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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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Ghana

Ghana US Consular Information Sheet
23rd September 2008
DESCRIPTION:
Ghana is a developing country on the West Coast of Africa. The capital is Accra. Facilities for tourism are available in the population centers of the greater Accra regio
, Kumasi in the Ashanti region, and in the Cape Coast area of the Central region, but they are limited in the more remote areas of the country. Read the Department of State Background Notes on Ghana for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and visa are required, as is evidence of a yellow fever vaccination. Travelers should obtain the latest information and details from the Embassy of Ghana, 3512 International Drive NW, Washington, DC
20008; telephone (202) 686-4520. Consular services are also available at the Ghana Permanent Mission to the UN at 19 East 47th Street, New York, NY
10017, telephone (212) 832-1300, and the Honorary Consulate of Ghana, 3434 Locke Lane, Houston, TX, telephone (713) 960-8806. Overseas, inquiries should be made at the nearest Ghanaian embassy or consulate. Visit the Embassy of Ghana web site at www.ghanaembassy.org for the most current visa information.
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
Due to the potential for violence, U.S. citizens should avoid political rallies and street demonstrations and maintain security awareness at all times. There will be frequent political rallies across Ghana in the run-up to the presidential and parliamentary elections on December 7, 2008.

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Pick-pocketing, purse snatching, and various types of scams are the most common forms of crime confronting visitors. U.S. travelers have reported these types of theft at crowded markets, beaches, parks, and tourist attractions. Incidences of violent crime, such as armed robbery, are on the rise, including reports of armed robberies in expatriate residential areas. Victims who resist attackers run a high risk of serious physical injury. Take security measures, such as traveling in groups and avoiding travel at night. Avoid travel in communal taxis. Travelers who limit their display of jewelry and handle their cash discreetly reduce their vulnerability to crime. Travelers are advised to carry limited amounts of cash and only photocopies of key documents.

Use of credit cards in Ghana should be avoided if possible, as a growing number of travelers have been victims of credit card fraud.

In recent years, U.S. citizens have reported substantial financial losses from questionable transactions involving gold and other precious metals. The Government of Ghana maintains strict regulations on these natural resources. All agents must be licensed and all transactions must be certified. (See Special Circumstances below).

Perpetrators of business fraud often target foreigners, including Americans. Such fraud schemes are now prevalent throughout West Africa, including Ghana.
Please refer to the Country Commercial Guide for Ghana at http://www.buyusa.gov/ghana/en/doing_business_in_ghana.html, for further information.

American citizens frequently consult the Embassy regarding questionable business offers sent by people in Ghana. These are scams and typically begin with an unsolicited communication (usually by e-mail) from an unknown individual who describes a situation that promises quick financial gain, often by assisting in the transfer of a large sum of money or valuables out of the country.
A series of “advance fees” must be paid in order to conclude the transaction, such as fees to open a bank account or to pay certain taxes.
In fact, the final payoff does not exist; the purpose of the scams is simply to collect money from the victim.
The Embassy has also received reports of fraudulent charities soliciting contributions through the Internet or direct mail. If you receive such business offers or charity requests, carefully check them out before you commit any funds, provide any goods or services, or undertake any travel. Check with the U.S. Embassy in Ghana at telephone (233-21) 741-100 for an assessment of the offer’s credibility.

Another type of fraud is committed by persons claiming to live in Ghana or who claim to be traveling to Ghana on business, and who profess friendship or romantic interest over the Internet. Once a relationship has been established, the correspondent typically asks the American to send money for living expenses, travel expenses, or visa costs. Sometimes a “hospital” or “doctor” telephones to say that the friend has suffered an “accident” and needs immediate financial assistance to cover medical bills. There are other variations of this scam, but the common goal is to fraudulently obtain as much money as possible from the victim.
Americans have reported losing thousands of dollars through such scams. The anonymity of the Internet means that the victim cannot be sure of the real name, age, marital status, nationality, or even gender of the correspondent. In most cases reported to the Embassy, the correspondent turned out to be a fictitious persona created to lure Americans into sending money.

Visitors to Ghana should also be wary of overly-friendly locals offering tours, discounted lodging or other services that seem too good to be true.
Tourists are often targeted by touts and scam artists.
Some Americans have been the victims of false criminal accusations and have found themselves separated from time, money and trust as they seek to resolve these difficult situations.

For additional information, please see the Department of State brochure International Financial Scams.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
Ghana maintains a specialized Domestic Violence Victim Support Unit (DOVVSU) within the Ghana Police Service to assist victims of domestic violence, especially women and children. In addition to its law enforcement responsibilities, the Unit can refer victims to medical providers and counselors, as well as to community support services. Further information is available by following the DOVVSU link at www.ghanapolice.org
The local equivalent to the “911” emergency line in Ghana is: 191
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Ghana are limited, particularly outside Accra, the capital. Travelers should carry adequate supplies of any needed prescription medicines, along with copies of their prescriptions, the generic name of the drugs, and a supply of preferred over-the-counter medications. For information on avian influenza (bird flu), please refer to the Department of State's Avian Influenza Fact Sheet.
Documentation of Yellow fever vaccination is required upon arrival from all countries.
There are no HIV/AIDS entry restrictions for visitors to or foreign residents of Ghana.

Motor vehicle accidents, drownings and water-related accidents due to Ghana’s rough surf, muggings and other violent attacks, and the development of sexually transmitted diseases—including HIV—are
health and safety concerns that have been reported by U.S. citizens and can be at least partially mitigated by using common-sense safety precautions.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Ghana is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Primary roads are generally paved and well maintained. However, some side roads within major cities and roads outside of major cities are in poor condition. The road from Accra to the central region tourist area of Cape Coast continues to be the site of many accidents. Travel in darkness, particularly outside the major cities, is extremely hazardous, due to poor street lighting and the unpredictable behavior of pedestrians, bicyclists and farm animals, particularly goats and sheep. Aggressive drivers, poorly maintained vehicles and overloaded vehicles pose serious threats to road safety.

The safety standards of the small private buses that transit roads and highways are uncertain. Travelers are encouraged to consider this when making travel arrangements.

Travelers are routinely stopped at police checkpoints throughout Ghana, and vehicles and passengers may be searched. Drivers must possess an international driver’s license (available from AAA and the American Automobile Touring Alliance). Foreign nationals should carry documentation of their status, such as a passport and visa.

Please refer to our Road Safety page for more information. Visit the website of Ghana’s national tourist office at http://www.touringghana.com/default.asp and the national authority responsible for road safety at http://www.mrt.gov.gh/
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Ghana’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Ghana’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

Service provided by a number of regional air carriers is reported to be unreliable. The airlines may alter scheduled stops, cancel or postpone flights on short notice, and regularly overbook flights. Travelers may experience unexpected delays even after checking in. Passengers should get the required seat reconfirmation stamped on the ticket, have enough emergency funds for food and lodging in case of unexpected delays, and arrive at the airport at least two hours before the scheduled departure time.

SPECIAL CIRCUMSTANCES:
Effective July 1, 2007, the Government of Ghana redenominated the local currency, the cedi, introducing new banknotes (Ghana Cedi) and coins (Ghana Pesewa). 10,000 cedis = 1 Ghana Cedi = 100 Ghana Pesewas. The old cedi was taken out of circulation on December 31, 2007, and as of January 1, 2008, can be converted only at commercial banks or the Bank of Ghana. Travelers should be alert to persons who may try to defraud them with the old and new bills. The Government of Ghana established a web site in 2007, www.ghanacedi.gov.gh, to inform the public about the redenomination exercise. The web site includes a useful currency converter.

Visitors arriving or departing Ghana with more than $5,000 in cash are required to declare the amount at the border. Currency exchange is available at most banks and at licensed foreign exchange bureaus, but currency transactions with private citizens are illegal. The Government of Ghana also prohibits departing travelers from carrying more than 5,000,000 cedis (500 Ghana Cedis) out of the country. Ghanaian currency must either be spent or exchanged before departure, or it will be confiscated.

Strict customs regulations govern temporary importation into or export from Ghana of items such as gold, diamonds and precious natural resources. Only agents licensed by the Precious Metals and Mining Commission, telephone (233-21) 664-635 or 664-579, may handle import-export transactions of these natural resources. Any transaction without the commission’s endorsement is illegal and/or fraudulent. All transactions must be completed through the commission at the price set daily by the London exchange. Any transaction that discounts this price, or includes a previously negotiated price, is either illegal or fraudulent. Export of gold dust is rare as it encourages dangerous and environmentally destructive practices, and transactions involving the export of gold dust are probably fraudulent. Attempts to evade regulations are punishable by imprisonment. It is advisable to contact the Embassy of Ghana in Washington, DC, or one of the Ghanaian consulates in the United States, for specific information regarding customs requirements.

In rare instances, visitors arriving in Ghana with sophisticated electronic equipment (video cameras and laptop computers) may have to deposit 17.5 per cent of the item's value with the Customs and Excise office at the airport. To get the deposit refunded, visitors must apply to the Customs and Excise Office in central Accra 48 hours before departure.

Taking pictures near sensitive installations, including military sites and some government buildings, is prohibited. These sites are not always clearly marked and application of these restrictions is subject to interpretation. Permission may be obtained from Ghanaian security personnel. Permission should also be obtained before photographing anyone in uniform (e.g., police officers and military officers). In some cases, film and cameras have been confiscated. For security reasons, taking photographs of the U.S. Embassy is also prohibited.

It is strictly prohibited to wear any military apparel such as camouflage jackets or trousers, or any clothing or items that may appear military in nature.

Please see our Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Ghana laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Ghana are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.
REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Ghana are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Ghana. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located at No. 24 Fourth Circular Road, Cantonments, Accra; telephone (233-21)741-000. The public entrance to the Consular Section is No. 19 Fifth Link Road, Cantonments, Accra; telephone (233-21) 741-100; fax (233-21) 741-362 or 741-426; after-hours (233-21) 741-775.
*

*

*
This replaces the Country Specific Information for Ghana dated February 21, 2008, to update sections on safety and security, crime, information for victims of crime, and medical facilities and health information.

Travel News Headlines WORLD NEWS

Date: Sat 3 Nov 2018
Source: Ghana Web [edited]
<https://www.ghanaweb.com/GhanaHomePage/health/Doctors-announce-Apollo-outbreak-in-Tamale-697640>

A new surge of the contagious viral eye disease known [locally] as "apollo" or haemorrhagic conjunctivitis has been confirmed by doctors at the Tamale Central Hospital in the northern regional capital. Apollo is an infection caused by the Coxsackie virus and presents with painful swollen red eyes, purulent discharges and headache, and affects the lining of the eyelids and eyeball. It usually affects both eyes but may affect one eye and later spread to the other. The disease affects people of all ages, particularly those in crowded living conditions (i.e., homes, schools, daycare centres, and work places) and those who engage in poor handwashing practices.

Apollo is spread by contact with the hands, towels, face cloths, goggles and other surfaces exposed to secretions that contain the virus. The symptoms of apollo include sore eyes, feeling of grittiness or burning, redness, watery discharge, swelling of eyelids and light sensitivity. The disease has damaged eyes of many people since its last outbreak 7 years ago in the country. A report of the outbreak has been issued by the senior optometrist of the hospital, Dr. Daniel Opoku, to the National Health Directorate in the region. The report said the hospital had received an increasing number of cases of the disease since last month [October 2018], without specifying a figure.

The statement also confirms some of the hospital staff have been affected in the outbreak and have been asked to visit the eye clinic for treatment. The hospital staff have been cautioned to be careful in their contact with patients and their folders. The staff have also been advised to practice proper hand hygiene to avoid being infected. The Ophthalmological Society of Ghana (OSG) in the region has not commented on the report, and there have not been any comments from the Red Cross Society. The Regional Health Service has confirmed the report but said the situation is being contained.
===========================
[Acute haemorrhagic conjunctivitis (AHC) was 1st described in Ghana in 1969 [1]. Its appearance coincided with the 1st Apollo moon landing, prompting the Ghanaians to give it the name Apollo 11 disease [2]. The etiological agent in this outbreak was identified as enterovirus 70 (EV70) [2, 3]. In the following year [1970], an outbreak of apollo was described in Singapore [4]; however, in this case, the cause was determined to be a Coxsackie virus A24 variant (CVA24v) [5].

Since then, numerous reports of AHC have emerged from across the world, associated with either EV70 or CVA24v. These 2 viruses are now recognized as the primary agents of AHC [6]. ... AHC usually resolves without sequelae, although secondary corneal infection has been reported after treatment with topical steroids [8].

References
1. Chatterjee S, Quarcoopome CO, Apenteng A. Unusual type of epidemic conjunctivitis in Ghana. Br J Ophthal 1970;54:628-630.
2. Kono R. Apollo 11 disease or acute hemorrhagic conjunctivitis: a pandemic of a new enterovirus infection of the eyes. Am J Epidemiol 1975;101:383-390.
3. Mirkovic RR, Kono R, Yin-Murphy M, et al. Enterovirus type 70: the etiologic agent of pandemic acute haemorrhagic conjunctivitis. Bull World Health Org 1973;49:341-346.
4. Mirkovic RR, Schmidt NJ, Yin-Murphy M, Melnick JL. Enterovirus etiology of the 1970 Singapore epidemic of acute conjunctivitis. Intervirology A 1974;4:119-127.
5. Line KH, Yin-Murphy M. An epidemic of conjunctivitis in Singapore in 1970. Singapore Med J 1971;12:247-249.
6. Wright PW, Strausss GH, Langford MP. Acute hemorrhagic conjunctivitis. Am Fam Phys 1992;45:173-178. …
8. Vajpayee RB, Sharma N, Chand M, et al. Corneal superinfection in acute hemorrhagic conjunctivitis. Cornea 1998;6:614-617. Excerpted from Burr SE, Sillah, Joof H, et al. An outbreak of acute haemorrhagic conjunctivitis associated with coxsackievirus A24 variant in The Gambia, West Africa. BMC Res Notes 2017;10:692. - ProMED Mod.LK]
 
[HealthMap/ProMED-mail map:
Ghana: <http://healthmap.org/promed/p/53>]
Date: Thu, 20 Sep 2018 22:11:23 +0200

Accra, Sept 20, 2018 (AFP) - At least 34 people have died in northern Ghana during flooding caused by heavy rains and waters spilling from a dam in neighbouring Burkina Faso, relief agency officials said Thursday.   Bagre Dam is located on the White Volta river that begins in Burkina Faso and which converges with the Black Volta downstream and feeds into Lake Volta in southern Ghana.  The authorities open the dam's spillways during annual rains, but the excess volumes of water regularly flood communities along the rivers.

People living along the White Volta have been urged to stay away from its banks.Others have been told to move to higher ground.   Seji Saji, deputy head of Ghana's National Disaster Management Organisation, said the situation was under control and teams were working flat out to reach those affected.   "In all we have on record 34 deaths and two people missing. The affected people are over 52,000 and we are still assessing the situation," he added.   "All these happened during the time that the river overflowed its banks but the rate of spillage has reduced considerably and fortunately since last week and this week there has not been any heavy rainfall."

Ghana's President Nana Akufo-Addo and his government have been criticised for not visiting victims of the floods.  Aid agency Oxfam's inequality programmes and campaign manager in Ghana, Zakaria Sulemana, said the situation required "high-powered political attention".   "People want to hear the president, in fact we should have seen the president visit the area to console them or better still initiate an action to ensure that this does not happen again," he added.   Saji said Vice-President Mahamudu Bawumia will be visiting flood victims this weekend.   In 1999, flooding in the Upper West, Upper East, Northern and Brong Ahafo and Volta regions of northern Ghana affected more than 300,000 people, according to NADMO.
Date: Wed 13 Jun 2018
Source: WHO, Regional Office for Africa [edited]

The World Health Organization (WHO) today [Wed 13 Jun 2018] congratulated Ghana for having eliminated trachoma as a public health problem, 2 decades after the World Health Assembly resolved to tackle the leading infectious cause of blindness. The announcement comes the day after a commitment from Pfizer, the manufacturer of Zithromax (azithromycin) to extend their donation programme for the antibiotic until 2025, if required, to finish the task of global trachoma elimination.

"It's been 20 years since the global health community committed to eliminating trachoma worldwide" said WHO Director-General, Dr. Tedros Adhanom Ghebreyesus. "Although there's more work to do elsewhere, the validation of elimination in Ghana allows another previously heavily-endemic country to celebrate significant success."

Ghana is the 1st country in WHO's African Region to achieve this milestone.

"This success is a result of a tremendous amount of hard work by thousands of health, education and development workers to improve the lives of individuals with trachoma and their families", said Mr. Kwaku Agyemang-Manu, Ghana's Minister of Health. "The Government of Ghana is enormously grateful to its staff and to the many partners that have joined forces with us to eliminate trachoma and the cycle of poverty it triggers."

The global trachoma community learnt a lot from Ghana's experience. Innovations pioneered there include the use of height-based dosing for azithromycin; systematic active case-searches for trichiasis involving door-to-door, community-by-community fieldwork; and, intensive counseling of patients found to have trichiasis with an offer of immediate surgery, which produced considerable improvement in surgical uptake.

"Success in Ghana is a result of the strong leadership at all levels, implementation of the full SAFE strategy right from the outset, strong collaboration between Ghana Health Service and its many partners, and integration at lower levels of programme delivery, including community ownership," said Dr. Matshidiso Moeti, WHO Regional Director for Africa. "Hearty congratulations are deserved for this achievement."

Trachoma: Ghana's story
-----------------------
Trachoma was identified in the 1950s as the most important cause of blindness in Ghana. By the 1990s, the disease was known to persist as a significant public health problem in the Northern and Upper West Regions. There were about 2.8 million people at risk of trachomatous blindness nationally, with an estimated 13 000 people suffering from trichiasis. In 2000, the Ministry of Health and Ghana Health Service set up a national Trachoma Elimination Programme.

Ghana's Trachoma Elimination Programme implemented the WHO-recommended elimination strategy, SAFE, which comprises Surgery for trichiasis, Antibiotics to clear infection, Facial cleanliness, and Environmental improvement to reduce transmission.

Trichiasis surgery was provided at no cost, a critical Ghana Health Service decision reflecting the socioeconomic disadvantage of people with trichiasis and the impact of the condition on future earning potential.

Azithromycin, donated by Pfizer through the International Trachoma Initiative, was distributed with support from FHI 360 (using funds from the United States Agency for International Development), The Carter Center, Sightsavers and other organizations.

Facial cleanliness was promoted through community events, dramas, the school health education programme, radio messages and radio clubs. Environmental improvement was coordinated by Ghana's Community Water and Sanitation Agency.

The disease
-----------
Trachoma, a devastating eye disease caused by infection with the bacterium _Chlamydia trachomatis_, is spread through contact with infective eye or nose discharges, either directly from person to person, or mediated by flies. Active (inflammatory) trachoma occurs as a result of infection, and is common among preschool-aged children. Women are blinded up to 4 times as often as men, mainly due to their close contact with infected children. Transmission is associated with poor sanitation and hygiene, which increase the availability of eye discharges and encourage the breeding of flies.

GET2020
-------
In 1996, WHO launched the WHO Alliance for the Global Elimination of Trachoma by the year 2020 (GET2020). With other partners in the Alliance, WHO supports country implementation of the SAFE strategy and strengthening of national capacity through epidemiological assessment, monitoring, surveillance, project evaluation and resource mobilization. Elimination of trachoma is inexpensive, simple and extremely cost effective, yielding a high rate of net economic return.
------------------------------------------
Communicated by:
Dr. Anthony Solomon MBBS, DTM&H, PhD, PGCAP, FHEA, FRCP
Medical Officer, Neglected Tropical Diseases
Department of Control of Neglected Tropical Diseases
World Health Organization
Switzerland
========================
[ProMED-mail thanks Dr. Anthony Solomon for this submission. Dr. Solomon comments: "I'm delighted to share news of the validation of elimination of trachoma in Ghana - the 1st country in WHO's African Region to reach this mark."

For a discussion of trachoma, please see my moderator comments in a prior ProMED-mail post Trachoma - Nepal: WHO, eliminated as a public health problem http://promedmail.org/post/20180522.5810321.

HealthMap/ProMED-mail map of Ghana can be seen at
Date: Tue, 15 May 2018 12:48:37 +0200
By Stacey KNOTT

Obuasi, Ghana, May 15, 2018 (AFP) - Bismark Owusu moves food and bowls from a bedroom and covers clothes and furniture with a large sheet before mixing a mosquito-killing chemical with water in his spray pack.   He then puts on head-to-toe safety gear, straps the pack to his back and methodically sprays the walls, windows and corners of the room.   Owusu's visit to Domeabra, a small community in the Obuasi area of the Ashanti region in central Ghana, is his latest stop in the country's fight against malaria.

The death of two of his friends from the disease spurs him on. "Why wouldn't I help if others are dying? I am here today helping to eradicate this deadly malaria," he told AFP.   Malaria, which is spread to people through the bites of infected female mosquitoes, is one of the world's deadliest diseases.   According to the World Health Organization, there were 216 million cases of malaria in 91 countries across the world in 2016 and 445,000 deaths.   Most of those cases and deaths  -- about 90 percent -- were in sub-Saharan Africa.

In Ghana, which is home to some 28 million people, there were 4.8 million cases and 599 deaths last year, a marked drop from the 2,200 who died in 2011.   But with global concern that the fight against malaria has reached a plateau, African governments and development agencies are looking at new ways to step up the fight.   That includes preventative measures such as distribution of insecticide-treated mosquito nets and developing a vaccine against the disease but also indoor spraying.   Ghana is the first on the continent to introduce the large-scale use of a new "third generation insecticide" against mosquitoes, which have developed a resistance to other chemicals.

- 'Intelligent insects' -
As Ghana's rainy season approaches, when malaria cases increase, Owusu and his colleagues at the non-profit organisation AGALMal are working flat out.   The organisation grew out of a social initiative by global mining firm AngloGold Ashanti and has a laboratory in the grounds of an old mining site in Obuasi.   There, tiny mosquito pupae dart around in water in a white plastic container in a lab. 

Soon they will transform into mosquitoes and be studied by scientists. Technologist Paul Osei-Bonsu said chemical resistance was a major issue for the spraying programme.   If a population of mosquitoes is sprayed and just one survives and reproduces, the resistance will be passed on, he explained.   "If you use the same spray over time you will have 90 percent of the population not dying," he added.

Programme director Samuel Asiedu says mosquitoes are "intelligent insects", so the new chemical -- SumiShield 50WG -- should be more effective when rotated with others.   In 2006, after the first two years of the indoor spraying, the hospital in Obuasi saw a 75-percent decrease in malaria cases.    That led to the programme being expanded with additional support from global health initiative Unitaid and the Global Fund partnership.

Currently, the indoor spraying programme targets the homes of 1.2 million people.   "We are anticipating other chemicals to come on board by the end of the year so we can be rotating the use of chemicals to prevent resistance development," said Asiedu.   Unitaid project director David McGuire said he hoped the scheme "will convince donors and national governments to increase their investment in this life-saving intervention".

- 'Peace of mind' -
Keziah Malm, who manages the national malaria control programme at the Ghana Health Service, says the new WHO-approved spray is considered safe and has been tested internationally and locally.   It will be used in Obuasi and Ghana's far north -- all of the Upper West region and three districts in the Upper East -- which are high-risk zones for malaria.

Local communities still need to be convinced about the benefits of having their homes sprayed. But Asiedu says only a handful of people refuse.   Sprayers themselves also speak to households about the work and the risks to health from the disease, which can lead to severe illness and death if not treated within 24 hours.   "If I go to the whole house and someone does not want it I have to sit the person and let them know the importance of the spraying because malaria kills," said Owusu.    "It's very important we all understand that malaria is a killer. We have to eradicate it and kick it out of Obuasi and the nation as a whole."

During the course of his work, he's found everyone has a story about the disease.   "I sprayed a full house and the owner was telling me her son died some years go from malaria. He would be 18 years today. She was crying bitterly," he added.   Children under five and pregnant women are considered most vulnerable to malaria.   Seamstress Victoria Awuah lives in an eight-room house some 30 minutes from the lab.   She is seven months pregnant and doesn't need much persuasion to have her room sprayed.   "The spraying really helps. It helps us so that we don't get sick, give us peace of mind and rid this area of all these insects," she added.
Date: Thu 1 Mar 2018
Source: Graphic Online [edited]

The Ghana Health Service (GHS) has confirmed the 1st recorded case of Lassa fever in the country at Tema General Hospital. Dr Anthony Nsiah-Asare, the director-general of the Ghana Health Service, who was speaking to the media in Accra on Thursday [1 Mar 2018], said one person has been confirmed dead from Lassa fever.

Lassa fever is transmitted to humans via contact with food or household items contaminated with the urine, saliva faeces, and blood of infected rodents.

The confirmation, Dr Nsiah-Asare said, followed a test conducted by the Noguchi Memorial Institute for Medical Research. He said that, currently, all the frontline staff at the hospital that handled the patient before he died were being screened, while further investigations to trace the background and all contacts of the deceased were being pursued to prevent the spread of the virus. He called on the public to be extremely cautious of rodents and maintain good hygiene. He also urged the public to report any suspected case of the disease.

The GHS in February 2018 issued an alert of the likelihood of an outbreak of Lassa fever in the country. The disease is said to have already affected several countries in West Africa with, over 300 cases and 31 deaths in Nigeria.

The GHS recommended the following to all health workers and institutions:

1. Surveillance on Lassa fever, and acute hemorrhagic fevers in general (using case definitions), should be enhanced.
2. Suspected cases of Lassa fever should be managed in specific isolation conditions.
3. Health workers should adhere to regular infection prevention and control (IPC) measures to prevent and protect against possible nosocomial transmission.
4. Blood samples from suspected case(s) should be taken and safely packaged and sent to Noguchi Memorial Institute for Medical Research (NMIMR) for laboratory investigations.
5. All levels (national, regional, districts and facilities) are requested to update their preparedness and response plans for Lassa fever and VHF in general, sensitize the respective staff, and create necessary public awareness.

Lassa fever [LF] is an acute viral haemorrhagic fever illness which is endemic in West Africa. The incubation period is 6-21 days. The onset of LF illness is often gradual, with non-specific signs and symptoms and commonly presents with fever, general weakness, and malaise at the early onset. After a few days, headache, sore throat, muscle pain, chest pain, vomiting, diarrhoea and abdominal pain may follow. Severe cases may progress to show facial swelling, and bleeding tendencies (from mouth, nose, vagina or gastrointestinal tract), and low blood pressure. Shock, seizures, disorientation, and coma may be seen in the late stages. Complications include: deafness, transient hair loss, and gait disturbance may occur during recovery. About 80 per cent of Lassa fever infections are mild or asymptomatic.

- Lassa fever virus is transmitted to humans via contact with food or household items contaminated with the urine, saliva faeces, and blood of the rodent (Multi-mammate rat).
- Person-to-person infections and laboratory transmission can also occur, particularly in hospitals lacking adequate infection prevent and control measures.
- The disease is endemic in the rodent population in parts of West Africa, and the multi-mammate rat serves as reservoir for the virus.
- Lassa fever is known to be endemic in Benin, Guinea, Liberia, Mali, Sierra Leone and parts of Nigeria, but probably exists in other West African countries as well.
- Ghana recorded the 1st confirmed case(s) in 2011 in 2 districts, one each in Ashanti and Eastern regions, then confirmed outbreaks of Lassa fever (see Lassa fever - Ghana: (AH, EP) susp. http://promedmail.org/post/20111220.3642).
- Early use of [Ribavirin] (within 7 days of disease onset), supportive care with re-hydration, and symptomatic treatment improve survival.
- There is no effective vaccine for the disease at the moment.  [byline: Seth J Bokpe]
======================
[Lassa fever has been active in several West African countries this year [2018], including Nigeria, Liberia ex Guinea, and Benin ex Nigeria, so it is not surprising that a case has been diagnosed in Ghana. Interestingly, this was predicted previously. In commenting on the 2011 cases in Ghana, the late Mod.CP commented that Lassa virus infection had not been recorded previously in Ghana, but the lesser prevalence of Lassa fever in Ghana was predicted by a spatial-climatic analysis of Lassa fever data from human cases and infected rodent hosts in West Africa during the period 1965-2007 (See Risk maps of Lassa fever in West Africa. PLoS Negl Trop Dis. 2009;3(3):e388) <http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0000388;jsessionid=A18CA8161C084054F4225595CF9E71CB> and also the ProMED-mail archived report: Lassa fever, predictive maps - West Africa http://promedmail.org/post/20090428.1605).

Halting the acquisition of Lassa fever virus infection at its source -- at the village level -- is not easy. As noted previously, getting local people to understand that virus transmission to humans occurs when people are in contact with the reservoir rodent host, the multimammate mouse (in the genus _Mastomys_) or its excreta can be difficult. Preventing this contact requires understanding that leads to action. Rodent control and prevention of contact with rodent excreta have to be undertaken at the village level with individual households. This requires an extensive and continuous public education effort. Transmission of the virus also occurs in health facilities when personal protective equipment is not employed and barrier-nursing practices are not adequate to protect staff from blood and secretions of infected patients. Although no vaccine is available, Ribavirin has been used to successfully treat patients and is most effective if patients are treated early in the course of infection.

Images of the mastomys mouse, the rodent reservoir of Lassa fever virus, can be seen at

[HealthMap/ProMED-mail map of Ghana:
More ...

World Travel News Headlines

Date: Fri, 19 Apr 2019 04:57:44 +0200
By Fran BLANDY

Udier, South Sudan, April 19, 2019 (AFP) - By the time he was brought into the remote clinic in northeastern South Sudan, two-year-old Nyachoat was already convulsing from the malaria attacking his brain.   After being given medication he lies fast asleep, naked and feverish, attached to a drip, his anxious mother sitting on the bed next to him.   Nyachoat could be saved, but others are not so lucky.   In South Sudan mind-bending horrors abound of war, ethnic violence, rape, hunger and displacement.

But for civilians living in the shadow of conflict, the greatest danger is often being cut off from health services, whether due to violence or lack of development in the vast, remote areas that make up much of the country.   According to the International Committee of the Red Cross (ICRC), which supports the tiny clinic where Nyachoat is recovering in Udier village, 70 percent of all illness deaths are due to easily treatable malaria, acute watery diarrhoea and respiratory infections.   In case of more serious illness there is "no place" to go, said Nyachoat's 22-year-old mother Buk Gader.

A study by the London School of Hygiene and Tropical Medicine (LSHTM) last year showed almost 400,000 people had died as a result of South Sudan's nearly six-year war.   Half of these were due to violent deaths, and half because of the increased risk of disease and reduced access to healthcare as a result of the conflict.   ICRC health field officer Irene Oyenya said the Upper Nile region was particularly affected.   "There were (aid) organisations which were supplying primary healthcare, but then during the war, most of the organisations got evacuated" and pulled out of the country, she said.

- Blocked by swamps -
Udier is a village with a dirt airstrip whose sun-baked sand, which when not used by twice weekly ICRC flights bringing medicine and supplies, serves as a football pitch for youths. It is also a pedestrian highway for those who come from far flung huts and cattle camps to market.   In the tiny market, there is little fresh food available. Villagers can buy red onions or sit for a strong Sudanese coffee, infused with ginger, while in the dry season nomadic Falata herdswomen in flowing dresses sell milk from their cattle.   A brick building next to the airstrip, its roof long blown off in a storm, is the village school, but for several days in a row no teacher shows up.   In the surrounding villages, women are hard at work mudding their huts and re-thatching the roof in anticipation of the rains to come within weeks.

When they do come, swelling the swampy marshlands and rivers for miles around, roads will become impassable.    It becomes "difficult for young children to swim or women or men to carry patients to reach here," said Oyenya.   Marginalised for decades prior to independence from Sudan in 2011, and engulfed in war since 2013, South Sudan has seen little development. The healthcare sector is one of many propped up by international aid organisations.   However, the country is also the most dangerous for humanitarian workers with around 100 killed over the past five years, according to United Nations figures. Dozens of organisations have been forced to pull out of areas they served due to the conflict.

The Upper Nile region, where Udier is situated near the borders of Sudan and Ethiopia, was wracked by conflict in 2017 as government forces waged a major offensive to seize the opposition-held town of Pagak.   The ICRC was forced to evacuate patients and staff from its hospital and health centre in the village of Maiwut which was looted, leaving "not even a needle on the ground", according ICRC's Oyenya.   Many relocated to Udier, which was spared from fighting.   A year later in 2018, angry protesters looted around 10 humanitarian agency compounds in the town of Maban, 72 kilometres (44 miles) north of Udier.   ICRC's head of delegation in South Sudan, James Reynolds, said a peace deal signed in September 2018 "has improved security, mobility, and access for humanitarian workers".   But fresh fighting in the southern Equatorias region "has made access to certain areas very difficult."

- Women bear the burden -
In opposition-held Udier, the clinic supported by the ICRC provides crucial healthcare support to the region, where like throughout South Sudan, maternal and child mortality is sky-high.   Every day a small group of patients sits outside under a fragrant Neem tree, waiting to be helped, some from nearby while others have walked for a day or two.   Oyenya says a major challenge is that women, who do all the heavy work and take care of up to 10 children, may delay bringing them to the centre in time. That can be deadly.

Sometimes the children come alone: a nine-year-old girl in a purple polka dot dress confidently tells Oyenya she is suffering from bloody diarrhoea and, she thinks, malaria. Her parents are nowhere in sight.   For anything more serious, such as pregnancy complications, blood transfusions and operations, the nearest hospital is in government-held Maban, a five-hour drive away or a three-day walk.   The other option is a three-day walk to Gambella in Ethiopia.   "They may reach there alive, or they may not reach there alive," said Oyenya.
Date: Fri, 19 Apr 2019 03:13:16 +0200
By Andrea PALASCIANO

Naftalan, Azerbaijan, April 19, 2019 (AFP) - Immersed up to her neck in a dark viscous liquid, Sulfiya smiles in delight, confident that the fetid substance will cure her painful condition.   Sulfiya, a Russian woman in her 60s, has travelled to Azerbaijan's north-western city of Naftalan in the hope that crude oil baths at a local sanatorium will end her years of suffering from polyarthritis, a disease affecting the joints.   "This is so pleasant," she enthuses, despite the reek of engine oil.

Her naked dip in oil heated to just above body temperature lasts 10 minutes, after which an attendant scrapes the brown oil off her skin and sends her into a shower.   The native of Russia's Tatarstan region said she and her friends "have long dreamed of coming" for treatment in Naftalan.   The petroleum spa resort in the oil-rich Caucasus country is a draw for visitors despite its proximity to Nagorny Karabakh, a region disputed between Azerbaijan and Armenia in a long-running armed conflict.

After 10 days of bathing in crude oil Sulfiya says she now feels "much better" and has even reduced her medication for the polyarthritis that she has had for 12 years.   "It is a gift from God," agrees 48-year-old Rufat, an Azerbaijani journalist and opposition party member who is undergoing treatment in the sanatorium called Sehirli, or "magic" in Azerbaijani.   Azerbaijan's vast oil deposits were discovered in the mid-19th century, making what was at the time part of the Russian Empire one of the first places in the world to start commercial oil production.

Oil exports to markets all over the world are the largest sector of Azerbaijan's economy, but the crude that comes from subsoil reservoirs in Naftalan is not suitable for commercial use.   Instead the local oil is used to treat muscular, skin and bone conditions as well as gynaecological and neurological problems.   According to a legend, which spa staff readily tell clients, the healing properties of Naftalan's "miraculous oil" were discovered by accident when a camel left to die near a pool of oil was cured.

The small town of Naftalan some 300 kilometres (185 miles) from the capital Baku became a popular health resort for Soviet citizens in the 1920s.   "In the past, when there weren't any hotels or sanatoriums, people would come to Naftalan and stay with locals," said one of the doctors at the Sehirli sanatorium, Fabil Azizov, sitting in her office under a portrait of strongman President Ilham Aliyev.   "But as time passed, sanatoriums were built and treatment methods developed."

- Controversial benefits -
Some specialists warn the method has dangerous side effects.   "Despite the stories of past cures, the use of crude oil for medicinal purposes has been condemned by Western doctors as potentially carcinogenic," former journalist Maryam Omidi wrote in a 2017 book published in Britain about Soviet-era sanatoriums.

In fact, the oil at Naftalan is almost 50 percent naphthalene, a carcinogenic substance found in cigarette smoke and mothballs that in large amounts can damage or destroy red blood cells.   But doctors and patients at Naftalan brush aside any misgivings and the sanatorium even has a small museum displaying crutches that once belonged to patients who have recovered from their illnesses.

- 'We heard gunshots' -
During its heyday in the 1980s, Naftalan would host more than 70,000 visitors a year.    But in 1988, a bloody war began with neighbouring Armenia for the control of Azerbaijan's separatist Nagorny Karabakh region, which unilaterally proclaimed independence from Baku in 1991.

The conflict claimed the lives of some 30,000 people from both sides and forced hundreds of thousands to flee their homes.   A 1994 ceasefire agreement ended hostilities, but the arch foes have yet to reach a definitive peace deal and there are frequent skirmishes along the volatile frontline.   During the war, the sanatoriums in Naftalan -- a few kilometres from the frontline -- were converted into hospitals for wounded soldiers and temporary accommodation for refugees.

Over the last two decades, the Azerbaijani authorities have worked hard to re-establish Naftalan's reputation as a health resort.    They resettled refugees in other regions, demolished decrepit Soviet-era sanatoriums and built brand-new tourist facilities.   Modern Naftalan is a blend of kitsch-looking high-end spas where a week's treatment costs some 1,000 euros, and modest sanatoriums where a week's treatment costs around 100 euros.   The simmering Karabakh conflict may be out of sight, but guests can still feel uncomfortably close to the military action.   During one of the deadliest recent bouts of fighting in April 2016, "we heard gunshots," said a member of staff at Naftalan's luxurious Garabag spa, adding quickly that "everyone stayed on."
Date: Fri, 19 Apr 2019 02:59:34 +0200

Montreal, April 19, 2019 (AFP) - Three world-renowned professional mountaineers -- two Austrians and an American -- were missing and presumed dead after an avalanche on a western Canadian summit, the country's national parks agency said Thursday.   American Jess Roskelley, 36, and Austrians Hansjorg Auer, 35, and David Lama, 28, went missing Tuesday evening in Banff National Park, according to media reports. 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, according to Parks Canada.   They were part of a team of experienced athletes sponsored by American outdoor equipment firm The North Face, the company confirmed to AFP.   Rescuers found signs of several avalanches and debris consistent with climbing equipment, Parks Canada said, leading them to presume that the climbers were dead.

Poor weather conditions have increased avalanche risks in the mountainous area on the border between Alberta and British Columbia, with the search halted for safety reasons.   It is unlikely the three men survived, John Roskelley, father of missing Jess Roskelley, told local media in the US state of Washington.   "This route they were trying to do was first done in 2000. It's just one of those routes where you have to have the right conditions or it turns into a nightmare. This is one of those trips where it turned into a nightmare," he told the Spokesman-Review.   Himself considered one of the best American mountaineers of his generation, John Roskelley climbed Mount Everest with his son in 2003, making then 20-year-old Jess Rosskelley the youngest person to have conquered the summit.
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: Thu, 18 Apr 2019 07:40:27 +0200

Taipei, April 18, 2019 (AFP) - A 6.0-magnitude earthquake jolted Taiwan on Thursday, the US Geological Survey said, shaking buildings and disrupting traffic.   In the capital Taipei, highrises swayed violently while some panicked school children fled their classrooms in eastern Yilan county, according to reports.      Local media said the quake had been felt all over the island and a highway connecting Yilan and Hualien was shut down due to falling rocks.    The quake struck at 13:01 pm (0501 GMT) at a depth of 19 kilometres (11.8 miles) in eastern Hualien county. There were no immediate reports of casualties.

The island's central weather bureau put its magnitude at 6.1.   The Japan Meteorological Agency warned people living near the coast could notice some effects on sea levels, but said there would be no tsunami.   "Due to this earthquake, Japan's coastal areas may observe slight changes on the oceanic surface, but there is no concern about damage," the agency said.   Hualien was hit by a 6.4 magnitude earthquake last year that killed 17 people.    Taiwan lies near the junction of two tectonic plates and is regularly hit by earthquakes.    The island's worst tremor in recent decades was a 7.6 magnitude quake in September 1999 that killed around 2,400 people.
Date: Thu, 18 Apr 2019 03:07:58 +0200

Canico, Portugal, April 18, 2019 (AFP) - Twenty-nine German tourists were killed when their bus spun off the road and tumbled down a slope before crashing into a house on the Portuguese island of Madeira.   Drone footage of the aftermath of the accident showed the badly mangled wreckage of the bus resting precariously on its side against a building on a hillside, the vehicle's roof partially crushed and front window smashed.

Rescue workers attended to injured passengers among the undergrowth where the bus came to rest, some of them bearing bloodied head bandages and bloodstained clothes, others appearing to be more seriously hurt.   Local authorities said most of the dead were in their 40s and 50s.   They were among the more than one million tourists who visit the Atlantic islands off the coast of Morocco each year, attracted by its subtropical climate and rugged volcanic terrain.   "Horrible news comes to us from Madeira," a German government spokesman tweeted after the crash.   "Our deep sorrow goes to all those who lost their lives in the bus accident, our thoughts are with the injured," he added.

German holidaymakers were the second largest group after British tourists to visit the islands -- known as the Pearl of the Atlantic and the Floating Garden in the Atlantic -- in 2017, according to Madeira's tourism office.    The islands are home to just 270,000 inhabitants.    Filipe Sousa, mayor of Santa Cruz where the accident happened, said 17 women and 11 men were killed in the crash, with another 21 injured.    A doctor told reporters another woman died of her injuries in hospital.   "I express the sorrow and solidarity of all the Portuguese people in this tragic moment, and especially for the families of the victims who I have been told were all German," President Marcelo Rebelo de Sousa told Portuguese television.   He said he would travel to Madeira overnight.

- 'Profound sadness' -
Portuguese Prime Minister Antonio Costa added on Twitter that he had contacted German Chancellor Angela Merkel to convey his condolences   "It is with profound sadness that I heard of the accident on Madeira," he wrote on the government's Twitter page.   "I took the occasion to convey my sadness to Chancellor Angela Merkel at this difficult time," he added.  The regional protection service in Madeira confirmed 28 deaths in the accident that happened at 6:30 pm (1730 GMT) Wednesday, while hospital authorities said another woman later died of her injuries.

The bus had been carrying around 50 passengers.   Regional government Vice President Pedro Calado said it was "premature" to speculate on the cause of the crash, adding that the vehicle was five years old and that "everything had apparently been going well".   Judicial authorities had opened an investigation into the circumstances of the accident, the Madeira public prosecutor's office told the Lusa news agency.   Medical teams were being sent from Lisbon to help local staff carry out post-mortems on the dead.
Tanzania - National. 11 Apr 2019

Tanzania on Thursday [11 Apr 2019] confirmed an outbreak of dengue fever, saying the business capital, Dar es Salaam, has reported 252 cases and Tanga has 55 diagnosed cases.
- La Reunion. 10 Apr 2019

From 800 confirmed cases the previous week, the dengue epidemic increased to 904 cases in the week.
<https://la1ere.francetvinfo.fr/reunion/dengue-barre-900-cas-confirmes-semaine-est-depassee-698934.html> [in French, trans. ProMED Corr.SB]

- La Reunion. 12 Apr 2019. Dengue La Reunion (French overseas territory): dengue cases near 5000 in Q1 2019. New transmission zones have been identified in Saint-Andre, Saint-Denis, Sainte-Marie, and Sainte-Suzanne. In addition, the number of hospitalizations is increasing with 25-30 recorded weekly.

- La Reunion. 27 Mar 2019. The circulation of the dengue virus continues at a sustained level, say the prefecture and the ARS. From 11-17 Mar 2019, 682 cases of dengue fever were confirmed. Since the beginning of the year [2019], 153 emergency room visits have been recorded and 80 patients have been hospitalized. In addition, 5 deaths have been reported since the beginning of 2019, of which 2 have been considered, after investigation, as directly related to dengue fever. The most active households are located at: the Saint-Louis River, Saint Louis, Saint Pierre, the Etang-Sale Cabris Ravine.
- Cook Islands. 12 Apr 2019

As of Wednesday [10 Apr 2019], the Ministry for Health has 18 confirmed and 12 probable dengue fever cases. This is a total of 30 cases compared to 24 previously identified.
- Taihiti (French Polynesia). 13 Apr 2019

DEN-2 confirmation of several autochthonous cases