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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 ...

Uruguay

Uruguay - US Consular Information Sheet
May 01, 2008
COUNTRY DESCRIPTION:
Uruguay is a constitutional democracy with a large, educated middle class and a robust developing economy.
The capital city is Montevideo .
Tourist facilit
es are generally good with many 5-star accommodations at resort destinations such as Punta del Este and Colonia de Sacramento.
The quality of tourist facilities varies according to price and location.
Travelers are encouraged to seek travel agency assistance in making plans to visit Uruguay .
Read the Department of State Background Notes on Uruguay for additional information.

ENTRY/EXIT REQUIREMENTS:
All United States citizens entering Uruguay for business or pleasure must have a valid passport.
U.S. citizens traveling on a regular passport do not need a visa for a visit of less than three months.
U.S. citizens traveling on diplomatic or official passports require a visa.
Air travelers are required to pay an airport tax upon departure.
This fee may be paid in U.S. dollars or in Uruguayan pesos.
For further information on entry requirements, contact the Embassy of Uruguay at 1913 “Eye” Street NW, Washington, DC 20006, tel. (202) 331-4219; e-mail: conuruwashi@uruwashi.org.
Travelers may also contact the Consulate of Uruguay in New York, Miami, Chicago, Los Angeles, and Puerto Rico.
Visit the Embassy of Uruguay web site at http://www.uruwashi.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:
Regular protests, some with an anti-American flavor, take place outside Congress, City Hall and the “University of the Republic.”
U.S. citizens visiting or residing in Uruguay are advised to take common-sense precautions and avoid any large gatherings or any other event where crowds have congregated to demonstrate or protest.
If travelers encounter a protest they should walk the other way or enter a commercial establishment until the protest passes.
Taking pictures of protesters is not a good idea.

Although there have been no past instances of violence directed at U.S. citizens from cross-border extremist groups, U.S. citizens traveling or residing in the more remote areas of Uruguay near the border with Argentina and Brazil are urged to exercise caution.

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

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

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

CRIME:
Petty street crime is prevalent in Montevideo .
The criminals tend to be non-violent.
However, criminals often resort to violence if the victims resist.
Travelers should exercise reasonable caution to minimize their exposure to crime.
Criminals prey on the unaware, particularly those carrying cameras, pocketbooks, laptops, or backpacks.
Travelers are advised to lock most valuables in secure hotel safes and to download their wallets of excess credit cards and cash.
If dining at an outdoor restaurant take extra care with pocketbooks or bags.
There are no “off limits” areas of the city and parts of “Ciudad Vieja” are popular tourist attractions.
However the only sections of Ciudad Vieja with continual police patrols are Plaza Independencia, the pedestrian street Sarandi, and the Mercado del Puerto.
Mugging is common in other parts of Ciudad Vieja - particularly for travelers walking alone, or couples walking at night.
A smart alternative is to call for a taxi for evening travel between restaurants, bars, and hotels.

Victims are usually foreign tourists, individuals openly carrying valuable items, and motorists in unlocked vehicles stopped at busy intersections, particularly on Montevideo 's riverfront road known as the Rambla. Drivers should keep all car doors locked, the driver's window open only one inch, and purses, bags, briefcases and other valuables out of sight on the floor or in the trunk. Parked cars, particularly in the Carrasco neighborhood, are also increasingly targeted for break-ins. During the summer months (December-March), beach resort areas such as Punta del Este attract tourists, and petty street crimes and residential burglaries--similar to those that occur in Montevideo --rise significantly. Visitors are advised to exercise common sense in the conduct of their activities around Montevideo and in Uruguayan resort areas. They should be very attentive to personal security and their surroundings in the aforementioned areas.

Those planning to live in Montevideo should note that burglaries and attempted burglaries seem to be on the rise in upscale neighborhoods.
The perpetrators are mostly non-confrontational but determined teenagers.
A combination of preventive measures including rigorous use of locks and alarms, strong grillwork on all windows, guard dogs, keeping a residence occupied as much as possible, and using a security service is highly recommended.

Montevideo continues to experience armed robberies of patrons at crowded restaurants in the Pocitos neighborhood.
Most of these crimes have occurred very late at night.
Restaurant patrons should exercise extreme caution for late night dining.

Uruguayan law enforcement authorities have increased the number of uniformed policemen on foot in areas where criminal activity is concentrated and the number of patrol cars in residential areas. The clearly marked patrol cars are equipped with cellular phones and the phone numbers are conspicuously painted on the vehicles.

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 U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Facilities for medical care are considered adequate. Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost tens of thousands of dollars.


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 Uruguay is provided for general reference only, and may not be totally accurate in particular location or circumstance.

The Uruguayan Ministry of Transportation is responsible for maintaining safe road conditions countrywide. The Uruguayan Ministry of Interior highway police (tel. 1954) are responsible for traffic safety on highways and other roads beyond city limits. In urban and suburban areas, transit police and municipal employees share road safety responsibilities.

Driving is on the right-hand side of the road. Wearing seat belts and using headlights on highways and other inter-city roads 24 hours a day are mandatory. Children under 12 must ride in the back seat. Motorcyclists must wear helmets. The use of cellular phones while driving is prohibited. Right turns on red lights and left turns at most intersections marked with a stoplight are not permitted. Drivers approaching an intersection from the right or already in traffic circles have the right of way.
Flashing high beams indicate intent to pass or continue through unmarked intersections.
Many drivers ignore speed limits and traffic signs.
If you plan to drive, use extreme caution and drive defensively.

For driving under the influence, violators are fined and confiscated licenses may be retained for up to six months. In accidents causing injury or death, drivers are brought before a judge who decides if incarceration is warranted.

Inter-city travel is via bus, taxi, car service (remise), car, and motorcycle. Speed limits are posted on highways and some main roads. Most taxis have no seat belts in the back seat. Cycling outside the capital or small towns is hazardous due to a scarcity of bike paths, narrow road shoulders and unsafe driving practices.

Illumination, pavement markings, and road surfaces are sometimes poor. Route 1, which runs between Montevideo and Colonia or Punta del Este, and Route 2, between Rosario and Fray Bentos, are particularly accident-ridden because of heavy tourist traffic. Road accidents rise during the austral summer beach season (December to March), Carnaval (mid-to-late February), and Easter Week.

Within Montevideo , the emergency number to contact the police, fire department, rescue squad, or ambulance service is 911. In the rest of the country, dial 02-911 to connect with the Montevideo central emergency authority, which will then contact the local emergency service. The Automobile Club of Uruguay responds to emergency calls for roadside assistance at 1707, “Car Up” at 0800-1501 and the Automobile Center of Uruguay at 2-408-6131/2091. SEMM (tel. 159) and UCM (tel. 147), Montevideo-based ambulance services manned by doctors, have agreements with emergency medical units in other cities.

Please refer to our Road Safety page for more information.
You may also telephone Uruguay ’s national tourist office and national authority responsible for road safety in Miami at (305) 443-7431.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed Uruguay ’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Uruguay ’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:
Uruguay 's customs authorities may enforce strict regulations concerning temporary importation into or export from Uruguay of items such as precious jewels, gold, firearms, pornography, subversive literature, inflammable articles, acids, prohibited drugs (medications), plants, seeds, and foodstuffs as well as some antiquities and business equipment. It is advisable to contact the Embassy of Uruguay in Washington, D.C., or one of Uruguay 's consulates in the U.S. for specific information regarding customs requirements. Note: Travelers entering Uruguay with precious jewels or gold worth more than $500.00 ( U.S. ) must declare them to customs officers at the port of entry or face possible detention or seizure of the goods and charges of contraband or evasion of customs controls. Visitors are expected to comply with local law and regulations by approaching a customs officer before routine inspection of all incoming baggage, conducted on standard security equipment.
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 Uruguay ’s laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Uruguay 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.

The Uruguayan Ministry of Agriculture and Fishing strictly enforces all regulations regarding hunting permits, as well as seasonal and numerical limits on game. Visitors who contravene local law have been detained by the authorities and had valuable personal property (weapons) seized. Under Uruguayan law, seized weapons can only be returned after payment of a sum equivalent to the value of the property seized. Hunters are also subject to stiff fines for practicing the sport without all appropriate permits.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Uruguay are encouraged to register with the U.S. Embassy through the State Department's travel registration web site so that they can obtain updated information on travel and security within Uruguay .
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency. The U.S. Embassy is located at Lauro Muller 1776; telephone (598) (2) 418-7777; fax (598) (2) 418-4110 or -8611. Internet: http://uruguay.usembassy.gov/, email: MontevideoACS@state.gov. Consular Section hours for American Citizen Services are Monday to Thursday, 9:00 a.m. to 11:00 p.m. and 2:00 p.m. to 4:00 p.m., except U.S. and Uruguayan holidays.
* * *
This replaces the Consular Information Sheet dated August 28, 2007 to update Sections on Entry/Exit Requirements, Safety and Security, Crime, Aviation Safety Oversight, Children’s issues, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

20th June 2019
https://en.mercopress.com/2019/06/20/torrential-rains-in-uruguay-forces-7.400-to-abandon-their-homes
Troops will continue monitoring the situation because “there are many people who do not want to leave their homes due to fear of being looted” Bayardi said.Torrential rains in central and southern Uruguay in the past several days have caused massive floods and forced some 7,400 people to leave their homes, according to the latest update by the country's National Emergency System.  The central city of Durazno is the most affected, with 5,299 evacuees, according to official reports.

Defense Minister Jose Bayardi visited one of the camp sites managed by the military to help the displaced.  ”We have established a high level of experience (in the face of these catastrophes) which we have succeeded in institutionalizing,“ he told the media. Troops will continue monitoring the situation because ”there are many people who do not want to leave their homes due to fear of being robbed and looted” Bayardi said.

The National Highway Police also said that 12 national highways remain cut-off in different directions. Uruguay's National Meteorological Institute said that between June 11 and 16, some southern regions of the country received around 270 mm of rain.  On Wednesday morning, the Yi River, which had been 11.8 meters higher than its normal water level in the Durazno area, was falling at a rate of 11 cm per hour, according to local media reports.

Date: Tue 12 Mar 2019
Source: Carmelo Portal [in Spanish, trans. Mod. TY, edited]

The departmental health director, Dr Jorge Mota, confirmed for Carmelo Portal the death in our city of a young 17 year old girl from [a] hantavirus [infection]. "In Colonia department, there are on average 3 cases per year. The evolution of the disease is in thirds. One-third of the [infected] people do not have notable symptoms; another third have serious symptoms, especially respiratory symptoms and ones in all the systems, but with adequate treatment, [the infected people] survive, sometimes with sequelae. There is another third that die. It is those few with the virus that die with an evolution so drastic, such as is the case of this girl, sadly," Dr Mota stated.

The department health director said that hantaviruses are not contagious person-to-person. "It is transmitted from an intermediate animal, the field mouse. Only 3% of these mice have [a] hantavirus. To become infected, one must be in contact with an [infected] mouse's secretions that have dried, are mixed with dust, and are in a closed space, away from sunlight and ventilation. A spa, a shed, or a wood pile [are examples of such a space]. The person had to have been moving around there and inhaled the dust," he explained.

Dr Mota spoke about the epidemiological surveillance that is carried out. "We tracked places where the person was, even those that could be identified 2 months before contracting the virus; sometimes we found the place, but sometimes not." As a preventive measure, Mota stated that in these cases, ventilate these closed spaces for at least half an hour. Wet down floors and shelves with water [with 10% bleach]. Use masks [and gloves].
==========================
[The report above does not mention the circumstances under which the infection might have been acquired nor which hantavirus was responsible for this or earlier cases in Uruguay. Hantaviruses that cause hantavirus pulmonary syndrome (with rodent hosts found in Uruguay) include Laguna Negra virus (_Calomys laucha_), Maciel virus (_Necromys benefactus_), Central Plata virus, Lechiguanas virus (_Oligoryzomys flavescens_, complex of rodents), and Anajatuba virus and Juquitiba virus (_Ologoryzomys fornesi_).

The rodent reservoir hosts shed the virus in its saliva, urine, and faeces, contaminating the environment in which they live and breed.

A HealthMap/ProMED-mail map showing the location of Uruguay in South America can be accessed at
<http://healthmap.org/promed/p/28995>.

A map of Colonia department in southern Uruguay is available at
<https://en.wikipedia.org/wiki/Colonia_del_Sacramento>
and <http://healthmap.org/promed/p/27367>. - ProMED Mod.TY]
Date: Thu, 19 Jul 2018 03:23:55 +0200
By Lucia LACURCIA

Montevideo, July 19, 2018 (AFP) - Enrique Curbelo is delighted. Selling cannabis has allowed the affable 76-year-old to keep his privately owned pharmacy in Montevideo open in a market dominated by big chains.   "I had to sell what they didn't sell," he told AFP. "For me it's like selling aspirin."   It's been this way for a year now.   Every Wednesday, Ismael Fernandez receives a WhatsApp message from his local pharmacist telling him a new stock of cannabis has arrived.   After leaving work, he heads there and buys the 10 grams that Uruguayan law permits, costing 400 pesos, around $13.

Fernandez then heads home and rolls a joint "to relax" with his partner Stefania Fabricio.   No longer do they need to surreptitiously contact a dealer and pay more for Paraguayan or Brazilian marijuana that's been "pressed, mixed (and is) sometimes very bad and full of chemicals."   "Now it's much easier than when it started," Fernandez, a 31-year-old who works for a cleaning company, told AFP.   It has been four and a half years since marijuana use became legal in Uruguay and a year since it has been sold in pharmacies -- up to 40 grams a month per person.

Initially, there was insufficient supply, leaving people standing in long queues as stocks sometimes ran out. Pharmacies are better prepared now.   "They send you a message with a number which you use later to go and collect it, and in my pharmacy you can order it online," added Fernandez, the father of a three-year-old.   Hairdresser Fabricio, also 31, says "it's good quality," but not too strong.   "It doesn't send your head spinning, but it's not meant to. You get a hit but you can still do things perfectly."   - 'Privileged' -   She says she feels "privileged" to live in a country that enacted a law to "get tons of people out of the black market."   As a result, she said, the stigma attached to those who smoke pot is changing, "albeit slowly."

The system is simple: to buy cannabis in a pharmacy you must be at least 18, live in Uruguay and sign up as a "buyer" at the post office.   An initial stumbling block arose when banks refused to work with establishments selling cannabis due to international rules against drug-trafficking.   But the country plowed on, and last year it became the first in the world to fully legalize its sale.   But Enrique Curbelo had to get over his own prejudices before deciding to join the select band of pharmacies selling the plant.   There are 14, half of them in the capital, serving the 24,812 registered buyers.

- 'Normal people' -
Users can choose between two brands and two types of cannabis -- sativa and indica -- both provided by an official distributor.   Customers are generally not the stereotypical grubby-looking student or idle waster.    On this day in Curbelo's store they include two young women, a man in his 50s and an older lady -- "normal people," says the pharmacist.   Official statistics say 70 percent of buyers are male and 49 percent are between the ages of 18 and 29.

To keep anyone from exceeding their monthly allowance, a fingerprint machine is used to register every sale.   Along with the ability to purchase cannabis in a pharmacy, Uruguayans have the right to grow their own -- up to a six-plant maximum -- or to join a cannabis club, which can have up to 45 members and 99 plants.   Federico Corbo, a 41-year-old gardener, grows cannabis in his garden on the outskirts of Montevideo. He experiments by crossing species in an attempt to improve quality and optimize the flowering period.   Corbo is not impressed with the quality on offer in pharmacies.   "It's not the worst, but it's low," he said, insisting quality control needs to be improved.   "Marijuana that doesn't reach the minimum standards -- with crushed flowers, no aroma, low quality -- shouldn't be sold in the pharmacy.   "Maybe, as I'm a grower, I'm very demanding, but there is a cost associated to the product and it must be offered to the public in the best way possible."

According to the Institute of Cannabis Regulation and Control (Ircca), an average cultivator or club member supplies cannabis to two other people, while those who buy it in a pharmacy share it with one other.   "Approximately half of marijuana users have access to regulated cannabis," says Ircca.   The rest prefer to continue buying the drug on the black market, put off by the need to register as a user.   "It's wrong -- if they legalize it they have to do so in a way in which the state doesn't keep a paternalistic role in overseeing how much you smoke or stop smoking," one clandestine user, who wished to remain anonymous, told AFP.   This 48-year-old lawyer simply doesn't trust the authorities. He pointed to the danger a change of government could bring, or even the return of dictatorship.   "Right now that seems impossible," he said, "but you can never discount it."
Date: Thu 1 Feb 2018 23:02hs UYT
Source: LaRed 21 [in Spanish, machine trans. edited]

The Ministry of Public Health (MSP) issued a statement through which it reports that it has detected cases of infection by the bacterium _Vibrio vulnificus_ in Montevideo, Canelones, and Maldonado [departments]. The State Secretariat assured that every year there are cases of this bacterium, but so far in 2018, 4 serious cases have been reported, of which 3 died. All of them had underlying illnesses.

"90 percent of these cases, in the world, are associated with the consumption of undercooked or raw seafood. Infrequently, the infection can be acquired when entering the sea with open wounds, especially in elderly people or people with diseases that affect the immune system," explained the MSP. It is an event "extremely rare in our country," said the State Secretariat. It also indicated that fewer than 10 cases per year are registered per year for this bacterium.

It is an infection that "can be serious and in some cases fatal, so it is recommended to avoid the consumption of undercooked or raw sea products (as well as their handling without protection measures) and in the same way, avoid entering the sea with wounds or cuts on the skin." The bacteria can be found in coastal marine waters and estuaries in areas of tropical and subtropical climates that have a moderate degree of salinity and temperatures that usually exceed 18 C [64.4 F].
====================
[The following is extracted from the previous edition of the "Bad Bug Book," Center for Safety and Applied Nutrition, US FDA (Food and Drug Administration). The newest version is available at:  <https://www.fda.gov/downloads/Food/FoodborneIllnessContaminants/UCM297627.pdf>:

"_Vibrio vulnificus_, a lactose-fermenting, halophilic, Gram-negative, opportunistic pathogen, is found in estuarine environments and associated with various marine species such as plankton, shellfish (oysters, clams, and crabs), and finfish. Environmental factors responsible for controlling numbers of _V. vulnificus_ in seafood and in the environment include temperature, pH, salinity, and amounts of dissolved organics. It may be normal flora in salt water, and acquiring this organism from shellfish or water exposure does not imply that the water is contaminated by sewage.

"Wound infections result either from contaminating an open wound with sea water harbouring the organism, or by lacerating part of the body on coral, fish, etc., followed by contamination with the organism. The ingestion of _V. vulnificus_ by healthy individuals can result in gastroenteritis."

The "primary septicaemia" form of the disease follows consumption of raw seafood containing the organism by individuals with underlying chronic disease, particularly liver disease. The organism can also enter through damaged skin. In these individuals, the microorganism enters the blood stream, resulting in septic shock, rapidly followed by death in many cases (about 50 percent). Over 70 percent of infected individuals have distinctive bullous skin lesions (shown at <http://safeoysters.org/medical/diagnosis.html>).

There are 2 points to be emphasized: that vibrios are normal flora in warm saltwater (not indicative of any sewage contamination) and that most of the life-threatening illnesses occur in individuals with underlying medical illnesses, including immunocompromised states, chronic liver disease, and diabetes. So-called normal individuals often just develop gastroenteritis. The range of disease due to _V. vulnificus_ can involve more northern geographical areas as overall global warming takes effect. - ProMED Mod.LL]

Date: Mon 29 Jan 2018
Source: Monte Carlo [in Spanish, trans. ProMED Mod.TY, edited]

Personnel of the Ministry of Public Health are investigating the death of a young --28-years old -- agronomist caused by [a] hantavirus [infection]. After completion of the specific studies, which could take 48 hours, they will be able to determine if the young woman died as a consequence of the virus [infection].

The disease is contracted by the inhalation of excretions or secretions of rodents infected by the hantavirus.

As a preventive measure, personnel of the Department of Epidemiology of the Ministry of Health will go to the rural area in Canelones, where the young woman resided.  [Byline: Enrique Puig]
====================
[No information is given about the symptoms that the young woman experienced prior to her death, nor the date of her illness and death. Presumably, the diagnosis of a suspected hantavirus infection leading to death was hantavirus cardiopulmonary syndrome (HPS).

The report above does not mention which hantavirus was responsible for this or earlier cases in Uruguay. Central Plata hantavirus could be the etiological agent responsible (for this and previous HPS cases). Its rodent host is the yellow pygmy rice rat, _Oligoryzomys flavescens_, complex of rodents. This rodent reservoir host sheds the virus in its saliva, urine and faeces, contaminating the environment in which it lives and breeds.

An image of this rodent can be accessed at

A HealthMap/ProMED-mail map showing the location of Uruguay in South
America can be accessed at: <http://healthmap.org/promed/p/28995> and
Canelones department in southern Uruguay at
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.