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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: Tue, 30 Apr 2019 16:30:41 +0200
By Stacey KNOTT

Cape Coast, Ghana, April 30, 2019 (AFP) - Ghana on Tuesday rolled out the world's only proven malaria vaccine for infants as part of a landmark campaign against the deadly mosquito-borne disease, one week after Malawi became the first country to do so.   Malaria kills hundreds of thousands of people each year, mainly in Africa, and it is hoped a vaccine will bring down the toll.    Children are especially at risk, and babies were Ghana's first vaccine recipients Tuesday in the town of Cape Coast, 150 kilometres (90 miles) west of the capital Accra.   "I hope this will help us to be able to eliminate malaria, so Ghana can be a malaria-free country," said Justice Arthur, the doctor running the clinic.

The vaccines will be given to children between the ages of six months and two years, in a project run by Ghana's health ministry and the World Health Organization (WHO).   "I am really hopeful that the vaccine is going to help me and my family," said Abigail Aguanyi, a woman waiting to get her child, Blessing, vaccinated. Many of her family members had previously been stricken.   The vaccine, known by its lab initials RTS,S, has passed lengthy scientific trials which found it to be safe and effective at preventing about four in ten cases of malaria in infants -- the best ever recorded.   To achieve this level of partial protection, four successive doses must be administered on a strict timetable -- a challenge for rural Africa.

- 'Exciting' -
The rollout in Ghana, Malawi, and soon also Kenya, will seek to evaluate the vaccine's effectiveness as a complementary tool, augmenting -- but not replacing -- measures such as insecticide-treated bed nets and the use of sprays.   It will also test the feasibility of administering the four required doses in children in areas of the world with limited access to healthcare.   Data from the programme will inform a WHO policy on the broader use of RTS,S.   Malaria is spread to people by mosquitoes, which transfer the parasite while sucking blood from humans. RTS,S is effective against the Plasmodium falciparum parasite most prevalent in Africa.   In Ghana alone, there were 5.5 million confirmed cases of malaria last year, and many more suspected.

Worldwide, the WHO says malaria killed 435,000 people worldwide in 2017.    The number of cases climbed to 219 million in 2017, two million more than in 2016. Over 90 percent of cases occurred in Africa.   "This is an exciting and long-awaited step forward to fight malaria and its devastating effects on the most vulnerable," said WHO boss in Ghana, Owen Kaluwa.
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.
More ...

Turks and Caicos Islands

Turks & Caicos US Consular Information Sheet
November 17, 2008
COUNTRY DESCRIPTION:
The Turks and Caicos Islands are a British Overseas Territory comprising a small archipelago of eight major islands and numerous uninhabited keys, 500 mile
southeast of Miami.
Most tourist facilities are located on Providenciales ("Provo") Island.
The U.S. dollar is the unit of currency and the larger hotels and shops accept credit cards.
The U.S. Embassy in Nassau, Bahamas, has jurisdiction for consular matters in the Turks and Caicos.
ENTRY/EXIT REQUIREMENTS:
U.S. citizens do not need to obtain visas to visit the Turks and Caicos Islands.
All Americans traveling by air outside the United States are required to present a passport or other valid travel document to enter or re-enter the United States.
This requirement will be extended to sea travel (except closed-loop cruises), including ferry service, by the summer of 2009.
Until then, U.S. citizens traveling by sea must have either a WHTI-compliant document (such as a valid U.S. passport or passport card) or both a government-issued photo identification and a document showing their U.S. citizenship (for example, a certified U.S. birth certificate or certificate of nationalization).
Sea travelers should also check with their cruise line and countries of destination for any foreign entry requirements.
Applications for the new U.S. Passport Card are now being accepted.
The card may not be used to travel by air and is available only to U.S. citizens. Further information on the passport card is available at http://travel.state.gov/passport/ppt_card/ppt_card_3926.html and upcoming changes to U.S. passport policy can be found on the Bureau of Consular Affairs web site at http://travel.state.gov/travel/cbpmc/cbpmc_2223.html.
We strongly encourage all American citizen travelers to apply for a U.S. passport well in advance of anticipated travel.
American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

Visit the British Embassy web site at http://ukinusa.fco.gov.uk/en for the most current entry information, including any visa requirements.
Information about dual nationality or the prevention of international child abduction can be found on our website.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
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 United States and Canada, or for callers outside the United States and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

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

CRIME:
Petty street crime does occur.
Visitors should not leave valuables unattended in their hotel rooms or on the beach.
Visitors should make sure that their hotel room doors are securely locked at all times.
In the Turks and Caicos, carrying illegal/undeclared firearms or ammunition is a very serious crime, as is possession of illegal narcotics.

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 are 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.

The local equivalent to the “911” emergency line in the Turks and Caicos Islands is 999 or 911.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities are available but limited in the Turks and Caicos Islands.
There is a small public hospital on Grand Turk and a private clinic on Provo, which has a hyperbaric chamber.
Most serious medical problems require medical evacuation by air from the Turks and Caicos to the United States.

The Turks and Caicos Islands do not have a pathologist to perform services in cases of death.
Medical examiners from neighboring countries visit the island regularly to provide this service.
It can take up to two weeks for the Government of the Turks and Caicos Islands to release the remains of the deceased under normal circumstances, and severe weather during the hurricane season could delay the process even more.The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of the Turks and Caicos Islands.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s website at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) 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 the Turks and Caicos Islands is provided for general reference only, and may not be totally accurate in a particular location or circumstance. Driving in the Turks and Caicos Islands is on the left.
Traffic tends to be light, and the terrain is flat.
When entering roundabouts and other intersections without signs or traffic signals, drivers are required to give way to those on their immediate right.
Driving under the influence of alcohol is illegal, and drivers convicted of the offense may face fines, detention, or both.
Wild donkeys are a common sight and often walk on the roads, presenting a hazard to drivers, especially at night.
Road signs are not prevalent, but as there are few roads on the island, finding one's way with a tourist map is generally not a problem.
Drivers should be alert for unmarked hazards such as blind intersections or changes in road conditions.
Primary roads are generally drivable in both urban and rural areas.
Secondary roads are often unpaved, and have ruts and potholes.
Be aware that, in the event of a breakdown, roadside assistance is generally not available.
For emergencies, drivers may call 999 or 911 for police, fire, or medical assistance.
Visitors require a valid driver's license from their country of residence.
Safety of public transportation in the Turks and Caicos is generally good.
Most car and motor scooter rental agencies will not rent to anyone under the age of 21.
A government tax is levied on all car and motor scooter rentals (insurance is extra).Please refer to our Road Safety page for more information.
Visit the website of the country’s national tourist office at http://www.turksandcaicostourism.com.

AVIATION SAFETY OVERSIGHT:
Civil aviation operations in the Turks and Caicos Islands fall under the jurisdiction of British authorities.
The U.S. Federal Aviation Administration (FAA) has assessed the Government of the United Kingdom’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the UK’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa
SPECIAL CIRCUMSTANCES:
The importation of firearms to the Turks and Caicos is strictly forbidden without prior approval in writing from the Commissioner of Police.
U.S. citizens may contact the Turks and Caicos Customs Department at (649) 946-2867 for specific information regarding customs requirements. Please see our Customs Information.

The Turks and Caicos Islands, like all countries in the Caribbean basin, are vulnerable to hurricanes.
Hurricane season officially runs from June 1 to November 30, although hurricanes have been known to occur outside that time period.
Visitors to the Turks and Caicos Islands during hurricane season are advised to monitor weather reports in order to be prepared for any potential threats.
General information about disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov
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 Turks and Caicos laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in the Turks and Caicos 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 residing or traveling in the Turks and Caicos Islands 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 the Turks and Caicos Islands.
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 42 Queen Street, Nassau, The Bahamas.
It is next to the McDonald’s Restaurant on Queen Street and may be reached Monday-Friday at telephone (242) 322-1181 x4406; after-hours (242) 328-2206; fax (242) 356-7174.
The U.S. Embassy web site is http://nassau.usembassy.gov.
Office hours are from 9:00 a.m. to 11:00 a.m. and 1:00 p.m. to 3:00 p.m. Monday-Thursday; 9:00 a.m. to 11:00 a.m. Friday (except for U.S. and Bahamian holidays).
* * *
This replaces the Country Specific Information for the Turks and Caicos Islands dated March 14, 2008, without substantive changes.

Travel News Headlines WORLD NEWS

Date: 12 Jun 2017
Source: TC weekly News [edited]

The Ministry of Health is advising the public of an increase in the number of cases of conjunctivitis in the Turks & Caicos Islands [TCI].

Conjunctivitis, also called "pink eye," is defined as an inflammation of the conjunctiva and can be caused by viruses, bacteria, or an allergy. It can affect children and adults.

Viral conjunctivitis is typically caused by a virus that can also cause the common cold. A person may have symptoms of conjunctivitis alone or as part of a general cold syndrome like fever, a sore throat and runny nose.

Viral conjunctivitis is highly contagious; usually people catch it from touching something that has been in contact with an infected person's eye (e.g. door handle, towel or pillow case), and then that person touches his or her eyes.

Some of the most common symptoms of conjunctivitis are pink or red eyes; the eyes might secrete a gooey liquid or become itchy or burn, get stuck shut, especially when you 1st wake up. These symptoms tend to last for several days.

The ministry stated in a press release: "The treatment depends on the cause. When pink eye is caused by a virus, antibiotics will not help. You can use warm or cool compresses to relieve the pain and irritation in the eyes.

"Most cases of pink eye go away on their own without treatment, but it is best to see your primary care physician if you are experiencing these symptoms so that you can be treated properly.

"Simple hygiene measures can help minimise transmission to others. Adults or children with bacterial or viral conjunctivitis should not share handkerchiefs, tissues, towels, cosmetics, or bed sheets/pillows with uninfected family or friends. Hand washing is an essential and highly effective way to prevent the spread of infection. Hands should be wet with water and plain soap, and rubbed together for 15 to 30 seconds.

"Teach children to wash their hands before and after eating and after touching the eyes, coughing or sneezing. Alcohol-based hand rubs are a good alternative for disinfecting hands if a sink is not available."

Anyone with viral conjunctivitis should remain home from school and work to avoid spreading the virus to others.
================
[The report above does not specify any laboratory confirmation of the conjunctivitis cases.

Conjunctivitis can result from many causes, including viruses, bacteria, allergens, contact lens use (especially the extended-wear type), chemicals, fungi, and certain diseases. Viral conjunctivitis can be caused by the following viruses, with adenoviruses being the most common cause: adenoviruses, picornaviruses (particularly enterovirus 70 and coxsackievirus A24), measles virus, and several herpes viruses.

Viral conjunctivitis is highly contagious. Most viruses that cause conjunctivitis are spread through hand-to-eye contact by hands or objects that are contaminated with the infectious virus. Hands can become contaminated by coming into contact with infectious tears, eye discharge, faecal matter, or respiratory discharges.

Many of the viruses that cause conjunctivitis may be associated with an upper respiratory tract infection, cold, or sore throat. - ProMED Mod.UBA]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Mon 9 May 2016
Source: Outbreak News Today [edited]

Health officials on the Caribbean island group, Turks and Caicos (TCI), are reporting a significant increase in chickenpox [varicella] cases during the 1st 4 months of 2016.

As of the end of the week of 23 Apr 2016, a total of 327 cases have been reported for the year. Of these, 41 (13 percent) were reported by persons younger than 5 years old and 296 (87 percent) were reported by persons older 5 years old.

These cases were reported by TCI Hospital on Providenciales 234 (72 percent) and Grand Turk 5 (1 percent); with 28 cases in North Caicos and 60 (18 percent) cases in clinics in Providenciales. In summary, the majority cases are being reported from Providenciales (90 percent).

By comparison, in all of 2015, a total of 98 cases of chickenpox were reported by TCI Hospital in Providenciales.

Chickenpox is a common, usually benign childhood disease caused by the varicella-zoster virus (VZV), a member of the herpes family. This virus causes 2 distinct diseases; varicella (chickenpox) is the primary infection, and later when VZV reactivates, herpes zoster (shingles).

Chickenpox is highly contagious and is spread by coughing and sneezing, by direct contact, and by aerosolization of the virus from skin lesions. You can also get it by contact with the vesicle secretions from shingles.

The disease is characterized by fever and a red, itchy skin rash of that usually starts on the abdomen, back, or face and then spreads to nearly all parts of the body. The rash begins as small red bumps that appear as pimples or insect bites. They then develop into thin-walled blisters that are filled with clear fluid which collapse on puncture. The blisters then breaks, crusts over, and leaves dry brown scabs.

The chickenpox lesions may be present in several stages of maturity and are more abundant on covered skin rather than exposed. Lesions may also be found in the mouth, upper respiratory tract, and genitals.

Chickenpox is contagious from 1-2 days before the rash forms and continues until all the lesions are crusted over (usually about 5 days).

This disease is more serious in adults than in children. Complications of chickenpox are rare, but include pneumonia, encephalitis, and secondary bacterial infections.

Infection with this virus usually gives lifelong immunity, although 2nd attacks have been documented in immunocompromised people. The viral infection remains latent, and disease may recur years later as shingles.

The TCI Ministry of Health strongly advises persons affected with chickenpox to remain at home during their sick leave period to prevent further spread of this illness within the community and schools.  [Byline: Robert Herriman]
=====================
[Varicella-zoster virus, a member of the herpesvirus family is the causative agent for chickenpox. Humans are the only reservoir of the virus, and disease occurs only in humans. After primary infection as varicella (chickenpox), the virus remains dormant in the sensory-nerve ganglia and can reactivate at a later time, causing herpes zoster (shingles).

Varicella occurs worldwide. In temperate climates, varicella tends to be a childhood disease, with peak incidence among preschool and school-aged children during late winter and early spring. In these countries, less than 5 percent of adults are susceptible to varicella. In tropical climates, the highest incidence was described in the driest, coolest months; overall, infection tends to be acquired later in childhood, resulting in higher susceptibility among adults than in temperate climates, especially in less densely populated areas.

All people, including those traveling or living abroad, should be assessed for varicella immunity, and those who do not have evidence of immunity or contraindications to vaccination should receive age-appropriate vaccination. Vaccination against varicella is not a requirement for entry into any country (including the United States), but people who do not have evidence of immunity should be considered at risk for varicella during international travel.

Varicella vaccine contains live, attenuated varicella-zoster virus. Single-antigen varicella vaccine is licensed for people aged 12 months and older, and the combination measles-mumps-rubella-varicella (MMRV) vaccine is licensed only for children 1-12 years. CDC recommends varicella vaccination for all people aged 12 months and older without evidence of immunity to varicella who do not have contraindications to the vaccine: 1 dose for children aged 1-4 years and 2 doses for people aged 4 years and older. The minimum interval between doses is 3 months for children aged less than 13 years and 4 weeks for people aged 13 years and older. Contraindications for vaccination include allergy to vaccine components, immune-compromising conditions or treatments, and pregnancy. When evidence of immunity is uncertain, a possible history of varicella is not a contraindication to varicella vaccination. Vaccine effectiveness is approximately 80 percent after 1 dose and 95 percent after 2 doses.

(Excerpted and edited from

Maps of the Turks and Caicos Islands may be accessed at
and <http://healthmap.org/promed/p/48358>. - ProMED Mod.LK]
Date: 7 Jul 2014
Source: TC Weekly News [edited]

Pet owners are being cautioned about a tick disease which is becoming a problem in dogs in the Turks and Caicos Islands. Licensed veterinarian Mark Woodring said that the disease, babesiosis, can be transmitted by bites from ticks.

Infected dogs show a number of signs, including decreased appetite, weight loss, fever, an enlarged abdomen, and dark orange or yellow skin and urine. The disease causes the dog's red blood cells to be destroyed, leading to pale gums and fatigue due to anemia. All dogs, including potcakes, (the local indigenous dog of the islands) can be infected. Some breeds are more susceptible to infection, especially greyhounds and all pitbull breeds, both purebred and mixed.

Woodring said that this disease can develop in a dog without ticks after an infected dog bites him or her, even playfully. He said that an infected female will pass along the disease to her puppies before birth.

"Accurate testing for babesiosis can be done with blood sent to the US for DNA studies, but most cases in the TCI are diagnosed by experienced veterinarians based on signs and physical exam. Although the disease is treatable with antibiotics, not every dog responds."

Early treatment is best, but even then, the disease can be fatal. The veterinarian said that another problem is that since 2012, the antibiotics most commonly used to treat tick-borne diseases have tripled in cost.

"Some antibiotics are in very short supply worldwide, to the point of restricting veterinarians from even ordering the medication. Preventing babesiosis means treating dogs and their environments to limit tick exposure."

He said that many prescription and non-prescription flea and tick prevention medications as well as yard treatments like Diatomaceous Earth and chemical preparations are available.

"This can be a difficult, expensive and frustrating task, as ticks eventually can become resistant to most products. To stop the spread of babesiosis, infected dogs should be treated with a full course of antibiotics."

Even after a dog recovers, he or she may still carry the disease. Females who have had the disease, even healthy-appearing ones, should not be bred. Adopting puppies from previously infected dogs or dogs with an unknown infection history is risky. Puppies are more likely to die from it than adult dogs.

Woodring said that the good news is that dogs cannot transmit this to humans.
===============
[Canine babesiosis is a disease caused by the intra-erythrocytic protozoan parasites _Babesia canis_ and _Babesia gibsoni_. Babesiosis is transmitted by ticks to susceptible canine hosts. _Rhipicephalu ssanguineus_ is the most common tick vector in the United States. Splenectomized dogs, immunocompromised dogs and young dogs between the ages of 2 and 8 months are most susceptible to infection. Canine babesiosis occurs worldwide. Within the United States, it is most common in the southeast. Although canine babesiosis is considered uncommon in the U.S., it is of clinical significance due to its morbidity and mortality. It is an important differential when history and clinical signs are consistent with infection and other more common diseases have been ruled out.

Hemolytic anemia and hypotensive shock are typical clinical syndromes of infection. Hemolytic anemia results from direct erythrocyte damage by the parasite, and both intravascular and extravascular immune-mediated destruction of red blood cells. Infection can produce thrombocytopenia, the mechanism of which consists of immune-mediated destruction and sequestration in the spleen. Physical examination reveals splenomegaly, lymphadenomegaly, fever and, less frequently, lethargy, vomiting, hematuria, and icterus. Hypotensive shock results from the release and production of vasoactive amines and cytokines which produce vasodilation. It most often occurs in puppies with the peracute form of the disease. Death may occur and is seen most often in _B. gibsoni_ infections and in puppies affected with _B. canis_ and _B.gibsoni_. Chronic infections, subclinical carrier states and atypical canine babesiosis may also occur.

Infection with _B. canis_ or _B. gibsoni_ is definitively diagnosed by demonstration of the parasites on red cells. Blood smears may be stained with Diff-Quik or preferably Wright's or Giemsa stain.

The most effective drugs used in the treatment of canine babesiosis include diminazene aceturate, phenamidine isethionate, and imidocarb dipropionate, which are not available or approved for use in the United States. Treatment of canine babesiosis in the U.S. is, therefore, mostly aimed at treating signs. The majority of babesia cases diagnosed in dogs in the U.S. are caused by the less virulent strains of _B. canis_, and dogs frequently recover from these infections naturally with supportive therapy. Clindamycin has been successfully used to treat canine babesiosis and may be considered in refractory or more severe and virulent infections.

Prevention of canine babesiosis is mostly aimed at controlling the vector. It is an important aspect since treatment is not always successful. The environment should be treated to decrease tick numbers, dogs should be treated to control tick infestations, and ticks should be removed from parasitized animals as quickly as detected.

Recently, a vaccine which minimizes the severity of infection was developed. The vaccine is reported to be 70 to 100 percent effective in diminishing the pathologic effects which typically ensue upon infection. The vaccine is currently available in Europe where canine babesiosis is a more common life-threatening disease.

Blood transfusion poses a significant risk to recipient animals; therefore, it is recommended that donor animals be tested for infection with babesia organisms. Splenectomy prior to testing significantly improves the likelihood of finding organisms in a blood sample from an infected donor.

Portions of this comment were extracted from:

Turks and Caicos Islands, a British Overseas Territory, may be located on the interactive HealthMap/ProMED-mail map at <http://healthmap.org/promed/p/6007>. - ProMed Mod.TG]
Date: Mon 18 Mar 2013
Source: Turks & Caicos Weekly News [abbrev., edited]
-------------------------------------------------
The nation capital has seen an increase in the number of diarrhoea and vomiting cases this week. Premier, Dr. Rufus Ewing, told the media on Wednesday [13 Mar 2013] that the last reported number was 74, of which two-thirds have direct linkages to operations at a major restaurant establishment on Grand Turk. Ewing holds the portfolio of Health Minister. The Premier noted that officials from the Pan American Health Organisation (PAHO), here on other businesses, were on hand to support the Ministry of Health. According to him, samples have been collected and sent to the Caribbean Public Health Agency (CARPHA) for testing. Ewing, at Parliament on Thursday, also addressed the issue and said: "Tourism is our main revenue earner and we have to do all that is necessary to protect the industry...the pathological agent causing the diarrhea and vomiting is unknown at this time.

"But the Communicable Disease Surveillance and outbreak response team are vigilantly working and collaborating with the Caribbean Public Health Agency to establish the cause and implement public health measures to control and contain the outbreak. It is uncertain at this time whether this is a viral outbreak initiated by a cruise ship passenger or a point food source outbreak from the restaurant." The Premier acknowledged that the ministry of health staff within the various departments and units are doing a tremendous job in communicable disease surveillance and control with respect to this outbreak, but noted that much strengthening of the system is needed.

The Ministry has stressed the importance of minimising the opportunities to spread illness-causing germs by practicing proper food safety and personal hygiene measures at all times. It is also reminding all stakeholders to educate clients and patients about proper food safety and hygiene practices as well as of their obligations to report cases of diarrhoea or vomiting to the Ministry in a timely manner. Anyone who experiences diarrhoea and or vomiting has been urged to report to their nearest health care provider and avoid going to work until their symptoms have resolved. The situation continues to be monitored.
******
Date: Wed 27 Mar 2013
Source: ABC News, Associated Press report [edited]

T&C Cruise Terminal Closes After Illness Outbreak
------------------------------------------
The tourist board in the Turks & Caicos Islands announced Tuesday [26 Mar 2013] that the cruise terminal on Grand Turk has been temporarily closed. Cruise lines starting cancelling port calls to Grand Turk on 11 Mar 2013 after passengers suffered from symptoms of gastroenteritis after visiting the Grand Turk Cruise Center in the British Caribbean territory. In its Tuesday statement, the British territory's tourist board didn't say why or when the nearly 18-acre Grand Turk Cruise Center closed. Board Director Ralph Higgs said local authorities were addressing the problem and hoped to reopen the terminal soon.

In Turks & Caicos, the general manager of the Grand Turk Cruise Center declined comment and referred queries to Carnival Corp., which opened the terminal in 2006. Carnival spokesman Vance Gulliksen said the Miami-based company was "investigating whether there may be a link with consumption of food and beverages while guests were ashore in Grand Turk." Gulliksen said Carnival and other cruise lines cancelled port calls to Grand Turk to be cautious and are monitoring the situation while authorities try to determine the cause of the illness. Various cruise lines rerouted their ships or extended their stays in ports in Puerto Rico, Bahamas and other locales.

A Florida-based spokesman for the cruise center said Tuesday [26 Mar 2013] afternoon that numerous experts, working with local health officials, have been examining and testing food and water at the cruise terminal over the last 2 weeks.

"Multiple measures are currently being taken to ensure the quality of all food, water and sanitation systems going forward," spokesman Buck Banks wrote in an e-mail. He said he works for a public relations company hired by the cruise terminal. The Grand Turk Cruise Center declined to provide information about when the terminal closed to ships, but the terminal's port schedule listed no arrivals after 13 Mar 2013. The port includes a 45 000-square-foot shopping center, a big swimming pool and numerous food and beverage outlets.
******
Date: Tue 26 Mar 2013
Source: Cruise news [edited]

As Precaution, Cruise Lines Skip Calls to Grand Turk
--------------------------------------------
Cruise lines are continuing to pull out of their calls in Grand Turk after passengers reported feeling ill following visits to the Caribbean port in early March [2013]. Carnival Cruise Lines, Holland America Line and Princess Cruises have replaced planned stops in Grand Turk next week. Several lines canceled calls last week after passengers on previous cruises to the port reported gastrointestinal issues. While no link between illness and food and beverage consumption on the island has been confirmed, Holland America, Carnival and Princess report they are investigating.

As a precaution, Carnival has canceled Freedom's 25 Mar 2013, Breeze's 26 Mar 2013 call, and Glory's 29 Mar 2013 call. Instead, Freedom will visit Freeport and Breeze will call on Key West, according to spokesman Vance Gulliksen. Glory will have an extra sea day and will extend port times in St. Thomas and San Juan. Holland America's Eurodam will forgo its scheduled 25 Mar 2013 call to Grand Turk and will sail directly to San Juan, its next scheduled port of call. Eurodam will arrive 5 hours earlier than scheduled, so passengers will have more time in port. Ruby Princess also was scheduled to call on Grand Turk on 29 Mar 2013 but instead will call on Nassau, according to Princess Cruises spokeswoman Karen Candy. Spokespeople for the lines have said the companies will continue to monitor the situation.

"Scheduled calls to Grand Turk on future Caribbean sailings through the end of the season in early April will be assessed, as the call dates get closer," Holland America spokesman Erik Elvejord said in a statement. Eurodam and Nieuw Amsterdam each has one scheduled call to Grand Turk the 1st week of April [2013]. The port's online calendar shows no ships scheduled in Grand Turk for the rest of the month.   [Byline: Colleen McDaniel]
=======================
[The absence of a diagnostic test result from the gastroenteritis outbreak inked to a particular shore-based restaurant 14 days ago limits interpretation of this outbreak. But the predominant symptoms of gastroenteritis and vomiting are suggestive of an outbreak of norovirus infection. Outbreaks of norovirus infection have been frequently associated with cruise ships trading mostly, but not exclusively, in the Caribbean.

The Turks and Caicos Islands outbreak is unusual in that the source of the infection appears to have been land-based and not associated with the cruise ship. Prudently cruise ships are presently avoiding the Turks and Caicos Islands until the source and identification of the causative agent have been established.

The Turks and Caicos Islands are a British Overseas Territory consisting of 2 groups of tropical islands in the West Indies. The larger Caicos Islands and the smaller Turks Islands are popular destinations for tourists, and also trade as offshore financial centres. The total population is about 45,000.

A map of the Turks and Caicos islands can be accessed at:
<http://www.turksandcaicos.tc/turks/index.htm> - ProMed Mod.CP]
Date Thu 24 May 2012
Source: fptci [edited]
Officials Investigate Outbreak Of Diarrhea, Vomiting
--------------------------------------------
The Turks and Caicos Islands Health Surveillance team is investigating a recent outbreak of diarrhea, abdominal pain and vomiting on Providenciales among more than 100 people who stayed in or dined at local resorts over the last several weeks.

On 26 May 2012, the Ministry of Health and Education (MOHE) and Environmental Health Department (EHD) confirmed that tests results for one individual confirmed the presence of norovirus [infection], a highly contagious viral illness which is common in outbreaks of gastroenteritis (diarrhea and vomiting) throughout the world. It can be transmitted from person to person, through contact with vomitus or feces of infected individuals, consumption of contaminated food or water, contact with soiled surfaces and bed linens etc. Other than supportive therapy, norovirus [infection] usually requires little by way of medical interventions and usually resolves without incident.

"The MOHE and EHD would like to emphasize that at this time norovirus [infection] cannot be confirmed as the cause of the current outbreak of diarrhoea and vomiting based on this single positive result," the statement said. "Investigations of the Public Health Team are ongoing, in collaboration with the Caribbean Epidemiology Center and Pan American Health Organization, the global experts in outbreak investigation."

One foursome staying on Providenciales in a private villa told that they were stricken with the illness -- which hospital officials told them was some kind of virus -- after eating at a restaurant in a hotel on Grace Bay. One woman became so ill she had to be hospitalized and receive intravenous fluids to overcome the symptoms. Grace Bay Club announced 24 may 2012 that it has stopped accepting reservations until 1 Jun 2012 to sanitize the resort. "Currently, Grace Bay Club is providing hand sanitizers throughout the resort to all guests and staff, and all public spaces, kitchens, restaurants, plumbing systems and guest rooms are being thoroughly sanitized with bleach according to the safety standards of the Department of Environmental Health," the resort said. "Additionally, Grace Bay Club is providing medical assistance to affected guests, alerting current and future guests of the situation and offering them the option to adjust existing reservations without penalty. Once all guests depart the resort, a more extensive, full-property sanitization will take place."

Sources tell the fptci agency that Grace Bay Club was not the only resort where guests had the symptoms and that more than 100 people have been treated since April [2012]. The government health team would not say how many have been affected pending the outcome of its investigation. "We have deployed our public health  eams to assess, to identify and report on the situation utilizing CAREC and PAHO/World Health Organization guidelines," the Ministry of Health and Education said in a statement May 22. "Our top priority is to protect the public as well as the tourism industry from any further illness by containing this outbreak."

The team asks that anyone who experiences the symptoms to report to any health care facility for evaluation and treatment. Those people may be interviewed in confidence to help pinpoint the source of the outbreak. The ministry encourages the public to practice healthy hygiene such as frequent hand washing, especially when preparing meals, before eating and after using the toilet. [Byline: Richard Green]
=========================
[The single positive diagnostic test result and the description of the illnesses (presumed to be predominantly sudden onset and rapid resolution in most cases) are consistent with an outbreak of norovirus infection. However the report does not exclude possibility of transmission of another food-borne agent from a common source. Further information is awaited.

The Turks and Caicos Islands are a British Overseas Territory consisting of 2 groups of tropical islands in the West Indies, the larger Caicos Islands and the smaller Turks Islands, known for tourism and as an offshore financial centre. The total population is about 45 000, of whom approximately 22 500 live on Providenciales in the Caicos Islands.

A map of the Turks and Caicos islands, showing the location of Providenciales can be accessed at: <http://www.turksandcaicos.tc/turks/index.htm>. - ProMed Mod CP]
More ...

World Travel News Headlines

Date: Tue, 16 Jul 2019 10:44:51 +0200

Zagreb, July 16, 2019 (AFP) - Some 10,000 tourists were evacuated from a popular party beach on a Croatian island after a forest fire erupted early Tuesday, police said.

Police ordered visitors to night clubs on Zrce beach on the northern island of Pag to leave after the blaze erupted in a pine forest at around 1:00 am (2300 GMT Monday), a police statement said.   No one was injured in the fire which was brought under control, the mayor of the nearby town of Novalja, Ante Dabo, told national radio.  The cause was not immediately known.   Three firefighting planes were rushed to the scene to help extinguish the blaze which spread to a local road that had to be closed.

The island of Pag and its Zrce beach are popular with young tourists, notably British, who party there.  Tourism is a pillar of Croatia's economy, with visitors flocking to hundreds of islands and islets along its stunning Adriatic coast.   Last year the country of 4.2 million people welcomed more than 19 million tourists.
Date: Mon, 15 Jul 2019 01:09:24 +0200

Kinshasa, July 14, 2019 (AFP) - The first case of Ebola has been confirmed in Goma, now the biggest city to have been affected by the disease since its outbreak in eastern DR Congo last August, the health ministry said on Sunday.  A sick man had arrived in Goma early Sunday by bus with 18 other passengers and the driver from Butembo, one of the main towns touched by Ebola in Nord-Kivu province.

The man was tested  "and the results of the laboratory test confirmed that he was positive for Ebola," the ministry said in a statement.   It added that his trip began on Friday after "the first symptoms appeared on July 9 (Tuesday)".   "Given that the patient was quickly identified, as well as all the passengers on the bus from Butembo, the risk of the disease spreading in the city of Goma is low," the ministry said.    The passengers and the bus driver will begin getting vaccinations on Monday, it added.

The Ebola outbreak in eastern Democratic Republic of Congo has so far killed 1,655 people and 694 have been cured, according to a health ministry bulletin on Saturday.  And 160,239 people have been vaccinated, it added.  But efforts to tackle the crisis have been hampered both by militia attacks on treatment centres, in which some staff have been killed, and by the hostility of some local people to the medical teams.
Date: Sun, 14 Jul 2019 13:37:24 +0200

Pamplona, Spain, July 14, 2019 (AFP) - Three men were gored Sunday during the eighth and final bull run of Spain's San Fermin festival, bringing to eight the total number of daredevils injured during this year's fiesta.   Among those who were hospitalised this year after being injured by a bull's horns was an American who was wounded in the neck while taking a selfie.    In the last run, two Australians aged 27 and 30 as well as well as a 25-year-old Spaniard from Madrid were gored by the half-tonne fighting bull, "Rabonero", regional health authorities said.

The three men suffered injuries to the armpit, arm and leg from the bull's horns. Another two men were taken to hospital with bruises.   During Sunday's run in the northern city of Pamplona, Rabonero, the heaviest of the six bulls used in the event, became separated from the pack moments into the run and began charging people in its way.   Isolated bulls are more likely to get disoriented and start charging at people.

The bulls from the Miura ranch in the southwestern province of Seville completed the 848.6-metre (928-yard) course from a holding pen to the city bull ring in two minutes and 45 seconds.   Each morning from July 7 to 14, hundreds of daredevils, many wearing traditional white shirts with red scarves tied around their necks, tested their bravery by running ahead of a pack of bulls through the course set up in the narrow, winding streets of the medieval city.

- Like getting hit by a truck -
The bulls face almost certain death in afternoon bullfights, and earlier this month animal rights activists staged a "die-in" protest in the streets of the city to protest the tradition.   At the end of the festival's first run, a bull ran over and sunk one of its horns deep in the neck of a 46-year-old  American from San Francisco, Jaime Alvarez, narrowly missing key arteries.    He was injured as he was trying to take a video-selfie with his mobile phone.   "It was like a truck or car just hitting me in the side of the head. I put my hand on my neck and I saw blood," he told US television from a Pamplona hospital.   His wife had asked him not to take part in the bull run, he added.    He was released from hospital two days later.

Another 23-year-old American from Kentucky and 40-year-old Spaniard were also gored that day.   In addition to the eight men who were gored, another 27 people were taken to hospital for broken bones and bruises suffered during the bull runs.   About 500 more people were treated at the scene for more minor injuries, according to the Red Cross.   The festival dates back to medieval times and was immortalised in Nobel Prize-winning author Ernest Hemingway's 1926 novel "The Sun Also Rises".   It claims scores of casualties every year although last year just two men were gored.

Although the runs are over, the festival's closing ceremony takes place at midnight Sunday.   People from around the world flock to the city of 200,000 residents to test their bravery and enjoy the festival's mix of round-the-clock parties, religious processions and concerts.   Sixteen people have been killed in the bull runs since records started in 1911.   The last death was in 2009 when a bull gored a 27-year-old Spaniard in the neck, heart and lungs.
Date: Sun, 14 Jul 2019 12:47:38 +0200

Labuha, Indonesia, July 14, 2019 (AFP) - A major 7.3-magnitude earthquake hit the remote Maluku islands in eastern Indonesia Sunday, sending panicked residents running into the streets, but no tsunami warning was issued.   The shallow quake struck about 165 kilometres (100 miles) south-southwest of the town of Ternate in North Maluku province at 6:28 pm (0928 GMT), according to the US Geological Survey.
 
"The earthquake was quite strong, sending residents to flee outside. They are panicking and many are now waiting on the roadside," said local disaster mitigation official Mansur, who like many Indonesians goes by one name.   Officials were assessing the situation but there were no immediate reports of casualties, he told AFP.

In the town of Labuha, one of the closest to the epicentre, panicked residents took to motorcycles in a bid to flee to higher ground, according to an AFP photographer in town when the earthquake hit.   Local disaster official Ihsan Subur told Metro TV that no damage or casualties had been reported there so far, but residents took to the streets and many evacuated to higher ground.   "Electricity went of during the earthquake, but now it's back to normal," ubur said, adding that at least seven big aftershocks were felt after the initial quake.

The province was also hit by a 6.9-magnitude tremor last week.   Indonesia experiences frequent seismic and volcanic activity due to its position on the Pacific "Ring of Fire", where tectonic plates collide.   Last year, a 7.5-magnitude quake and a subsequent tsunami in Palu on Sulawesi island killed more than 2,200 people, with another thousand declared missing.   On December 26, 2004, a devastating 9.1-magnitude earthquake struck off the coast of Sumatra and triggered a tsunami that killed 220,000 across the Indian Ocean region, including around 170,000 in Indonesia.
Date: Sun, 14 Jul 2019 09:02:36 +0200

Sydney, July 14, 2019 (AFP) - A strong 6.6-magnitude earthquake struck off northwest Australia Sunday, shaking buildings over a wide area but causing no immediate reports of damage or injuries.   The shallow quake hit early Sunday afternoon 10 kilometres under the Indian Ocean 203 kilometres (126 miles) west of the West Australian beach resort of Broome, the US Geological Survey said. No tsunami alert was issued.   Sergeant Neil Gordon of the Broome police department said the quake rattled the city for more than a minute.   "The building here was shaking for about a minute and a half ... a steady shaking for that period of time," he told AFP by telephone.   He added that there had been "no reports of any injuries or any damage throughout the district," following the tremor.   The national broadcaster ABC said there were some reports of minor damage from the quake, and no injuries.   Australian media said the tremor was felt across a long stretch of the northwestern coast of Australia, from the West Australian capital of Perth and the mining centres of Karatha and Port Hedland to the south and as far as Darwin to the north.

Thursday 11th July 2019
https://www.who.int/csr/don/11-july-2019-ebola-drc/en/

The outbreak of Ebola virus disease (EVD) in North Kivu and Ituri provinces, Democratic Republic of the Congo continues this past week with a similar transmission intensity to the previous week. While the number of new cases continues to ease in former hotspots, such as Butembo, Katwa and Mandima health zones, there has been an increase in cases in Beni, and a high incidence of cases continues in parts of Mabalako Health Zone. In addition to these re-emerging hotspots, there are a large number of people with confirmed and probable infections moving to other health zones, with the greatest number coming from Beni Health Zone. The movement of cases causes the outbreak to spread to new health zones and re-emerge in health zones with previously controlled infections. Overall, this underscores the importance of robust mechanisms for listing and following up contacts and understanding the motivations for peoples’ decisions to move.

After the first reported case in the Ariwara Health Zone on 30 June, no new cases have been observed in that health zone. A response team deployed to that zone continues to identify contacts, engage the community, and vaccinate individuals at risk. Response personnel from the bordering countries of Uganda and South Sudan continue to support operational readiness activities. Resources are being dedicated to monitoring the Uganda-Democratic Republic of the Congo border in that area.

In the 21 days from 19 June through 9 July 2019, 72 health areas within 22 health zones reported new cases, representing 11% of the 664 health areas within North Kivu and Ituri provinces (Figure 2). During this period, a total of 247 confirmed cases were reported, the majority of which were from the health zones of Beni (41%, n=101), Mabalako (19%, n=48), Lubero (6%, n=16), and Mandima (5%, n=13). As of 09 July 2019, a total of 2437 EVD cases, including 2343 confirmed and 94 probable cases, were reported (Table 1). A total of 1646 deaths were reported (overall case fatality ratio 68%), including 1552 deaths among confirmed cases. Of the 2437 confirmed and probable cases with known age and sex, 57% (1384) were female, and 29% (704) were children aged less than 18 years.

Cases continue to increase among health workers, with the cumulative number infected rising to 132 (5% of total cases). Of the 128 health workers with information available, the greatest proportion is among health workers at health posts [poste de santé] (20%, n = 26) and private health facilities (35%, n = 45). The majority (68%, n = 87) of health worker infections were among nurses.

No new EVD cases or deaths have been reported in the Republic of Uganda since the previous EVD Disease Outbreak News publication on 13 June 2019. As of 3 July, 108 contacts exposed to those cases were identified, and they all completed the 21-day follow-up period. All contacts were asymptomatic. Arua district, located in the north-western part of Uganda near the Uganda-Democratic Republic of the Congo border, is currently stepping up its response readiness to prevent imported cases of Ebola following the case that died on 30 June 2019 in Ariwara Health Zone in neighbouring Democratic Republic of the Congo, located 8 kilometres from the Uganda border. This case is known to have over 200 contacts, some of whom are in the communities bordering the Arua district. As of 9 July 2019, two suspected cases in the Arua district were reported and both tested negative. As of 9 July 2019, the cumulative number of individuals vaccinated in Arua district is 811 out of 1092 targeted front line and healthcare workers.

More information here: https://www.who.int/csr/don/11-july-2019-ebola-drc/en/

Date: Sat, 13 Jul 2019 10:41:55 +0200

Kuala Lumpur, July 13, 2019 (AFP) - Flash floods killed a Dutch tourist in a popular cave located in the rugged Mulu National Park on Malaysia's Borneo island, an official said Saturday, as a search continues for a missing guide.    Local fire and rescue chief Law Poh Kiong identified the dead man as 66-year-old Peter Hans Hovenkamp from Utrecht in the central Netherlands.     "He died due to drowning following flash floods in the caves. His body was found in a river inside the cave and was taken to the Miri public hospital for a post-mortem on Saturday," he told AFP.   Law said a search-and-rescue operation involving 16 officers had been launched to locate 20-year local tour guide Roviezal Robin.   Eight other tourists in the same group "almost become victims" but fled to higher ground and escaped from being washed into the river, Law added.

Hovenkamp was reported missing on Friday while the group was touring the popular "Deer Cave", home to an estimated three million bats which form amazing patterns in the sky when they leave each dusk.   Mulu park, located in the remote Borneo jungle of Sarawak state and famous for its caves, cliffs and gorges, is a UNESCO world heritage site.   It sees thousands of visitors annually, particularly for its cooling rains during the summer months.    Law described the death as "a freak tragedy."
Date: Sat, 13 Jul 2019 09:52:36 +0200

Kathmandu, July 13, 2019 (AFP) - Floods and landslides triggered by torrential monsoon rains have killed at least 40 people across South Asia in the last two days, officials said Saturday.   The monsoon, which lasts from June to September, causes widespread death and destruction across South Asia each year.   In Nepal, 27 people have died in floods and landslides after heavy rains hit the country's eastern region and the southern plains.

Bishwaraj Pokharel, spokesperson for Nepal Police, added that another 11 people were injured and 15 others reported missing.    Three of the victims were killed when a wall collapsed in the capital Kathmandu.   "Our first priority is life saving rescue and all our resources have been deployed," Home Ministry official Umakanta Adhikari told AFP.

Police used boats to bring people to safety as rivers swelled, inundating their settlements, while parents were seen wading across chest-high waters carrying children on their shoulders.    Nepal's weather department issued a high alert for the southern Sapta Koshi river on Saturday and sent SMS warnings to people in the area.

In neighbouring India 11 deaths have been recorded in the north-eastern states of Assam and Arunachal Pradesh, officials said Friday.  Monsoon floods have inundated 21 districts in Assam, affecting thousands, officials said Friday.

In Bangladesh aid groups were providing rations to Rohingya refugees in the southeast of the country with the UN World Food Programme saying Friday that two people including a child had died.   Last year, more than 1,200 people were been killed across South Asia in monsoon storms with India's Kerala suffering its worst floods in nearly 100 years.
Date: Fri, 12 Jul 2019 16:00:57 +0200

Chennai, India, July 12, 2019 (AFP) - A special 50-wagon train carrying 2.5 million litres of water arrived in the Indian city of Chennai Friday, as the southern hub reels under one of its worst shortages in decades.    The wagons were hauled by a special locomotive, decorated with flowers and with a "Drinking Water for Chennai" banner on its front.   Four special trains a day have been called up to bring water to Chennai -- India's sixth most populous city -- from Vellore, some 80 miles (125 kilometres) away, to help battle the drought.    The first consignment will be taken to a water treatment centre, and then distributed in trucks to different parts of the metropolis on Saturday.   Chennai has seen only a fraction of the rain it usually receives during June and July.   The city of 4.9 million people also needed trains to bring water in when it suffered a similar crisis in 2001.

The bustling capital of Tamil Nadu state normally requires at least 825 million litres of water a day, but authorities are currently only able to supply 60 percent of that.   With temperatures regularly hitting 40 degrees Celsius (104 Fahrenheit), reservoirs have run dry and other water sources are dwindling further each day.   The Chennai metro has turned off its air conditioning, farmers have been forced to stop watering their crops, and offices have asked staff to work from home.   The city's economy has also taken a hit as some hotels and restaurants shut shop temporarily, and there have been reports of fights breaking out as people queue for water. 
Date: Fri, 12 Jul 2019 11:42:26 +0200

Sydney, July 12, 2019 (AFP) - A looming ban on climbing Australia's Uluru rock, intended to protect the sacred site from damage, has instead triggered a damaging influx of visitors, tourism operators said Friday.    Clambering up the giant red monolith, also known as Ayers Rock, will be prohibited from October -- in line with the wishes of the traditional Aboriginal owners of the land, the Anangu.   But a rush to beat the ban has led to a sharp increase in tourists and is causing its own problems for the World Heritage Uluru-Kata Tjuta National Park.   Families arriving in campers vans and RVs are a particular problem, chief executive of Tourism Central Australia Stephen Schwer told AFP.   "We have got so much of one particular market coming, we don't have enough infrastructure to handle the number of drive travellers."

While most visitors are doing the right thing, camping venues in the area are at capacity with advance bookings, leaving many less organised arrivals to set up illegally.   "People don't realise when they go off the road they are actually trespassing on pastoral land, or Aboriginal land, or protected land," Schwer said.   "We are getting people that are leaving their rubbish behind and lighting fires," he added.   "Sadly, people are also emptying their toilet waste out of their vans on what they think is unpopulated land, but is actually private land."   In the 12 months to June 2019, more than 395,000 people visited the Uluru-Kata National Park, according to Parks Australia, about 20 percent more than the previous year.   Yet just 13 percent of those who visited also climbed the rock, the government agency said.    Tourism operators say that Australian and Japanese tourists most commonly seek to climb Uluru.

The Aboriginal connection to the site dates back tens of thousands of years and it has great spiritual and cultural significance to them.   "Since the hand back of Uluru and Kata Tjuta to traditional owners in 1985, visitors have been encouraged to develop an understanding and respect for Anangu and their culture," a spokesperson for Parks Australia said.     "This is reflected in the 'please don't climb' message," they added.   Lyndee Severin from Curtin Springs station and roadhouse, one of just a few camping venues within 100 kilometres of Uluru, said "the vast majority of people are doing the right thing" but hundreds were setting up illegally by the side of the road or down a bush track.   "So we have some people that think that the rules don't apply to them," she told AFP.