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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

United Kingdom and Gibraltar (England, Wales, Scotland, Northern Ireland) US Consular Information Sheet
October 09, 2008
COUNTRY DESCRIPTION:
The United Kingdom of Great Britain and Northern Ireland is a highly developed constitutional mon
rchy composed of Great Britain (England, Scotland, and Wales) and Northern Ireland.
Read the Department of State Background Notes on the United Kingdom for additional information.
Gibraltar is a UK Overseas Territory bordering Spain, and is located at the southernmost tip of Europe at the entrance to the Mediterranean Sea.
It is one of 13 former British colonies that have elected to continue their political links with London.
Tourist facilities are widely available throughout the United Kingdom and Gibraltar.

ENTRY/EXIT REQUIREMENTS:
A UK visa/entry clearance is not required for tourist or business visits to the United Kingdom of less than six months in duration.
Visitors wishing to remain longer than one month in Gibraltar should regularize their stay with Gibraltar immigration authorities.
Those planning to visit the United Kingdom for any purpose other than tourism or business, or who intend to stay longer than six months, should consult the website of the British Embassy in the United States at http://ukinusa.fco.gov.uk/en for information about current visa/entry clearance requirements.
Those who are required to obtain a visa/entry clearance and fail to do so may be denied entry and returned to their port of origin.
The U.S. Embassy cannot intervene in UK immigration matters.

In the past year, the British government has completely restructured its immigration system, tightening visa/entry clearance regulations and enforcement at its borders.
All American travelers to the United Kingdom are urged to check the web site of the British Embassy in the United States at http://ukinusa.fco.gov.uk/en or the web site of the UK Border Agency at http://www.bia.homeoffice.gov.uk/ to determine whether they must have a visa/entry clearance before traveling to the United Kingdom.
Students should be especially alert to UK visa/entry clearance requirements.
Under no circumstances should Americans seeking to study or work in the United Kingdom attempt to enter the country without the appropriate visa/entry clearance from a British Consulate in the United States.
If you do so, you are likely to be detained by UK immigration officials at the port of entry and held in an immigration detention facility until you can be returned to the United States.
Again, the U.S. Embassy cannot intervene in UK immigration matters.

In addition to the British Embassy web site at http://ukinusa.fco.gov.uk/en, those seeking current UK visa/entry clearance information may also contact UK consular offices in the United States via their premium rate telephone service at 1-900-656-5000 (cost $3/minute) or 1-212-796-5773 ($12 flat fee).
There is also a no-fee website for visa information at www.visainfoservices.com.

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

SAFETY AND SECURITY:
The United Kingdom is politically stable, with a modern infrastructure, but shares with the rest of the world an increased threat of terrorist incidents of international origin, as well as the potential, though significantly diminished in recent years, for isolated violence related to the political situation in Northern Ireland (a part of the United Kingdom).

Like the United States, the United Kingdom shares its national threat levels with the general public to keep everyone informed and explain the context for the various increased security measures that may be encountered. UK threat levels are determined by the UK Home Office and are posted on its web site at http://www.homeoffice.gov.uk/security/current-threat-level/.

Information from the UK Security Service, commonly known as MI5, about the reasons for the increased threat level and actions the public can take is available on the MI5 web site at http://www.mi5.gov.uk/.
American citizens are advised to check with the UK Department for Transport at http://www.dft.gov.uk/transportforyou/airtravel/airportsecurity/ regarding the latest security updates and carry-on luggage restrictions.

The British Home Secretary has urged UK citizens to be alert and vigilant by, for example, keeping an eye out for suspect packages or people acting suspiciously at subway (called the Tube or Underground) and train stations, as well as at airports, and reporting anything suspicious to the appropriate authorities.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.
For more information about UK public safety initiatives, consult the UK Civil Contingencies Secretariat web site at http://www.ukresilience.gov.uk.

The political situation in Northern Ireland has improved dramatically.
The potential remains, however, for sporadic incidents of street violence and/or sectarian confrontation.
American citizens traveling to Northern Ireland should therefore remain alert to their surroundings and should be aware that if they choose to visit potential flashpoints or attend parades, sporadic violence remains a possibility.
Tensions may be heightened during the summer marching season (April to August), particularly during the month of July (around the July 12th public holiday).

The phone number for police/fire/ambulance emergency services – the equivalent of 911 in the United States – is 999 in the United Kingdom and 112 in Gibraltar.
This number should also be used for warnings about possible bombs or other immediate threats.
The UK Anti-Terrorist Hotline, at 0800-789-321, is for tips and confidential information about possible terrorist activity.

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 and Travel Alerts, as well as the Worldwide Caution, can be found.
Recent communications from U.S. Embassy London to the local American citizen community, called Warden Messages, can be found on the U.S. Embassy's American Citizens Services web page at http://london.usembassy.gov/cons_new/acs/index.html.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the United States, or for callers outside the United States and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.

CRIME:
The United Kingdom and Gibraltar benefit from generally low crime rates, which decreased slightly in 2007 in significant categories, including violent crime.
The crime situation in the United Kingdom is similar to that in the United States: typical incidents include pick pocketing; muggings; “snatch and grab” thefts of mobile phones, watches and jewelry; and thefts of unattended bags, especially at airports and from cars parked at restaurants, hotels, and resorts.
Pickpockets target tourists, especially at historic sites and restaurants, and on buses, trains, and the London subway (known as the Tube or Underground).
Thieves often target unattended cars parked at tourist sites and roadside restaurants, looking for laptop computers and handheld electronic equipment, especially global positioning satellite equipment.
Walking in isolated areas, including public parks, especially after dark, should be avoided, as these are advantageous venues for muggers and thieves.
At night or when there is little foot traffic, travelers should be especially careful using the underground pedestrian tunnels.
As a general rule, either walk the extra distance to use a surface crossing or wait until there are other adult pedestrians entering the tunnel.

In London, travelers should use only licensed Black Cabs or car services recommended by their hotel or tour operator.
Unlicensed taxis or private cars posing as taxis may offer low fares, but are often uninsured and may have unlicensed drivers.
In some instances, travelers have been robbed and raped while using these cars.
You can access 7,000 licensed Black Cabs using just one telephone number: 087-1871-8710.
This taxi booking service combines all six of London’s radio taxi circuits, allowing you to telephone 24 hours a day if you need a cab.
Alternatively, to find a licensed minicab, text HOME to 60835 on your mobile phone to get the telephone number to two licensed minicab companies in the area.
If you know in advance when you will be leaving for home, you can prebook your return journey.
The Safe Travel at Night partnership among the Metropolitan Police, Transport for London, and the Mayor of London maintains a web site with additional information at http://www.cabwise.com/.
Travelers should not leave drinks unattended in bars and nightclubs.
There have been some instances of drinks being spiked with illegal substances, leading to incidents of robbery and rape.

Americans should take steps to ensure the safety of their U.S. passports.
Visitors in England, Scotland, Wales, Northern Ireland, and Gibraltar are not expected to produce identity documents for police authorities and thus may secure their passports in hotel safes or residences.
Abundant ATMs that link to U.S. banking networks offer an optimal rate of exchange, and they preclude the need to carry a passport to cash travelers’ checks.
Travelers should be aware that U.S. banks might charge a higher processing fee for withdrawals made overseas.
Common-sense personal security measures taken in the United States when using ATMs should also be followed in the United Kingdom.
ATM fraud in the United Kingdom is becoming more sophisticated, incorporating technologies to surreptitiously record customer ATM card and PIN information.
Travelers should avoid using ATMs that look in any way temporary in structure or location, or are located in isolated areas.
Travelers should be aware that in busy public areas, thieves use distraction techniques, such as waiting until the PIN number has been entered and then pointing to money on the ground, or attempting to hand out a free newspaper.
When the ATM user is distracted, a colleague will quickly withdraw cash and leave.
If distracted in any way, travelers should press the cancel transaction button immediately and collect their card before speaking to the person who has distracted them.
If the person’s motives appear suspicious, travelers should not challenge them but remember the details and report the matter to police as soon as possible.
In addition, travelers should not use the ATM if there is anything stuck to the machine or if it looks unusual in any way.
If the machine does not return the card, report the incident to the issuing bank immediately.

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 at the opening of the next business day.
The U.S. Embassy or Consulate issues replacement passports only during regular business hours.
If you are the victim of a crime while overseas, report it to local police.
The nearest U.S. Embassy or Consulate will also be able to assist by helping you to find appropriate medical care, contacting family members or friends, and explaining how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

Visit the Victim Support web site, maintained by an independent UK charity to help people cope with the effects of crime: http://www.victimsupport.org.uk/.

See our information for Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
While medical services are widely available, free care under the National Health System is allowed only for UK residents and certain EU nationals.
Tourists and short-term visitors will be charged for medical treatment in the United Kingdom.
Charges may be significantly higher than those assessed in the United States.

Hiking in higher elevations can be treacherous.
Several people die each year while hiking, particularly in Scotland, often due to sudden changes in weather.
Visitors, including experienced hikers, are encouraged to discuss intended routes with local residents familiar with the area, and to adhere closely to recommendations.

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 from 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.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance companies prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
If your medical insurance policy does not provide overseas coverage, you may want to purchase a short-term policy for your trip.
The Department of State provides an online list of travel insurance companies that can provide the additional insurance needed for the duration of one’s trip abroad.

Remember also that most medical care facilities and medical care providers in the United Kingdom do not accept insurance subscription as a primary source of payment.
Rather, the beneficiary is expected to pay for the service and then seek reimbursement from the insurance company.
This may require an upfront payment in the $10,000 to $20,000 range

Please see our information on medical insurance overseas.

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

UK penalties for driving under the influence of even minimal amounts of alcohol or drugs are stiff and often result in prison sentences.
In contrast to U.S. and continental European traffic, which moves on the right side of the road, UK traffic moves on the left.

The maximum speed limit on highways/motorways in the United Kingdom is 70 mph.
Motorways generally have a hard shoulder (breakdown lane) on the far left, defined by a solid white line.
It is illegal to stop or park on a hard shoulder unless it is an emergency.
In such cases, you should activate your hazard lights, get out of your vehicle, and go onto an embankment for safety.

Emergency call boxes (orange telephone booths with SOS printed on them) may be found at half-mile intervals along the motorway.
White and blue poles placed every 100 yards along the motorway point in the direction of the nearest call box.
Emergency call boxes dial directly to a motorway center.
It is best to use these phones rather than a personal cell phone, because motorway center personnel will immediately know the location of a call received from an emergency call box.

Roadside towing services may cost approximately £125 (as of 10/08, approximately $225).
However, membership fees of automotive associations such as the RAC (Royal Automobile Club) or AA (Automobile Association) often include free roadside towing service.

Visitors uncomfortable with or intimidated by the prospect of driving on the left-hand side of the road may wish to avail themselves of the United Kingdom’s extensive bus, rail, and air transport networks.
Roads in the United Kingdom are generally excellent but are narrow and often congested in urban areas.
If you plan to drive while in the United Kingdom, you may wish to obtain a copy of the Highway Code, available at http://www.direct.gov.uk/en/TravelAndTransport/Highwaycode/index.htm.

Travelers intending to rent cars in the United Kingdom should make sure that they are adequately insured.
U.S. auto insurance is not always valid outside the United States, and travelers may wish to purchase supplemental insurance, which is generally available from most major rental agents.
A congestion charge of £8 (as of 10/08, approximately $15) is imposed on all cars entering much of central London Monday through Friday from 7:00 a.m. to 6:30 p.m.
Information on the congestion charge can be found at http://www.tfl.gov.uk/roadusers/congestioncharging/.
Public transport in the United Kingdom is excellent and extensive.
However, poor track conditions may have contributed to train derailments, resulting in some fatalities.
Repairs are under way and the overall safety record is excellent.
Information on disruptions to London transportation services can be found at http://www.tfl.gov.uk/tfl/livetravelnews/realtime/tube/default.html and information about the status of National Rail Services can be found at http://nrekb.nationalrail.co.uk/service_disruptions/today.html.
Many U.S. pedestrians are injured, some fatally, every year in the United Kingdom because they forget that oncoming traffic approaches from the opposite direction than in the United States.
Extra care should be taken when crossing streets; remember to remain alert and look both ways before stepping into the street.

Driving in Gibraltar is on the right-hand side of the road, as in the United States and continental Europe.
Persons traveling overland between Gibraltar and Spain may experience long delays in clearing Spanish border controls.
Please refer to our Road Safety Overseas page for more information.
For specific information concerning UK driving permits, vehicle inspection, road tax, and mandatory insurance, refer to the UK Department of Environment and Transport web site at http://www.dft.gov.uk/ or the Driving Standards Agency web site at http://www.dsa.gov.uk/.
The U.S. Embassy London’s web site at http://london.usembassy.gov/ also provides information.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the UK Government’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the United Kingdom’s air carrier operations.
For further information, travelers may visit the FAA's web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

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SPECIAL CIRCUMSTANCES:
The legal drinking age in the United Kingdom is generally lower than that in the United States, and social drinking in pubs is often seen as a routine aspect of British life.
Parents, organizers of school trips, and young travelers should be aware of the impact that this environment may have when combined with the sense of adventure that comes with being abroad.
Please see our Students Abroad web site as well as Studying Abroad to help students plan a safe and enjoyable adventure.

The United Kingdom has strict gun-control laws, and importing firearms is extremely complicated.
Travelers should consider leaving all firearms in the United States.
Restrictions exist on the type and number of weapons that may be possessed by an individual.
All handguns, such as pistols and revolvers, are prohibited, with very few exceptions.
Licensing of firearms in the United Kingdom is controlled by the police.
Applicants for a license must be prepared to show “good reason” why they require each weapon.
Applicants must also provide a copy of their U.S. gun license, a letter of good conduct from their local U.S. police station, and a letter detailing any previous training, hunting, or shooting experience.
Background checks will also be carried out.
Additional information on applying for a firearm certificate and/or shotgun certificate can be found on the Metropolitan Police Firearms Enquiry Teams web site at http://www.met.police.uk/firearms-enquiries/index.htm.

A number of Americans are lured to the United Kingdom each year in the belief that they have won a lottery or have inherited from the estate from a long-lost relative.
Americans may also be contacted by persons they have “met” over the Internet who now need funds urgently to pay for hospital treatment, hotel bills, taxes, or airline security fees.
Invariably, the person contacted is the victim of fraud.
Any unsolicited invitations to travel to the United Kingdom to collect winnings or an inheritance should be viewed with skepticism.
Also, there are no licenses or fees required when transiting a UK airport, nor is emergency medical treatment withheld pending payment of fees.
Please see our information on International Financial Scams.

Please read ourCustoms Information.

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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 British law, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in the United Kingdom are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.

Please see our information on Criminal Penalties.

Many pocket knives and other blades, and mace or pepper spray canisters, although legal in the United States, are illegal in the United Kingdom and will result in arrest and confiscation if detected.
A UK Metropolitan Police guide to items that are prohibited as offensive weapons is available at http://www.met.police.uk/youngpeople/guns.htm.
A UK Customs Guide, detailing which items visitors are prohibited from bringing into the United Kingdom, is available at http://customs.hmrc.gov.uk/channelsPortalWebApp/downloadFile?contentID=HMCE_CL_001734.

Air travelers to and from the United Kingdom should be aware that penalties against alcohol-related and other in-flight crimes (“air rage”) are stiff and are being enforced with prison sentences.
Please also see our information on customs regulations that pertain when returning to the United States.

CHILDREN'S ISSUES:
Visit our web site for information on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in the United Kingdom are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, and to obtain updated information on travel and security within the United Kingdom.
By registering, Americans make it easier for the Embassy or Consulate to contact them in case of emergency, and to relay updated information on travel and security within the United Kingdom.
The Embassy and Consulates regularly send security and other information via email to Americans who have registered.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
The Consular Section also disseminates a newsletter every month.
Those wishing to subscribe to the monthly consular newsletter in London should send a request by email to LondonACSNewsletter@state.gov.

The U.S. Embassy is located at 24 Grosvenor Square, London W1A 1AE; telephone: in country 020-7499-9000, from the United States 011-44-20-7499-9000 (24 hours). Consular Section fax: in country 020-7495-5012, from the United States 011-44-20-7495-5012, and on the web at http://london.usembassy.gov.

The U.S. Consulate General in Edinburgh, Scotland, is located at 3 Regent Terrace, Edinburgh EH7 5BW; telephone: in country 013-1556-8315, from the United States 011-44-13-1556-8315.
After hours: in country 012-2485-7097, from the United States 011-44-12-2485-7097.
Fax: in country 013-1557-6023, from the United States 011-44-13-1557-6023.
Information on the Consulate General is included on the Embassy’s web site at http://london.usembassy.gov/scotland.

The U.S. Consulate General in Belfast, Northern Ireland, is located at Danesfort House, 228 Stranmillis Road, Belfast BT9 5GR; telephone: in country 028-9038-6100, from the United States 011-44-28-9038-6100.
Fax:
in country 028-9068-1301, from the United States 011-44-28-9068-1301.
Information on the Consulate General is included on the Embassy’s web site at: http://london.usembassy.gov/nireland.

There is no U.S. consular representation in Gibraltar.
Passport questions should be directed to the U.S. Embassy in Madrid, located at Serrano 75, Madrid, Spain; telephone: 34-91-587-2200 and fax 34-91-587-2303.
The web site is http://madrid.usembassy.gov.
All other inquiries should be directed to the U.S. Embassy in London.
* * *
This replaces the Consular Information Sheet dated May 8, 2008 and updates the sections on Entry Requirements, Safety and Security, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Thu, 18 Apr 2019 17:35:41 +0200

London, April 18, 2019 (AFP) - Climate change activists on Thursday brought parts of the British capital to a standstill in a fourth consecutive day of demonstrations that have so far led to more than 400 arrests.   Hundreds of protesters continued to rally at several spots in central London, where they have blocked a bridge and major road junctions this week as part of a Europe-wide civil disobedience campaign over the issue.   The Metropolitan Police said, as of 0830 GMT on Thursday, that 428 people had been arrested since the protests began on Monday, with reports of further detentions during the day.   Meanwhile, a judge denied bail to three people who appeared in court charged with obstructing the transport system at financial hub Canary Wharf on Wednesday.

District judge Julia Newton ordered the trio, who allegedly glued themselves to a train, be held in custody until their next court appearance on May 16.   Under pressure in the media to crackdown on the distruptive demonstrations, interior minister Sajid Javid warned "unlawful behaviour will not be tolerated" after meeting Met Commissioner Cressida Dick.   "No one should be allowed to break the law without consequence," he said in a statement, adding he expected police "to take a firm stance".   Protesters have been snaring traffic and setting up impromptu encampments at Waterloo Bridge, Parliament Square and at Oxford Circus in London's busy West End entertainment and shopping district.   They laid trees in pots along the bridge's length and also set up camps in Hyde Park in preparation for further demonstrations.

More than 1,000 officers were being deployed to the streets of the capital each day this week, according to the interior ministry.   The police have ordered the protesters to confine themselves to a zone within Marble Arch, a space at the junction of the park, Oxford Street and luxury hotel-lined Park Lane.   The protests are being spearheaded by the "Extinction Rebellion" activist group, which was established last year in Britain by academics and has become one of the world's fastest-growing environmental movements.   It has vowed to maintain the protests for weeks in a bid to force state action over climate change, with Heathrow Airport -- Europe's busiest flight hub -- the latest site to be targeted on Friday.

The group wants the British government to declare a climate and ecological emergency, reduce greenhouse gas emissions to zero by 2025, halt biodiversity loss and be led by new "citizens' assemblies on climate and ecological justice".   Its protesters say they are practising non-violent civil disobedience and aim to get arrested to raise awareness of their cause.    The majority arrested this week were detained for breaching public order laws and obstructing a highway.   However, police seized three men and two women outside the UK offices of energy giant Royal Dutch Shell on suspicion of criminal damage after they allegedly daubed graffiti and smashed a window there.
Date: Tue 26 Mar 2019
Source: BBC News [edited]

More than 220 suspected cases of mumps have been reported at 2 universities, Public Health England (PHE) has said.  Students are being urged to ensure they are vaccinated due to an outbreak at Nottingham Trent University and the University of Nottingham.  A total of 40 cases have been confirmed so far. PHE, which confirmed the cases, said it was working with the universities to persuade unprotected students to get the MMR [measles, mumps, rubella] jab.

Latest news and stories from the East Midlands Dr Vanessa MacGregor said: "We have seen a rise in the figures recently and teenagers and young adults who have not had 2 doses of MMR vaccine are particularly vulnerable.  "School leavers and other young adults who have not received the MMR or only received one dose should ensure that they take up the offer of MMR vaccination."

PHE said latest figures showed cases of mumps in England had decreased in 2018, with 1024 confirmed cases compared to 1796 in 2017.  A spokesman for Nottingham Trent University said it was offering support to those affected.  "If any students have any symptoms of the illness we would encourage them to visit their GP as they would do normally and inform a relevant member of staff on their course if it has an impact on their studies," he said.
======================
[HealthMap/ProMED-mail map of England, United Kingdom:
Date: Tue, 12 Mar 2019 16:39:06 +0100

London, March 12, 2019 (AFP) - Two people were killed and two more injured in an avalanche on Ben Nevis, Britain's highest mountain, Scottish police said on Tuesday.   Police had earlier said three people were killed.   "We can sadly confirm that two people have died and two people have been injured," Police Scotland said.   Police said they were informed about an avalanche in the area at around 1150 GMT and mountain rescuers and emergency workers had been sent to the scene.

The Scottish Ambulance Service said it had sent an air ambulance, three ambulances and a trauma team to the peak.   The Scottish Avalanche Information Service on Monday said the risk of avalanches in Lochaber, where Ben Nevis is located, was "high".   There have been several climbing accidents on Ben Nevis this winter.   A 21-year-old British climber was killed on the mountain in December, and a German woman of the same age was killed on New Year's Day after falling from a ridge.
Date: Tue 22 Jan 2019
Source: BBC [edited]

An infection linked to pigeon droppings was a "contributing factor" in the death of a child at a Glasgow hospital, it has been confirmed.

Scotland's health secretary ordered a review of the design of the Queen Elizabeth University Hospital after the deaths of 2 patients. The hospital has put infection control measures in place, and officials insist it is safe for patients and visitors. Jeane Freeman [Cabinet Secretary for Health and Sport in the Scottish Government, <https://en.wikipedia.org/wiki/Cabinet_Secretary_for_Health_and_Sport>] said there was an "absolute focus on patient safety".

At the weekend, it emerged that 2 patients who had died at the hospital had contracted a cryptococcal fungal infection, which is linked to pigeon droppings. Ms. Freeman said one of the patients was elderly and had died from an unrelated cause, but that the infection had been a "contributing factor" in the death of a child.

The likely source of the infection has been traced to a 12th floor [top floor] room containing machinery, which is not open to the public. Ms. Freeman said traces of excrement had been found in the room, where there was a small break in the wall, which was "invisible to the naked eye".

The health secretary spoke to the chief executive of NHS Greater Glasgow and Clyde and senior clinical staff to seek reassurance for patients at the hospital. She told MSPs: "In November [2018?] the bacteria _Cryptococcus_ [sic - _Cryptococcus_ is a fungus, not a bacterium] was identified in one patient. That patient was discharged for palliative care and sadly subsequently died in late December [2018?] - but _Cryptococcus_ was not a contributing factor in the death.

"In December [2018?], a post mortem of a child who had passed away confirmed that _Cryptococcus_ was both present and contributing factor in the death.

"I know I speak for the whole chamber when I say to both families that our thoughts and sympathies go to them."

The identification of 2 cases acted as the trigger for additional infection control measures at the hospital, including antifungal treatment for potentially vulnerable patients.

The health secretary said NHSGGC [National Health Service Greater Glasgow and Clyde] had kept patients and their families updated on an ongoing basis and would ensure they had the opportunity to discuss concerns with the senior clinical team.

Portable HEPA [high-efficiency particulate air] air filter units have been installed in specific areas as an additional precaution. There have been no further cases reported.

Ms. Freeman said: "There are 2 strands to this. The first is to deal with the current infection, which the board has done thoroughly; they've taken all the measures they should take. The other is the building itself. We need to be absolutely sure about the current state of this infrastructure - what do we need to fix, how has that arisen, and what are the lessons for our buildings elsewhere in the health service. That may be in aspects of the design that we weren't aware of at the time, it might be in aspects of the commissioning, it might be maintenance, or maybe a combination of all of those. That work has already been scoped out, and towards the end of this week I will agree with the board what external independent advice they will bring in to ensure that work is taken forward and that I'm assured that we do that as thoroughly and quickly as we possibly can."

Prof. Jason Leitch, NHS Scotland's national clinical director for healthcare quality and strategy, said he was "assured that this hospital is safe today". He said: "That doesn't mean there aren't issues around the building that need reviewed and looked into, both for this building and to learn for Scotland. But I can assure the families who are coming in tomorrow for chemotherapy or coming in this week for bone marrow transplants, that this hospital is safe."

On [Sun 20 Jan 2019], former health secretary Alex Neil called for an inquiry into the deaths as it emerged concerns about pigeon numbers at the hospital were raised in December [2018?]. Mr. Neil told BBC Scotland: "I think there has to be an outside inquiry by experts to find why this happened in the 1st place, secondly how it has been handled by the health board and, thirdly, what precautions need to be taken for the future."
=======================
[The news article above reports that 2 patients are believed to have acquired cryptococcal infection at Queen Elizabeth University Hospital in Glasgow, Scotland in late 2018 and are attributing these infections to pigeon droppings found in the 12th floor machine room. Both patients, one elderly and the other a child, died; underlying conditions clouded the exact cause of death in the elderly patient, but the infection was thought to have contributed to the death in the child. However, we are not told if either patient had HIV/AIDS or was a transplant-recipient, the usual predisposing conditions, or the type of cryptococcal infection they had, e.g., pulmonary or CNS, the most common clinical manifestations.

Cryptococcosis is a fungal disease caused by the encapsulated yeast _Cryptococcus neoformans_ or _C. gattii_. These 2 species have 5 serotypes based on antigenic specificity of the capsular polysaccharide; these include serotypes A, D, and AD (_C. neoformans_) and serotypes B and C (_C. gattii_). The ecologic niches for _C. neoformans_ and _C. gattii_ appear to be distinct. _C. gattii_ lives in the soil and areas on or around trees, such as the eucalyptus. _C. gattii_ is not associated with birds, whereas _C. neoformans_ is found in the accumulated droppings around roosting and nesting sites of birds, especially pigeons. Pigeons are not known to acquire symptomatic disease but can carry cryptococci on feathers, skin, in the crop and cloaca (common cavity into which the intestinal, genital, and urinary tracts open). _Cryptococcus neoformans_ is presumably the cryptococcal species isolated from the patients in the above news report.

Cryptococci can become aerosolized when dried bird droppings or contaminated soil are stirred up. People can become infected when they inhale aerosolized cryptococci, which primarily infect the lung, but may subsequently spread systemically via the bloodstream, especially to the central nervous system (where the organisms cause a basilar meningoencephalitis), skin, prostate, and medullary cavity of bones. Pulmonary _C. neoformans_ infection in immunocompetent persons is asymptomatic or resolves without specific therapy. Dissemination of _C. neoformans_ is more likely to occur in immunocompromised patients, especially with defective cell-mediated immunity, e.g., HIV/AIIDS patients or transplant recipients. However, the news report above fails to detail the type of cryptococcal disease in the 2 patients who died and if the 2 patients were known to have an immune defect.

Queen Elizabeth University Hospital (QEUH) is an acute care hospital located in southwest Glasgow, Scotland, UK. The hospital opened at the end of April 2015, with 1109 beds for adults, 256 beds for children and 2 major emergency departments, one for adults and one for children, in addition to buildings retained from the former hospital on its grounds.

Although the source of cryptococci at QEUH is said to be pigeon droppings found in the 12th floor machine room, the news report fails to detail the type of machinery housed on the 12th floor and how the 2 patients, who were likely housed in different areas of the hospital, were exposed to cryptococci in the pigeon droppings. Because clusters of patients with cryptococcosis from acute fungal exposure is said to be quite unusual (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4593437/>), genotyping the clinical isolates, if they match, will help determine if this is a common source outbreak and genotyping the environmental isolate will help confirm the source, if the genotypes of the clinical and environmental isolates match. - ProMED Mod.ML]

[HealthMap/ProMED map available at:
Scotland, United Kingdom: <http://healthmap.org/promed/p/280>]
Date: Sun 13 Jan 2019
Source: Kent Live [edited]

The number of scarlet fever and measles cases reported in Kent has hit worrying new levels in the past year [2018]. But perhaps more worryingly, cases of scarlet fever hit their highest level since available records began in 2010.

Scarlet fever is a very contagious, seasonal bacterial illness that usually presents with a sore throat, fever, headaches, and a rosy rash that generally starts on a patient's chest. It mainly affects children and the sickness usually peaks between December and May, meaning we are now in its prime season.

The figures show there [was] a record high of 1143 cases of scarlet fever reported in Kent in 2018, up from 362 in 2017. PHE [Public Health England] suggested that the increase in cases in scarlet fever was partly due to more infections, but also partly due to more awareness of the condition leading to better reporting.

Reported scarlet fever cases across the whole country hit a record 31 865 in 2018, up from 17 813 in 2017.

Two of the most severe, but rare, forms of invasive GAS [group A streptococcal] disease are necrotising fasciitis (occasionally described as "the flesh-eating bacteria") and streptococcal toxic shock syndrome. There were 663 cases of invasive group A streptococcal disease in 2018, the highest number since records began in 2010.  [Byline: Claire Miller, Ben Ashton]
======================
[For a discussion of scarlet fever, see my moderator comments in the prior ProMED-mail post: Streptococcus group A, scarlet fever - China: (HK) increased cases http://promedmail.org/post/20171214.5503881.

Kent, with a population of about 1.8 million residents in 2017, is a county in southeast England, parts of which are within the London commuter belt (<https://en.wikipedia.org/wiki/Kent>).

A map of England showing its counties can be found at

[HealthMap/ProMED map available at:
England, United Kingdom: <http://healthmap.org/promed/p/279>]
More ...

World Travel News Headlines

Date: Tue, 23 Apr 2019 13:01:09 +0200
By Ron LOPEZ

Porac, Philippines, April 23, 2019 (AFP) - Philippine rescuers raced Tuesday to reach some two dozen people still feared buried under a building near Manila that collapsed a day earlier in a deadly earthquake, as a powerful second tremor hit the nation.   The US Geological Survey put the second quake -- on the central island of Samar -- at 6.4 magnitude, stronger than the one that wrought significant damage Monday near the capital in the north.

The latest quake sent terrified locals fleeing into the streets, with images on social media showing cracked roads, crumbling church walls and shattered glass.   "No one started crying, but of course some panicked because it was really strong," said Rey Estrobo, a supervisor at a hotel in Borongan town, near the epicentre.   At the same time, the toll in Monday's quake rose to 16, with most of the fatalities in the worst-hit northern province of Pampanga, national disaster officials said.   More than 100 others were injured by falling rubble on Monday, including in Manila, according to police.

However, initial reports indicated relatively minor destruction in Samar given the strength of Tuesday's quake, which could be down to differences in ground composition.   "The damage is more pronounced if the houses and buildings are built on a foundation of soft soil," seismologist Myla Advincula told AFP, referring to Pampanga's soft sediment. "It enhances the shaking effect."

Scores of rescuers in the northern town of Porac spent Tuesday using cranes and jackhammers to peel back the pancaked concrete structure of a four-storey market building where the Red Cross said 24 people were unaccounted for.   "Every minute, every second is critical in this rescue," Cris Palcis, a volunteer rescue dog handler, told AFP. "Time is short for the people under the rubble so we have to be quick."

Pampanga Governor Lilia Pineda told journalists that rescuers could still hear at least one person trapped beneath the rubble, but the digging was proceeding delicately to avoid accidentally crushing the survivor.   Rogelio Pacelo was shopping with his wife and child when the market building collapsed around them, but they incredibly made it out almost without a scratch.   "I thought this only happens in movies. I thought that was the end of the world, it's our end," he told journalists. "I looked for a way out."   The quake also damaged several centuries-old churches which were crowded with worshippers in recent days as the majority-Catholic Philippines marked the Easter holiday.

- 'Ring of Fire' -
Father Roland Moraleja, who is based in Porac, said the 18th-century belfry of the Saint Catherine of Alexandria church collapsed in the quake.   "It was the only part left from the old church," he told AFP. "The historical value is now gone, but we are hopeful that it will rise again."   High-rise buildings in the capital swayed after the tremor struck Monday evening, leaving some with large cracks in their walls.

Thousands of travellers were stranded after aviation authorities shut down the secondary Clark Airport, which is located on the site of the former US military installation that lies about an hour's drive north of the capital.   It was still closed on Tuesday as officials assessed the heavy damage to the terminal building and some cracking on the air traffic control tower.

The quake was centred on the town of Castillejos, about 100 kilometres (62 miles) northwest of Manila, local geologists said.   Seismologists put Monday's tremor at 6.3 initially, but subsequently downgraded it to a 6.1 magnitude.   The Philippines is in the Pacific "Ring of Fire", an arc of intense seismic activity that stretches from quake-prone Japan through Southeast Asia and across the Pacific basin.
Date: Tue, 23 Apr 2019 10:08:27 +0200

Johannesburg, April 23, 2019 (AFP) - At least five people died early Tuesday in South Africa's coastal city of Durban after torrential rains triggered mudslides that crushed homes, emergency services said.   Among those killed were a six-month-old baby, a child of about 10 and two adults.   "Torrential rains damaged peoples houses (and) there were mudslides," Garrith Jamieson, spokesman for Rescue Care, told AFP.

"I can confirm five (deaths) but there are many more casualties," he said, adding there were unconfirmed reports of "multiple" deaths in other parts of the KwaZulu-Natal province.   Victims were either crushed to death by the mudslides or drowned in flood waters.   It was not immediately clear how many people were missing, but search and rescue operations continued on Tuesday.

Downpours have caused flooding in the southern and eastern parts of the country.   The military has been dispatched to help in rescue and evacuation efforts in some of the affected areas.   The South African Weather Services warned that more heavy rain was expected until Wednesday which could lead to more flooding and pose a threat to low-lying bridges and roads.
Date: Tue, 23 Apr 2019 06:03:52 +0200

Colombo, April 23, 2019 (AFP) - The toll from a string of deadly suicide bomb attacks in Sri Lanka has risen to 310, with several people dying of their injuries overnight, a police spokesman said Tuesday.   Around 500 people were wounded in the blasts, Ruwan Gunasekera said in a statement.   He added that 40 people were now under arrest in connection with the attacks, which Sri Lanka's government has blamed on a previously little-known local Islamist group, National Thowheeth Jama'ath.
Date: Mon, 22 Apr 2019 06:22:23 +0200

Melbourne, April 22, 2019 (AFP) - A father and son lifesaving team drowned while trying to save a tourist swept out to sea near one of Australia's most famous sights off the south coast, officials said Monday.   Ross Powell, 71, and his son Andrew, 32, died on Sunday after their lifesaving boat overturned in the surf during the rescue of a 30-year-old man near the Twelve Apostles, a set of 12 limestone stacks off the Victoria state coast.

The tourist, whose nationality or name has not been released, had been wading at the mouth of a river when he got into trouble.   He was winched from the water alongside a third lifesaver from the boat, who was seriously injured, by a rescue helicopter and taken to hospital, Victoria Police said. The bodies of the Campbells were found in the water shortly after.   The tragedy has rocked the small tourist town of Port Campbell where the two men came from, with Prime Minister Scott Morrison leading the tributes.   "Surf lifesavers are selfless & brave. We thank them all for their service & extend our deepest sympathies to Ross & Andrew's family & friends," Morrison tweeted Monday.

Surf Lifesaving Victoria president Paul James hailed the pair as heroes, and said the conditions had been rough and "not the place to be swimming".   "It's just terrible, it's heart-breaking," he told reporters in an emotional press conference of the death of the dairy farmers and experienced volunteer lifesavers.   "I understand the boat was operating in a two-metre (6.5 feet) swell, so a very high swell, and we know that it is very treacherous down there... These brave people, these heroes, have gone out to try and help."   Amber Griffiths, the partner of Andrew Campbell and who local media reported was pregnant with their second child, wrote about her heartbreak on Facebook.   "Today we lost two of the most beautiful people to ever exist -- always putting others first," she wrote.   "The love of my life, light of my life, father of my baby girl. My heart is broken. I miss you Andrew Powell."

Australia's beaches are among the island continent's biggest tourist drawcards, but can have strong rips and tides. Swimmers are advised to keep between areas bounded by flags and patrolled by lifesavers.   The area where the tourist was rescued is near high cliffs and said to have wild and treacherous seas.   The Twelve Apostles are giant rock stacks of varying heights in the Southern Ocean which began forming 20 million years ago when erosion gradually began whittling away the limestone cliffs of Port Campbell.
Date: Mon, 22 Apr 2019 01:55:28 +0200

Montreal, April 21, 2019 (AFP) - Flooding in eastern Canada forced the evacuation of more than 1,500 people while over 600 troops have been deployed in response, authorities said Sunday.   Warming weather over the Easter weekend has brought spring floods due to heavy rains and snowmelt from Ontario to southern Quebec and New Brunswick.

Authorities, who initially feared a repeat of catastrophic 2017 floods in Quebec, the worst in half a century, appeared more confident about the situation on Sunday.   "We are optimistic about the coming days," civil security spokesman Eric Houde told AFP.   "There will be significant floods but overall not at the level of 2017, except in certain areas like Lake St Pierre," a widening of the St Lawrence River in Quebec, he added.   "The big difference from 2017 is the level of preparation of municipalities and citizens."

Over the past several days, towns have mobilized volunteers and distributed hundreds of thousands of sandbags to erect barriers or protect houses in threatened areas.   The areas most affected were around Ottawa, and Beauce, a region south of Quebec City where nearly 800 people were evacuated. More than 1,200 homes had been affected by the flooding in Quebec by late Sunday.

The provincial governments of Quebec and New Brunswick asked for reinforcements from the military.    About 200 soldiers had deployed in Quebec by late Saturday, and 400 others near Ottawa, in Laval north of Montreal and in Trois-Rivieres between Montreal and Quebec City.   About 120 additional soldiers stood at the ready to be mobilized in New Brunswick.   On Saturday, the flooding claimed its first victim in the municipality of Pontiac, west of Ottawa: a man in his seventies who did not see that a bridge had been washed away, and plunged his car into the stream below.
Date: Mon, 22 Apr 2019 01:08:11 +0200

Montreal, April 21, 2019 (AFP) - The bodies of three world-renowned professional mountaineers -- two Austrians and an American -- were found Sunday after they went missing during an avalanche on a western Canadian summit, the national parks agency said.   American Jess Roskelley, 36, and Hansjorg Auer, 35, and David Lama, 28, of Austria went missing late Tuesday at Banff National Park. Authorities launched an aerial search the next day.   The three men were attempting to climb the east face of Howse Pass, an isolated and highly difficult route.

They were part of a team of experienced athletes sponsored by American outdoor equipment firm The North Face.   "Parks Canada extends our sincere condolences to their families, friends and loved ones," the agency said in a statement.   "We would also like to acknowledge the impact that this has had on the tight-knit, local and international climbing communities. Our thoughts are with families, friends and all those who have been affected by this tragic incident."

Roskelley was the son of John Roskelley, who was also considered one of the best mountaineers of his own generation.   Father and son had climbed Mount Everest together in 2003. At the time, the younger Roskelley was only 20 years old, and became the youngest mountaineer to climb the planet's highest mountain above sea level.   Auer and Lama, from Tyrol in Austria, were also considered among the best mountaineers of the times.
Date: Sun, 21 Apr 2019 23:36:53 +0200

Kano, Nigeria, April 21, 2019 (AFP) - Two people including a British aid worker have been shot dead and four tourists abducted in an attack by armed gunmen on a holiday resort in north-western Nigeria, police said on Sunday.   Police and aid agency Mercy Corps named the dead woman as Faye Mooney.   "Faye was a dedicated and passionate communications and learning specialist", Chief executive Neal Keny-Guyer said in a statement posted on social media, adding that colleagues were "utterly heartbroken".   Mooney had "worked with Mercy Corps for almost two years, devoting her time to making a difference in Nigeria", Keny-Guyer added.

Gunmen stormed the Kajuru Castle resort, 60 kilometres (40 miles) southeast of Kaduna City at 11.40 pm (2240 GMT) on Friday, Kaduna state police spokesman Yakubu Sabo told reporters.   The Briton "was gunned down from the hill by the kidnappers who tried to gain entrance into the castle but failed", Sabo said.   "They took away about five other locals but one person escaped," he said.   A Nigerian man believed by local residents in Kajuru to be Mooney's partner was also killed in the attack on the resort where a group of 13 tourists had arrived from Lagos, southwest Nigeria the police spokesman said.   In Kaduna and the wider northwest region, kidnapping for ransom has become an increasingly rampant, particularly on the road to the capital, Abuja, where armed attacks have thrived.

Kidnapping in Nigeria's oil-rich south, has long been a security challenge, where wealthy locals and expatriate workers are often abducted.   Yet the problem has escalated in northern areas too, like Kaduna where criminal gangs made up of former cattle rustlers have been pushed into kidnapping after military crackdowns on cattle theft.   Kajuru is also flash point in the deadly conflict over increasingly limited land resources in Africa's most populous country, between herders and farmers, predominantly across central and northern Nigeria.    The conflict has increasingly taken on ethnic and religious dimensions in the region, with the Fulani Muslim herders in conflict with Christian Adara farmers in Kajuru.

Tourists are rarely affected by the herder-farmer violence and Kajuru Castle resort has attracted many foreign and local visitors.   Yet police have struggled to thwart kidnappers in the region. The latest attack comes in a resort in northern Nigeria, particularly popular amongst foreign and well-to-do local tourists.   In January four western tourists -- two Americans and two Canadians -- were also abducted in Kaduna by gunmen in an ambush in which two of their police escorts were killed.   Earlier in April, recently re-elected President Muhammadu Buhari, ordered his most senior security chiefs to curb kidnapping in the region.
Date: Sun, 21 Apr 2019 09:55:31 +0200

Lilongwe, Malawi, April 21, 2019 (AFP) - Three people died after a landslide hit a village in the Rumphi district in northern Malawi, with at least five still missing Sunday and many others injured and hospitalised.   Rumphi police spokesperson Tupeliwe Kabwilo told AFP that incessant rains in the area led to the landslide early Saturday which washed away an entire village nestled between Mphompha Hills and Lake Malawi.   Among the dead are two boys aged 12 and 15 and a 35-year-old woman, according to police.   The missing persons, who are feared dead, include a one-year-old boy, two other boys aged six and 10 as well as two women aged 35 and 46.

A Rumphi district council official who was at the scene of the disaster told AFP that the affected area was inaccessible by road and it would be impossible to mount a rescue operation.   "Huge boulders rolled from the mountain and these are the ones that cause the biggest damage and if the missing victims are buried under these rocks, then we will need an excavator to move them." said council official Wakisa Mtete.    "But there is no access by road to the area so this is an impossible task. The boulders are so big that moving them by hand is not possible," Mtete said.    He added that it was also possible for some of the missing bodies to have been washed into the lake, in which case the bodies would resurface within the next two days.

Disaster management officer Alufeyo Mhango told AFP that government ministries were preparing to step in to transport heavy duty excavation equipment over the lake as soon as the weather cleared.   "We have been informed by government ministries that we should get ready to transport the equipment. But this will depend on whether we get a large boat for that and on whether the hailstorm stops because there could be a recurrence of the landslide," he said.   According to Mhango, Police officers, soldiers and emergency personnel are on site attending to the disaster.
Date: Sat, 20 Apr 2019 15:21:54 +0200

Butembo, DR Congo, April 20, 2019 (AFP) - The DR Congo army fought off an attack on a hospital by a rebel group, killing one militiaman, police said Saturday, in the latest assault on medical staff trying to rein in an Ebola outbreak in the east of the country.   Armed rebels from the Mai-Mai militia attacked Katwa hospital near the city of Butembo at around 3.40 am (0140 GMT), officers told AFP.   "We have resisted and repelled the attack even though these 'Mai-Mai' had a PKM machine gun," said Butembo police chief Colonel Paul Ngoma.   He said one rebel was killed and four captured.   The attack came a day after a WHO doctor, Richard Valery Mouzoko Kiboung, was shot dead in an assault by armed militiamen on Butembo University Hospital, according to the World Health Organization.   The WHO said the epidemiologist had been deployed to help combat Ebola in the region.

The attacks are the latest in a string of assaults on teams grappling with a near nine-month-old Ebola outbreak that has claimed almost 850 lives.   UN Secretary General Antonio Guterres on Friday condemned the Butembo University Hospital attack and called on Congolese authorities to bring the perpetrators to justice.   DR Congo declared its tenth outbreak of Ebola last August, in north-eastern North Kivu province, before the virus spread into the neighbouring Ituri region.   Local organisations have said the number of Ebola deaths is rising.    An updated toll by the health ministry, issued on Wednesday, said there had been 843 deaths since August.

WHO data from April 9 put the number of confirmed or probable cases at 1,186, of which 751 had been fatal.   The outbreak is the second deadliest on record, after the epidemic that struck West Africa in 2014-16, which killed more than 11,300 people.    Efforts to roll back the highly contagious haemorrhagic fever in DRC have been hampered by fighting but also by resistance within communities to preventative measures, care facilities and safe burials.    On March 9, an attack on a treatment centre at Butembo left a policeman dead and a health worker wounded. It was the third attack on that centre.   On February 24, a treatment centre in Katwa was set ablaze.
Date: Fri, 19 Apr 2019 16:36:32 +0200

Khokha, Yemen, April 19, 2019 (AFP) - Oxfam has warned that war-torn Yemen risks a "massive resurgence" of cholera, with around 195,000 suspected cases of the disease recorded so far this year.   "Fears that the world's worst cholera outbreak could be set for a massive resurgence are growing," the relief organisation said Thursday.   It said aid agencies were struggling to reach suspected cases.

In a statement, Oxfam pointed to "fighting and restraints on access, including checkpoints and permit requirements imposed by the warring parties", and warned the coming rainy season was likely to accelerate the spread of the disease.   The water-borne bacterial infection has claimed more than 3,000 lives in Yemen since the outbreak began in 2016, according to Oxfam.

At a medical centre for the displaced in the government-held western town of Khokha, Qassem Suleiman had brought his son Alaa for tests after a serious case of diarrhoea.   Doctor Wadah al-Tiri told AFP that several patients had been transferred to Aden while others had been treated at the Khokha centre.   He said a tent was to be set up for suspected cases.

The doctor said Yemen badly needed international aid to combat the epidemic.   The UN's humanitarian coordination office OCHA said last month that children under the age of five make up nearly a third of this year's cases.   The spike, which comes two years after Yemen suffered its worst cholera outbreak, was concentrated in six governorates including in the Red Sea port of Hodeida and Sanaa province, both combat zones, it said.

Yemen's conflict, which pits Iran-linked rebels against a regional pro-government alliance led by Saudi Arabia, has left some 10,000 people dead since 2015 and pushed millions to the brink of famine.   Aid groups say the actual death toll could be five times as high.    The war has created the perfect environment for cholera to thrive, as civilians across the country lack access to clean water and health care.