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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tajikistan - US Consular Information Sheet
December 9, 2008
COUNTRY DESCRIPTION: Tajikistan remains the poorest of the former Soviet republics in Central Asia.
It is a nominally constitutional, democratic, and secular republic, dominated b
President Emomali Rahmon who has been in power since 1992.
Tourist facilities are undeveloped and many goods and services usually available in other countries are unavailable.
Read the Department of State Background Notes on Tajikistan for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid passport and visa are required to enter and exit Tajikistan, as well as for registration at hotels.
The visa should be valid for the entire period of stay in country, through departure, and travelers should ideally request visas which allow for changing travel dates.
Failure to produce a valid visa will require the traveler to leave the country immediately.
Travelers planning to arrive in Tajikistan from countries that have Tajik embassies or consulates must obtain Tajik visas abroad prior to their travel.
Tajikistan is represented by embassies and consulates in the following countries:
United States of America, United Kingdom, Austria, Germany, Belgium, Turkey, China, Afghanistan (Kabul, Mazori Sharif), Iran, Pakistan, India, Russian Federation, Belarus, Kazakhstan, Kyrgyzstan, Uzbekistan, Turkmenistan, Egypt, and United Arab Emirates (Dubai).
Travelers arriving in Tajikistan from countries in which there are no Tajik embassies or consulates must have Tajik visa support, in the form of a letter from the Tajik Ministry of Foreign Affairs (MFA) confirming that a visa may be issued, in order to receive a Tajik visa at the Dushanbe International Airport upon arrival.
Travelers need to have two passport-size photos and a passport valid for at least six months longer than the duration of the planned stay in Tajikistan.
Visas issued at the Dushanbe airport are normally valid for only 45 days.
This “upon arrival” visa service does not apply to any other Tajik airports or land borders.

Travelers staying in Tajikistan three days or longer must, within three days of arrival in Tajikistan, obtain registration stamps at the MFA or the Department of Visas and Registration of the Ministry of Internal Affairs (OVIR), depending on whether the purpose of the visit to Tajikistan is for official or personal travel.
Immigration authorities may deny the departure of travelers who failed to register their visas until after they have paid a fine and obtained the registration stamps at the MFA or OVIR.

In order to receive visa support, an organization inviting a traveler to Tajikistan must submit a request to the MFA at least two weeks in advance of the planned travel date to Tajikistan.
Persons planning to arrive in Tajikistan at the invitation of a private Tajik resident (e.g., a friend or relative in Tajikistan) need to obtain a notification letter from OVIR.
According to OVIR, it may take up to 45 days to obtain the notification letter.
The MFA will issue Tajik visa support on the basis of the OVIR notification letter.
The inviting party will send a copy of visa support to the traveler.
The original MFA visa support will be sent to the Consular bureau at Dushanbe airport.
According to the Ministry of Foreign Affairs, persons traveling at the invitation of Tajik organizations or travel agencies, who are applying for visas at Tajik embassies or consulates abroad, will be able to obtain single-entry Tajik visas valid for 45 days upon direct submission of their visa request to the Tajik embassy or consulate (without a visa support letter).
With the issuance of visa support, travelers applying for visas at Tajik embassies or consulates abroad will be able to obtain multiple-entry visas valid for a maximum of three months.
Travelers who would like their visas extended need to apply for extension in advance through the MFA (official travelers) or OVIR (tourist or commercial travelers).
Entry into the Gorno-Badakhshan region, both from inside and outside of Tajikistan, requires special authorization in advance in addition to a valid Tajik visa.
Travelers can obtain this authorization at Tajik embassies and consulates abroad, or by applying to the MFA or OVIR once in Tajikistan.
Tajik authorities advise that sponsoring organizations in Tajikistan submit requests for travel authorization for the Gorno-Badakhshan Autonomous Region at least two weeks in advance of the planned travel.
The Tajik MFA or OVIR will list the names of the settlements and cities in Gorno-Badakhshan which the traveler plans on visiting in the travel authorization stamp.
The Gorno-Badakhshan travel authorization is not written on a Tajik visa sticker; it is a separate note put in a passport.

The government of Tajikistan requires visitors who remain in country for more than 90 days to present a medical certificate showing that they are HIV-free, or to submit to an HIV test in Tajikistan.
HIV is a growing health threat in Tajikistan.

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

Note: Departure options from Tajikistan may be limited in an emergency.
U.S. citizens, their family members, and their dependents can maximize departure options by obtaining extended visas for travel to countries with reliable connections to Tajikistan, including Kazakhstan, Kyrgyzstan, Uzbekistan and Russia.
Other destinations, notably Turkey, offer several flights a week and do not require American citizens to obtain visas in advance.
Please note, however, that in emergency situations, flights may be suspended.

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

SAFETY AND SECURITY:
Supporters of terrorist groups such as the Islamic Movement of Uzbekistan (IMU), the Islamic Jihad Union (IJU), al-Qaida, and the Eastern Turkistan Islamic Movement remain active in Central Asia, as do anti-Western, anti-Semitic extremist organizations such as Hizb’ut-Tahrir.
These groups have expressed anti-U.S. sentiments and may attempt to target U.S. Government or private interests in the region, including in Tajikistan.
Terrorist attacks involving the use of suicide bombers have previously taken place in neighboring Uzbekistan.
Taliban resurgence and successful operations in Afghanistan, including attacks in the north, could also affect the security situation in southern Tajikistan.

Minor explosions have occasionally occurred in Dushanbe in the last two years.
These explosions usually happen at night.
In June 2007, an individual threw a grenade at the Supreme Court building.
Witnesses and unofficial reports indicate that three guards were killed, although no official reports confirmed this.
In November 2007, a small explosive killed an individual outside the Kokhi Vahhdat conference center in the center of Dushanbe.
In both cases, no individual or organization claimed responsibility and authorities continue to investigate.
Also in November 2007, a small improvised explosive device destroyed the official car belonging to the Commander of the President’s National Guard.
Incursions along the Afghan border have resulted in shootings and kidnappings; however, most are believed to be related to narcotics trafficking.
None of these incidents have indicated the targeting of Americans or Westerners.

Criminal groups and terrorists do not distinguish between official and civilian targets.
Because of increased security at official U.S. facilities, terrorists are seeking softer civilian targets such as residential areas, clubs and restaurants, places of worship, hotels, outdoor recreation events, and other venues.
The limited number of facilities catering to Westerners presents a heightened risk.
American travelers should also avoid demonstrations and large crowds.
Demonstrations and mobs are rare in Tajikistan following the 1992-1997 civil war, and police reaction to such behavior is unpredictable.

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

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

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

CRIME:
The current crime rating for Dushanbe is high.
The primary concern is the inability of Tajikistan’s law enforcement entities to provide adequate and immediate assistance.
Lack of manpower, low salaries, and inadequate training all contribute to a lack of professionalism.
Tajikistan’s struggling economy and high unemployment have resulted in incidents of street crime, including pick pocketings, muggings and armed robberies.
Alcohol-related incidents such as bar fights and drunk driving are common.
Criminals are not deterred by the risk of confrontation and tend to operate in groups of two or more to decrease their chances of arrest.
When crimes do occur, they can be violent in nature.
Additionally, the lack of a free media, and the infrequent public outreach between the government and the public through the media, does not provide the average citizen current and accurate information to make informed decisions about safety.

Government statistics are typically inaccurate because many crimes are not reported to law enforcement organizations.
Often police refuse to open minor or routine cases that seem too difficult to resolve.
In 2007, the Ministry of Interior reported a number of arrests related to organized crime, although overall reported crimes saw a slight decrease.
The Ministry also reported a slight increase in firearm and drug-related offenses compared to previous years.

Crimes of opportunity can occur against anyone, and the Embassy reminds visitors to be careful and cautious in their own personal security, whether within the city limits of Dushanbe or in the more remote areas of the country.
Americans should be aware that danger increases after dark, and they are advised to use caution when traveling alone or on foot after dark.
The U.S. Embassy encourages visitors to travel in pairs and to notify colleagues of their whereabouts when not working, especially during evening hours.
Travelers are also encouraged to carry a copy of their passport (separate from their wallets) to speed up issuance of a new passport in case of theft.

In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products are illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm.

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.

The local equivalent to the “911” emergency line in Tajikistan is: 01 - Fire, 02 - Police, 03 - Ambulance
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
The quality of Tajikistan’s medical infrastructure is significantly below Western standards, with severe shortages of basic medical supplies, including disposable needles, anesthetics, and antibiotics.
Many trained medical personnel left the country during and following the civil war.
Elderly travelers and those with pre-existing health problems may be at particular risk due to inadequate medical facilities.

Significant disease outbreaks are possible due to population shifts and a decline in some immunization coverage among the general population.
There have been outbreaks of typhoid in the Dushanbe area and in the south, and the risk of contracting malaria, cholera, and water-borne illnesses is high.
Throughout Central Asia, rates of infection of various forms of hepatitis and tuberculosis (including drug-resistant strains) are on the rise.
Tuberculosis is an increasingly serious health concern in Tajikistan.
For further information, please consult the CDC’s Travel Notice on tuberculosis at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.
It is advised to drink only bottled or thoroughly boiled water while in Tajikistan.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Tajikistan.
However, the government of Tajikistan does require visitors who remain in country for more than 90 days to present a medical certificate showing that they are HIV-free, or to submit to an HIV test in Tajikistan.
HIV is a growing health threat in Tajikistan.

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

Travel to, from, and within Tajikistan is difficult and unreliable.
Neighboring countries may unilaterally close borders and some borders are poorly delineated.
Armed police or military checkpoints can make road travel outside of Dushanbe more difficult.
Crossing the Tajik-Uzbek border, in particular, has been known to present difficulties for drivers operating vehicles with non-Tajik government-issued plates.
Road travel should be undertaken only in daylight hours and on routes known to the traveler or a reliable escort.
Those traveling to Gorno-Badakhshan by car should do so only during daylight hours.
The roads traverse mountainous terrain along the Afghan border that is difficult to navigate, even in daylight hours.
Public transportation vehicles in the city are often overcrowded and not always safe.
If you are driving, be vigilant because pedestrians often tend to cross the street at inappropriate places or walk along the highway without paying attention to vehicular traffic.
Bus services between major cities have been severely disrupted by border closures and should not be relied upon.
The State Traffic Inspectorate (GAI, or in Tajiki, BDA), which has checkpoints in many cities and at regular intervals along all highways outside the city, frequently stops vehicles for inspection of the vehicle and the driver’s documents.

During the winter months, the potential dangers when traveling outside of Dushanbe in the mountainous areas of the country are heightened.
Every year, accidents and casualties occur on Tajikistan’s mountain roads and passes, often when drivers ignore warnings not to travel over a closed mountain pass.
Avalanches are a common occurrence in Tajikistan’s mountains during the winter months.
The tunnel bypassing the Anzob Pass is still not complete and travel via this construction project is not advised in any season.
Please exercise caution and limit winter travel to Tajikistan’s mountain regions.

In certain parts of the country, including in the Vakhsh and Rasht valleys and along the Afghan-Tajik border, land mines and cluster munitions form an additional hazard.
If an area has land mine warning signs, or is marked off with red and white plastic tape, heed the warning and do not venture off the road.
In all cases, do not pick up or handle anything that looks like unexploded munitions.

Emergency phone numbers in Tajikistan:
police – 02, ambulance – 03, state traffic control (GAI) duty officer – 235-45-45.
Please refer to our Road Safety page for more information.

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

SPECIAL CIRCUMSTANCES: Tajikistan has a cash-only economy.
International banking services are limited, but ATM machines have been installed in several locations.
Cash is dispensed in both U.S. and local currency.
Few establishments in the country accept credit cards and none accepts traveler's checks.
Tajikistan's national currency is the Somoni, which is convertible.

Tajik customs authorities may subject all items that are imported into or exported from Tajikistan to a high level of scrutiny.
The Government of Tajikistan may enforce strict customs regulations against those who import and export goods.
The export of antiques and cultural valuables requires special permission.
There are also currency restrictions.
Travelers must fill out a Customs Declaration Form upon arrival in Tajikistan, have it stamped by Tajik customs officials at the port of entry and retain the form until departure to demonstrate that the travelers are not leaving Tajikistan with more money than they brought into the country.
Please contact the Embassy of the Republic of Tajikistan in the United States, 1005 New Hampshire Avenue NW, Washington, DC, 20037; telephone (202) 223-6090, fax:
(202) 223-6091, e-mail: tajikistan@verizon.net, web site: http://www.tjus.org for specific information about customs requirements.

The Republic of Tajikistan does not recognize dual citizenship with most countries, including the United States (one exception is with Russia, where dual citizenship is regulated by a special interstate agreement).
Dual nationals who attempt to leave Tajikistan on U.S. passports without valid Tajik visas in them are likely to have problems with immigration authorities upon departing Tajikistan.

Travelers to Tajikistan are subject to frequent document inspections by local police.
U.S. citizens are strongly encouraged to carry copies of their U.S. passports, Tajik visas, and visa registration at all times (including while traveling within Tajikistan) so that, if questioned by local officials, proof of identity,
U.S. citizenship, and valid visa status in Tajikistan are readily available.
Always check your visa and registration validity dates so that these documents can be renewed if necessary before they expire.
Taking photographs of anything that could be perceived as being of military or security interest, including many government buildings, may result in problems with the authorities.
In accordance with the Vienna Convention on Consular Relations and certain bilateral agreements, local authorities must grant a U.S. consular officer access to any U.S. citizen who is arrested.
U.S. citizens who are arrested or detained should ask to contact the U.S. Embassy immediately.

Tajikistan is an earthquake-prone country.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.

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 Tajik laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Tajikistan 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 Tajikistan 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 Tajikistan.
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 109A Ismoili Somoni Avenue, Dushanbe, Tajikistan, Main Phone: 992-37-229-2000, Consular Direct Line: 992-37-229-23-00, consular e-mail dushanbeconsular@state.gov, embassy fax:
992-37-229-20-50, Duty Officer: 992-90-770-10-32, web site: http://dushanbe.usembassy.gov
* * *
This replaces the Country Specific Information for Tajikistan dated February 14, 2008, to update the sections on Entry/Exit Requirements, Crime, Aviation Safety Oversight and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Mon, 6 Aug 2018 06:19:37 +0200
By Akbar Borisov, with Christopher Rickleton in Almaty

Dushanbe, Tajikistan, Aug 6, 2018 (AFP) - En route to mountainous Tajikistan's "roof of the world" lies a hastily-erected memorial to four bike tourists killed in an attack claimed by the Islamic State group late last month.     Roses and tulips lie scattered at the tribute -- featuring a plaque inscribed in English -- in the foreground of a scrubby mountain landscape.    "We express sincere condolences on behalf of all Tajik people and Tajikistan to the families and relatives of the died tourists in our country tragically and cruelly," the plaque reads.

It was here, approximately 100 kilometres south of Tajikistan's capital Dushanbe, that American tourists Lauren Geoghegan and Jay Austin, Dutch citizen Rene Wokke and Swiss citizen Markus Hummel were fatally wounded in an attack initially reported as a hit-and-run road accident.    The attack comes as a deep blow to Tajikistan, which has been trying to promote the authoritarian country as a tourism hotspot, simplifying visa bureaucracy and even declaring 2018 "the year of tourism."

Police said the gang that attacked the group of seven tourists, injuring two others, had also stabbed their victims, while a video released via IS' official media channel indicated the attackers were inspired by the Islamist group.   "It was a tragedy," 32-year-old account manager and biking enthusiast Pau Ros told AFP ahead of a seven-day cycle over Tajikistan's legendary Pamir Highway with girlfriend Mariona Miranda.   "This happens around the world now. But we are not going to change our lives because that is what these bad people would want," said Ros, who is a native of Barcelona.

- IS-linked? -
Authorities have played down video evidence that appears to show five men -- four of whom they say were killed resisting arrest -- swearing an oath of allegiance to IS leader Abu Bakr al-Baghdadi.   On Friday Tajikistan's state prosecutor said the clip had been released "with the aim of deflecting suspicions from another terrorist organisation -- the Islamic Renaissance Party", a former opposition party banned by the government in 2015. 

The IRPT has refuted links to the attack, as has Iran, a country that Tajikistan has poor ties with and says provided training to a 33-year-old man called Hussein Abdusamadov, who was detained for allegedly leading the attack on the cyclists.   In a brief interview with AFP, the mother of Abdusamadov, who was shown sporting a black eye in his police photo, could not say if he had traveled to Iran but said he spoke Arabic and had worked in Russia, a migration destination for hundreds of thousands of Tajiks.   "We do not know when he came back to (Tajikistan). The police just came to our door and told us he had committed a crime," Gulchekhra Shodmonova told AFP.

Analysts have pointed to a number of reasons to doubt the official narrative linking IRPT and Iran to the attack -- chiefly a downturn in Tajikistan's relations with Iran, an intensified crackdown on the opposition since 2015 and the IS video evidence.     Mahmudjon Faizrahmon, a spokesman-in-exile for the party that has always described itself as peaceful opposition force said on Thursday that police brought his 62-year-old mother for questioning after he denied links between the party and the attack on Twitter.     In addition to Abdusamadov, Tajikistan's prosecutor says 10 people have been detained under suspicion of financing the crime and failing to supply information to police before the attack took place.

- 'Simply Cycling' -
At the US embassy in Dushanbe, Tajikistan, a simple bicycle donated by a local student provides a fitting flourish to a display honouring 29-year-old Geoghegan and Austin, whose blog Simplycycling.org was popular among other bike-the-world cyclists.   The pair whose photo stood on a table at the heart of the display described themselves as enthusiasts who fell in love with cycling in adulthood but were not above "hitching a ride when a stretch of road is dangerous or just awful."   It is uncertain how the attack from which only one tourist, a Frenchman, emerged unscathed, will affect one of the few sources of economic optimism in the poorest country to gain independence from the Soviet Union.    Tajikistan announced plans to create a "tourist police" earlier this week, but provided few details.    One representative of a Bed and Breakfast in Dushanbe told AFP that a Polish tourist who had planned on cycling the highway had flown home. 
Date: Mon, 30 Jul 2018 10:24:00 +0200

Dushanbe, Tajikistan, July 30, 2018 (AFP) - Four foreign tourists were killed in Tajikistan on Sunday by armed attackers in what was originally reported as a hit-and-run road accident, the interior minister said Monday.   "(The suspects) had knives and firearms," minister Ramazon Hamro Rahimzoda said of the attack that left tourists from the United States, Switzerland and the Netherlands dead and two others injured.
Date: Sun, 29 Jul 2018 20:22:04 +0200

Dushanbe, Tajikistan, July 29, 2018 (AFP) - Four tourists were killed and another three injured on a bike tour in southern Tajikistan on Sunday when a car hit them before fleeing the scene, authorities said.   The seven cyclists included two Americans, two Dutch nationals and three other foreigners, the interior ministry told AFP without specifying the nationalities of those who died.   However, the US embassy in Tajikistan said two of the fatalities were US citizens.

The hit-and-run accident took place in the district of Danghara, 150 kilometres (90 miles) south of the capital Dushanbe.    "Three foreigners were killed at the scene and another died in hospital," the interior ministry said, adding that three other tourists had also received medical treatment.

Authorities in the Central Asian nation announced later Sunday one arrest and the deaths of two other suspects during a special operation launched to find those responsible for the deadly hit-and-run incident.   "One person has been arrested, two others resisted arrest and have been killed," the interior ministry said, without giving further details about the suspects.   Tajikistan is the poorest of the ex-Soviet republics and has been ruled by the iron hand of President Emomali Rakhmon since 1992.
Date: Tue 7 Nov 2017
Source: UN OCHA, ReliefWeb, Int Fed of Red Cross and Red Crescent Societies (IFRC) report [edited]

Measles outbreak DREF [Disaster Relief Emergency Fund] Operation MDRTJ025 Final Report
----------------------------------------------------------------------
A. Situation analysis
Description of the disaster
The measles epidemic in Tajikistan started in April 2017 in Rudaki district, and gradually spread to the capital city of Dushanbe and the surrounding districts, as well as Khatlon oblast. In mid-April 2017, 263 registered cases of measles were reported, out of which 157 were laboratory confirmed. By 1 May 2017, the number of notified and investigated cases rose from 263 to 345, with 246 patients (71 per cent) hospitalised. There were 2 child deaths registered over the course of the epidemic -- one in Khatlon oblast and one in the Districts of Republican Subordination).

The group most affected by the epidemic were children between 1 and 9 years of age. This also corresponded to the cohort born after the last national measles and rubella (MR) immunisation campaign conducted in 2009. Normally, the immunisation centre of the Ministry of Health and Social Protection (MoHSP) carries out immunisation on an annual basis for approx. 97 per cent of this cohort. The remaining 3 per cent -- including migrants, Roma and displaced people -- however, tends to remain non-immunised.

In response to the outbreak, the MoHSP decided to conduct a nationwide MR vaccination campaign targeting children aged 1-9 years, 15-26 May 2017, with the support of the Measles and Rubella Outbreak Response Initiative (MRI) Fund. The government of Tajikistan issued a decree on National Additional Immunisation Days in the country on 28 Apr 2017. The MoHSP issued an internal order on immunisation accordingly.
=====================
[The complete IFRC report is available at

Maps of Tajikistan can be seen at
Date: Mon, 30 Jan 2017 09:06:48 +0100

Dushanbe, Tajikistan, Jan 30, 2017 (AFP) - Authorities in Tajikistan said Monday that at least seven people were killed in a series of avalanches that hit the mountainous Central Asian country over the weekend.   Avalanches killed at least five people on a highway linking the capital Dushanbe with Khujand, Tajikistan's second largest city, the emergency services committee said.

Two more died in avalanches in the remote Pamir region in the country's east, the committee said.   Authorities said a rescue operation was ongoing and the casualty toll could continue to rise.    A spokesperson for the committee told AFP around 800 people had been evacuated Sunday following the avalanches.   Mountainous and poverty-struck Tajikistan is prone to natural disasters including avalanches, landslides and earthquakes.   In February 2015, a single avalanche claimed six lives in the east of the country.
More ...

Bahamas

The Bahamas Consular Information Sheet
July 14, 2005

COUNTRY DESCRIPTION:
The Bahamas is a developed, English-speaking Caribbean nation composed of hundreds of islands covering a territory approximately the size of California.
To
rism and financial services comprise the two largest sectors of the economy. Independent from the United Kingdom since 1973, The Bahamas is a Commonwealth nation with a centuries-old democratic tradition.
The capital, Nassau, is located on New Providence Island.
Read the Department of State Background Notes on The Bahamas at http://travel.state.gov for additional information.

ENTRY/EXIT REQUIREMENTS:
On December 31, 2005, the U.S. Government will begin to phase in new passport requirements for U.S. citizens traveling in the Western Hemisphere.
By December 31, 2007, all U.S. citizens will be expected to depart and enter the United States on a valid passport or other authorized document establishing identity and U.S. citizenship.
The Department of State strongly encourages travelers to obtain passports well in advance of any planned travel.
Routine passport applications by mail take up to six weeks to be issued.
For further information, go to the State Department's Consular website: http://travel.state.gov/travel/cbpmc/cbpmc_2223.html.

U.S. citizens must present original proof of U.S. citizenship (valid U.S. passport or certified U.S. birth certificate with a government-issued photo ID) and a return ticket. A passport is recommended as it eases processing upon return to the United States.
Voter registration cards, Social Security cards, driver's licenses, affidavits, and other similar documents are not acceptable as proof of U.S. citizenship. U.S. citizens do not need to obtain visas for stays of up to one month. Travelers arriving via private watercraft are charged docking fees.
See our Foreign Entry Requirements brochure for information on entry to The Bahamas and other countries.
U.S. citizens may also contact The Embassy of The Bahamas at 2220 Massachusetts Ave., NW, Washington, DC 20008 (tel: 202-319-2660), its Consulates in Miami and New York, or by email at bahemb@aol.com.

For entry and exit requirements pertaining to dual nationality and the prevention of international child abduction, read our information at http://travel.state.gov/travel/cis_pa_tw/cis/cis_1469.html.
For Customs Information see http://travel.state.gov/travel/cis_pa_tw/cis/cis_1468.html.

SAFETY AND SECURITY:
The water sports and scooter rental industries in The Bahamas are not carefully regulated.
Visitors should rent equipment only from reputable operators, and should insist on sufficient training before using the equipment.
Every year, people are killed or injured by the improper use of scooters, jet-skis, and personal watercraft or by the careless or reckless operation of such equipment by others.
You should insist on seeing proof that operators have sufficient medical and liability insurance. Travelers should also invest in low-cost traveler's insurance that includes medical evacuations, as most American insurance companies do not cover this.

For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site at http://travel.state.gov where the current Travel Warnings and Public Announcements, including the Worldwide Caution Public Announcement, 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., 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 at http://travel.state.gov/travel/tips/safety/safety_1747.html.

CRIME:
While The Bahamas has a relatively low crime rate, visitors should exercise caution and good judgment. Although most criminal incidents take place in a part of Nassau not usually frequented by tourists (the "over-the-hill" area south of downtown), crime and violence has moved into more upscale tourist and residential areas.
Criminals also target restaurants and nightclubs frequented by tourists.
The most common approach for criminals is to offer victims a ride, either as a "personal favor" or by claiming to be a taxi, and then robbing and/or assaulting the passenger once they are in the car. Visitors should take care to ride only in licensed taxis, identifiable by their yellow license plates.

In the last year the U.S. Embassy has received several reports of sexual assaults, including against teen-age girls. Most assaults have been perpetrated against intoxicated young women, some of whom were reportedly drugged. To minimize the potential for sexual assault, the Embassy recommends that young women stay in groups, consume alcohol in moderation or not at all, ride only in licensed taxis, and not accept rides or drinks from strangers.
Travelers should avoid walking alone after dark or in isolated areas, and avoid placing themselves in situations where they are alone with strangers. Be cautious on deserted areas of beaches at all hours. Hotel guests should always lock their doors and should never leave valuables unattended, especially on beaches.
Visitors should store passport/identity documents, airline tickets, credit cards, and extra cash in hotel safes. Avoid wearing expensive jewelry, particularly Rolex watches, which criminals have specifically targeted. Use only clearly marked taxis with yellow license plates and make a note of the license plate number for your records.

The legal age in the Bahamas for consumption of alcoholic beverages is 18. Parents should be aware, however, that enforcement of the drinking age is weak.
It is easy for teenagers to obtain alcoholic beverages and underage drinking is prevalent.
Many of the arrests, accidents and violent crimes suffered by U.S. citizens in The Bahamas involve alcohol.

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 understand the local criminal justice process and find an attorney if needed.

See our information on Victims of Crime at http://travel.state.gov/travel/tips/emergencies/emergencies_1748.html.

MEDICAL FACILITIES AND HEALTH INFORMATION:
High quality medical care is generally available, but expensive, in Nassau and Freeport. Medical care is limited outside of Nassau and Freeport. Bahamian doctors and hospitals do not usually accept U.S. medical insurance policies and typically expect immediate cash payment for professional services. It is the patient's responsibility to seek reimbursement later from their insurance companies. Serious health problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars. Persons with serious or life-threatening conditions who wish to return to U.S. medical facilities for treatment normally must be airlifted.
There is a chronic shortage of blood at Princess Margaret Hospital in Nassau, where most emergency surgery is performed.
Travelers with rare blood types should know the names and locations of possible blood donors should the need arise.
The Lyford Cay Hospital has a hyperbaric chamber for treatment of decompression illness.
Ambulance service is available, but may not be able to respond quickly in the event of a major emergency or disaster.

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); fax 1-888-CDC-FAXX (1-888-232-3299), or via the CDC's Internet site at http://www.cdc.gov/travel.
For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas at http://travel.state.gov/travel/cis_pa_tw/cis/cis_1470.html.

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

Traffic in The Bahamas moves on the left side of the roadway. Roads in Nassau and Freeport are generally adequate, but traffic congestion in those cities is endemic.
Rural roads can be narrow, winding, and in poor repair.
Flooding frequently occurs on roads in low-lying areas throughout The Bahamas, including Nassau and Freeport.
Drivers should be alert for unmarked construction zones throughout The Bahamas.
Travel by moped or bicycle can be quite hazardous, especially in the heavy traffic conditions prevalent in Nassau and Freeport. Travelers should exercise appropriate caution when renting motorbikes. Accidents involving U.S. tourists on motorbikes have caused severe injuries and fatalities. Those who choose to ride a moped or bicycle should wear helmets and drive defensively.
Pedestrians need to remember that vehicular traffic comes from the right.
Pedestrians have been hit by cars after failing to check properly for oncoming traffic.

Emergency ambulance service is generally available and can be reached by dialing 911. Roadside assistance is also widely available through private towing services, listed in the phone book.

For specific information concerning driver's permits, vehicle inspection, road tax, and mandatory insurance in The Bahamas, please contact The Bahamas Tourist Board in New York at http://bahamas.com, (tel:
1-800-823-3136).

Please refer to our Road Safety page for more information at http://travel.state.gov/travel/tips/safety/safety_1179.html.
Visit the website of the country's national tourist office and national authority responsible for road safety.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of The Bahamas as being in compliance with ICAO international aviation safety standards for oversight of The Bahamas' air carrier operations.
For more information, travelers may visit the FAA's Internet web site at http://www.faa.gov/avr/iasa/index.cfm.

SPECIAL CIRCUMSTANCES:
CUSTOMS:
The Bahamas customs authorities may enforce strict regulations concerning temporary importation into or exportation from The Bahamas of firearms. It is advisable to contact the Embassy of The Commonwealth of The Bahamas in Washington or one of the Bahamian consulates in the U.S. for specific information regarding customs requirements. Tourists who arrive by private boat are required to declare firearms to Bahamian Customs and leave firearms on the boat while in The Bahamas. Please see our information on customs regulations at http://travel.state.gov/travel/cis_pa_tw/cis/cis_1468.html.

BOATING/FISHING:
Boaters should be aware that long-line fishing in Bahamian waters is illegal. All long-line fishing gear is required to be stowed below deck while transiting through Bahamian waters. Fishermen should note that stiff penalties are imposed for catching crawfish (lobster) or other marine life out of season or in protected areas.

TIME-SHARES:
U.S. citizens should exercise caution when considering time-share investments and be aware of the aggressive tactics used by some time-share sales representatives. Bahamian law allows time-share purchasers five days to cancel the contract for full reimbursement. Disputes that arise after that period can be very time-consuming and expensive to resolve through the local legal system.
HURRICANES:
The Bahamas, like all countries in the Caribbean basin, is vulnerable to hurricanes. Hurricane season officially runs from June 1 to November 30, although hurricanes have been known to occur outside that time period. Visitors to The Bahamas during hurricane season are advised to monitor weather reports in order to be prepared for any potential threats. General information about disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating The Bahamas' laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in The Bahamas are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
For more information visit http://travel.state.gov/travel/cis_pa_tw/cis/cis_1467.html.

CHILDREN'S ISSUES:
For information on international adoption of children and international parental child abduction, see the Office of Children's Issues website at http://www.travel.state.gov/family/family_1732.html.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in The Bahamas are encouraged to register with the nearest U.S. Embassy through the State Department's travel registration website, https://travelregistration.state.gov, and to obtain updated information on travel and security within The Bahamas.
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 next to McDonald's restaurant on Queen Street in downtown Nassau; telephone (242) 322-1181, after hours: (242) 328-2206.
Consular Section hours are 1:00 p.m. - 4:00 p.m. Monday-Thursday and 10:00-12:00 on Fridays. The Embassy is closed on local and U.S. holidays.
You may wish to visit the Embassy's website at http://bahamas.usembassy.gov/ or contact the Consular Section by e-mail at acsn@state.gov .

The U.S. Embassy is also responsible for consular services in the Turks and Caicos Islands (TCIS), a United Kingdom (British) overseas territory.
U.S. citizens may obtain updated information on travel and security in TCIS from the U.S. Embassy in Nassau or the Consular Information Sheet for the Turks and Caicos.
*

*

*
This replaces the Consular Information Sheet dated October 15, 2004, to update Sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Traffic Safety and Road Conditions, Special Circumstances, and Registration/Embassy Location; to include a Section on Information For Victims of Crime; and to combine and update the Sections on Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Mon, 2 Sep 2019 11:42:27 +0200 (METDST)

Geneva, Sept 2, 2019 (AFP) - Hurricane Dorian has caused "extensive damage" across the Bahamas, the Red Cross said Monday, warning that as many as 13,000 houses may have been severely damaged or destroyed.   "We don't yet have a complete picture of what has happened," Sune Bulow, head of the International Federation of Red Cross and Red Crescent Societies' Emergency Operation Centre in Geneva, said in a statement.   "But it is clear that Hurricane Dorian has had a catastrophic impact," he said, adding that "we anticipate extensive shelter needs, alongside the need for short-term economic support, as well as for clean water and health assistance."

Hurricane Dorian battered the Bahamas with ferocious wind and rain on Sunday, the monstrous Category 5 storm wrecking towns and homes as it churned on an uncertain path toward the US coast where hundreds of thousands were ordered to evacuate.   There was no immediate word on casualties in the low-lying islands.   But IFRC said that up to 13,000 houses may have been severely impacted.

The organisation also warned that extensive flooding on the island of Abaco was believed to have contaminated wells with saltwater.   IFRC said it had released 250,000 Swiss francs ($252,000, 230,000 euros) from its Disaster Relief Emergency Fund to bolster the initial response to the crisis, and to provide some 500 families with emergency shelter assistance.   Packing sustained winds of 185 miles per hour (295 kilometre per hour), Dorian crashed onshore in the Abacos Islands, in the northwest of the Bahamas, as the strongest storm ever to hit the Caribbean chain.

After days of nerve-wracking uncertainty surrounding the storm's path, the southeastern US states of Florida, Georgia and South Carolina finally ordered coastal residents to evacuate in a mass exodus set to affect hundreds of thousands of people.    The American Red Cross estimated that some 19 million people live in areas that could be impacted by the storm, with as many as 50,000 people in Florida, Georgia and South Carolina potentially in need of emergency shelter, depending on the impact.   IFRC said that hundreds of Red Cross volunteers, emergency response vehicles and more than 30 truck loads of relief supplies were being mobilised to help people living in the path of the hurricane.
Date: Mon, 2 Sep 2019 00:55:48 +0200 (METDST)
By Leila MACOR

Riviera Beach, United States, Sept 1, 2019 (AFP) - Hurricane Dorian blasted the northern Bahamas as a monster Category 5 storm on Sunday, pummeling the low-lying island chain with torrential rains and winds of a violence unprecedented in its history.   Packing winds of 185 miles per hour (295 kilometers per hour), Dorian made landfall twice in the Bahamas' Abaco Islands, and was tied for the second most powerful hurricane ever in the Atlantic basin, the National Weather Service said.

Footage posted on social media showed major destruction. There was no immediate word on casualties.   Parts of the Abaco Islands were reported to be under water as forecasters warned it was facing a towering 18 to 23 foot storm surge. Winds were gusting over 220 mph, the National Hurricane Center in Miami said.   Video posted on the website of the Bahamian newspaper Tribune 242 showed water up to the roofs of wooden houses in what ppeared to be a coastal town. Capsized boats floated in muddy brown water dotted with wooden boards, tree branches and other debris.

In other social media footage of what appears to be an inland area, cars were smashed or turned over, telephone poles and trees were snapped like twigs and debris filled the yards of severely damaged homes. AFP could not immediately confirm the authenticity of any of this footage.   Bahamas Prime Minister Hubert Minnis broke down in tears as he addressed a news conference, calling it "probably the most sad and worst day of my life," the Nassau Guardian reported.   "We're facing a hurricane... one that we've never seen in the history of the Bahamas," he said.

Footage shot in Cooper's Town, Abaco and obtained by AFP showed waves crashing violently onshore, sending up huge clouds of spray along the coastline.   Local radio reported that people were calling for help after winds blew the roof off the Island Breezes Hotel in Marsh Harbour, a commercial hub in the Abacos.   "Things are really starting to rock and roll," a post on the Facebook page of the Hope Town Bulletin in Abacos said at 10:00 am local time.    As of 2200 GMT, the storm was 75 miles (120 kilometers) east of Freeport on the island of Grand Bahama and moving slowly west.   In Grand Bahama, thousands have evacuated to get out of Dorian's predicted path.   "It feels like we are standing in a line waiting for a beating," Yasmin Rigby, a resident of Freeport, the island's main city, told AFP.

- Strongest storm to hit Bahamas -
The NHC said Dorian had become "the strongest hurricane in modern records for the northwestern Bahamas."   Describing "catastrophic" conditions in the Abacos Islands, it said the storm was "heading with all its fury towards Grand Bahama," where it was expected Sunday night into Monday.  NHC director Ken Graham on Facebook Live said the Bahamas would be under major hurricane conditions for a punishing 30 hours or more.   "That's major hurricane winds, that's storm surge of 10 and even 20 feet in some of those areas," he said. "That's also torrential rainfall of 15 to 20 inches, isolated 30 inches."

In Washington, US President Donald Trump met with his emergency management chiefs and declared "this looks monstrous."   "We expect that much of the eastern seaboard will be ultimately impacted and some of it very, very severely," he said.   Tropical storm warnings were in effect for parts of the Florida coast, and residents up and down the Atlantic coast braced for a brush with danger.   Florida issued its first evacuation orders in parts of Palm Beach, home of Trump's Mar-a-Lago resort, and Martin Counties.

- 'Very great danger' -
Kevin McAleenan, acting homeland security secretary, said hurricane force winds could hit Florida, followed by a prolonged rain event combined with a storm surge.   "That's going to be very difficult as the storm starts to move northward, mostly like, up the coast of Florida and toward Georgia and South Carolina," he said on ABC's "This Week."   While Miami appeared likely to be largely spared, 30-year-old David Duque, picking up sandbags there on Saturday, noted that "everything could change... I know it could be a scare, but better prepare instead of doing nothing."   The Florida National Guard said roughly 2,000 service members had been mobilized, with another 2,000 poised to join them.

- 'Absolute monster' -
Trump has declared a federal state of emergency in Florida, authorizing US assistance to supplement state and local efforts.   Following a similar state order in Florida, South Carolina Governor Henry McMaster declared a state of emergency Saturday, saying, "Given the strength and unpredictability of the storm, we must prepare for every possible scenario."   Neighboring North Carolina also declared a state of emergency, and Georgia announced a state of emergency for 12 counties.   Orlando International Airport was to protectively halt commercial flights at 2:00 am (0600 GMT) Monday, and Florida's NASA Kennedy Space Center said it was moving an enormous mobile rocket launcher inside to protect it.
Date: Wed 25 Jul 2018
Source: Eyewitness News [edited]

Cases of reported conch poisoning are on the rise in the capital, according to Minister of Health Dr. Duane Sands. The health minister confirmed Tue 24 Jul 2018 that over 3 dozen persons have sought medical attention for conch poisoning since the Ministry of Health announced the new outbreak in New Providence nearly a month ago.

Luckily, there have been no reports of conch poisoning in the Family Islands. Dr. Sands confirmed that the outbreak has been isolated to New Providence. "We can now confirm 25 clinical cases with laboratory testing," he said. "There are an additional 15 clinical cases that meet the definition but are still awaiting finalization of their laboratory data, so there may be as many as 40 clinical cases that might have been presented to the hospital. There are some people who get conch poisoning but it's not severe enough for them to come to the hospital for treatment."

The health minister continued to issue warning to patrons and vendors. "I continue to say that this is a preventable problem, so to the vendors, you have to wash the conch in fresh water. To the patrons, it is a good idea to insist that [the conch] is washed in fresh water."

Conch poisoning occurs when raw conch meat is not thoroughly washed in fresh water. Bacteria that resides on the skin of conch is what leads to the treacherous poisoning. The most recent major outbreak of conch poisoning in the Bahamas dates back to the 1990s.  [Byline: Theo Sealy]
=====================
[The aetiology is _V. parahaemolyticus_, a bacterium in the same family as those that cause cholera. It lives in brackish saltwater and causes gastrointestinal illness in humans. Symptoms include watery diarrhoea, abdominal cramping, nausea, vomiting, and fever and chills. Usually these symptoms begin within 24 hours of exposure. Illness is usually self-limited and lasts approximately 3 days. Severe disease is rare and occurs more commonly in persons with weakened immune systems.

Infections with this organism, which can be normal microflora in seawater, have been associated with the consumption of raw, improperly cooked, or cooked and recontaminated fish and shellfish. A correlation exists between the probability of infection and warmer months of the year. Improper refrigeration of seafood contaminated with this organism will allow its proliferation, which increases the possibility of infection. ProMED-mail covered a large 2005 outbreak in Chile. It was impressive in its size (more than 10 000 cases), continued to spread despite early recognition, and involved clams and mussels rather than the classical oyster vehicle. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
New Providence Island, New Providence, Bahamas:
Date: 5 Jul 2018
Source: The Nassau Guardian [edited]

The Ministry of Health warned yesterday of a recent outbreak of conch poisoning. Health authorities yesterday [4 Jul 2018] confirmed 4 cases of conch poisoning stemming from Potter's Cay in the past 72 hours but said the outbreak of _Vibrio parahaemolyticus_ could easily be prevented by vendors washing their conch supplies in fresh water.

_V. parahaemolyticus_ is a bacterium found in brackish saltwater, which, when ingested, causes symptoms including abdominal cramps, vomiting, headache, diarrhea and fever. "This is a preventable illness that requires basic hygiene as it relates to conch preparation," said Minister of Health Dr. Duane Sands during a press conference at the Ministry of Health of Meeting Street. He continued, "I think there is no reason why we can't say we will ensure that every single vendor is reminded of the requirement to wash the conch with copious amounts of fresh, clean water. To those in the purchasing public, if your vendor does not have access to fresh tap water or distilled water, and is only washing the conch in seawater, until we get the all clear, don't buy from that vendor."

The 4 patients with confirmed cases of vibriosis are Bahamians. There were at least 6 more people exhibiting symptoms awaiting confirmation of conch poisoning.

Sands assured the public that health officials, who received reports of the cases yesterday morning [4 Jul 2018], have mobilized in conjunction with the Ministry of the Environment to take the necessary steps to protect the health of those affected and, through targeted interventions, prevent further cases. The minister also advised all conch vendors will be required to take a food-handling course and maintain fresh potable water at their stalls.

As it relates to the unconfirmed cases, Sands said those patients, who were admitted to the Emergency Room at Doctors Hospital and Princess Margaret Hospital in the past 24 hours with gastroenteritis, were awaiting lab results. "Bear in mind that gastroenteritis can occur for a number of reasons," he said, "And so, to ascribe a case of gastroenteritis to vibrio would require confirmatory testing."

Sands said one of the priorities of the ministry is to have the conversation with the public early and spread awareness. "The 2nd thing we would like to do and we have started to do is to ensure the environmental health teams speak directly with the vendors, but throughout New Providence [Bahamas] and anywhere else we may suspect a possibility of exposure," the minister said. "We learned back in the 1990s this is easily controlled if people practice very simple techniques of washing conch with fresh water, which minimizes, if not eliminates, the possibility of transmission. And so, we just redouble those efforts combined with public education."

Additionally, Sands advised conch purchasers to ask vendors and restaurants whether the conch has been washed in fresh water before purchasing and eating it. "If the answer is affirmative, then you ought to feel reasonably comfortable you can eat it," he said. "If the answer is no, then I wouldn't suggest you eat or purchase it." No vendor has been closed down as a result of the cases presented. Sands said that would be premature, noting that conch poisoning from _V. parahaemolyticus_ can be easily prevented.

Thousands of visitors frequent Potter's Cay and other venues to sample conch in the variety of ways it is prepared, such as conch salad, in which the conch is consumed raw with vegetables, pepper and lime. According to health officials, cooking the conch removes the chance of it being contaminated.

There were 223 cases of vibriosis in New Providence [Bahamas] in 2003. In 1991 and 1999, there were also outbreaks of conch poisoning with a combined 1100 cases, Sands said.

Regarding testing, Sands was asked whether the ministry has periodically tested random conch batches from vendors. "This is not an issue of the meat itself," he responded. "Vibrio is a bacteri[um] ordinarily living in sea water and is a part of the surface of the conch. The conch meat itself is not infected with _V. parahaemolyticus_, so you can wash it off. Testing the conch meat itself is not the issue."

Sands continued, "We have learned historically you can eliminate this problem by washing the conch in fresh water. If you are washing the conch with _Vibrio_-containing water, you are not going to solve the problem, even though the conch may appear clean on the surface." Sands said while this is a breaking matter and the ministry has a strategic plan, it has not gotten to the stage of testing batches of conch and the storage water, but "that does not mean that we won't get there."

Symptoms of conch poisoning from _V. parahaemolyticus_ can persist for 72 hours, and some patients may require hospitalization for treatment of dehydration. Those experiencing symptoms are asked to contact the ministry's surveillance unit at +1-242-502-4790 between 9 a.m. and 5 p.m. EDT.  [Byline: Torrell Glinton]
====================
[There is now confirmation the agent involved in the conch poisoning situation is the bacterium _Vibrio parahaemolyticus_. I apologize for the error regarding identification of the agent. Laboratory confirmation is always appreciated. [ProMED would like to thank Mr. Ryan Burke for bringing the laboratory confirmation to our attenttion. - ProMED Mod.JH]

_V. parahaemolyticus_ is a bacterium in the same family as those that cause cholera. It lives in brackish saltwater and causes gastrointestinal illness in humans. Symptoms include watery diarrhea, abdominal cramping, nausea, vomiting, and fever and chills. Usually these symptoms begin within 24 hours of exposure. Illness is usually self-limited and lasts approximately 3 days. Severe disease is rare and occurs more commonly in persons with weakened immune systems <http://www.health.state.mn.us/divs/idepc/diseases/vibrio/basics.html>.

Additional information regarding _V. parahaemolyticus_ may be found on the CDC fact sheet <https://www.cdc.gov/vibrio/faq.html> - ProMED Mod.TG]

[Infections with this organism, which can be normal microflora in seawater, have been associated with the consumption of raw, improperly cooked, or cooked and recontaminated fish and shellfish. A correlation exists between the probability of infection and warmer months of the year. Improper refrigeration of seafood contaminated with this organism will allow its proliferation, which increases the possibility of infection. ProMED-mail covered a large 2005 outbreak in Chile. It was impressive in its size (more than 10 000 cases), continued spread despite early recognition, and the involvement of clams and mussels rather than the classical oyster vehicle. - ProMED Mod.LL]

[HealthMap/ProMED-mail map: <http://healthmap.org/promed/p/11584>]
Date: Thu 5 Jul 2018
Source: EW News [edited]

With 4 confirmed cases of conch poisoning in New Providence, [Bahamas], the Ministry of Health cautioned Bahamians against consuming the delicacy in the wake of this latest outbreak. Health Minister Dr. Duane Sands confirmed the 4 Bahamians suffering from the illness. The earliest case, he said, dates back to [Sat 30 Jun 2018].

Dr. Sands revealed that an additional 6 persons have been hospitalized with symptoms of conch poisoning. He said even though the number of cases is considered minimal, the ministry's warning is a proactive measure to prevent future cases. The ministry, he said, is expected to begin dialogue with local vendors to ensure they are utilizing proper cleaning methods in the preparation of conch dishes.

"Conch should be washed with fresh water, and not salt water, to ensure that all bacteria is removed from the conch meat," suggested Dr. Sands. He urged Bahamians to ask local vendors about the processes they employ during the preparation of conch dishes. "If they do not wash the conch in fresh water during the process of preparing it, then do not purchase the conch," he warned.

The early onset of conch poisoning is said to be accompanied by watery diarrhoea and extreme abdominal cramps. Some cases, the health minister said, are severe and can lead to dehydration and subsequent hospitalization.

The last major outbreak of conch poisoning dates back to the 1990s, according to Dr. Sands.  [Byline: Theo Sealy]
=========================
[The group of conchs that are sometimes referred to as "true conchs" are marine gastropod molluscs in the family Strombidae, specifically in the genus _Strombus_ and other closely related genera. For example, see _Lobatus gigas_, the queen conch, and _Laevistrombus canarium_, the dog conch (<https://en.wikipedia.org/wiki/Conch>).

In ciguatera poisoning, the poisonous ingredient is ciguatoxin. This is a poison made in small amounts by certain algae and algae-like organisms called dinoflagellates. Environmental conditions are right for other organisms, mollusks, or fish to ingest the algae and dinoflagellates. Smaller organisms may be ingested by larger organisms, thus transferring the toxic agent to the larger animal.

Ciguatera is a foodborne illness (food poisoning) caused by eating fish that is contaminated by ciguatera toxin. Ciguatera toxin, a heat-stable, lipid-soluble compound produced by dinoflagellates and concentrated in fish organs, can cause nausea, pain, and cardiac and neurological symptoms in humans when ingested.

Ciguatera toxin is harmless to fish but poisonous to humans. The toxin is odorless and tasteless, and cooking does not destroy the toxin. The toxin activates voltage-dependent sodium channels, causing symptoms in gastrointestinal, cardiac, and nerve tissues of humans and other mammals.

Symptoms in people generally begin 6-8 hr after eating the contaminated fish but can occur as early as 2 or as late as 24 hr after ingestion. Symptoms include nausea, vomiting, diarrhea, muscle pain, numbness, tingling, abdominal pain, dizziness, and vertigo. There is no specific antitoxin available for ciguatera toxin.

Some investigators have suggested vomiting should be induced if the victim is awake and alert and has eaten ciguatera toxin-containing fish within the last 3-4 hr. Ipecac, a substance that causes vomiting, was suggested as the medication to use, but many investigators now think ipecac causes too much dehydration. Currently, some physicians recommend gastrointestinal decontamination with activated charcoal. Activated charcoal may absorb the toxin if administered 3-4 hr after ingestion.

Victims should maintain hydration. Intravenous fluids may be necessary for uncontrollable nausea and vomiting. Although there is no specific antidote available, supportive therapy and time usually is curative.

Portions of this comment were extracted from

[HealthMap/ProMED-mail map:
New Providence Island, New Providence, Bahamas:
More ...

Malaysia

General
**************************************
Malaysia consists of two separate components; peninsular Malaysia (which is situated between Thailand and Singapore) and Borneo (which has the states of Sabah and Sarawak.) The total population is o
er 20 million and it has a very diverse cosmopolitan culture. Bahasa Malaysia is the official language though English is very widely spoken. The entire country has an equatorial climate with rainfall throughout most of the year. However there are two distinct rainy seasons – March to May and September to November. The costal regions may also experience monsoon conditions. Info: http://www.visitmalaysia.com
Safety & Security
**************************************
Violent crime against tourists is rare though petty incidents like bag snatching, burglaries and car break-in crimes are increasing. It is wise to take special care of your personal belongings when walking through some of the crowded market places or along the curb. Credit card fraud is becoming a serious problem so don’t let your card out of your sight at any time. Travelling out from the main tourist destinations on Borneo may lead to a higher risk of personal danger. Kidnapping from Pandanan Island and Sipadan (both diving resorts) show how there is a need for increased vigilance when visiting parts of coastal Sabah near to the islands. Drug offences of any kind are treated very seriously in Malaysia and may result in disruption of travel plans or imprisonment. Never carry drugs for another individual unless you are certain that there is no risk involved whatsoever.
Climate
**************************************
All over Malaysia the climate tends to be very humid though this can vary from location to location and throughout the year. Being so close to the equator, the sun is strong and proper care against sun burn must be constantly taken. Dehydration and loss of salt through perspiration are two other common problems for the unprepared traveller. Drink plenty of fluids and replace your salt loss. Make sure you pack clothing suitable for a warm humid climate.
Long Haul Flight & Jet Lag
**************************************
On the plane make sure you exercise your calf muscles and drink plenty of fluids. Female travellers on the contraceptive pill should be aware of the higher risk of venous clotting. After your long haul flight it is essential to allow your body catch up and so try to ensure that you have sufficient time to rest on the first day after arrival. (Make sure you don’t fall asleep beside the pool after arrival and then awaken with sunburn.)
Food & Water
**************************************
Generally the level of food hygiene throughout the country is high. Nevertheless avoidance of bivalve shellfish meals is a wise precaution. Food from street vendors should also be treated with suspicion though unpeeled fresh fruit or various well-cooked foods should be fine. Adding ice to your drinks is probably unnecessary and potentially harmful and should be avoided. The menus will usually be in English so that should make meal selection somewhat easier!
Mosquitoes
**************************************
Due to the constant humid climate mosquitoes tend to be present throughout the year. In Malaysia there are a number of diseases transmitted by mosquitoes and so care to avoid their bite is to be encouraged at all times. The three most significant diseases transmitted by mosquitoes are Malaria, Dengue Fever and Japanese B Encephalitis. In the case of Dengue Fever the mosquito responsible tends to prefer to live in the towns and cities throughout both Borneo and Peninsular Malaysia. This mosquito usually bites during the day-light hours. The transmission of Japanese B is usually in the rural regions of the country seldom visited by tourists. Most cases occur in Sarawak. Both of these viral diseases can be very serious and even life threatening and so avoidance of mosquito bites is essential.
Malaria Risk
**************************************
The risk of malaria for most tourists visiting Peninsular Malaysia is extremely small. There is insignificant risk in Kuala Lumpur, Penang etc and so many tourists opt not to use prophylaxis. However in Sarawak and Sabah the risk of malaria is present throughout the year. Even in these regions the risk is mainly off the coastal plains and towards the border areas. Generally prophylaxis is recommended for those visiting Sabah or Sarawak.
Water Sports in Malaysia
**************************************
Many tourists will undertake some water sports while in Malaysia and so make sure your insurance policy will cover this eventuality. Before you agree a contract with a provider check that their equipment appears to be well maintained and that they have good safety instructions. If you are unsure do not take part. Never swim alone or after a heavy meal (or excess alcohol intake) and always listen to local advice regarding sea currents etc.
Vaccinations for Malaysia
**************************************
Travelling directly from Ireland there are no vaccines which are essential for entry into Malaysia. However for most tourists the following vaccines are recommended for personal protection.
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Poliomyelitis (childhood booster)
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Tetanus (childhood booster)
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Typhoid (food & water borne disease)
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Hepatitis A (food & water borne disease)
For those undertaking a more adventurous trip further vaccines may need to be considered such as Hepatitis B, Rabies, Japanese B Encephalitis and Meningitis. The need for Malaria prophylaxis will depend on your proposed itinerary.
Summary:
**************************************
Malaysia is becoming a more common destination for holidays and also as a stop-off for those travelling on to Australia. With commonsense and care you should be able to have a very enjoyable safe time. If you do develop any unusual health problem after your trip (skin rash, bowel disturbance, influenza symptoms etc) make sure you attend for urgent medical attention.

Travel News Headlines WORLD NEWS

Date: Thu 3 Oct 2019
Source: European Centre for Disease Prevention and Control (ECDC) News & events [edited]

[Authorities in] Denmark has reported a travel-related case of malaria caused by _Plasmodium cynomolgi_ in a Danish traveller returning from a visit to forested areas in peninsular Malaysia and Thailand during August-September 2018.

_P. cynomolgi_ is a parasite causing disease among macaque monkeys across Southeast Asia but rarely infects humans.

The traveller was admitted to hospital with the suspicion of malaria. Routine initial tests for malaria (rapid diagnostic test and microscopy) and more in-depth tests (malaria-specific loop-mediated isothermal amplification test and Sanger sequencing) were required to diagnose malaria caused by _P. cynomolgi_. After receiving treatment, symptoms resolved on the 2nd day and the patient recovered fully.

ECDC wants to raise awareness about the possibility of more human cases due to the presence of _P. cynomolgi_ in macaques across Southeast Asia and the volume of tourists visiting these areas, including national parks. Since the diagnosis is challenging, advanced detection and identification techniques should be performed when all other tests show negative results.

Travellers to the region are advised to apply preventive measures against malaria such as taking chemoprophylaxis and using mosquito nets and insect repellents, wearing long sleeved shirts and trousers, and sleeping in air-conditioned rooms.
=====================
[It is well known that _P. cynomolgi_ can be transmitted from monkeys to humans just as it is seen for _P. knowlesi_ (Eyles DE, Coatney GR, Getz ME. _Vivax_-type malaria parasite of macaques transmissible to man. Science. 1960; 131: 1812-3; Coatney GR et al. Transmission of the M strain of _Plasmodium cynomolgi_ to man. Am J Trop Med Hyg. 1961; 10: 673-8). Thus, it is not surprising that _P. cynomolgi_ is seen in humans visiting areas where the simian host is abundant and the _Anopheles_ vectors are present, as is the case for _P. knowlesi_. As far as we know, neither _P. cynomolgi_ nor _P. knowlesi_ can be transmitted between humans. - ProMED Mod.EP]

[HealthMap/ProMED-mail maps:
Date: Tue, 17 Sep 2019 15:38:37 +0200 (METDST)

Jakarta, Sept 17, 2019 (AFP) - Massive forest fires in Indonesia that have caused a toxic haze to spread as far as Singapore and peninsular Malaysia are also seriously affecting endangered orangutans and their habitat, a rescue foundation said Tuesday.   Jakarta has deployed thousands of troops as temporary fireman and deployed dozens of water-bombing aircraft to battle blazes that are turning pristine forest into charred landscape in Sumatra and Borneo islands.   The fires -- usually started by illegal burning to clear land for farming -- have unleashed a choking haze across parts of southeast Asia.

The Borneo Orangutan Survival Foundation said Tuesday that the haze was affecting hundreds of great apes in its care at rescue centres and wildlife re-introduction shelters.   "The thick smoke does not only endanger the health of our staff... but also it affects the 355 orangutans we currently care for", the foundation said in a statement, referring to just once cetre in Kalimantan   "As many as 37 young orangutans are suspected to have contracted a mild respiratory infection," it added.   Conditions were so bad at their Samboja Lestari facility in East Kalimantan that outdoor activities for the animals had been restricted to a few hours a day.

Orangutans have been particularly vulnerable to commercial land clearances and have seen their natural habitat shrink dramatically in the last few decades.   The population of orangutan in Borneo has plummeted from about 288,500 in 1973 to about 100,000 today, according to the International Union for Conservation of Nature.   The toxic smoke caused by the forest fires is an annual problem for Indonesia and its neighbours, but has been worsened this year by particularly dry weather.   On Borneo island, which Indonesia shares with Malaysia and Brunei, pollution levels were "hazardous", according to environment ministry data.   Hundreds of schools across Indonesia and Malaysia were shut.
Date: Mon, 9 Sep 2019 11:49:46 +0200 (METDST)

Kuala Lumpur, Sept 9, 2019 (AFP) - Malaysia prepared to seed clouds after air quality in parts of the country reached unhealthy levels due to smog from forest fires in neighbouring Indonesia, an official said Monday.   Smog regularly blankets parts of Southeast Asia during the dry season when burning is used to clear Indonesian land for palm oil, paper plantations and other crops, sparking ire from regional neighbours.   In the latest outbreak, parts of Malaysia's eastern state of Sarawak on Borneo island have been blanketed over the past few days.

The pollutant index in some places has reached "very unhealthy levels", said Gary Theseira, special functions officer with the environment ministry.   "It is extremely severe in Kuching," Theseira told AFP, referring to a city of half a million people.   He said Malaysia is prepared to carry out cloud seeding to induce rain in an effort to ease the smog.   "The moment the cloud situation is right, the chemicals will be loaded and the aircraft will take off and proceed with the seeding," he said.

Some countries conduct seeding during prolonged dry spells to induce rain and clear the air by releasing certain chemicals into the clouds, although some experts have questioned its efficacy.   Boo Siang Voon, a 47 year-old engineer in Kuching described the skies as "hazy, hot with smoky smell".   "This year the smog is getting worse. Residents are using face masks. We should not pay the price of our health for the open burning. We want a solution," he told AFP.   The Malaysian capital Kuala Lumpur and neighbouring Singapore were also experiencing hazy conditions on Monday, with the air laced with the smell of burning foliage, although the pollutant index remained at moderate levels.   Some Kuala Lumpur residents complained about eye and throat irritation.

Malaysia's meteorological department Sunday warned that hot conditions will prevail for another week, and the monsoon season is only expected to arrive at the end of September or early October.   The ministry of science, technology and innovation on Friday said it would lodge a complaint with Indonesia for the haze and called for quick action to be taken to put out the fires.   Indonesian authorities have deployed thousands of extra personnel since last month to prevent a repeat of the 2015 fires, which were the worst for two decades and choked the region in haze for weeks.   Under pressure from neighbours, Indonesian leader Joko Widodo last month warned that officials would be sacked if they failed to stamp out forest fires.
Date: Tue 16 Jul 2019 3:34 PM MYT
Source: The Star [abridged, edited]

The Japanese encephalitis (JE) virus has been detected in Tambunan [Sabah], about 100 km (62 mi) from [the state capital, Kota Kinabalu], says the state agriculture and food industries minister Datuk Junz Wong on [Tue 16 Jul 2019]. He said Health Department officials in Sabah had detected the virus in a pig farm in Kampung Lubang, Tambunan on [11 Jul 2019].

On being informed, the Department of Veterinary Services started inspection at all 7 pig farms within the vicinity. "My officers are still on the ground and taking samples from the pigs in the area."

Wong's confirmation came after an internal memo from the Veterinary Department informing the department that health officials had found a [presumably human] case of JE in Tambunan.

There is no cure for JE, but vaccinations [for people] are encouraged by health officials as they provide a form of protection. JE is a type of viral brain infection that can affect both humans and animals. It can be passed on to humans by infected animals through the bite of an infected culex mosquito.

An infected person develops inflammation of the brain (encephalitis) and suffers symptoms such as sudden onset of headache, high fever, neck stiffness, convulsions and muscle weakness, and might even fall into a coma.

Last month [June 2019], the Sarawak Health Department urged public to be cautious after confirming 5 JE cases in the state.  [byline: Muguntan Vanar]
===================
[JE virus is endemic in Malaysia's Borneo, including Sabah and its neighbouring state, Sarawak. Pigs are susceptible to JE virus infection, develop high viremias that serve as infectious blood meals for culex vector mosquitoes. The report above does not indicate which tests were done to determine JE virus infection in the pigs, whether by virus isolation, PCR demonstration of JE virus genomic segments or development of antibodies. Pregnant sows may have transplacental infection of their foetal piglets with teratogenic effects. Piglets and very young pigs may develop encephalitis when infected by JE virus. Infected adult male pigs may develop orchitis with a loss of libido and reduced fertility. Since pigs are JE virus amplifying hosts, people in the areas where pigs are infected should be especially careful to avoid mosquito bites. Vaccination may be the best measure for avoiding JE. - ProMED Mod.TY]

[Maps of Malaysia:
Date: Mon 15 Jul 2019
Source: Outbreak News Today [edited]

Health officials in Malaysia are investigating a malaria cluster in Kuala Lipis, Pahang state. On [Thu 11 Jul 2019], 4 confirmed cases of malaria were reported to Kuala Lipis District Health Office (PKD) from Betau Health Clinic. All cases involve Orang Asli children aged 4-10 from 2 villages, 2 cases [each] from Kampung Pagar and Kampung Serdang. All cases have been taken to the Kuala Lipis Hospital ward and given treatment.

Kuala Lipis has not reported a malaria case for the past 8 years; the last case was reported in 2011.

The Pahang State Health Department has activated the epidemic room on [12 Jul 2019] and control activities and case detection (active case detection) conducted by Kuala Lipis PKD Team in Kampung Pagar and Kampung Serdang. A total of 393 blood slides have been taken from residents in both villages for microscopic testing. [Based on] initial examination of the slides, PKD found 11 more malaria infections in Kampung Serdang.

>From [11-15 Jul 2019], there have been 15 cases reported from these 2 villages. All cases have been diagnosed with _Plasmodium vivax_, hospitalized for treatment and are in a stable condition.

PKD has also carried out malaria control activities by conducting indoor residual spraying and distribution of mosquito nets in the affected locality. At this point, the PKD team is in the process of tracking cases and vector control activities.

Residents in the locality have been given health education to take preventive measures by wearing clothing that covers the limbs and using repellents to prevent mosquito bites. In addition, residents are advised to sleep in the mosquito nets and avoid activities that take place in or near the forest area at night.

The Ministry of Health is monitoring the occurrence of this malaria case cluster, and the collaboration of the public is very much needed to ensure that the incidence of malaria can be controlled.
=====================
[Along with China and the Republic of Korea, Malaysia is one of the 3 countries of the WHO Western Pacific Region, and it's also among 21 countries in total across the globe identified by WHO in 2016 as having the potential to eliminate malaria by 2020. The selection was based on an analysis that looked at the likelihood of elimination across key criteria. Reaching malaria-free status is a critically important public health and sustainable development goal. It is also a core objective of the WHO Global Technical Strategy for Malaria 2016-2030, which calls for the elimination of malaria in at least 10 countries by the year 2020.

It is also worth noting that the dominant local human malaria species in Malaysia is _Plasmodium vivax_ (69%) with 33 areas (foci) with active malaria transmission; the populations at greater risk are labourers, including foreign workers, in agriculture, farming, and forestry sectors in East Malaysia. There are 8666 people at risk of malaria in these areas.

As "an important aspect of the disease in the country is the presence of _P. knowlesi_ malaria, a parasite normally found in monkeys, and now accounting for the majority of local cases", the 3 main activities to keep Malaysia on the course of malaria elimination by 2020 are as follows:
- increase surveillance of _P. knowlesi_ zoonotic infections and strengthen elimination efforts;
- intensify surveillance activities to address the threat of malaria importation and better target foreign and migrant workers engaged in activities such as agriculture, forestry, and mining; and
- continue to invest in its national malaria strategy to ensure the financing of programmes targeting elimination and prevention of reintroduction. (<https://apps.who.int/iris/bitstream/handle/10665/273633/WHO-CDS-GMP-2018.13-eng.pdf>)

The resurgence of _P. vivax_ among this specific group of people (aged 4-10 years old) is worrisome, and further investigation will elucidate the specific contextual situation to support the national effort to eliminate malaria by 2020. - ProMED Mod.ST]

[_Plasmodium vivax_ are seen in 2 isoforms, one with a long incubation time of up to 8 months (White NJ. The rise and fall of long-latency _Plasmodium vivax_. Trans R Soc Trop Med Hyg. 2019 Apr 1; 113(4):  163-168. doi: 10.1093/trstmh/trz002.  <https://www.ncbi.nlm.nih.gov/pubmed/30809676>).

Outbreaks like this one is common in areas where there is a transmission potential due to the presence of anopheles mosquitoes, and a limited local transmission is started from an introduced case, usually an asymptomatic carrier from an endemic area. It is important to know which isoform is found in this outbreak to understand the transmission dynamics and when it was introduced. Thus, genotyping should be performed. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Pahang, Malaysia:
More ...

World Travel News Headlines

Date: Fri, 6 Dec 2019 10:30:54 +0100 (MET)

Moscow, Dec 6, 2019 (AFP) - More than 50 polar bears have gathered on the edge of a village in Russia's far north, environmentalists and residents said, as weak Arctic ice leaves them unable to roam.   The Russian branch of the World Wildlife Fund said climate change was to blame, as unusually warm temperatures prevented coastal ice from forming.   The WWF said 56 polar bears had gathered in a one-square-kilometre (0.4-square-mile) area near the village of Ryrkaipy in Chukotka on the north-eastern tip of Russia.

There were concerns they could enter the village, home to fewer than 1,000 people, and patrols had been set up to monitor their movements.   "The number of human and predator encounters in the Arctic is increasing," the WWF said in statement.    "The main reason is the decline of sea ice area due to the changing climate. In the absence of ice cover, animals are forced to go ashore in search of food."

Residents had gathered walrus carcasses in the area to try to keep the bears from wandering into the village.   "We have created a feeding point with walrus carcasses that we gathered along the coast," Tatyana Minenko of the local "Bear Patrol" told news agency RIA Novosti.   "As long as there is no big freeze, the sea ice will not form and the bears will stay on the coast," she said.

Russia's weather service said temperatures in the region should fall from Saturday and that coastal ice should freeze by December 11.    Polar bears regularly visit areas inhabited by humans in Arctic Russia to search for food, often in rubbish tips.   But the number of visits has been growing as the melting of Arctic ice from climate change forces the bears to spend more time on land where they compete for food.
Date: Fri, 6 Dec 2019 10:28:26 +0100 (MET)
By Joseph Schmid

Paris, Dec 6, 2019 (AFP) - Travellers across France endured a second day of chaos on Friday as unions vowed to keep up their strike until President Emmanuel Macron backs down on controversial pension overhauls.   Rail operator SNCF said 90 percent of high-speed TGV trains were again cancelled, and several airlines dropped flights including Air France, EasyJet and Ryanair.

Nine of the capital's 16 metro lines were shut and most others severely disrupted, sparking some 350 kilometres (220 miles) of traffic jams in the Paris region, well above the usual 200 km, the traffic website Sytadin reported.   Many employees were unable to get to work and several schools again provided only daycare, though fewer teachers were on strike compared with Thursday when some 800,000 people demonstrated across the country according to the interior ministry.   Bike paths were crowded with bikes and electric scooters, with metro operator RATP sponsoring special deals for commuters with a range of ride-hailing companies and other transportation alternatives.

The walkout is the latest test for Macron after months of protests from teachers, hospital workers, police and firefighters as well as the "yellow vest" movement demanding improved living standards.   Unions say his "universal" pension system, which would eliminate dozens of separate plans for public workers, forces millions of people in both public and private sectors to work well beyond the legal retirement age of 62.   Health Minister Agnes Buzyn said Friday that the government had "heard" the protesters' anger and would meet with union leaders to discuss the reform on Monday.   The government has yet to lay out the details of its plan, and Buzyn told Europe 1 radio that "there is indeed a discussion going on about who will be affected, what age it kicks in, which generations will be concerned -- all that is still on the table".

- Macron 'determined' -
Yves Veyrier, head of the hardline FO union, warned Thursday the strike could last at least until Monday if the government did not take the right action.   But it remains to be seen if the protests will match the magnitude of the 1995 strikes against pension overhauls, when France was paralysed for three weeks from November to December in an action that forced the government to back down.

Macron, a former investment banker, has largely succeeded in pushing through a series of controversial reforms, including loosening labour laws and tightening access to unemployment benefits.   But this is the first time the various disgruntled groups have come together in protest.   So far Macron has not spoken publicly on the stoppages though a presidential official, who asked not to be named, said Thursday that the president was "calm" and "determined to carry out this reform" in a mood of "listening and consultation".

While most of Thursday's rallies were peaceful, police fired tear gas to disperse dozens of black-clad protesters smashing windows and throwing stones during the Paris march, with one construction trailer set on fire. Sporadic clashes were also reported in some other cities.   Many people were bracing for further disruptions over the weekend, including the prospect of fuel shortages as unions blocked most of the country's eight oil refineries.

The minimum pension age in France is 62, one of the lowest among developed countries, but there are 42 "special regimes" for railway workers, lawyers, opera employees and others offering earlier retirements and other benefits.   The government says a single system will be fairer for everyone while ensuring its financial viability while acknowledging that people will gradually have to work longer.
Date: Fri, 6 Dec 2019 04:23:51 +0100 (MET)

Sydney, Dec 6, 2019 (AFP) - Three hundred animals have been evacuated from a wildlife park north of Sydney as massive bushfires encircled Australia's largest city and foreign firefighters arrived to relieve beleaguered local forces.   Walkabout Wildlife Park said it had shipped out lizards, dingoes, peacocks and marsupials, as firefighters battled more than 100 fires up and down the eastern seaboard.   "This fire has been doing some crazy things, so we have to be prepared," general manager Tassin Barnard told AFP.

Prolonged drought has left much of eastern Australia tinder dry and spot fires have raged every day for the past three months, leaving firefighters struggling to cope.   New South Wales rural fire chief Shane Fitzsimmons said Friday that some US and Canadian firefighters had arrived to help out, easing the strain on the exhausted largely volunteer Australian force.

The incident-management and aviation specialists will help ease "fatigue and crew rotations" he said.   "We are not only appreciative of their presence here today, but of their sacrifice," said Fitzsimmons -- who has become a fixture on Australian television screens for weeks, updating the public on blazes in towns, national parks and backwaters.    "They are volunteering to sacrifice time from loved ones, from families, to give up that special time of the year around Christmas and New Year to come down here and lend us a hand," he said.

More than 600 homes have been destroyed and six people have died since the crisis began in September. That is many fewer than Australia's deadliest recent fire season in 2009 when almost 200 people died, but 2019's toll belies the scale of devastation.    Millions of hectares have burned -- the size of some small countries -- across a region spanning hundreds of kilometres (miles).   Bushfires are common in Australia but scientists say this year's season has come earlier and with more intensity due to a prolonged drought and climatic conditions fuelled by global warming.

The fires have taken a toll in Sydney and other major cities, which have been blanketed in toxic smoke for weeks and occasionally sprinkled with snow-like embers.   Fitzsimmons said he could not "overstate the effect that this profound drought is having" as he warned of a long, painful summer ahead.   "There is an absolute lack of moisture in the soil, a lack of moisture in the vegetation... you are seeing fires started very easily and they are spreading extremely quickly, and they are burning ridiculously intensely."
Date: Fri, 6 Dec 2019 03:03:18 +0100 (MET)
By Pierre-Henry DESHAYES

Half Moon Island, Antarctica, Dec 6, 2019 (AFP) - The swimsuit-clad tourists leap into the icy water, gasping at the shock, and startling a gaggle of penguins.   They are spectators at the end of the world, luxury visitors experiencing a vulnerable ecosystem close-up.   And their very presence might accelerate its demise.   Antarctica, a vast territory belonging to no one nation, is a continent of extremes: the coldest place on Earth, the windiest, the driest, the most desolate and the most inhospitable.   Now, it's also a choice destination for tourists.

All around Half Moon Island, off the Antarctic Peninsula, blocks of ice of all sizes float by on a calm sea, their varying forms resembling weightless origami shapes.    On this strip of land, that juts out of the Antarctic Polar and towards South America, visitors can see wildlife normally only viewed in zoos or nature documentaries along with spectacular icy landscapes.   The ethereal shades of white that play across the pillowy peaks change with the light, acquiring pastel hues at dawn and dusk.   "Purity, grandeur, a scale that's out of this world," says Helene Brunet, an awestruck 63-year-old French pensioner, enjoying the scene.    "It's unbelievable, totally unbelievable. It's amazing just to be here, like a small speck of dust."

AFP joined the 430 passengers on board the Roald Amundsen, the world's first hybrid electric cruise ship, on its maiden voyage in the Southern Ocean.    "It's not your typical beach, but it's awesome to do it," says a numb Even Carlsen, 58, from Norway, emerging from his polar plunge in the three-degree C (37.4 F) water.   When tourists go ashore, bundled up in neon-coloured windbreakers and slathered in SPF50 sunscreen, they have to follow strict rules: clean your personal effects so you don't introduce invasive species, keep a respectful distance from wildlife to avoid distressing them, don't stray from the marked paths and don't pick up anything.   "We mucked up the rest of the world. We don't want to muck up Antarctica too," says an English tourist, as she vacuums cat hair off her clothes before going ashore.

- 'Heart of the Earth' -
The Antarctic peninsula is one of the regions on Earth that is warming the fastest, by almost three degrees Celsius in the past 50 years, according to the World Meteorological Organization -- three times faster than the global average.    In March 2015, an Argentinian research station registered a balmy 17.5 degrees Celsius, a record.    "Every year you can observe and record the melting of glaciers, the disappearance of sea ice... (and) in areas without ice, the recolonisation of plants and other organisms that were not present in Antarctica before," said Marcelo Leppe, director of the Chilean Antarctic Institute.

Antarctica is "like the heart of the Earth," he added, saying that it expands and contracts like a heart beating, while the mighty current which revolves around the continent is like a circulatory system as it absorbs warm currents from other oceans and redistributes cold water.   The Antarctic Treaty, signed 60 years ago by 12 countries -- it now has 54 signatories -- declared the area a continent dedicated to peace and science, but tourism has gradually increased, with a sharp rise in the past few years.   Tourism is the only commercial activity allowed, apart from fishing -- the subject of international disputes over marine sanctuaries -- and is concentrated mainly around the peninsula, which has a milder climate than the rest of the continent and is easier to access.

Cruise ships have roamed the region for around 50 years, but their numbers only started to increase from 1990, as Soviet ice-breakers found new purposes in the post-Cold War era.   Some 78,500 people are expected to visit the region between November and March, according to the International Association of Antarctica Tour Operators (IAATO).   That's a 40-percent increase from last year, due in part to short visits by a few new cruise ships carrying more than 500 passengers, too many to disembark under IAATO regulations.     "Some might say 'Well, 80,000 people, that doesn't even fill a national stadium'... (and that it) is nothing like Galapagos which welcomes 275,000 a year," says IAATO spokeswoman Amanda Lynnes.    "But Antarctica is a special place and you need to manage it accordingly."

- 'Leave Antarctica to the penguins' -
It is Antarctica's very vulnerability that is attracting more and more visitors.   "We want to see this fantastic nature in Antarctica before it's gone," Guido Hofken, a 52-year-old IT sales director travelling with his wife Martina, says.    They said they had paid a supplement to climate compensate for their flight from Germany.

But some question whether tourists should be going to the region at all.   "The continent probably would be better off being left to penguins and researchers, but the reality is, that is probably never going to happen," said Michael Hall, professor and expert on polar regions at the University of Canterbury in New Zealand.   "Vicarious appreciation never seems to be enough for humans. So with that being the case, it needs to be made as low risk to the Antarctic environment and as low carbon as possible," said Hall.    "However, when the average tourist trip to Antarctica is over five tonnes of CO2 emissions per passenger (including flights), that is a serious ask."

Soot or black carbon in the exhaust gases of the scientific and cruise ships going to the region is also of concern, said Soenke Diesener, transport policy officer at German conservation NGO Nabu.   "These particles will deposit on snow and ice surfaces and accelerate the melting of the ice because the ice gets darker and will absorb the heat from the sun and will melt much faster," he told AFP.   "So the people who go there to observe or preserve the landscape are bringing danger to the area, and leave it less pristine than it was," he added.

- Responsible tourism -
Antarctic tour operators insist they are promoting responsible tourism.   The trend is for more intimate, so-called expedition cruises, in contrast to popular giant cruise liners elsewhere which are criticised for being invasive and polluting.   With greener ships -- heavy fuel, the most commonly used for marine vessels, has been banned in Antarctica since 2011 -- cruise companies have sought to make environmental awareness a selling point, occasionally earning them accusations of greenwashing.

Global warming, pollution and microplastics are the result of human activities on other, faraway continents, say tour operators.   Here, their motto is "Take nothing but photographs, leave nothing but footprints, keep nothing but memories".   But before they've even set foot on the cruise ships departing from South America -- the most common itinerary -- visitors to Antarctica will already have flown across the world, causing emissions that harm the very nature they have come so far to admire.

Most visitors hail from the Northern Hemisphere, and almost half are from the United States and China, IAATO says.   "I'm a tourist who feels a little guilty about taking a flight to come here," admits Francoise Lapeyre, a 58-year-old globetrotter om France.   "But then again, there are priorities. There are some trips I just won't take, because they leave a big footprint and they're not worth it.   "Crisscrossing the planet to go to a beach for example," she says.

- Don't mention climate change -
Like other expedition cruises where accessible science is part of their trademark, the Roald Amundsen, owned by the Hurtigruten company, has no dance floor or casino.  Instead, there are microscopes, science events and lectures about whales and explorers like Charles Darwin.   But they steer clear of climate change, which is only mentioned indirectly.   That's a deliberate decision as the subject has proven "quite controversial", said Verena Meraldi, Hurtigruten's science coordinator.   "We held several lectures dedicated specifically to climate change but it leads to conflicts. There are people who accept it as a fact, others who don't," she said.   Onboard, "passengers" are referred to as "guests" and "explorers" rather than "cruisers".   "Explorers" are typically older, well-heeled, often highly travelled pensioners who are handed walking sticks as they step ashore.   "My 107th country," says a Dane, stepping ashore onto Antarctica.

The Roald Amundsen "guests" choose between three restaurants, from street food to fine dining -- a far cry from the conditions endured by the Norwegian adventurer for whom the ship is named, who had to eat his sled dogs to survive his quest to reach the South Pole in 1911.   They have paid at least 7,000 euros ($7,700) each for an 18-day cruise in a standard cabin, and up to 25,000 euros ($27,500) for a suite with a balcony and private jacuzzi.   Other cruises are banking on ultra-luxury, with James Bond-like ships equipped with helicopters and submarines, suites of more than 200 square metres (2,153 square feet) and butler services.   With a seaplane to boot, the mega-yacht SeaDream Innovation will offer 88-day cruises "from Pole to Pole" starting in 2021. The two most expensive suites, with a price tag of 135,000 euros per person, are already booked.
 
- Worlds collide -
Outside, in the deafening silence, wildlife abounds.   All around are penguins, as awkward on land as they are agile in water. Massive and majestic whales slip through the waves, and sea lions and seals laze in the sun.   On Half Moon Island, chinstrap penguins -- so called because of a black stripe on their chin -- strut about in this spring breeding season, raising their beaks and screeching from their rocky nests.   "This is to tell other males 'This is my space' and also, maybe, 'This is my female'," ornithologist Rebecca Hodgkiss, a member of the Hurtigruten's scientific team, explains, as a group of tourists stroll around ashore.   The colony of 2,500 penguins has been gradually declining over the years, but it's not known if that is man's fault or they have just moved away, according to Karin Strand, Hurtigruten's vice president for expeditions.   Invisible to the naked eye, traces of humankind are however to be found in the pristine landscape.   Not a single piece of rubbish is in sight but microplastics are everywhere, swept in on ocean currents.   "We've detected them in the eggs of penguins for example," Leppe told AFP.

- Venice under water -
The Antarctic, which holds the world's largest reserve of freshwater, is a ticking time bomb, warn experts and studies.   They say that the future of millions of people and species in coastal areas around the world depends on what is happening here.   As a result of global warming, the melting ice sheet -- especially in the western part of the continent -- will increasingly contribute to rising sea levels, radically re-drawing the map of the world, says climate scientist Anders Levermann, of the Potsdam Institute for Climate Impact Research.   This meltwater will contribute 50 centimetres (almost 20 inches) to the global sea level rise by 2100, and much more after that, he said.   "For every degree of warming, we get 2.5 metres of sea level rise. Not in this century, but in the long run," he said.

Even if the international community meets its obligations under the Paris Agreement to limit global warming to under two degrees Celsius, sea levels will still rise by at least five metres.   "Which means that Venice is under water, Hamburg is under water, New York, Shanghai, Calcutta," he said.   It's impossible to predict when, but the scenario appears unavoidable, says Levermann.   In the same way that a cruise ship powering ahead at full speed can't immediately stop, sea levels will continue to rise even if all greenhouse gas emissions were to cease immediately, a study has said.

- Changing the world? -
The tourism industry says it hopes to make "ambassadors" out of Antarctica visitors.   "It's good for the animal life and for the protection of Antarctica that people see how beautiful this area is, because you cherish what you know and understand," said Hurtigruten chief executive Daniel Skjeldam.   Texan tourist Mark Halvorson, 72, says he is convinced.   "Having seen it, I am that much more committed to having a very high priority in my politics, in my own inner core convictions to being as environmentally friendly in my life as I can," he said.   So, do Guido and Martina Hofken see themselves as future "ambassadors of Antarctica"?    "Just a little bit, probably. But I don't think I will change the world," Guido Hofken concedes.    "The best thing would be for nobody to travel to Antarctica."
Date: Thu, 5 Dec 2019 16:37:37 +0100 (MET)

Paris, Dec 5, 2019 (AFP) - French rail operator SNCF said Thursday that it had cancelled 90 percent of all high-speed TGV trains and 70 percent of regional trains for Friday due to a strike over the government's pension reforms.   SNCF said that services would "still be very disrupted" on the second day of the biggest transport strike in the country in years, with the Eurostar service to Britain and the Thalys service to northern Europe set to be "very heavily disrupted".   In Paris, where only two of 16 metro lines were operating normally Thursday, public transport workers voted to remain on strike until Monday.

France's civil aviation authority meanwhile told airlines to cut 20 percent of their flights in and out of airports in Paris, Beauvais, Lyon, Marseille, Toulouse and Bordeaux on Friday, the same proportion as on Thursday.   Striking transport workers, air traffic controllers, teachers, fire fighters, lawyers and other groups all fear they will have to work longer or receive reduced pensions under the government's proposal to scrap 42 special pension schemes and replace them with a single plan.   Anticipating the worst travel chaos in years, many employees opted to work from home on Thursday. Those who did venture out travelled mainly by car, bicycle, electric scooter or on foot.
Date: Thu, 5 Dec 2019 12:19:45 +0100 (MET)
By Sofia CHRISTENSEN

Johannesburg, Dec 5, 2019 (AFP) - South African Airways was placed under a state-approved rescue plan on Thursday to avoid the embattled airline's collapse following a costly week-long strike last month.   Thousands of South African Airways (SAA) staff walked out on November 15 after the flag carrier failed to meet a string of demands, including higher wages and job in-sourcing.   The strike was called off the following week after SAA management and unions eventually clinched a deal.

But the walkout dealt a severe blow to the debt-ridden airline, which has failed to make a profit since 2011 and survives on government bailouts.   "The Board of SAA has adopted a resolution to place the company into business rescue," said a statement by South Africa's Public Enterprises Minister Pravin Gordhan, adding that the decision was also supported by the government.   "It must be clear that this is not a bailout," said Gordhan. "This is the provision of financial assistance in order to facilitate a radical restructure of the airline."   The business rescue process will be directed by an independent practitioner. It is meant to prevent a "disorderly collapse of the airline", he added.   Gordhan said the government would provide 2 billion rand ($136 million) to SAA in "a fiscally neutral manner".   Existing lenders will also provide a 2 billion rand loan guaranteed by the government.

- 'Financial challenges' -
South Africa is struggling to get state-owned companies back on track after nine years of corruption and mismanagement under former president Jacob Zuma.   Its national airline -- which employs more than 5,000 workers and is Africa's second largest airline after Ethiopian Airlines -- had been losing 52 million rand ($3.5 million) a day during the strike.   SAA's board said the business rescue, scheduled to start immediately, was decided after consultations with shareholders and the public enterprises department "to find a solution to our company's well-documented financial challenges".

"The considered and unanimous conclusion has been to place the company into business rescue in order to create a better return for the company's creditors and shareholders," said the SAA board of directors in a statement.   The rescue plan will include a "new provisional timetable" and ensure "selected activities... continue operating successfully".   With a fleet of more than 50 aircraft, SAA flies to over 35 domestic and international destinations.   "SAA understand that this decision presents many challenges and uncertainties for its staff," said the board.   "The company will engage in targeted communication and support for all its employee groups at this difficult time.

- 'Lesser evil' -
Unions told AFP they would comment later on Thursday.   They have agreed to a 5.9-percent wage increase backdated to April, but which would only start to be paid out next March depending on funding.   SAA had initially refused any pay rise.    The cash-strapped airline needs two billion rand ($136 million) to fund operations through the end of March. But it was unable to cover all of its staff salaries last month.    "Business rescue allows for the airline to continue to operate while it is being restructured, as opposed to liquidation," analyst Daniel Silke told AFP.   He said the rescue was a "lesser evil for SAA" and would save more jobs than a "shutdown".

But Silke still expected jobs to be cut as SAA attempted to reduce costs.   "Various divisions that make of SAA could be privatised," he said. "There will be a review of SAA aircraft and routes covered by SAA."   Unions had already demanded a three-year guarantee of job security following an announcement last month that almost 1,000 SAA employees could lose their jobs as part of another restructuring plan.   SAA pledged to defer that process to the end of January as part of the deal that ended the strike.
Date: Wed 4 Dec 2019
Source: Stock Daily Dish [edited]

Bihar Health Minister Mangal Pandey on [Sat 30 Nov 2019] said the state government is doing its best to save children, as the death toll due to acute encephalitis syndrome [AES] in Muzaffarpur mounted to 73.

Pandey said doctors and nurses are being called in from Patna for additional help. "We are trying everything and anything that can save children's lives. Everything is being made available from medicines to doctors. We have even called doctors and nurses from AIIMS in Patna," he said. "There is a protocol regarding what kind of medicines and facilities should be given and we are doing the same. We are monitoring things regularly and trying to save our children."

Recalling the situation that prevailed 5 years ago, Pandey said a team that was formed to ascertain the cause of this disease concluded that sleeping empty stomach at night, dehydration due to humidity and eating lychee on empty stomach were some of the causes of encephalitis.

"Our government has tried to spread awareness which will be beneficial as well. Advertisement in newspapers, radio jingles, pamphlets and mic [microphone] announcements are going to spread awareness regarding the disease. Health ministry is also working on it," he said.

On being asked about spread of ASE in Gorakhpur last year [2018], he said, "From Gorakhpur to Muzaffarpur region, this disease had spread last year and the Union government had worked on this and we will continue to fight it now."

"This incident in Muzaffarpur is very saddening and we also feel bad when children of our nation die like this. Not the whole district is affected but a large part is suffering from it," he added.

From [1 Jan 2019], until now [5 Dec 2019], 220 children were admitted in Sri Krishna Medical College and Hospital in Muzaffarpur due to AES, out of which 62 lost their lives.

As per the data of SKMCH hospital, 235 children were admitted, of which 89 died; in 2013 - 90 children were admitted, of which 35 died; in 2014 - 334 children were admitted, of which 117 died; in 2015 - 37 children were admitted, of which 15 died; in 2016 - 31 children were admitted, of which 6 died; in 2017 - 44 children were admitted, of which 18 died; and in 2018 - 43 children were admitted, of which 12 died.

Meanwhile, Minister of State for Union ministry for home affairs, Nityanand Rai, visited Sri Krishna Medical College and Hospital to review the situation after the outbreak of AES.

Encephalitis is a viral disease, which causes mild flu-like symptoms such as high fever, convulsions and headaches and has been claiming lives in the district for the past few weeks.
======================
[The dates within which these AES cases have occurred is not stated. The urgency that has prompted Behar health officials to request the aid of physicians and nurses from adjoining Patna suggests that the AES outbreak is going on currently. The uncertainty about the etiology of AES continues. It is curious that the above report makes no mention of negative or positive tests for Japanese encephalitis among the AES patients, although that virus is endemic in northeastern India, including Bihar state. Neighboring Uttar Pradesh state has had JE cases as well this summer (2019) but has intensified its JE vaccination program.

The issue of the aetiology of AES has been under discussion for a long time. Lychee fruit contain toxins. Encephalopathy and hypoglycaemia have been associated with consumption of lychee fruit contains phytotoxins, specifically alpha-(methylenecyclopropyl)glycine (see ProMED-mail archive no. http://promedmail.org/post/20150201.3132842). However, the current cases cannot be due to lychee consumption, since the season for that fruit has passed.

AES has continued to be attributed to a variety of aetiologies, including Reye syndrome-like disease, possible enterovirus infection from polluted water, heatstroke, lychee fruit consumption, and scrub typhus (_Orientia tsutsugamushi_). A recent publication (reference below) states that dengue virus is one of the 3 most common agents identified in AES, but existing surveillance for AES does not include routine testing for dengue. Until the etiology (or etiologies) of these AES cases is determined, effective and efficient prevention of these cases will not be possible.

Reference:
Ravi V, Hameed SKS, Desai A, et al. Dengue virus is an under-recognised causative agent of acute encephalitis syndrome (AES): results from a 4-year AES surveillance study of Japanese encephalitis in selected states of India. Int J Infect Dis 2019;84 Suppl:19-24. <https://doi.org/10.1016/j.ijid.2019.01.008>.

Available at:

[Maps of India:
HealthMap/ProMED maps available
at:<http://healthmap.org/promed/p/364>, and Bihar, India:
Date: Thu 5 Dec 2019 6:11 PM EET
Source: Enab Baladi [edited]

[Leishmaniasis] is spreading widely among residents of Deir ez-Zor, and especially children. Some of the areas affected are controlled by the Kurdish self-administration while others are under the control of the Syrian regime. Medical sources counted hundreds of infected civilians and confirmed the disease's rapid spread.

According to Atef al-Tawil, a manager of the Leishmania & Environmental Health Programme at the Syrian regime's Ministry of Health, most infections in eastern Deir ez-Zor are spread among school children.

In a Facebook comment on a post by Twasol agency, al-Tawil claimed that cases of leishmaniasis were detected, at the end of November [2019], in primary schools in eastern Deir ez-Zor and its surrounding villages (al-Jalaa, al-Salihiyah, al-Tawtha, al-Abbas, al-Mujawdeh, al-Hasarat, al-Saial, al-Ghabrah).

According to al-Tawil, 455 infections of children were detected. A treatment team of 10 members was formed in the affected locations, to help control the disease to aid in early detection.

The Syrian Ministry of Health acted after several appeals by civilians residing in the area as they noticed the disease spreading among their children. Al-Tawil said that this rapid spread was due to the fact that all the infected people have lately returned to their original areas which lack medical centers.

Autonomous administration areas
-------------------------------
According to Euphrates Post network, leishmaniasis is also widely spread in areas controlled by the Syrian Democratic Forces (SDF). In its post on [Sun 1 Dec 2019], the network claimed that the spread of leishmaniasis is mostly concentrated in the eastern countryside of Deir ez-Zor.

According to the network, unofficial statistics by the SDF-affiliated local council shows more than 7000 leishmaniasis infections among children in al-Baghouz, Hajin, Diban, al-Sha'afa, al-Kishkiye, Abu Hamam, and Gharanij. The local councils' attempts of controlling the disease are still substandard, according to the Euphrates Post.

The network also quoted doctors and nurses calling for international organizations to interfere and provide hospitals and clinics with the required vaccine [there is no vaccine for leishmaniasis; ed.], and to train specialized medical staff in each clinic to deal with the disease.

The autonomous-administration-affiliated media center in Deir ez-Zor also confirmed the spread of leishmaniasis and pointed out that the authorities took actions, by the end of November [2019], to provide treatments.

According to the media center, special medical teams and cadres were distributed among the clinics to provide 12,000 ampoules of the required [medicine] to treat leishmaniasis with the support of the World Health Organization.

Leishmaniasis is a parasitic disease transmitted by the bite of infected female phlebotomine sandflies -- a very small yellow fly that is active at night and makes no sound when it bites -- and the main cause for its spread is dirt and lack of hygiene.  [Byline: Enab Baladi]
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[Deir ez-Zor is east and south of the locations in the previous ProMED reports (see below), indicating further increase in cases of cutaneous leishmaniasis beyond its historical concentration in western Syria (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861536/>) and beyond the area of the MENTOR initiative in northern Syria (<https://wwwnc.cdc.gov/eid/article/24/11/17-2146_article>).

Cutaneous leishmaniasis is endemic in Syria with its reservoir in rodents. It has been a problem throughout the Syrian civil war and in ISIS controlled areas during the war due to a breakdown in rodent and vector control. - ProMED Mod.EP]

[Maps of Syria:
Date: Tue 3 Dec 2019
Source: Twitter feed in Arabic [machine trans., edited]

Taiz health official: 24 laboratory-confirmed cases of West Nile virus and more than 300 suspected cases. #Republic_Yemen
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[Any information on the actual number of WNV cases, their lab confirmation, and public health response activities in this regard will be highly appreciated. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map of Yemen:
Date: Tue 3 Dec 2019
Source: Cordoba Epidemiology Report and Los Tiempos news article [in Spanish, trans., edited]
<http://www.reporteepidemiologico.com/wp-content/uploads/2019/12/REC-2264.pdf>

Los Tiempos, Bolivia, 2 Dec 2019 Confirmation of the 1st case of the year (2019) of human rabies in Cochabamba After confirming the death of rabies of a 7-year-old girl in the southern area of Cochabamba, the Departmental Health Service (SEDES) and the Zoonosis Unit of the Mayor's Office intensified prevention actions to prevent the proliferation of the virus. This would be the 1st case confirmed so far this year [2019].

The head of the Epidemiology Unit of SEDES, Arturo Fernando Quiaones Lapez, reported that in the last rabies vaccination campaign for dogs more 1000 doses were given. "We suspected rabies in the case of this minor. She tested positive by laboratory both in cerebrospinal fluid as well as in brain tissue," according to lab results obtained on 2 Dec 2019. The victim died on 26 Nov 2019 after being hospitalized in intensive care of the Children's Hospital for 2 days with signs of rabies," said Dr Manuel Ascencio Villarroel.

The patient's relatives reported the girl had contact with a puppy which died a month ago. The dog did not receive rabies vaccines and belonged to someone the family knows. Quiñones mentioned the family members of the girl and the owners of the animal are receiving preventive treatment. Meanwhile, the head of Zoonosis of the Mayor's Office, Javier Humberto Rodraguez Herrera, stated on 2 Dec 2019 a "massive focus blockade" will be held with the participation of 8 health centers to prevent the circulation of the virus in the area.

He commented that, to date, 11 cases of canine rabies have been recorded in the municipality. In more than 11 months of 2019, SEDES identified 25 positive cases of canine rabies, the majority in the metropolitan region. Quiaones asked the population to report the death of their pets with signs of rabies at health centers for follow-up to fight the disease. Meanwhile, from the City Hall, the owners of dogs were urged to have their dogs vaccinated. Javier Rodra­guez added another risk factor is when animals are collected from the street and they are not vaccinated.
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[The rabies virus attacks the nervous system in animals.  When a rabid animal bites a human being, it can transfer the virus, contained in saliva, to that individual. "After inoculation, rabies virus may enter the peripheral nervous system directly and migrates to the brain or may replicate in muscle tissue, remaining sequestered at or near the entry site during incubation, prior to central nervous system invasion and replication. It then spreads centrifugally to numerous other organs. The case-fatality ratio approaches unity [100%], but exact pathogenic mechanisms are not fully understood. "Susceptibility to lethal infection is related to the animal species, viral variant, inoculum concentration, location and severity of exposure, and host immune status.

Both virus-neutralizing antibodies and cell-mediated immunity are important in host defense. "Early diagnosis is difficult. Rabies should be suspected in human cases of unexplained viral encephalitis with a history of animal bite. Unvaccinated persons are often negative for virus-neutralizing antibodies until late in the course of disease. Virus isolation from saliva, positive immunofluorescent skin biopsies or virus neutralizing antibody (from cerebrospinal fluid, or serum of a non-vaccinated patient), establish a diagnosis. "Five general stages of rabies are recognized in humans: incubation, prodrome, acute neurologic period, coma, and death (or, very rarely, recovery).

No specific anti-rabies agents are useful once clinical signs or symptoms develop. The incubation period in rabies, usually 30 to 90 days but ranging from as few as 5 days to longer than 2 years after initial exposure, is more variable than in any other acute infection. Incubation periods may be somewhat shorter in children and in individuals bitten close to the central nervous system (such as the head).

Clinical symptoms are first noted during the prodromal period, which usually lasts from 2 to 10 days. These symptoms are often nonspecific (general malaise, fever, and fatigue) or suggest involvement of the respiratory system (sore throat, cough, and dyspnoea), gastrointestinal system (anorexia, dysphagia, nausea, vomiting, abdominal pain, and diarrhoea), or central nervous systems (headache, vertigo, anxiety, apprehension, irritability, and nervousness).

More remarkable abnormalities (agitation, photophobia, priapism, increased libido, insomnia, nightmares, and depression) may also occur, suggesting encephalitis, psychiatric disturbances, or brain conditions. Pain or paraesthesia at the site of virus inoculation, combined with a history of recent animal bite, should suggest a consideration of rabies. "The acute neurologic period begins with objective signs of central nervous system dysfunction.

The disease may be classified as furious rabies if hyperactivity (that is, hydrophobia) predominates and as dumb rabies if paralysis dominates the clinical picture. Fever, paraesthesia, nuchal rigidity, muscle fasciculations, focal and generalized convulsions, hyperventilation, and hypersalivation may occur in both forms of the disease. "At the end of the acute neurologic phase, periods of rapid, irregular breathing may begin; paralysis and coma soon follow. Respiratory arrest may occur thereafter, unless the patient is receiving ventilatory assistance, which may prolong survival for days, weeks, or longer, with death due to other complications.

"Although life support measures can prolong the clinical course of rabies, rarely will they affect the outcome of disease. The possibility of recovery, however, must be recognized, and when resources permit, every effort should be made to support the patient. At least 7 cases of human "recovery" have been documented." (<https://www.ncbi.nlm.nih.gov/books/NBK8618/>)

A very sad situation which could have been prevented if the animal had been vaccinated. Responsible owners vaccinate their animals. Condolences to the family. - ProMED Mod.TG]

[HealthMap/ProMED-mail map of Bolivia: <http://healthmap.org/promed/p/55162>]