial and transport hub of 11 million people in China's centre, spreading to several other countries including the United States.   China is in the midst of its Lunar New Year holiday, a typically joyous time of family gatherings and public festivities.   But on Friday Wuhan was a ghost town, its streets deserted and stores shuttered.

- Worried patients -
Hospitals visited by AFP journalists bustled with worried patients being screened by staff wearing full-body protective suits.   At a temperature-check station, a medical staffer in bodysuit, face mask and goggles took a thermometer from a middle-aged woman, pausing to examine the reading before quickly turning back to the patient.   "Have you registered? Then go and see the doctor," the staffer said.   One 35-year-old man surnamed Li voiced the fears of many.   "I have a fever and cough, so I'm worried that I'm infected," he said.   "I don't know the results yet."

With hundreds of millions of people on the move across China for the holiday, the government has halted all travel out of Wuhan, shut down its public transport and told residents to stay home. Deepening the isolation, there were few flights available to the city.   "This year we have a very scary Chinese New Year. People are not going outside because of the virus," said a taxi driver in the city, who asked not to be named.   But said a prolonged shutdown should not pose food-shortage problems because many Chinese had stocked up for the holiday.

Besides Wuhan, 12 other smaller cities nearby have battened down the hatches, with most of them going public on Friday with various measures ranging from closing public venues and restricting large gatherings to halting public transportation and asking citizens not to leave their cities.   Several of the cities have populations numbering several million, led by Huanggang, which has 7.5 million.    The pathogen -- 2019 Novel Coronavirus (2019-nCoV) -- has caused many outlets in Shanghai, Beijing and other cities to sell out their stocks of face masks.   As reports surfaced of bed shortages in Wuhan hospitals, state media said authorities were rushing to build a new facility devoted to the outbreak in a mind-blowing 10 days.

The Wuhan hospital is targeted to be ready by February 3. Dozens of excavators and trucks were filmed working on the site by state television.   To discourage nationwide travel, the government has said all tickets for rail, air, road, or water transport could be exchanged for a refund.   On Friday, staff in full body protective suits were seen checking the temperatures of people entering a subway station in Beijing.   Thermal cameras scanned passengers arriving at Beijing's West Railway Station.

- 'Work as one' -
Chinese authorities said the number of cases leapt overnight to more than 800, with 177 in serious condition. There were another 1,072 suspected cases.   Officials also said that a virus patient died in Heilongjiang province in China's far northeast, the second death outside the Wuhan epicentre.   Beijing has been praised for its response in contrast to SARS, when it took months to report the disease and initially denied WHO experts any access.

Gao Fu, head of the Chinese Center for Disease Control and Prevention, asked China's people to forego New Year gatherings this year and confine themselves at home until the all-clear.    "If we all work as one, we can contain the virus in Wuhan and add no more cases exported from Wuhan, so as to stem the virus nationwide," Gao told state TV.   Beijing has cancelled popular New Year public events at temples in the capital, the historic Forbidden City will close from Saturday, and Shanghai Disneyland said it also will shut down for an indefinite period from Saturday to protect visitors and staff.
Date: Fri, 24 Jan 2020 07:46:42 +0100 (MET)

Shanghai, Jan 24, 2020 (AFP) - Shanghai Disneyland will close until further notice this weekend due to a deadly virus outbreak that has infected hundreds of people in China, the amusement park said Friday.   The closure comes as China entered its nearly week-long Lunar New Year holiday, and the home of Mickey Mouse had prepared special "Year of the Mouse" celebrations for its guests.

But the park and resort said on its website it would temporarily close from Saturday "in response to the prevention and control of the disease outbreak and in order to ensure the health and safety" of its guests and staff.   "We will continue to carefully monitor the situation and be in close contact with the local government, and we will announce the reopening date upon confirmation," it said, adding that guests who had purchased tickets or booked a resort hotel would be reimbursed.   The entertainment conglomerate opened its $5.5 billion theme park in Shanghai in June 2016, Disney's sixth amusement park and third in Asia.
Date: Fri, 24 Jan 2020 03:33:13 +0100 (MET)
By Rusmir SMAJILHODZIC with Emmy VARLEY in Belgrade

Sarajevo, Jan 24, 2020 (AFP) - As winter grips the Balkans, the poor are caught in a cruel bind, being forced to light fires at home for heating while fuelling a pollution crisis smothering the region.   In recent weeks, Balkan capitals from Belgrade and Sarajevo to Skopje and Pristina have been ranked among the world's top 10 most polluted major cities, according to the monitoring application AirVisual.

While these are small cities compared to leading Asian polluters like New Delhi and Dhaka, a combination of coal-fired power plants, old cars and fires to heat homes are pumping the air with toxins.   "I know it is polluting. I am not an idiot but my only other choice would be to heat this home with electricity and that is damn expensive," said Trajan Nestorovski, who like many in his working-class Skopje neighbourhood burns wood to stay warm in winter.   His wife Vera added: "There are a couple of factories near our neighbourhood that are burning God knows what in the evenings".

Thanks to the rise of mobile phone apps that measure air quality, like the local Moj Vozduh (My Air) created by a Macedonian developer, citizens are finally grasping the full extent of the crisis.    "Serbia is suffocating, has anyone seen the minister of the environment?", said a recent headline in Belgrade's local Blic newspaper, speaking of the fog and dirty air enveloping the city.   Protests have been erupting around the region in recent days.

In Skopje, the capital of North Macedonia, young people have taken inspiration from Swedish activist Greta Thunberg by holding a spate of protests on Fridays.    "Greta inspired all of us," said 17-year-old Iskra Ilieska.   "In winter, half of my school class is absent because of lung problems. That is not normal," she said.

In neighbouring Bosnia, several hundred people wearing face masks gathered in the city of Tuzla to demand a plan from authorities to tackle pollution and phase out coal-fired plants in the next five years.   "The only recommended measures are that we stay shut up at home... when you go out on the streets, in the playgrounds, you won't see children anywhere," said Alisa Kasumovic, a mother in her forties.

- Silent killer -
According to a recent UN environment report, air pollution causes nearly 20 percent of premature deaths in 19 Western Balkan cities.   The main sources of the dust, soot and smoke are low-grade coal plants and household heating, the report said.    More than 60 percent of people in the region rely on coal and firewood to heat their homes, the report said. Only 12 percent of buildings are connected to district heating systems.

Governments need to make "clean energy more accessible", ban old polluting vehicles and tighten regulations on industry emissions and power plants, the UN urged.    Many people cannot afford cleaner heating options at home in countries where average wages are around 500 euros or less.   Sali Ademi, a 78-year-old in Kosovo's capital Pristina, uses coal.     "There's no worse thing, but what can you do?" he said in a city whose air is already poisoned by two nearby coal-fired power plants running on outdated technology.

- Cable car escape -
Those who warm their homes with fires also bear the brunt of health risks, according to experts.   "Some of the emissions from these stoves stay in the house and poison them," warned Anes Podic, president of an environmental group in Bosnia who has called on the government to replace inefficient wood stoves in the country.

In cities like Sarajevo and Skopje, a circle of mountains helps trap the hazardous air in the valleys where residents live.   Sakiba Sahman, 60, is a Sarajevan taking advantage of a recent reduction on ticket prices for a cable car that rides to the top of the 1,160-metre-high (3,800-foot-high) Mount Trebevic, which peaks above the smog over the Bosnian capital.   "We've come to spend a few hours to ventilate the lungs," she told AFP.   Down below, "the pollution is enormous, there are a lot of cars, everything is dirty, grey and depressing."
Date: Fri, 24 Jan 2020 00:46:15 +0100 (MET)

Lima, Jan 23, 2020 (AFP) - Peru's government promised on Thursday to protect the Machu Picchu sanctuary and other Inca ruins when building a new airport to serve the ancient civilization's capital of Cusco.   Machu Picchu and the Inca road system are UNESCO World Heritage sites, and the UN agency has previously expressed concerns over the proposed airport at Chinchero, less than 60 kilometers from the Inca sanctuary that was built in the 15th century.   "We have made a commitment that before work begins on constructing the Chinchero airport, in June of this year, we will present the heritage impact study that UNESCO demands," Transport Minister Edmer Trujillo, who is responsible for the project, told journalists.

UNESCO has told Peru that even though the airport will be built outside of the archeological areas, it is necessary to study how a potential increase in tourists would affect them.   The new airport will be able to receive six million passengers per year -- 60 percent more than the current Cusco airport, which has a capacity for 3,000 passengers a day but receives 5,000.

The existing airport cannot grow because it is inside Cusco, a major Andean city in southeast Peru.   Machu Picchu -- the most iconic site from the Inca empire that ruled a large swathe of western South America for 100 years before the Spanish conquest in the 16th century -- is Peru's most popular tourist attraction, located about 100 kilometers (60 miles) from Cusco.   Trujillo said construction of the new airport would be constantly monitored
by culture ministry experts in case archeological ruins are found.

The airport will be built at 3,780 meters above sea level in the old Inca Sacred Valley.   Many have criticized the impact it could have not only on the country's national treasures but on rural communities.   "Building an airport in the Sacred Valley will have irreparable effects in terms of noise, increase in traffic and uncontrolled urbanization," historian Natalia Majluf said in August.   But local Cusco authorities say it will bring in vital tourism revenue, which the region depends on.
Date: Tue 21 Jan 2020
Source: Channels TV [edited]

In Ondo state, 16 people have been confirmed killed as a result of a Lassa fever outbreak. The state chief epidemiologist, Dr Steven Fagbemi, disclosed this on Tuesday [21 Jan 2020] at the governor's office in the Government House in Akure, the state capital.

Dr Fagbemi made the disclosure while briefing Governor Oluwarotimi Akeredolu as well as the local government chairmen from Ondo North and Central senatorial districts of the state. He also revealed that 84 cases have been reported so far in the state since 1 Jan 2020.

According to the epidemiologist, 16 of the patients have passed on, as their cases had reached the advanced stage before they were taken to the hospital. He added that 47 patients on admission were responding to treatment, while 21 others had already been treated and discharged.

The outbreak is said to have affected Owo, Akoko South-West, Akure South, and Ondo West LGAs of the state.

Also confirming the outbreak, the commissioner for health, Dr Wahab Adegbenro, noted that the disease has been occurring in the state for some years, especially during the dry season. He therefore advised Nigerians to visit hospitals when they noticed symptoms of fever.

Earlier, Governor Akeredolu advised the local government chairmen in the state to deploy cleaners to markets and public places to prevent the outbreak of diseases. He also called on residents to maintain a high level of hygiene to curtail further spread of the Lassa virus in the state.
====================
[The 81 new confirmed and 159 suspected cases in week 3 of 2020 indicate that Lassa fever (LF) virus transmission is continuing to accelerate. The 1st report above confirms that Ondo state has the majority of cases, tied with Edo state. Nigeria is now entering the period of the year when fewer cases usually occur, as illustrated in the graph in Figure 6 (at the source URL above). There has been a peak in case numbers between weeks 1 and 11 (January-March) over the past 3 years and probably will be the case again this year (2020).

Transmission of LF virus occurs when individuals are in contact with rodent reservoir host excreta or are within healthcare facilities. It would be interesting to know whether the prevalence of Lassa fever virus has been increasing in populations of rodent hosts in areas where human cases are occurring.

Images of the rodent reservoirs of Lassa fever virus:
_Mastomys natalensis_: <https://www.inaturalist.org/taxa/45326-Mastomys-natalensis>
_Mastomys erythroleucus_ and _Hylomyscus pamfi_: <http://punchng.com/nigerias-large-rat-population-threatens-lassa-fever-war/>

The pygmy mouse (_Mus baoulei_) has recently been implicated as a reservoir species in West Africa but not in Nigeria.

There is no specific mention in the plans above of public education for avoidance of contact with these rodents and their excreta. - ProMED Mod.TY]

[Maps of Nigeria:
Date: Tue 21 Jan 2020
Source: Ahora Noticias, Costa Rica [in Spanish, machine trans., edited]
<https://www.ahoranoticiascr.com/2020/01/21/autoridades-cerraron-pizzeria-debido-a-casos-de-hepatitis-a-en-san-ramon/>

As many as 22 people suffered from hepatitis A infection in San Ramon de Alajuela, and consequently the Health authorities closed a pizzeria in the area. A source close to this media confirmed the existence of the cases which were detected since 13 Jan 2020.

The cases were thought to be related to food consumption in that establishment 4 of patients were employees of the pizzeria. In statements to the media La Nación, Azalea Espinoza of the Directorate of Surveillance of the Ministry of Health, said they intervened in the business, issued a closing health order, and proceeded to cleaning and disinfecting it. [Byline: Carlos Miranda]
========================
[Although the eating establishment was identified as a pizzeria, pizza itself is not likely to be the vehicle of transmission as it is cooked before serving unless ingredients are added after the cooking process. It is unclear if the pizzeria employees were the source of, or just part of, the outbreak.

With an incubation period averaging 28 but up to 45 days, more cases may occur. The cases are not broken down in regard to age. In children, most cases of HAV infection are subclinical so it is likely that the cases reported were in adults. In the developing world, HAV is not reported much in adults as most children have been infected, and therefore immune to subsequent infection, by the age of 10. That outbreaks are occurring in the area suggests improvement in potable water so fewer children are infected and therefore still susceptible to HAV as adults. - ProMED Mod.LL]

[HealthMap/ProMED map available at: Costa Rica:
<http://healthmap.org/promed/p/17>]
Date: Thu, 23 Jan 2020 17:57:34 +0100 (MET)
By Eva XIAO

Beijing, Jan 23, 2020 (AFP) - The first fatality of China's new virus would come to represent a common set of traits for those who died to the disease: he was over the age of 60 and in poor health.   Since China reported the emergence of a new coronavirus at the end of December, the SARS-like virus has infected more than 500 and killed 17.   So far, the majority of the victims were elderly individuals with pre-existing health conditions, such as diabetes and liver cirrhosis.   All hailed from central Hubei province, where a local seafood market in the capital city of Wuhan is believed to be the epicentre of the epidemic.   But while older individuals have died from the Wuhan virus, some younger patients -- including a 10-year-old boy -- have since been released from the hospital.   Here's what we know so far about the deaths:

Most victims were over 60
According to details released by China's National Health Commission (NHC) on Thursday, the 17 victims of the virus were between 48 and 89 years old.   Only two were under the age of 60, while the average age of the victims was 73.   Most of them died this week, according to the NHC.   Among those who have been discharged from the hospital were younger patients, including a 35-year-old man from Shenzhen, a bustling tech hub in southern Guangdong province.   He was released from the hospital on Thursday, according to the local health commission, as well as the 10-year-old boy who had visited relatives in Wuhan before falling ill.

Many had pre-existing health conditions
Many of those who died from the virus also had pre-existing health issues before contracting the Wuhan disease, such as diabetes and hypertension.   One man, an 86-year-old who was hospitalised on January 9, had surgery for colon cancer four years prior, on top of suffering from high blood pressure and diabetes.   Another, an 80-year-old woman surnamed Hu, had Parkinson's Disease and more than 20 years of high blood pressure and diabetes in her medical history.

Some were hospitalised for weeks before dying
Several of the 17 victims were hospitalised for weeks before dying -- raising questions on the preparedness of hospitals that may have to treat patients for long periods of time.   The youngest victim of the Wuhan virus, a woman surnamed Yin, was hospitalised for more than a month before succumbing to the virus.   On December 10, the 48-year-old woman reported a fever, coughing, body soreness, and fatigue, and underwent anti-infection treatment for two weeks, according to the NHC.   Later in the end of the month, Yin suffered shortness of breath and chest tightness, and she passed away on January 20.

Not all of them had a fever
Currently, Wuhan authorities are screening passengers for fever at the airport, railway stations, and bus terminals.   At four airports in Thailand, authorities introduced mandatory thermal scans of passengers arriving from high-risk areas of China.   But not all those who died after being infected reported a fever before being hospitalised, according to the NHC.   A 66-year-old man surnamed Luo reported a "mainly dry cough" but no fever on December 22 before suffering from shortness of breath more than a week later.

By mid-January, Luo required a ventilator to help him breathe.   "A major concern is the range of severity of symptoms this virus is causing," said Dr Jeremy Farrar, Director of the Wellcome Trust.   "It is clear some people are being affected and are infectious while experiencing only very mild symptoms or possibly without experiencing symptoms at all," he said in an emailed statement.   "This may be masking the true numbers infected and the extent of person to person transmission," he added.
Date: Thu, 23 Jan 2020 16:05:30 +0100 (MET)

Singapore, Jan 23, 2020 (AFP) - Singapore Thursday confirmed its first case of the new SARS-like virus which has killed 17 people in China and spread to multiple countries including the United States.   The Ministry of Health (MOH) said the patient was a 66-year-old man from Wuhan who arrived in Singapore with his family on Monday.    He was immediately isolated after arriving at a hospital with a fever and cough, and test results later confirmed he was infected with the coronavirus.   One of his travelling companions, a 37-year-old man from Wuhan, has also been admitted to hospital as a suspect case.

Prior to admission, they had stayed at a hotel on the resort island of Sentosa, the ministry said.   It added that Singapore was expecting more cases and alarms "given the high volume of international travel".   Singapore's Changi Airport started screening flights from Wuhan at the beginning of the month, and on Wednesday extended the checks to all flights from China.   The travel hub receives over 430 flights from China every week.   The virus has caused alarm in China and abroad because of its genetic similarities to Severe Acute Respiratory Syndrome (SARS), which killed nearly 650 people across mainland China and Hong Kong in 2002-2003.

Singapore was among the hardest hit by SARS with 33 deaths.   Prime Minister Lee Hsien Loong, who is in Davos for the World Economic Forum, said there was "no need to panic".   Speaking to reporters travelling with him, Lee said Singapore has beefed up its hospital facilities and laid out response measures since the SARS epidemic.   "I think we are much better prepared now," he said in remarks carried by the Straits Times newspaper.