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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

Miami, Sept 24, 2019 (AFP) - A strong 6.0 magnitude struck off the northwest coast of Puerto Rico late Monday, the United States Geological Survey said, although no casualties or damage were reported.   The quake struck 62km northwest of San Antonio at 11:23 pm local time (03:20 GMT) at a depth of 10km, the agency said.  San Antonio is home to Rafael Hernandez Airport, a key air link to the mainland US.    In 2010 nearby Haiti was struck by a devastating 7.0 magnitude earthquake that killed more than 250,000 people and crippled the nation's infrastructure.
Date: Mon, 12 Feb 2018 05:54:19 +0100

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[A HealthMap/ProMED-mail map can be accessed at:
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Cook Islands

No Profile is available at present

Travel News Headlines WORLD NEWS

8 Aug 2019

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

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

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

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

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

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

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

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

ProMED thanks Alyssa Pyke for sending in this report.

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

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

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

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

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

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

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

Nigeria US Consular Information Sheet
June 02, 2008
COUNTRY DESCRIPTION:
Nigeria is a developing country in western Africa that has experienced periods of political instability. It has the largest population on the continent, estimated at
44 million people, and its infrastructure is not fully functional or well maintained. Read the Department of State’s Background Notes on Nigeria for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. The visa must be obtained in advance from a Nigerian Embassy or Consulate. Visas cannot be obtained on arrival at the airport. Promises of entry into Nigeria without a visa are credible indicators of fraudulent commercial schemes in which the perpetrators seek to exploit the foreign traveler's illegal presence in Nigeria through threats of extortion or bodily harm. U.S. citizens cannot legally depart Nigeria unless they can prove, by presenting their entry visas, that they entered Nigeria legally. Entry information may be obtained at the Embassy of the Federal Republic of Nigeria, 3519 International Court NW, Washington, DC 20008, telephone (202) 822-1500, or at the Nigerian Consulate General in New York, telephone (212) 808-0301. Overseas, inquiries may be made at the nearest Nigerian embassy or consulate.

Visit the Embassy of Nigeria web site at http://www.nigeriaembassyusa.org/ for the most current visa information.

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

SAFETY AND SECURITY:
The Department of State continues to caution U.S. citizens about the possible dangers of travel to some parts of Nigeria. [Please also see the Crime Section below.] In light of the risk of kidnapping, crime, militant activity, or armed attacks, the U.S. Mission restricts the travel of U.S. government personnel to the following states to official travel only: Delta, Bayelsa, Rivers and Akwa Ibom in the Niger Delta, and Edo and Imo in the south. Only essential travel by non-official Americans is recommended to these areas. In addition, the military's Joint Task Force patrols the creeks in the Niger Delta because of ongoing militant and piracy incidents, especially against oil-related facilities or infrastructure, so individuals may be questioned, detained or arrested when traveling in these sensitive areas without evidence of permission from the Nigerian government or for carrying electronic equipment such as cameras, recorders, etc. Periodically, travel by U.S. mission personnel is restricted in certain parts of Nigeria based on changing security conditions, often due to crime, general strikes, or student/political demonstrations or disturbances. See the Department of State’s Travel Warning for Nigeria for more information.

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 current Travel Warnings, Travel Alerts, and 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: Violent crime committed by individual criminals and gangs, as well as by some persons wearing police and military uniforms, is a problem, especially in Lagos, Abuja and other large cities, although it can occur anywhere. Some visitors and resident Americans have experienced armed muggings, assaults, burglary, carjacking, kidnappings and extortion, often involving violence. Home invasions are on the rise in Lagos, with armed robbers accessing even guarded compounds by following, or tailgating, residents or visitors arriving by car into the compound, subduing guards and gaining entry into homes or apartments. Armed robbers in Lagos also access waterfront compounds by boat. U.S. citizens, as well as Nigerians and other expatriates, have been victims of armed robbery on roads to airports during both daylight and evening hours. Law enforcement authorities usually respond to crimes slowly or not at all, and provide little or no investigative support to victims. U.S. citizens and other expatriates have experienced harassment and shakedowns at checkpoints and during encounters with Nigerian officials.

Nigerian-operated fraud scams, known as 419s, are noted for their cleverness and ingenuity. These scams target foreigners worldwide, posing risks of both financial loss and personal danger to their victims. Scams are often initiated through internet postings or from internet cafes, by unsolicited emails, faxes, and letters, or can involve credit card use. As anywhere else, no one should provide personal or financial information to unknown parties or via Nigerian telephone lines. The expansion of bilateral law enforcement cooperation, which has resulted in numerous raids on commercial fraud premises, has reduced the overall level of overt fraud activity, but new types of sophisticated scams are introduced daily.

American citizens are very frequently the victims of Nigerian confidence artists offering companionship through internet dating websites. These confidence artists almost always pose as American citizens visiting or living in Nigeria who unexpectedly experience a medical, legal, financial or other type of “emergency” that requires the immediate financial assistance of the American citizen in the United States. In these cases, we strongly urge the American citizen in the United States to be very cautious about sending money to any unknown person purportedly acting on their behalf, or traveling to Nigeria to meet someone with whom their sole communications have been via the internet. Other common scams involve a promise of an inheritance windfall, work contracts in Nigeria, or an overpayment for goods purchased on-line. For additional information on these types of scams, see the Department of State's publication, International Financial Scams.

Commercial scams or stings that targets foreigners, including many U.S. citizens, continue to be a problem. One needs to be alert to scams that may involve U.S. citizens in illegal activity, resulting in arrest, extortion or bodily harm. These scams generally involve phony offers of either outright money transfers or lucrative sales or contracts with promises of large commissions or up-front payments, or improperly invoke the authority of one or more ministries or offices of the Nigerian government and may cite, by name, the involvement of a Nigerian government official. In some scams, government stationery and seals are also improperly used to advance the scam. The ability of U.S. consular officers to extricate U.S. citizens from unlawful business deals or scams and their subsequent consequences is extremely limited. U.S. citizens have been arrested by police officials and held for varying periods on charges of involvement in illegal business activity or scams. Nigerian police or other law enforcement officials do not always inform the U.S. Embassy or Consulate immediately of the arrest or detention of a U.S. citizen. The U.S. Department of Commerce has advisories to the U.S. business community on a variety of issues that should be seriously reviewed with respect to doing business in Nigeria. To check on a business’s legitimacy while in the United States, contact the Nigeria Desk Officer at the International Trade Administration, Room 3317, Dept. of Commerce, Washington, D.C. 20230, telephone 1-800-USA-TRADE or (202) 482-5149, fax (202) 482-5198. If you are abroad, contact the nearest U.S. Embassy or Consulate.

The Department of State encourages all travelers abroad to register their travel. The most convenient way to do so would be through the online travel registration page. Travelers may also register in person at the U.S. Embassy in Abuja or the U.S. Consulate General in Lagos. See the section on Registration / Embassy Location below.

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, for example, can provide you with a list for appropriate medical care, or contact family members or friends and explain how funds could be transferred to you to cover unexpected costs. 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 the Department of State’s information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: While Nigeria has many well-trained doctors, medical facilities in Nigeria are in poor condition, with inadequately trained nursing staff. Diagnostic and treatment equipment is most often poorly maintained, and many medicines are unavailable. Caution should be taken as counterfeit pharmaceuticals are a common problem and may be difficult to distinguish from genuine medications. This is particularly true of generics purchased at local pharmacies or street markets. 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.

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their health insurance policy applies overseas and whether it will cover emergency expenses such as a medical evacuation from a foreign country to the United States or another location. Please see the our brochure 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 Nigeria is provided for general reference only and may not be totally accurate in a particular location or circumstance.

Roads in many areas are generally in poor condition, causing damage to vehicles and contributing to hazardous traffic conditions. There are few working traffic lights or stop signs. The rainy season from May to October is especially dangerous because of flooded roads and water-concealed potholes.

Excessive speed, unpredictable driving habits, and the lack of basic maintenance and safety equipment on many vehicles are additional hazards. Motorists seldom yield the right-of-way and give little consideration to pedestrians and cyclists. Gridlock is common in urban areas. Chronic fuel shortages have led to long lines at service stations, which disrupt or block traffic for extended periods.

Public transportation vehicles are unsafe due to poor maintenance, high speeds and overcrowding. Motorbikes, known in Nigeria as "okadas," are a common form of public transportation in many cities and pose particular danger to motorists, their own passengers and pedestrians. Motorbike drivers frequently weave in and out of traffic at high speeds and observe no traffic rules. Motorbikes are banned within Abuja's city limits. Passengers in local taxis have been driven to secluded locations where they were attacked and robbed. Several of the victims required hospitalization. The U.S. Mission advises that public transportation throughout Nigeria be avoided.

It is recommended that short-term visitors not drive in Nigeria. A Nigerian driver's license can take months to obtain, and to date an international driving permit is not recognized. Major hotels offer reliable car-hire services complete with drivers. Reliable car-hire services can also be obtained at the customer service centers at the airports in Lagos, Abuja, and Kano. Inter-city travelers must also consider that roadside assistance is extremely scarce, and as noted above medical facilities and emergency care are poor, meaning that being involved in a traffic incident might result in a lack of available medical facilities to treat either minor or life-threatening injuries.

All drivers and passengers are reminded to wear seat belts, lock doors, and raise windows. It is important to secure appropriate automobile insurance. It is also important to be aware that drivers and passengers of vehicles involved in accidents resulting in injury or death have experienced extra-judicial actions, i.e., mob attacks, official consequences such as fines and incarceration or involvement with the victim's family. Night driving should be done with extreme caution, but it is recommended to avoid driving between 6:00 p.m. and 6:00 a.m. as bandits and police roadblocks are more numerous at night. Streets are very poorly lit, and many vehicles are missing one or both headlights, tail lights, and reflectors.

The Government of Nigeria charges the Federal Road Safety Commission with providing maps and public information on specific road conditions. The Federal Road Safety Commission may be contacted by mail at: Ojodu-Isherri Road, PMB 21510, Ikeja, Lagos; telephone [243] (1) 802-850-5961 or [234] (1) 805-684-6911.
Please refer to our Road Safety page for more information.

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

The Port Harcourt International Airport, which was closed in mid-2006 for rehabilitation, resumed operations in December 2007 for domestic daylight flights. Installations and improvements needed for international flights and night operations are expected to be completed in 2008.

For additional information on aviation safety concerns, see the Department of State’s Travel Warning for Nigeria.
SPECIAL CIRCUMSTANCES:
Permission is required to take photographs or videotape any government buildings, airports, bridges, and in areas where the military is operating throughout the country. These sites include, but are not limited to, Federal buildings in the Three Arms Zone (Presidential palace area, National Assembly, Supreme Court/Judiciary) of the capital of Abuja, other government buildings around the country and foreign Embassies and Consulates. Many restricted sites are not clearly marked, and application of these restrictions is subject to interpretation by the Nigerian security services and can result in detention. Permission may be obtained from Nigeria's State Security Services, but even permission may not prevent the imposition of penalties or detention. Penalties for unauthorized photography or videography may include confiscation of the still or video camera, exposure of the film or deletion of film footage, a demand for payment of a fine or bribe, and/or detention, arrest, or physical assault. For these reasons, visitors to Nigeria should avoid taking still photos or videotaping in and around areas that are potentially restricted sites, including any government sites.

The Nigerian currency, the naira, is non-convertible. U.S. dollars are widely accepted. Nigeria is a cash economy, and it is usually necessary to carry sufficient currency to cover the expenses of a planned visit, which makes travelers an attractive target for criminals. Credit cards are rarely accepted beyond a few upscale hotels. Due to credit card fraud in Nigeria and by cohorts in the United States, credit card use should be considered carefully. While Citibank cashes some traveler’s checks, most other banks do not. American Express does not have offices in Nigeria; however, Thomas Cook does. Inter-bank transfers are often difficult to accomplish, though money transfer services such as Western Union are available. For further information, visitors may contact the U.S. Embassy or Consulate.

Please see the Department of State’s information on 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 Nigerian laws, even unknowingly, may be expelled, detained, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Nigeria 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 the Department of State’s information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Nigeria are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Nigeria and other general information.Americans withoutInternet 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 1075 Diplomatic Drive, Central Area, Abuja. American citizens can call [234] (9) 461-4176 during office hours (Monday through Thursday, 7:30 a.m. to 4:30 p.m.; Friday, 7:30 a.m. to 1:30 p.m.). For after-hours emergencies, call [234] (9) 461-4000. The email address for the Consular Section in Abuja is ConsularAbuja@state.gov.

The U.S. Consulate General is located at 2 Walter Carrington Crescent, Victoria Island, Lagos. American citizens can call [234] (1) 261-1215 during office hours (7:30 a.m. to 4:00 p.m.). For after-hours emergencies, call [234] (1) 261-1414, 261-0050, 261-0078, 261-0139, or 261-6477. The e-mail address for the Consular Section in Lagos is Lagoscons2@state.gov.

The Embassy and Consulate website is http://nigeria.usembassy.gov/.
* * *
This replaces the Consular Information Sheet dated April 16, 2007, to update sections on Country Description, Safety and Security, Crime, Traffic Safety and Road Conditions, Aviation Safety Oversight, Special Circumstances and Registration / Embassy Location.

Travel News Headlines WORLD NEWS

Date: Fri 11 Oct 2019
Source: International Centre for Investigative Reporting [edited]

Not less than 80,000 of Yellow [fever vaccination] cards that are issued to Nigerians as a proof of being administered with the yellow fever vaccine before travelling out of the country are now being sold in the markets and streets, without the travellers taking the vaccine, and causing the government to lose up to N200 million [USD 554,017].

This was revealed in a report of an investigation carried out by Progressive Impact Organization for Community Development, PRIMORG, a civil society organization working in the areas of accountability and anti-corruption.

The report revealed that some top officials of the Federal Ministry of Health (FMOH) carted away some of the e-yellow cards printed by the Federal Government which are meant to be issued to individuals after they must have taken the vaccine at the designated clinics, airports and border posts.

The card which officially costs N2,500 [USD 7] is sold to prospective travellers at prices as high as N5,000 [USD 14] without taking the vaccine, thereby undermining the objective of the yellow fever immunization.

The government has been making efforts to recover all the stolen cards with little success.

A copy of the yellow card obtained by PRIMORG undercover reporter was marked B947006 bearing the Nigerian coat of arms and a scan code to verify the card's authenticity while the medical detail in the card was pre-filled, indicating the type and milligram, the date and the official stamps of the "PORT HEALTH OFFICE, FMOH NIGERIA".

Earlier in February [2019], the federal government had approved the issuance of Yellow Card that could be read electronically to eliminate the incidents of forgery and sales of fake cards at designated locations.  [Byline: Rebecca Akinremi]
======================
[The sale of fake yellow fever (YF) vaccination cards has been a problem in Nigeria in the past. There has also been a problem of purchase of legitimate cards but without vaccination. Issuance of these new YF vaccination cards has been an effort to avoid the fake card problem. The theft of the new cards and their sale illegally to individuals who did not receive the vaccine was not contemplated.  Thetheft and illegal sale of thes cards poses more than just a financial loss to the government. More serious is the threat that this illegal practice poses to the public's health in Nigeria and abroad. In Nigeria. possession of a vaccination card will not necessarily indicate that the owner has, in fact, been vaccinated. More serious still is that individuals infected in Nigeria but having illegally purchased cards without vaccination could travel to YF-free areas in the world that have abundant vector populations, such as Southeast Asia, and initiate ongoing transmission within a largely unvaccinated and hence susceptible population. The results could be catastrophic. One wonders if admission of Nigerians into these susceptible countries will be denied, as occurred in South Africa several years ago when there was a fake YF vaccination card situation. - ProMED Mod.TY]

[Maps of Nigeria:
Date: Tue 8 Oct 2019
Source: WHO Emergencies preparedness, response, Disease Outbreak News (DONs) [edited]

On [29 Aug 2019], a suspected yellow fever case was reported from Kano state with a travel history to Yankari game reserve, Alkaleri Local Government Area (LGA), Bauchi state, Nigeria.

From [29 Aug 2019] through [22 Sep 2019], Nigeria reported an outbreak of yellow fever with an epi-centre in the Yankari game reserve of Alkaleri LGA, Bauchi state. According to Nigeria Centre for Disease Control (NCDC), 231 suspected cases have been reported in 4 states including Bauchi (110), Borno (109), Gombe (10), and Kano (2), of which there have been 13 presumptive positive by IgM testing and 24 cases positive by reverse-transcriptase polymerase chain reaction (RT-PCR) at national laboratories. Of 24 cases confirmed by RT-PCR (20 cases in Bauchi, 3 in Gombe and one in Kano state), 6 deaths were reported, all from Alkaleri LGA, Bauchi state, resulting in a case fatality ratio of 25% among the confirmed cases. The vaccination history for the 231 suspected yellow fever cases is not known, and the results of follow-up testing from regional reference laboratory Institute Pasteur Dakar (IPD) are not yet available.

This is the 1st time that cases have been reported in relation to this area since the outbreak started in Nigeria in September 2017. This outbreak is unique in the broad geographic distribution of cases, most with linkage through travel, work or residence in, or close to, the Yankari game reserve, which is an ecological zone highly prone to yellow fever virus circulation (vectors, reservoir).

Epidemiological summary for Nigeria from 1 January through 31 August 2019 (not including the cases in Bauchi)
--------------------------------------------------------------------------------
Since [15 Sep 2017], when the Nigeria Centre for Disease Control (NCDC) officially notified a confirmed case of yellow fever in Kwara state to WHO as per the International Health Regulations (2005), the country has been responding to successive yellow fever outbreaks over a wide geographic area.

From [1 Jan - 31 Aug 2019], a total of 2254 suspected yellow fever cases have been reported in 535 LGA's. All states including Federal Capital Territory (FCT) have reported at least one suspected case of yellow fever. Samples have been collected for 2197 suspected cases, and according to Nigerian laboratories 74 tests were presumptive positive and 29 inconclusive for yellow fever. A total of 103 (74 presumptive positive and 29 inconclusive) samples were sent to yellow fever reference laboratory Institute Pasteur in Dakar (IPD) for confirmatory testing, of which 29 tested positive. An additional 8l cases were confirmed by the Nigerian laboratories including National Reference Laboratory (7), Lagos University Teaching Hospital (1). These 37 confirmed cases were from the states of Edo (13), Ebonyi (8), Ondo (4), Katsina, (3), Kebbi (2), Anambra (1), Cross River (1), Imo (1), Osun (1), Oyo (1), Kano (1), and Sokoto (1). There were 44 deaths recorded from the states of Katsina (14), Edo (1), Adamawa (1) and Ebonyi (28) with an overall CFR of 2% among suspected cases.

Public health response
----------------------
The outbreak response activities are being coordinated by a multi-agency national yellow fever emergency operation centre (EOC) hosted at NCDC. On [5 Sep 2019], a national Incident Management System (IMS) was activated to coordinate the response activities. A national rapid response team (RRT), including NCDC and National Primary Health Care development Agency (NPHCDA), have been deployed to Bauchi and other affected states to support outbreak response activities such as case finding, case management and risk communication. The state, with the support of partners, has successfully conducted a reactive yellow fever vaccination campaign in Alkaleri LGA, vaccinating 407 708 people and is now planning to conduct a similar campaign in contiguous LGAs across the affected states, including submission of an International Coordination Group (ICG) request for reactive vaccination.

Routine yellow fever vaccination was introduced to Nigeria's Expanded Programme on Immunization (EPI) in 2004, but the overall population immunity in areas affected by the current outbreak remains below recognized herd immunity thresholds.

A 4-year (2018-2021) national yellow fever Preventive Mass Vaccination Campaign (PMVC) plan, supported by the Global Alliance for Vaccines and Immunization (GAVI) and partners, is currently being implemented to cover all states in the country. By 2025, it is anticipated that all states in Nigeria will have conducted PMVC activities to protect at-risk populations against yellow fever.

This year's [2019] phased preventive campaigns will target the following states, Anambra, Ekiti, Katsina, and Rivers, with specialized activities in Borno. Bauchi has not yet been covered by the phased PMVCs, and the states planned for the next phase are undergoing through a review process to consider the evolving epidemiology.

WHO risk assessment
-------------------
Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes and has the potential to spread rapidly and cause serious public health impact. There is no specific treatment, although the disease is preventable using a single dose of yellow fever vaccine, which provides immunity for life. Supportive care is required to treat dehydration, respiratory failure, and fever; and antibiotics are recommended to treat associated bacterial infections.

The recent confirmation by the national reference laboratory of the yellow fever outbreak in Bauchi states linked with cases in 3 other states including Borno, Kano and Gombe represents a concerning situation in Nigeria.  Given the scale of the outbreak in Bauchi and 3 other states, the national risk is assessed as high due to the potential for ongoing local transmission and amplification.

Factors considered include the low vaccination coverage; probability of the presence of competent vectors including _Aedes_ species; the potential spread to new LGAs, and the link of the outbreak to the game reserve in Alkaleri LGA, the most popular tourist destination in the country. There is currently a moderate risk at regional level due to the possible movement of the individuals of affected states to adjacent areas and neighbouring countries. The current overall risk is low at the global level.

Nigeria is facing several concurrent public health emergencies, including circulating Vaccine Derived Polio Virus (cVDPV), measles, Lassa fever, and cholera outbreaks, and a humanitarian crisis in the northeast of the country. WHO continues to monitor the epidemiological situation and will reassess the evolution of risks based on the latest available information.

WHO advice
----------
Nigeria is a high priority country for the Eliminate Yellow Fever Epidemic (EYE) strategy. Vaccination is the primary intervention for prevention and control of yellow fever. The early detection and investigation of yellow fever cases through strong surveillance is key to control the risk of yellow fever outbreaks. Prevention of mosquito bites (repellents, wearing long clothes) is an additional measure that limits the risk of yellow fever transmission. In urban centres, targeted vector control measures are also helpful to interrupt transmission. WHO and partners will continue to support local authorities to implement these interventions to control the current outbreak.

WHO recommends vaccination against yellow fever for all international travelers more than 9 months of age going to Nigeria, as there is evidence of persistent or periodic yellow fever virus transmission. Nigeria also requires a yellow fever vaccination certificate for travelers older than one year of age arriving from countries with risk of yellow fever transmission.

Yellow fever vaccines approved by WHO are safe, highly effective and provide life-long protection against infection. In the context of international travel, the amendment to Annex 7 of the International Health Regulations (IHR 2005) changes the period of validity of the related international certificate of vaccination against yellow fever, and the protection provided by vaccination against yellow fever infection from 10 years to the life of the person (traveler) vaccinated. Accordingly, as of [11 Jul 2016], for both existing or new certificates, revaccination or a booster dose of yellow fever vaccine cannot be required of international travelers as a condition of entry into a State Party, regardless of the date their international certificate of vaccination was initially issued.

On [1 Jul 2019], WHO updated the areas at-risk of yellow fever transmission and the corresponding recommendations for vaccination of international travelers. The list of countries at-risk, and revised recommendations for vaccination against yellow fever are available on the WHO website: International travel and health (ITH).

WHO encourages its Member States to take all actions necessary to keep travelers well informed of risks and of preventive measures, including vaccination. Travelers should also be made aware of yellow fever signs and symptoms and instructed to seek rapid medical advice should they develop signs of illness. Travelers returning to Nigeria who may be infected with possible high levels of the virus in the blood may pose a risk for the establishment of local cycles of yellow fever transmission in areas where the competent vector is present.

WHO does not recommend any restrictions on travel or trade to Nigeria on the basis of the information available on this outbreak.
======================
[With the geographic wide-spread distribution of yellow fever (YF) in Nigeria, achieving vaccination coverage of the population to the 80-90% coverage necessary to prevent cases will be a serious challenge. Nigerians traveling to countries abroad where YF virus is transmitted present a risk of introducing the virus to other areas of Nigeria with abundant vectors that could initiate a new outbreak. Also of serious concern is the possibility of an unvaccinated person becoming infected in Nigeria, at the popular gamepark for example, going to an area historically free of YF but with abundant vector populations, such as southeast Asia, and initiating an outbreak where few local individuals have been vaccinated. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Thu 19 Sep 2019
Source: Xinhua [edited]

A health official in Nigeria on Thursday [19 Sep 2019] confirmed 6 cases of yellow fever in the northeast state of Gombe. Nuhu Vile, an epidemiologist with the state health authorities, told media the confirmed patients were treated and discharged.

Yellow fever cases have been reported in north-eastern Nigeria, including the states of Bauchi and Borno, since 29 Aug [2019]. No death case has been recorded in the state, he said, noting that an investigation conducted by experts showed that the case originated from Yankari, neighbouring Bauchi state. The state government had set up a team to address the problem, the health expert said, while calling on the people to always report cases of fever to health facilities for quick examination and treatment.
According to [Vile], yellow fever was caused by [a virus transmitted by] mosquitoes and therefore urged people to sanitize their environment.

Vile advised parents to ensure they vaccinated their children from an early age during the routine immunization. He said once a child was immunized before he or she attained 9 months, chances of getting infected would be minimal.  Yellow fever is a viral haemorrhagic disease that causes bleeding, which may come out from any of the body openings. It is spread through the bite of infected _Aedes_ mosquitoes with symptoms such as fever with jaundice in the early stages and with multiple organ dysfunctions resulting in kidney and liver failure [in later stages].  [Byline: Shi Yinglun]
=========================
[It is difficult to determine if all the Gombe cases originated in that state or if all cases were infected with yellow fever virus (YF) in Yankari, Bauchi state, then travelled to Gombe and became ill there. There was one confirmed and one suspected YF case acquired in the Yankari Game Reserve, Bauchi state [see Undiagnosed illness - Nigeria (02): (BO) fatal, poss. link to game reserve, RFI http://promedmail.org/post/20190906.6660123], indicating that YF virus was circulating in that state. In any event, it is prudent to increase monitoring in Gombe and to vaccinate children around age 9 months, even if they had been vaccinated previously (see report on vaccine boosters below). - ProMED Mod.TY]

[Map of Nigeria:
HealthMap/ProMED-mail map:
Gombe state, Nigeria: <http://healthmap.org/promed/p/1280>]
Date: Thu 26 Sep 2019
Source: WHO Disease outbreak news [edited]

On 16 Jul 2019, the Ebonyi State Ministry of Health received information about suspected yellow fever cases in Ndingele ward, Izzi local government area (LGA), Nigeria. The cases had symptoms of fever and jaundice, reported with onset since May 2019. As of 30 Aug 2019, a total of 84 suspected yellow fever cases, including 26 deaths (case fatality ratio: 31%), have been reported across 9 LGAs within Ebonyi state. Of the suspected yellow fever cases, 55% (46/84) are male. The most affected age group is 0-9 years (28 cases, 33%), followed by age groups 20-29 years and above 30 years, each with 20 cases (24%). The  0-19-years age group has the least number of cases (16 cases, 19%). Of the suspected cases, 79% (66/84), including 7 confirmed cases positive by real-time polymerase chain reaction (RT-PCR), are reported from Izzi LGA, which is located in the northeastern part of the state, bordered with Cross River state in the east and Benue state in the north. One case has been confirmed in an international worker involved in the extractive industry in Izzi LGA and residing in adjacent Abakiliki LGA (an urban centre in the state).

The assessment conducted by the LGA rapid response team (RRT) and national agencies found low vaccination coverage and poor routine immunization documentation. Community surveys were conducted, and yellow fever vaccination coverage was estimated to be 56% (64% for children aged less than 5 years and 48% for those older than 5 years of age). Though Nigeria introduced routine vaccination for yellow fever into the immunization schedule in 2004, most adults remain susceptible, and overall population immunity is low. Although no entomological studies were conducted at the time, the geography and vegetation of the affected state is compatible with the presence of the _Aedes_ mosquitoes, as illustrated by the transmission patterns.

Since September 2017, when the Nigeria Centre for Disease Control (NCDC) informed WHO of a confirmed case of yellow fever in Kwara state, Nigeria has been responding to successive yellow fever outbreaks over a wide geographic area. Following the country's official notification to WHO (via the International Health Regulations, 2005) on 15 Sep 2017 of the resurgence in yellow fever outbreaks, suspect cases have been reported from all states and the Federal Capital Territory (FCT), and outbreak responses to protect over 10 million people have occurred in select areas in 13 states. Efforts to strengthen surveillance are ongoing.

From 1 Jan-31 Jul 2019, over 2000 suspected yellow fever cases have been reported in 506 LGAs from all 36 states including the Federal Capital Territory (FCT) of Nigeria.

Public health response
The response to the ongoing outbreak is being coordinated by the Nigerian Centre for Disease Control (NCDC) at the national level through a multi-agency, multi-partner Incident Management System (IMS). The public health emergency operations centre (PHEOC) located at the Ebonyi State Ministry of Health has been activated to monitor the outbreak. Active case-finding, case management, risk communication and community engagement have been implemented in affected LGAs. An International Coordination Group (ICG) request for reactive vaccination in the affected area has been approved covering 3 LGAs in Ebonyi state, 2 LGAs in Benue state, and one LGA in Cross River state targeting a population of about 1.64 million people aged 9 months to 44 years in Ebonyi and Benue states, and aged 1-6 years in Yala LGA of Cross River state.

Routine yellow fever vaccination was introduced to Nigeria's Expanded Programme on Immunization (EPI) in 2004, but the overall population immunity in areas affected by the current outbreak remains below recognized herd immunity thresholds.

A 4-year (2018-2021) national yellow fever Preventive Mass Vaccination Campaign (PMVC) plan supported by Gavi and partners is currently being implemented. By 2024, it is anticipated that all the states in Nigeria will have undergone campaign activities to protect at-risk populations against yellow fever.

WHO risk assessment
Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes and has the potential to spread rapidly and cause serious public health impact. There is no specific treatment, although the disease is preventable using a single dose of yellow fever vaccine, which provides immunity for life. Supportive care is required to treat dehydration, respiratory failure, and fever, and antibiotics are recommended to treat associated bacterial infections.

The recent confirmation by the national and regional reference laboratories of the yellow fever cases in Ebonyi state, with the probable epicentre in Izzi LGA, represents a concerning situation in Nigeria.

Given the rapid evolution of the situation in Ebonyi state, the national risk is assessed as high due to the high CFR (36%) and the potential for ongoing local transmission and amplification. Factors considered include the low vaccination coverage, the probability of the presence of competent vectors including _Aedes_ species, the proximity of a yellow fever case to Abakiliki LGA (an urban centre in the state), and the potential spread to new LGAs.

There is currently a moderate risk at the regional level due to the possible movement of the individuals of affected states to adjacent areas and neighbouring countries, particularly if there is arrival of unvaccinated visitors to the state. There is risk to national and international workers in high-risk extractive industries like open-pit mining and forestry, underscoring the importance of ensuring all international travelers and workers are vaccinated according to International Health Regulations (IHR) recommendations as emphasized in the Eliminate Yellow Fever Epidemics (EYE) strategy. The current overall risk is considered to be low at the global level.

Nigeria is facing several concurrent public health emergencies, including circulating vaccine-derived poliovirus (cVDPV), measles, cholera, and Lassa fever outbreaks and a humanitarian crisis in the northeast of the country.

WHO advice
Nigeria is a high-priority country for the EYE strategy. Vaccination is the primary intervention for prevention and control of yellow fever. In urban centres, targeted vector control measures are also helpful to interrupt transmission. WHO and partners will continue to support national and state authorities to implement these interventions to control the current outbreak.

WHO recommends vaccination against yellow fever for all international travelers more than 9 months of age going to Nigeria, as there is evidence of persistent or periodic yellow fever virus transmission. This is of particular importance to temporary or international workers engaged in extractive industries. Nigeria also requires a yellow fever vaccination certificate for all arriving travelers over one year of age.

Yellow fever vaccines recommended by WHO are safe and highly effective and provide life-long protection against infection. In accordance with the IHR (2005), 3rd edition, the validity of the international certificate of vaccination against yellow fever extends to the life of the person vaccinated with a WHO-approved vaccine. A booster dose of approved yellow fever vaccine cannot be required of international travelers as a condition of entry.

WHO encourages its member states to take all actions necessary to keep travelers well informed of risks and preventive measures including vaccination. Travelers should also be made aware of yellow fever signs and symptoms and instructed to seek rapid medical advice should they develop signs of illness. Travelers returning to Nigeria who may be infected with possible high levels of the virus in the blood may pose a risk for the establishment of local cycles of yellow fever transmission in areas where a competent vector is present.

WHO does not recommend any restrictions on travel or trade to Nigeria on the basis of the information available on this outbreak.

For more information on yellow fever, please see:

WHO Yellow Fever Factsheet
WHO strategy for yellow fever epidemic preparedness and response
WHO list of countries with vaccination requirements and recommendations for international travelers
A Global strategy to Eliminate Yellow Fever Epidemics (EYE) 2017-2026, WHO 2018
WHO Database for pre-qualified vaccines
Vaccine Position Papers
International Travel and Health
=======================
[Yellow fever (YF) cases continue to accumulate in Nigeria, most recently in Ebonyi state. The Nigeria CDC has intensified surveillance and response to outbreaks with vaccination campaigns. A recent WHO report indicates that the federal government, in collaboration with the World Health Organization (WHO), Gavi, the Vaccine Alliance, and partners, is launching a yellow fever reactive vaccination campaign in 3 states to help control an expanding YF outbreak in Nigeria identified in Ebonyi. The 10-day campaign (7-16 Sep 2019), to be implemented in parts of Ebonyi (3 LGAs), Benue (2 LGAs), and Cross River (1 LGA) states, targets vaccination of 1.6 million people (aged 9 months to 44 years old) to contain the outbreak in affected areas. The campaign, supported by Gavi, will use 1 802 044 vaccine doses provided by the International Coordination Group (ICG) on Vaccine Provision, funded by Gavi, the Vaccine Alliance (see Yellow fever - Africa (12): Nigeria, WHO (EB, BE, CR) http://promedmail.org/post/20190909.6665598).

If the estimated vaccine coverage is only 56%, there is an urgent need to bring it up to 80-90% to provide adequate protection against outbreaks. Interestingly, a recent report indicated that children vaccinated at around 9 months of age lose neutralizing antibodies to YF virus in 2-6 years and presumably become susceptible to infection (see Yellow fever - Africa (14): Nigeria (GO), vaccination-booster research http://promedmail.org/post/20190921.6687246). Follow-up of the immune status of this age cohort will be necessary over the long term. - ProMED Mod.TY]

[Maps of Nigeria:
and <http://healthmap.org/promed/p/62>. - ProMED Mod.TY]
Date: Wed 18 Sep 2019
Source: Nigeria CDC Situation Report [edited]

Highlights
-----------
Nigeria is currently responding to an outbreak of yellow fever in people who are either resident in or have visited Alkaleri Local Government Area (LGA) in Bauchi since [1 Aug 2019]. Suspected and confirmed cases with an epidemiological link to Bauchi have been reported in Borno, Kano, Gombe and Katsina states. Of the cases with an epidemiological link to Bauchi, [the] current [epidemiological] summary is as follows:

- 243 suspected cases
- 10 presumptive positives cases (IgM positive on serology)
- 28 confirmed cases by RT-PCR
- 34 deaths
- 5 states affected
- 42 LGAs affected

The National Yellow Fever technical working group (TWG) activated the national Incident Management System (IMS) to coordinate the response activities on [5 Sep 2019].

[Epidemiological] Summary from week[s] 27-38, September 2019:

- 243 suspected cases have been reported in 42 LGAs in 5 states: Bauchi (84), Borno (82), Gombe (7), Kano (4) and Katsina (66) [see Table 1 at source URL].
- Number of samples collected among suspected cases is 195 (8.2%).
- Number of presumptive positives is 10 (IgM positive on serology) and 1 inconclusive was recorded (Borno, 6; Kano, 1; Katsina, 3; and 1 inconclusive from Borno). All have been sent to the Institut Pasteur Dakar (IP Dakar) for further testing.
- A total of 28 (14.9%) cases have been confirmed in the Nigerian testing laboratories using RT-PCR from:
-- NCDC National Reference Laboratory Gaduwa, 27 (Bauchi, 20; Katsina, 4; Gombe, 3)
-- Lagos University Teaching Hospital, 1 (Kano, 1)
- A total of 34 deaths have been recorded among suspected cases (Bauchi, 10; Kano, 1; Katsina, 23), with [a] case fatality rate (CFR) of 14.0%.

[Epidemiological] Summary [see source URL]
Table 1: Showing all affected states in the Bauchi Cluster of Yellow Fever (YF) outbreak in Nigeria as [of] Week 38, 18 Sep 2019.
Figure 1 [graph]: National YF epicurve and cases as [of] Week 38, 18 Sep 2019.
Figure 2 [graph]: Bauchi State YF epicurve and cases by LGA as [of] Week 38, 18 Sep 2019.
Figure 3 [graph]: Borno State YF epicurve and cases by LGA as [of] Week 38, 18 Sep 2019.
Figure 4 [graph]: Katsina State YF epicurve and cases by LGA as [of] Week 38, 18 Sep 2019.
Figure 5 [graph]: Kano State YF epicurve and cases by LGA as [of] Week 38, 18 Sep 2019.
Figure 6 [graph]: Gombe State YF epicurve and cases by LGA as [of] Week 38, 18 Sep 2019
Figure 7. Map of Bauchi and the adjoining states with suspected/presumptive/confirmed cases as [of] Week 38, 18 Sep 2019.
========================
[The graph in Figure 1 shows a fairly steady number of cases during weeks 27-33 at 10-20 cases, a dip in week 34, and then a peak to around 50 cases each in weeks 35 and 36, with a decline to about 20 cases the following week. Figures 2 and 3 show that Bauchi and Borno states had relatively low numbers of cases until weeks 35-37, when they spiked to about 20-30 cases each week. We do not know if the 16 college girls who also visited this game reserve and became ill, 4 of whom died, are included in these cases. Samples were sent for laboratory diagnosis of these girls' illnesses but no results have been announced, so it is still not known if YF was involved. However, the occurrence of a YF case and possibly another in the Yankari Game Reserve in Borno state that the students also visited, indicates that YF virus was circulating there and there were additional YF cases in the state. A vaccination campaign to cover 500,000 people in Borno state is planned.

Maps of Nigeria:
and <http://healthmap.org/promed/p/62>. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Bauchi State, Nigeria: <http://healthmap.org/promed/p/3741>]
More ...

World Travel News Headlines

Date: Wed, 16 Oct 2019 18:45:39 +0200 (METDST)

Manila, Oct 16, 2019 (AFP) - A child was killed in a strong 6.4-magnitude quake that hit the southern Philippines on Wednesday, a local mayor said, as houses collapsed, power was knocked out and a shopping mall burst into flames.   Residents evacuated homes and buildings across the Mindanao region including a mall that caught fire in the city of General Santos shortly after the quake struck in the evening, officials said.   The child died in a house collapse in the town of Datu Paglas, while four residents of nearby Tulunan town were injured when at least two other houses fell down, Tulunan Mayor Reuel Limbungan told AFP.   "The child was crushed by a collapsed house wall" and pronounced dead in hospital, Limbungan said, adding that he had visited the medical facility and spoken to its director.

Rescue and local officials said there were no immediate reports of deaths elsewhere in Mindanao, and rescue official Anthony Allada told local television that 20 people were treated for injuries in the town of Magsaysay, near the epicentre.   Three other people were hurt in the town of M'lang, added its vice-mayor, Joselito Pinol.   The quake was 14 kilometres (8.7 miles) deep and was followed by at least two aftershocks, according to the United States Geological Survey (USGS).   "It was the most powerful earthquake I have ever experienced," Sara Duterte, mayor of the largest Mindanao city of Davao, and daughter of President Rodrigo Duterte, told local television.

- Falling debris -
The Philippines is part of the Pacific "Ring of Fire", an arc of intense seismic activity that stretches from Japan through Southeast Asia and across the Pacific basin.   An elderly man was treated for injuries after being struck by a falling object during the evacuation of a Davao mall, local TV reported.   Jerome Barranco, civil defence officer for the region, said several people were also injured in the city of Kidapawan "as a result of falling debris".   In General Santos, television footage showed firemen battling a blaze that engulfed the three-storey Gaisano shopping mall.   It was not known if there were still people inside the building, which was evacuated as the quake struck.   The blaze was still raging more than three hours later despite the efforts of nearly 100 firemen, fire officer Redentor Batulan told AFP.

Coastal residents of Davao fled their homes in fear of a tsunami, but rescue workers were trying to convince them to return as no warning was issued, city civil defence chief Rodrigo Bustillo told local television.   "Our volunteers are out to calm the people and tell them there is no tsunami," Bustillo added.   Chief Philippine government seismologist Renato Solidum said there was no risk of a tsunami because the quake occurred inland, but he advised residents to check their homes for possible damage.   "We ran out of the police station, and we also let the inmates at the municipal jail out," patrolwoman Celina Sarte told AFP by telephone from the town of Bansalan.   She said the 10 prisoners were put in handcuffs outside moments later.
Date: Tue, 15 Oct 2019 20:35:37 +0200 (METDST)

Addis Ababa, Oct 15, 2019 (AFP) - Rescue workers on Tuesday used excavators to dig out bodies after a landslide in southern Ethiopia washed away homes and killed more than 20 people, a local official said.    The landslide in the remote district of Konta occurred Sunday following 10 hours of heavy rains, said the official, Takele Tesfu.   "There are 22 people dead and we have only been able to dig up 17 using manpower and machine power," Takele told AFP.   "So far, we cannot get the others, so tomorrow we will continue to dig."     He said the victims included nine women and six children.

While the district -- located in Ethiopia's Southern Nations, Nationalities, and Peoples' Region -- sees landslides with some regularity, Takele said this was the deadliest he could remember.    "The area where this occurred is very mountainous, and this means the landslide was very dangerous," he said.    Ethiopia is nearing the end of its rainy season, but security forces are nonetheless relocating some families for fear that more rain in the coming days could lead to similar disasters, Takele said.
Date: Tue, 15 Oct 2019 10:00:23 +0200 (METDST)

New Delhi, Oct 15, 2019 (AFP) - New Delhi banned the use of diesel generators on Tuesday as pollution levels in the Indian capital exceeded safe limits by more than four times.   Every winter, New Delhi is enveloped in a noxious blanket of smog of car fumes, industrial emissions and smoke from stubble burning at farms outside the megacity of 20 million people.   The ban on generators is part of the Graded Response Action Plan (GRAP) that entered into force on Tuesday.   Other measures that will come into effect as smog levels rise, particularly following the Diwali festival in late October, include banning trucks and setting up a "war room".

From November 4-15, a road-rationing scheme will come into force, meaning cars with odd and even plates would be allowed on alternate days in that period.   "We will hand out anti-pollution masks to schoolchildren next week but the date is yet to be decided," the official told AFP.   Indian authorities have also sought to reduce the burning of stubble by farmers in areas surrounding Delhi.   According to government data, concentrations of particles measuring less than 2.5 microns across -- which can penetrate the lung barrier and enter the blood -- hit 108 icrograms per cubic metre on Tuesday.   This was more than four times the recommended World Health Organization safe daily maximum of 25. In previous years, the level has regularly exceeded 400.   Last year, a UN report found 14 of the world's 15 most polluted cities were in India, with one US study saying it kills a million people prematurely every year.
Date: Tue, 15 Oct 2019 09:50:21 +0200 (METDST)
By Kyoko HASEGAWA

Tokyo, Oct 15, 2019 (AFP) - Rescuers in Japan were working around the clock Tuesday in an increasingly desperate search for survivors of a powerful weekend typhoon that killed nearly 70 people and caused widespread destruction.   Hagibis slammed into Japan on Saturday night, unleashing fierce winds and unprecedented rain that triggered landslides and caused dozens of rivers to burst their banks.   By Tuesday afternoon, local media put the toll at nearly 70, with around a dozen people missing. The government's tally was lower, but it said it was still updating information.   Prime Minister Shinzo Abe said there was no plan to slow rescue operations, with around 110,000 police, coast guard, firefighters and military troops involved.   "Currently in damaged areas rescue work and searches for the missing are continuing around the clock," Abe told parliament.   "Where rivers flooded, work is ongoing to fix spots where banks broke, and water is being pumped out where floods occurred," he added.   The prime minister's office said more than 3,000 people have been rescued in the wake of the disaster, which affected 36 of the country's 47 prefectures.   The defence ministry has called up several hundred reserve troops in addition to active duty soldiers for the first time since the 2011 earthquake and tsunami.

- Rain prompts new warnings -
Government officials warned that more rain was expected throughout the day Tuesday in several parts of the country affected by the typhoon.   "We ask people not to drop their guard and to remain fully alert," chief cabinet secretary Yoshihide Suga. told reporters.   Hagibis crashed into land packing gusts up to 216 kilometres (134 miles) per hour, but it was the storm's heavy rain that caused the most damage.   At least 176 rivers burst their banks, including in central Nagano, where a levee breach sent water from the Chikuma river gushing into residential neighbourhoods and submerging bullet trains in a depot up to their windows.   Deaths were reported across many prefectures and included a man whose apartment was flooded, a municipal worker whose car was caught in rising waters and at least seven crew aboard a cargo ship that sank in Tokyo bay on Saturday night.   By Tuesday morning, some 34,000 households were still without power, and 133,000 homes had no water.   Tens of thousands of people spent Monday night in government shelters, with many unsure when they would be able to return home.   "My frightened daughter can't stop shaking. We want to go home quickly," Rie Nishioka, 39, told Kyodo News agency in Miyagi prefecture.

- Government pledges aid -
The government pledged financial support to affected regions without specifying how much aid it would set aside.   "Support for the victims of the disaster is an urgent task," Abe said.   "There are concerns that the impact on daily life and economic activities may be long-lasting."   Another area affected by the storm was Fukushima, where several bags containing soil and plants collected during nuclear decontamination efforts were washed away.   "Ten bags out of 2,667 were swept into a river during the typhoon, but six of them were recovered yesterday," environment ministry official Keisuke Takagi told AFP, adding that the remaining four bags had been found and would be collected soon.   "Residents must be worried about the environment, but there are no reports that the bags were broken, so there will be nothing to worry about once they have been recovered safely," he said.   Hagibis caused transport chaos over a holiday weekend in Japan, grounding flights and halting train services.   By Tuesday, things were largely back to normal, though some flights were cancelled and train services partially disrupted where tracks or train stock were damaged by the storm.   The typhoon also caused disruption to sporting events, delaying Japanese Grand Prix qualifiers and forcing Rugby World Cup organisers to cancel three matches.   A crunch fixture pitting the hosts against Scotland went ahead on Sunday night, with Japan winning its first-ever quarter final spot.
Date: Mon, 14 Oct 2019 17:55:47 +0200 (METDST)

Harare, Oct 14, 2019 (AFP) - Striking Zimbabwe doctors on Monday defied a court order to return to work, saying a pay rise offered by the government failed to meet everyday costs.   Doctors remained home for a 43rd consecutive day, striking for better pay after their salaries were eroded by the country's spiralling inflation.   Zimbabwe's labour court ruled the action "unlawful" on Friday and ordered the medics back to their wards within 48 hours.

The Zimbabwe Hospital Doctors Association (ZHDA) announced Sunday it would appeal to the Supreme Court.    "We noted the court order but unfortunately we don't have the means by which to comply," said ZHDA spokesman Masimba Ndoro on Monday.   "We remain incapacitated... There is nothing we can do when we don't have the means to go to work and to meet our basic needs," he told AFP.   The doctors say the value of their pay shrank 15-fold over the past year -- a legacy of hyperinflation caused by economic mismanagement under ex-president Robert Mugabe.   His successor Emmerson Mnangagwa has so far failed to redress the situation.    Fuel prices have increased by more than 400 percent since the start of the year, and the ZHDA said that doctors had to use their savings just to show up to hospital each morning.

Negotiations with the government have been deadlocked since the ZHDA rejected a 60-percent salary rise offer.   With pay slips worth less than the equivalent of $100 (91 euros) in some cases, they are demanding doctors' salaries be pegged to the US dollar and have appealed to international bodies to supplement their wages.   "While doctors would want nothing more than to return to work in service of their patients, they continue to be incapacitated and lack the resources to comply with the Labour Court judgement," the ZHDA said in a statement on Sunday.   Nurses joined in the action last week.   "We have reduced the number of days we are coming to work initially to three days a week now we are down to two days," Zimbabwe Nurses Association spokesman Enoch Dongo told AFP.   "If the issue of salaries is not urgently addressed we will soon have a situation where nurses will no longer be able to come to work," he said, adding that nurses were "taking turns" in coming to hospital.      Rural teachers also embarked on strike action on Monday with a stay-at-home protest "against underpayment".   "We urge the government to respect our right to engage in job actions and peacefully protest demanding a living wage," the Amalgamated Rural Teachers Union of Zimbabwe posted on Twitter.
Date: Mon, 14 Oct 2019 16:33:26 +0200 (METDST)
By Daniel BOSQUE

Barcelona, Oct 14, 2019 (AFP) - "I feel fury and a sense of powerlessness," said Joan Guich, a 19-year-old student protesting in Barcelona after Spain's Supreme Court jailed nine Catalan leaders jailed over a failed independence bid.   "They have been convicted for an ideology which I agree with."   Within minutes of the ruling demonstrators had poured onto the streets of the Catalan capital, waving flags and blocking traffic over the conviction of the separatist leaders who organised a 2017 referendum banned by Madrid.   "We have to mobilise and stick up for them ... in a way that has an impact, closing airports, stations, but always avoiding violence," Guich said. "Or at least, it won't be us that provokes it."

Workers rallied outside their offices, university students walked out of classes and regional lawmakers demonstrated inside Catalonia's parliament, where most of the defendants had held a senior role.   "Today is going to be historic, you can feel it in the atmosphere. Serious things are happening, we can't stay home," said Oscar Quiles, a 47-year-old real estate entrepreneur.   News of the verdict reached him as he arrived at the office and he immediately called his mother to join him at a protest in Plaza Cataluna in the centre of Barcelona.   By noon the square was packed with thousands of demonstrators, many waving yellow, red and blue Catalan separatist flags or banners reading "We would do it again" and "Freedom for political prisoners".   The protesters then set off walking towards Barcelona's airport, Spain's second busiest, in the hope of blocking it, just as pro-democracy activists have done recently in Hong Kong.

- 'Weeks of mobilisation' -
Tension gripped Barcelona on Monday morning ahead of the ruling, with a heavy police presence outside the courts, the airport and the city's main train station, as a helicopter flew overhead.    Democratic Tsunami, a group advocating more active forms of civil disobedience, had urged demonstrators to hit the streets as soon as the verdicts were announced.   "Tomorrow everyone ready! When the verdict is out, the response will be immediate," said the group in a message to its roughly 150,000 followers on mobile messaging service Telegram.   Juli Cuellar, a 44-year-old office worker, said he believed the verdict was politically motivated.    "Now all we have left is a life of civil and institutional disobedience," he told AFP, predicting "weeks of mobilisation".   The Catalan National Assembly (ANC) and Omnium Cultural, the region's two biggest grassroots pro-independence groups, have also called supporters to attend an evening rally. They have organised some of the largest separatist protests in recent years.   Several more protests are scheduled over the next few days across Catalonia, as well as a general strike on Friday.

- 'Felt like crying' -
Democratic Tsunami, the group that called the gathering in Plaza Cataluna, only emerged in recent weeks. It says it does not depend on Catalan separatist parties or civil associations for support.   Its leaders remain unknown, keeping in touch with each other through encrypted messaging apps such as Wire.   But supporters tend to be kept in the dark until the last minute.   "We don't know exactly what we have to do," said Arnau Font, a 22-year-old shop assistant who took the week off to protest.   "We have to get involved. Right now I feel really powerless in light of the verdicts," he told AFP.    "When I found out, I felt like crying."   The uncertainty was over a few minutes later when a Telegram message arrived urging everyone to "go to the airport", a 15-kilometre (nine-mile) walk from the city centre.    "The time has come to make our voice felt around the world. The goal: stop the activity of Barcelona's airport," it said.   Spain's airport operator Aena said no flights were disrupted, but many passengers got stuck in traffic jams leading to the airport.
Date: Mon, 14 Oct 2019 14:09:03 +0200 (METDST)

Frankfurt am Main, Oct 14, 2019 (AFP) - German cabin crew union UFO urged members Monday to walk off their jobs at airline giant Lufthansa on October 20, although the carrier contests its right to represent workers.   "We call on all cabin crew... not to show up to work" between six and eleven am (0400 to 0900 GMT) at Germany's two busiest hubs Frankfurt and Munich, Ufo chairman Daniel Flohr said in a video message to staff.   At least five of the Lufthansa group's airlines -- Lufthansa, Eurowings, Germanwings, Cityline and Sunexpress -- would be hit by strikes for higher pay in the coming weeks, Flohr added.

Lufthansa told AFP it would "maintain its entire timetable", calling UFO's call to strike "illegal".   Bosses at the airline group believe UFO may no longer have the legal right to speak for workers and have challenged its status in court.   Internal disputes at the union have cost it members and support among cabin crew, some of whom have now turned to other representative organisations.   Berlin daily Tagesspiegel on Monday called UFO a "half-dead" outfit.   "UFO is battling for its life," agreed business daily Handelsblatt.   "With its far-reaching call for strikes, it wants to show members it remains capable of acting and is representing cabin crew interests."   Lufthansa could also contest before a court whether UFO has the right to initiate a strike -- potentially leaving the worker representatives on the hook for any resulting costs.
Date: Mon, 14 Oct 2019 11:08:10 +0200 (METDST)

Manila, Oct 14, 2019 (AFP) - Parents lined up from sunrise holding sleeping infants as the Philippines launched a campaign on Monday to vaccinate millions of children against polio, which has re-emerged nearly two decades after the nation's last cases.   Years of falling vaccination rates, made worse by the botched rollout of a dengue vaccine, culminated in an outbreak of the preventable disease in September.   "This is for the welfare of my child," Ruth Miranda told AFP after the vaccine was squirted into her child's mouth at the Manila slum they call home.

Miranda's child is among scores who are unprotected in the capital of about 13 million people, where vaccination rates of young children plunged from 77 percent in 2016 to a mere 24 percent in June.   The atmosphere at the event in Manila was festive -- with ice cream vendors and music -- but the stakes for the campaign are high.

Polio, which can cause paralysis and can be fatal in rare cases, has no cure and can only be prevented with several doses of oral and injectable vaccines.   Two cases were detected in September, the first polio infections in the Philippines since 2001, adding to the woes of a country already hit by deadly measles and dengue epidemic.   The risk of the disease spreading within the Philippines is high, according to World Health Organization, due to low immunisation coverage partly blamed to a dengue vaccine scandal.

The Philippines was the first nation to use Dengvaxia in a mass programme in 2016, but a botched rollout led to claims that children had died after being vaccinated.   A dramatic drop in vaccine confidence followed, with trust plunging from 93 percent in 2015 to 32 percent in 2018, according to a study led by the London School of Hygiene and Tropical Medicine.   The Philippines polio outbreak has been traced back to the weakened form of the virus used in vaccines, which is excreted by people for a time after they receive it.   According to the WHO, that form can mutate and spread in the surrounding community when immunisation rates get too low.
Date: Mon, 14 Oct 2019 10:25:38 +0200 (METDST)
By Shingo ITO, Sara HUSSEIN

Tokyo, Oct 14, 2019 (AFP) - Tens of thousands of rescue workers in Japan battled on Monday to find survivors of a powerful typhoon that killed at least 43 people, as fresh rain threatened to hamper efforts.   Typhoon Hagibis crashed into the country on Saturday night, unleashing high winds and torrential rain across 36 of the country's 47 prefectures, and triggering landslides and catastrophic flooding.   "Even now, many people are still unaccounted for in the disaster-hit area," Prime Minister Shinzo Abe told an emergency disaster meeting on Monday.   "Units are trying their best to search for and rescue them, working day and night," Abe said.

But even as rescuers, including troops, combed through debris, the country's weather agency forecast rain in central and eastern Japan that it warned could cause further flooding and new landslides.   "I would like to ask people to stay fully vigilant and continue watching for landslides and river flooding," Chief Cabinet Secretary Yoshihide Suga told a news conference.   In Nagano, one of the worst-hit regions, rain was already falling and was expect to intensify.   "We are concerned about the impact of the latest rain on rescue and recovery efforts," local official Hiroki Yamaguchi told AFP.   "We will continue operations while watching out for secondary disasters due to the current rain."

- 43 dead, 16 missing: NHK -
By late Monday afternoon, national broadcaster NHK said the toll had risen to 43 dead, with 16 others missing and over 200 people injured. The government gave lower figures but was continuing to update its information.   The dead included a municipal worker whose car was overcome by floodwaters and at least seven crew from a cargo ship that sank in Tokyo Bay on Saturday night, a coast guard spokesman said.   Four others, from China, Myanmar and Vietnam, were rescued when the boat sank and the coast guard was still searching for a last crew member.   While Hagibis, one of the most powerful storms to hit the Tokyo area in decades, packed wind gusts of up to 216 kilometres (134 miles) per hour, it was the heavy rains that caused most damage.

A total of 142 rivers flooded, mainly in eastern and northern Japan, with river banks collapsing in two dozen places, local media said.   In central Nagano, a levee breach sent water from the Chikuma river gushing into residential neighbourhoods, flooding homes up to the second floor.   As water slowly receded Monday, television footage showed patients being transferred by ambulance from a Nagano hospital where some 200 people had been cut off by flooding.   Elsewhere, rescuers used helicopters to winch survivors from roofs and balconies, or steered boats through muddy waters to reach those trapped.

- Japan dedicates rugby win to victims -
By Monday afternoon, some 75,900 households remained without power, with 120,000 experiencing water outages.   The disaster left tens of thousands of people in shelters, with many unsure when they would be able to return home.   "Everything from my house was washed away before my eyes, I wasn't sure if it was a dream or real," a woman in Nagano told NHK.   "I feel lucky I'm still alive."   The storm brought travel chaos over the holiday weekend, grounding flights and halting commuter and bullet train services.

By Monday, most subway trains had resumed service, along with many bullet train lines, and flights had also restarted.   The storm also brought havoc to the sporting world, forcing the delay of Japanese Grand Prix qualifiers and the cancellation of three Rugby World Cup matches.   But a crucial decider pitting Japan against Scotland went ahead, with the hosts dedicating their stunning 28-21 win to the victims of the disaster.   "To everyone that's suffering from the typhoon, this game was for you guys," said Japan captain Michael Leitch.
Date: Sun, 13 Oct 2019 23:31:57 +0200 (METDST)

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

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

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