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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No Profile is available at present

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

British Virgin Islands US Consular Information Sheet
February 26, 2009
COUNTRY DESCRIPTION:
The British Virgin Islands (BVI) are a British overseas territory, part of the British West Indies, lying about 60 miles east of Puerto Rico.
here are about 50 islands in the BVI, many of them uninhabited.
Tortola is the main island; other islands include Virgin Gorda, Jost Van Dyke, and Anegada.
Tourist facilities are widely available. Read the Department of State Background Notes on the United Kingdom for additional information.
ENTRY/EXIT REQUIREMENTS:
The Intelligence Reform and Terrorism Prevention Act of 2004 requires all travelers to and from the Caribbean, Bermuda, Panama, Mexico and Canada to have a valid passport to enter or re-enter the United States. U.S. citizens must have a valid U.S. passport if traveling by air, including to and from Mexico.
If traveling by sea, U.S. citizens can use a passport or passport card.
We strongly encourage all American citizen travelers to apply for a U.S. passport or passport card well in advance of anticipated travel.
American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

As of June 1, 2009, sea travelers must have a valid U.S. passport or passport card.
While a U.S. passport is not mandatory for sea travel to the BVI, it is required to return to the U.S.
In addition to other documentary requirements, U.S. Citizens should also present onward or return tickets, and sufficient funds for their stay.
Upon initial entry, no more than 60 days will be granted.
At the end of 60 days, visitors must report to the Immigration Department's main office in Road Town for an extension.
Extensions of up to 90 days are issued at the discretion of the Immigration Officer subsequent to an interview.
Visitors entering the BVI by yacht during daylight hours are required to proceed directly to a port of entry and clear immigration controls.
Visitors arriving by yacht outside of business hours should register with Immigration at opening of business the following business day.
Failure to comply with these regulations can lead to heavy fines or imprisonment.

Visit the Embassy of the United Kingdom’s web site at http://www.britainusa.com for the most current visa information.

Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ website 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. and Canada or, for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Thefts, armed robberies, and other violent crimes do occur in the BVI.
Visitors should take common-sense precautions against petty crime.
Travelers should avoid carrying large amounts of cash and use hotel safety deposit facilities to safeguard valuables and travel documents.
Do not leave valuables unattended on the beach or in cars, and do not leave them in plain view in rental properties.
Always lock up boats when going ashore.

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 the BVI is: 999 or 911.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care in the BVI consists of a small general hospital, Peebles Hospital (Telephone (284) 494-3497), with an emergency room staffed 24 hours a day by physicians, several clinics on Tortola, and one clinic in Virgin Gorda.
Both islands are served by ambulances staffed with paramedics.
There are no medical facilities on the other islands.
A volunteer organization, Virgin Islands Search and Rescue (VISAR), responds 24 hours a day to medical emergencies at sea or on outer islands.
VISAR transports casualties to the nearest point for transfer to ambulance.
To reach VISAR, dial SOS (767) or call on Marine Channel 16.

There is no hyperbaric chamber in the BVI.
Patients requiring treatment for decompression illness are transferred to St. John, U.S. Virgin Islands.
Most sensitive medical cases are transferred to San Juan, Puerto Rico.

Some HIV/AIDS entry restrictions exist for visitors to and foreign residents of the BVI.
Anyone who does not appear to be in good health may be required to undergo a medical exam, including HIV test, prior to being granted or denied entry.
Please verify this information with the Embassy of the United Kingdom at http://www.britainusa.com before you travel.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s website at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning the British Virgin Islands is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Vehicles drive on the left (the British side) with most steering wheels on the left (the “American” side).
Road signs are limited and seatbelts are required by law.
Drivers often fail to yield the right-of-way to pedestrians, even at painted crosswalks.
Speeding and reckless driving are fairly common in the BVI.
Drivers can encounter nighttime drag racing on main thoroughfares and livestock on roads.
Roads in Tortola's interior can be steep and extremely slippery when wet.
Travelers planning to drive across the island should consider requesting four-wheel drive vehicles and should ensure that tires and brakes are in good operating condition on any rental vehicle.
Please refer to our Road Safety page for more information, as well as the BVI Tourist Board web site.
AVIATION SAFETY OVERSIGHT:
Civil aviation operations in the British Virgin Islands fall under the jurisdiction of British authorities.
The U.S. Federal Aviation Administration (FAA) has assessed the Government of the United Kingdom’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the UK’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa
SPECIAL CIRCUMSTANCES:
The removal of any marine organism from BVI waters is illegal for non-BV Islanders without a recreational fishing permit.
Fishing without a permit, even for sport, may lead to heavy fines or imprisonment.
Contact the Ministry of Natural Resources and Labour at (284) 468-3701 ext. 2147 for information.
Please see our Customs Information sheet..

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 BVI laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in BVI 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 the British Virgin Islands are encouraged to register with the the U.S. Embassy in Bridgetown, Barbados through the State Department’s travel registration website so that they can obtain updated information on travel and security within the BVI.
Americans without Internet access may register directly with the Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located in the Wildey Business Park in St. Michael, Barbados.
The Consular Section can be reached by telephone at 1-246-431-0225, by fax at 1-246-431-0179, contact them by e-mail.
* * * * * * *
This replaces the Country Specific Information for the British Virgin Islands dated April 2, 2008 to update sections on Entry/Exit Requirements, Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Sat, 16 Sep 2017 22:00:48 +0200
By Cécile AZZARO

Pointe-à-Pitre, Sept 16, 2017 (AFP) - The French-Dutch island of St Martin, where white sands and turquoise waters once drew foreign visitors in droves, is now attracting a different kind of population: rats and mosquitoes.   Just over a week after Hurricane Irma devastated the island and neighbouring St Barthelemy, killing 15 people, pools of stagnant water and mounds of trash seem to be the new normal.   Add to that the absence of fresh running water, and the situation is ripe for a health epidemic.   "Yes, there are risks of outbreaks," said Annick Girardin, the French minister for overseas affairs, who spent a week on St Martin following the Category five storm.   "There is an existing problem on the issue of contaminated water, the issue of trash, basically the issue of hygiene."

In poorer neighbourhoods where many families were not able to evacuate, residents fear the spread of mosquitoes -- which can carry diseases ranging from Zika and dengue fever to Chikungunya.   "My son has a fever maybe due to a mosquito," said Natacha, a resident in the Sandy Ground neighbourhood near Marigot. "We will have to clean to prevent too many mosquitoes, or else there will be outbreaks. But it's difficult without water."   "If we get sick, we'll have to go to Guadeloupe".   According to an AFP journalist, in some neighbourhoods like Concordia, control programs had begun on Wednesday.

- Boiling water -
The island, which is still struggling to get its electricity and telecommunications systems back up and running, has found it difficult to reach residents and warn them about the potential health risks.   To get the word out, the French government has distributed notices and posters in French, Spanish, English and Creole.

Still, French health minister Agnes Buzyn said, "We realise there are people on the island, in certain neighbourhoods, who are not following health instructions".   One of the most important notices reminds people that only bottled water is safe to consume, and that if it is unavailable, boiling water before use is paramount.   "We hand out fresh water all over the territory, but it remains difficult," Buzyn said. "There are zones not easily accessed, people that maybe we haven't been able to reach."   According to the government, 150,000 bottles of water are being distributed to residents every day.   But some people have still been fetching water directly from a reservoir.

A desalination plant destined for St Martin arrived Friday on Pointe-a-Pitre, on the French island of Guadeloupe, about 300 kilometres (185 miles) away.   It will continue its journey to the hurricane-hit island by barge and is expected to be operational by September 25, the authorities said.   Meanwhile drinking water has returned to St Barts, which is now able to produce about 800 cubic metres (176,000 gallons) a day.   "We are not yet at a level of signalling an outbreak, far from it," Buzyn said. "Today, it's mostly an individual risk, which means it is essential that people who live on St Martin drink the bottled water that is distributed".   Buzyn had said last Wednesday that there had been some cases of children with diarrhoea, but did not mention any signs of an outbreak.

- Racing the clock -
Medical epidemiologists are aware of and on the lookout for any sign of outbreaks, and will regularly track patients using health surveys, said Guadeloupe's public health director Patrice Richard.   On Saturday, St Martin's health services coordinator Sergio Albarello said there had been no cases of outbreak on the island.   "As of now, there have been no reported cases" of outbreak, he told reporters, adding that as far as mosquitoes, "we are not talking about carriers of genes that are epidemiologically relevant".   And while many buildings were flattened by the storm, the St Martin hospital is still able to treat people "in excellent conditions", even though one of its buildings was partially destroyed.   Philippe Gustin, the French envoy in charge of the islands' reconstruction, said the immediate plan was to fix the damaged buildings.

According to Gustin, about 30 percent of the buildings on the French side of the island were completely destroyed, but he cautioned that teams were still putting together a final estimate of damages -- which has been put at one billion euros ($1.2 billion) or more for roads and buildings.   But repairing them before the high season, which usually starts in November and runs until April, seems nearly impossible.   Cleaning up also remains a priority for St Martin, particularly in areas where rats could proliferate.   Home to some 35,000 people, St Martin -- whose livelihood rests almost entirely on tourists -- attracts around two million visitors a year, most of them American cruise ship passengers.   While visiting St Barts this past week, French President Emmanuel Macron promised emergency financial aid for those "who have lost everything".   As for the Dutch side of the island, the Dutch Red Cross said Saturday that it had collected 13.3 millions euros following a weeklong donation drive.
Date: Tue, 12 Sep 2017 16:18:07 +0200

London, Sept 12, 2017 (AFP) - Over 100 high-risk prisoners escaped in the British Virgin Islands during Hurricane Irma, a British junior minister said on Tuesday, as he raised the death toll in British territories to nine.   "We had a serious threat of a complete breakdown of law and order in the British Virgin islands (BVI)," junior foreign minister Alan Duncan told parliament.   "The prison was breached, over 100 very serious prisoners escaped," he said.

Duncan said Royal Marines were deployed to cope with the threat but did not disclose how many prisoners had been recovered or how many were still at large.   "We have maintained and kept law and order on the BVI, which at one point, could have dramatically threatened the already unfortunate plight of those who had been hit by the hurricane," he said.   Contacted by AFP, the foreign ministry declined to comment.

The Daily Telegraph said notes from a cabinet meeting that were leaked to the press on Tuesday suggested as many as 60 had yet to be recaptured.   "We are working with St Lucia and BVI authorities to secure the transfer to St Lucia of 40 high-risk prisoners that have escaped in BVI," the briefing notes were reported as saying.   Duncan said a total of nine people died in British Caribbean territories -- five in the BVI and four in Anguilla. The authorities had previously reported one person killed in Anguilla.

Britain's response to Irma has been criticised by some local inhabitants as too slow with some complaining about a breakdown of law and order and being left to fend for themselves.   Briton Claudia Knight said her partner Leo Whitting, 38, was stranded on the island of Tortola in the British Virgin Islands archipelago.   "Everyone's turned feral and no-one's going out without being armed... It's turning really nasty," she told the Press Association news agency.   "Leo carries a knife with him," she said.   But Duncan said he "wholeheartedly and comprehensively reject the criticism".   "I think they are unjustified," he added.
Date: Mon 13 Jan 2014
Source: Government of the British Virgin Islands [edited]

The Ministry of Health and Social Development has confirmed 3 cases of chikungunya [virus infections], following reports of confirmed cases in St Martin and increased surveillance throughout the Virgin Islands. Dr Ronald Georges, medical officer of health in the Ministry of Health and Social Development said, "We have confirmed 3 cases on Jost Van Dyke."

Chikungunya is a viral disease transmitted to humans by the bite of infected mosquitoes.

"It is important to note that these confirmed cases were not exposed to travel, which alerts us that the virus is already in our mosquito population," Dr Georges stated.

According to Dr Georges, the ministry has been coordinating a response with the Environmental Health Division to minimise the impact of chikungunya [virus infections]. He is reminding the public to take appropriate measures to minimise exposure to mosquitoes. As such, the health division has stepped up its fogging programme and will be addressing "hotspot" areas known for mosquito breeding.

Dr Georges explained that chikungunya [virus infection] causes symptoms similar to dengue fever, which last 2-5 days. Symptoms include rash, arthritis-like pain affecting multiple joints, headaches, conjunctival infection, back pain, nausea, vomiting, polyarteritis, and a fever of 102 deg F [39 deg C] or higher. "Anyone experiencing one or more of these symptoms should contact their healthcare provider immediately," he said, adding, "Persons are urged to be vigilant in inspecting their premises for mosquito breeding sites."

He said that measures should also be taken to keep mosquitoes out of homes for example: removing catchment of still water, cover containers storing water, and more importantly necessary precautions should be taken to protect babies by placing a protective net over cribs. In addition the use of insect repellent on adults and children is also useful.

Clinicians and health care providers are asked to continue to report syndromic data to the Surveillance Unit in the Ministry of Health and Social Development, especially fever surveillance within 24 hours for continuous monitoring.

The Environmental Health Division will continue surveillance and control measures at ports of entry. However, residents are asked to remain vigilant in preventing mosquitoes from breeding around their homes and businesses.
------------------------------
communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
==================
[Spread of chikungunya virus to other islands continues. In the absence of a commercially available vaccine, mosquito vector control and avoidance of mosquito bites are the only preventive measures that can be taken as noted in the report above. Fogging provides no long-term vector control. Breeding sites must be eliminated or treated with larvicides for effective control. That requires public cooperation and participation. Arrival of chikungunya virus in the dengue virus endemic areas of mainland Americas is probably more a matter of "when" than of "if".

Maps of the British Virgin Islands can be accessed at
Date: Wed, 15 Oct 2008 14:38:28 +0200 (METDST) MIAMI, Oct 15, 2008 (AFP) - Hurricane Omar moved toward the Virgin Islands Wednesday gaining power as warnings were issued across the Caribbean over the latest storm. With its center around 310 miles (495 kilometers) southwest of Puerto Rico's capital San Juan, the US National Hurricane Center said: "Additional strengthening is forecast in the next 24 to 36 hours." The hurricane -- with maximum sustained winds of near 120 kilometers (75 miles) per hour -- was moving slowly northeast toward San Juan. Hurricane warnings were issued for the US Virgin Islands, the British Virgin Islands, Saint Martin, Anguilla and Saint Kitts. "A hurricane warning could be required for Puerto Rico Wednesday morning," the NHC said. On the forecast track, the center of Omar was expected to move over or near the Leeward Islands -- just east of Puerto Rico -- by late Wednesday, the NHC said. Authorities also issued a hurricane warning for the French resort island of Saint Barthelemy, and tropical storm warnings for Antigua, Barbuda and Montserrat. Heavy rain was already falling across far northern Venezuela, where it could produce total rainfall of up to 15 centimeters (six inches), the NHC said. Up to 51 centimeters (20 inches) of rain "will be possible across Puerto Rico and the northern Leeward Islands," the NHC said. "These rains could produce life-threatening flash floods and mud slides," it warned. The busy 2008 hurricane season has included devastating Hurricanes Gustav and Ike, which caused millions of dollars in damage in Haiti, Cuba and the United States. Hurricanes and tropical storms have killed hundreds across the Caribbean and Mexico, with Haiti the worst hit.
Date: July 2008 Source: CAREC Surveillance Report - Communicable Diseases Vol. 28 No. 4 [edited] During epidemiological weeks 1-24, 2008, dengue virus type 2 was identified in the British Virgin Islands, Cayman Islands, Dominica, Grenada, St. Lucia and Trinidad & Tobago. Dengue virus type 4 was also identified in the British Virgin Islands, and virus type 1 was identified in Anguilla and Antigua & Barbuda. ------------------------ [This brief report does not indicate which of the islands had only imported dengue cases and which had local dengue virus transmission. As of mid-December 2007, the Cayman Islands only had imported dengue cases and had mounted an active surveillance and mosquito vector control campaign (see ProMED archive no. 20071218.4074). It would be interesting to know whether the 2008 cases were also all imported cases. An interactive ProMED HealthMap showing the location of the Cayman Islands can be accessed at: . - ProMed Mod.TY]
More ...

World Travel News Headlines

31st May 2019

A volcano on the Indonesian island of Bali erupted Friday, spewing a plume of ash and smoke more than 2,000 metres (6,500 feet) into the sky. Mount Agung, about 70 kilometres from the tourist hub of Kuta, has been erupting periodically since it rumbled back to life in 2017, sometimes grounding flights and forcing residents to flee their homes.
Mount Agung is about 70 kilometres from the tourist hub of Kuta

The latest shortly before noon on Friday shot a cloud of volcanic ash high into the sky, but caused no disruption to flights, Indonesia's geological agency said.  Agung remained at the second highest danger warning level, and there is a four-kilometre no-go zone around the crater.

Last summer, dozens of flights were cancelled after Agung erupted, while tens of thousands of locals fled to evacuation centres after an eruption in 2017.

The last major eruption of Agung in 1963 killed around 1,600 people.

Indonesia is situated on the Pacific "Ring of Fire", a vast zone of geological instability where the collision of tectonic plates causes frequent quakes and major volcanic activity.

31st May 2019

Heatwaves across India have exacted heavy casualties this year, including dozens of deaths by sunstroke and other heat-related causes. The deaths have been mainly reported from states like Maharashtra (particularly Vidarbha), Andhra Pradesh (mainly Rayalseema) and Telangana, due to the temperature extremes in these regions. What's worrying is, a study suggests that the heatwave conditions are likely to increase from next year and continue till 2064 because of El Niño Modoki and depletion in soil moisture. Here's how the heatwave is taking a toll in the above states.

Maharashtra

Parts of Maharashtra have been reeling under high temperatures accompanied by severe heatwave condition during this summer. According to a report in The Times Of India, a 50-year old man in Beed succumbed to death because of heatstroke recently, taking the overall number to 8. Reports show a total of 456 cases of heat-related illnesses in Maharashtra this summer. Last year, the number of cases reported was 568. However, the death toll this year is more than last year's figure of 2 victims.

Regions like Nagpur and Akola show the most number of deaths and illnesses in the Vidarbha region. About 163 cases of heat-related illness were reported in Nagpur and 76 ailments were reported in Latur region. Recently, Chandrapur in Maharashtra (which lies 150km south of Nagpur) registered a day temperature of 48°C, the highest recorded in India this summer.

Andhra Pradesh

Parts of Andhra Pradesh have been experiencing temperatures of 45°C and more since the last few days. These conditions have persisted in the state after the heavy rains caused by Cyclone Fani.

Two women going on a two-wheeler and covered themselves with scarfs to protect themselves from the heat wave, in Vijayawada
(Mahesh G, TOI, BCCL, Vijayawada.)

Three people have died in Andhra Pradesh due to heat-related causes this year. Also, 433 people have been diagnosed with heatstroke. Earlier this month, electrical transformers had blown up in many parts of Krishna and Guntur districts, disrupting power supply for more than five hours and intensifying the effects of heatwave conditions and the severe temperatures.

In 2015, Andhra Pradesh experienced the most number of heat deaths in the country: 1,369 people died that year from heat-related illnesses.

Telangana

Seventeen people have succumbed in Telangana over the last 22 days. However, the number of unconfirmed deaths is expected to be higher. The region saw 541 heat-related deaths in 2015, and 27 in 2018. The farmers and those who work in the sun are usually the ones to be affected the most by high temperatures and heatwave conditions.

As heat blankets the country, make sure you stay protected. Follow official guidelines and do not step out in the Sun, especially in the afternoon hours, unless absolutely necessary.

(With inputs from The Times Of India.)

11th June 2019
https://afro.who.int/news/confirmation-case-ebola-virus-disease-uganda

Kampala, 11 June 2019 - The Ministry of Health and the World Health Organization (WHO) have confirmed a case of Ebola Virus Disease in Uganda. Although there have been numerous previous alerts, this is the first confirmed case in Uganda during the Ebola outbreak on-going in neighbouring Democratic Republic of the Congo.

The confirmed case is a 5-year-old child from the Democratic Republic of the Congo who travelled with his family on 9th June 2019. The child and his family entered the country through Bwera Border post and sought medical care at Kagando hospital where health workers identified Ebola as a possible cause of illness. The child was transferred to Bwera Ebola Treatment Unit for management. The confirmation was made today by the Uganda Virus Institute (UVRI). The child is under care and receiving supportive treatment at Bwera ETU, and contacts are being monitored.

The Ministry of Health and WHO have dispatched a Rapid Response Team to Kasese to identify other people who may be at risk, and ensure they are monitored and provided with care if they also become ill. Uganda has previous experience managing Ebola outbreaks. In preparation for a possible imported case during the current outbreak in DRC, Uganda has vaccinated nearly 4700 health workers in 165 health facilities (including in the facility where the child is being cared for); disease monitoring has been intensified; and health workers trained on recognizing symptoms of the disease. Ebola Treatment Units are in place.

In response to this case, the Ministry is intensifying community education, psychosocial support and will undertake vaccination for those who have come into contact with the patient and at-risk health workers who were not previously vaccinated.  

Ebola virus disease is a severe illness that is spread through contact with the body fluids of a person sick with the disease (fluids such as vomit, faeces or blood). First symptoms are similar to other diseases and thus require vigilant health and community workers, especially in areas where there is Ebola transmission, to help make diagnosis. Symptoms can be sudden and include:
  • Fever
  • Fatigue
  • Muscle pain
  • Headache
  • Sore throat
People who have been in contact with someone with the disease are offered vaccine and asked to monitor their health for 21 days to ensure they do not become ill as well.

The investigational vaccine being used in DRC and by health and frontline workers in Uganda has so far been effective in protecting people from developing the disease, and has helped those who do develop the disease to have a better chance of survival. The Ministry strongly urges those who are identified as contacts to take this protective measure.

Investigational therapeutics and advanced supportive care, along with patients seeking care early once they have symptoms, increase chances of survival.

The Ministry of Health has taken the following actions to contain spread of the disease in the country:
  • The District administration and local councils in the affected area have been directed to ensure that any person with Ebola signs and symptoms in the community is reported to the health workers immediately and provided with advice and testing.
  • The Ministry of Health is setting up units in the affected district and at referral hospitals to handle cases if they occur.
  • •Social mobilization activities are being intensified and education materials are being disseminated.

There are no confirmed cases in any other parts of the country.

The Ministry is working with international partners coordinated by the World Health Organization.

The Ministry of Health appeals to the general public and health workers to work together closely, to be vigilant and support each other in helping anyone with symptoms to receive care quickly. The Ministry will continue to update the general public on progress and new developments.
Date: Mon, 10 Jun 2019 14:24:43 +0200

Lima, June 10, 2019 (AFP) - Peru has declared a health emergency in five regions, including Lima, after the deaths of at least four people linked to Guillain-Barre syndrome, an autoimmune disorder that attacks the nervous system.   Health Minister Zulema Tomas said Sunday that in addition to the deaths there were currently 206 cases of the disease.   "We have an outbreak, there has been a brusque increase" since June 5, Tomas said on state-run TV Peru, adding that health authorities were taking steps to control and contain the disease.

While the syndrome is not contagious, a 90-day health emergency was declared because the current cases "have unusual and atypical characteristics that require rapid or immediate initial treatment," Peru's Institute of Neurological Sciences said.   The precise cause of the disorder is unknown, but most cases develop after a person has been sick with diarrhoea or a respiratory infection.

The Centers for Disease Control and Prevention in the US says its research suggests that the syndrome is "strongly associated" with the Zika virus, a mosquito-borne illness.   The regions affected by GBS include three on the country's northern coast -- Piura, Lambayeque, La Libertad -- tourist destinations known for their archaeological sites and beaches.   Also included was the central region of Junin and Lima, which has nine million inhabitants.   Two deaths were reported in Piura, one in La Libertad and another in Junin.
Date: Mon, 10 Jun 2019 16:39:03 +0200

Madrid, June 10, 2019 (AFP) - Three tourists have fallen from their hotel balconies in Spain's Balearic Islands in recent days, one of them dying on impact, police said Monday as the summer season in the party archipelago begins.   The incidents came as Britain's foreign office warned holidaymakers heading to Spain against "balcony falls" and asked them not to "take unnecessary risks... particularly if you're under the influence of drink or drugs."   On Friday in Magaluf, a party resort notorious for its booze-fuelled tourism, a 19-year-old British man fell to his death from the second floor of his hotel, Spain's Civil Guard police force said.

A spokesman said police were looking at two theories -- either "he threw himself off voluntarily, or he fell by accident."   He did not know whether the victim had consumed drugs or alcohol.   On Thursday, a 35-year-old German man fell from the second floor of his hotel too, this time in Palma de Majorca, and was seriously injured, police said.   A source close to the probe, who declined to be named, said the man had drunk, dozed off, woken up and subsequently fallen from the balcony, possibly disorientated.   And on Monday, an Australian man in his early thirties fell from the second floor of his hotel in Ibiza and was seriously hurt, police said, without giving further details.

Balcony falls happen every year in the Balearic Islands and other party resorts in Spain, most of them due to excessive drinking or drug-taking/   Some are accidental slips, while others happen when tourists miss while trying to jump into pools or onto another balcony -- a practice known as "balconing."   The British foreign office's online travel advice for Spain has an entire section warning against "balcony falls".   "There have been a number of very serious accidents (some fatal) as a result of falls from balconies," says the website.    "Many of these incidents have involved British nationals and have had a devastating impact on those involved and their loved ones."
Date: Mon, 10 Jun 2019 06:44:54 +0200

Sydney, June 10, 2019 (AFP) - Australian police said Monday they were scouring bushland for a Belgian teenage tourist missing in a popular surf town for more than a week.   Theo Hayez, an 18-year-old backpacker, was last seen on May 31 at a hotel in the coastal tourist town of Byron Bay -- some 750 kilometres (470 miles) north of Sydney -- New South Wales state police said.   "We have a large amount of resources searching... in bushland that is towards the east and northeast of the town," police Chief Inspector Matthew Kehoe said in a statement.   "We are advised that this disappearance is completely out of character for him."   Police said they were alerted to his disappearance on Thursday after he failed to return to a hostel he was staying in.   Hayez's passport and personal belongings were all left at the hostel, and police believe he had not made any financial transactions since his disappearance or used his mobile phone.
Date: Sat 8 Jun 2019
Source: New Jersey 101.5 [edited]

The potentially deadly Powassan tick-borne virus has been confirmed in 2 Sussex county residents, one of whom died last month [May 2019], state health officials confirmed [Sat 8 Jun 2019].

The Powassan virus is spread by the deer tick [_Ixodes scapularis_]. The illness is rarer than Lyme disease, which is also spread by the tick, but 10% of people who contract the [Powassan virus] illness die from it.

A Department of Health official on [Sat 8 Jun 2019] said that the department had not determined the cause of death for the patient who died last month [May 2019] but said that lab results this week [week of 3 Jun 2019] confirmed that he had the virus.

A 2nd victim continues to recover at home.

Symptoms of the virus include brain swelling, meningitis, fever, headache, vomiting, weakness, confusion, loss of coordination, trouble speaking, and memory loss. Symptoms can appear a week to a month after a tick bite, although some people show no symptoms and do not require treatment.

There is no vaccine or cure for the disease. Treatment includes hospitalization, support for breathing, and intravenous fluids.

Prevention involves the same precautions that should be taken to avoid Lyme disease: avoid wooded areas with tall grasses, use insect repellent while outdoors, and check for ticks after being outdoors.

Powassan [virus] -- first discovered in Powassan, Ontario, in 1958 -- has been confirmed in recent years in New Jersey, with one case each in 2013, 2014, and 2015, and 4 cases in 2017, the most recent year for which data is available. The cases were reported in Sussex, Warren, Morris, and Essex counties.

Between 2008 and 2017, there were 125 confirmed cases in the entire country and 9 deaths.

A person who said they were close to the man who died last month [May 2019] posted on Facebook that the man was bitten in the arm by a tick while gardening and fell ill about 2 weeks later. The Facebook post said that there was no bull's-eye mark around the bite -- a known tell-tale sign for Lyme infection. About a day before he was hospitalized, the man reported feeling like he was coming down with a cold and had a high fever.

State health department's tip sheet for preventing Powassan [virus infection]:
- avoid contact with ticks by avoiding wooded areas with high grass;
- when hiking, stay on the center of the trail;
- picnic in areas away from wooded and bushy areas;
- keep children on playground equipment and away from tall grass and shrubs;
- when outdoors, apply insect repellents;
- wear light-colored clothes so it is easy to see and remove ticks;
- wear long-sleeve shirts and pants;
- tuck long pants into socks so ticks cannot crawl under pants;
- do tick checks every couple hours while outdoors and before coming indoors;
- if you see a tick during tick checks, remove it right away;
- keep grass mowed short;
- keep children's toys, playground equipment, pools, and lawn furniture at least 15 feet [4.6 m] from wooded areas;
- create a woodchip or mulch border between your yard and wooded areas;
- keep areas under bird feeders and pet dishes clean, so they do not attract animals that may carry ticks;
- keep trash in closed containers or areas so it does not attract animals that may carry ticks.  [Byline: Sergio Bichao]
=======================
[Powassan virus is endemic in New Jersey, and cases occur there sporadically. The tick vector is the deer tick, _Ixodes scapularis_. Humans become infected with POWV during spillover transmission from the natural transmission cycles. In humans, POWV can be a causative agent of a severe neuroinvasive illness, with 50% of survivors displaying long-term neurological sequelae. Individuals living or visiting areas where the deer tick occurs, should follow the above recommendations to avoid tick bites. If a tick is found feeding, it should be removed with forceps or tweezers grasping the tick at skin level and then gentle, constant force applied. The tick should never be removed by grasping it with thumb and forefinger, as squeezing the tick may cause inoculation of contents containing the pathogenic agent into the feeding site.

POWV was recognized as a human pathogen in 1958, when a young boy died of severe encephalitis in Powassan, Ontario, Canada. In that case, POWV was isolated from the brain autopsy. There are 2 distinct genetic lineages now recognized: POWV (lineage I) and deer tick virus (lineage II). Since the index case in 1958, over 100 human cases of POWV have been reported, with an apparent rise in disease incidence in the past 16 years. This recent increase in cases may represent a true emergence of POWV in regions where the tick vector species are prevalent, or it could represent an increase in POWV surveillance and diagnosis. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of New Jersey, United States:
New Jersey county map:
Date: 6 Jun 2019
Source: Washington Post [edited]

Dominican government officials released more-detailed autopsy results on Thursday [6 Jun 2019] for 3 American tourists who died at adjacent beach resorts owned by the same hotel company during the last week of May 2019.

All 3 victims experienced eerily similar symptoms and internal trauma before their deaths, according to a news release from Dominican authorities. Pathologists said autopsies showed the 3 had internal haemorrhaging, pulmonary oedema, and enlarged hearts.

Toxicology reports are pending [These are likely to be the most interesting. - ProMED Mod.TG].

A U.S. State Department official said authorities have not yet established a connection between the 30 May 2019 deaths of 49-year-old CAD, and 63-year-old NEH, both of Prince George's County, MD, and the death on 25 May 2019 of 41-year-old MSW of Pennsylvania.

The FBI is providing Dominican law enforcement with "technical assistance with the toxicology reports," the State Department official said.

MSW had just checked into the Luxury Bahia Principe Bouganville, in the town of San Pedro de Macoris, and was taking pictures from her room balcony when she started to feel ill.

Less than 2 hours later, she was dead, local authorities said.

The bodies of CAD and HEH were found inside their room at the Grand Bahia Principe La Romana after relatives grew concerned because they had not checked out of the resort.

The hotels are located next to each other on the island's southern coast, about 60 miles from the tourist-heavy Punta Cana area.

Dominican authorities initially did not run toxicology tests for MSW because there were no signs of violence, said Ramon Brito, a spokesman for the National Police's special tourism unit. After the Maryland couple was found, investigators ordered a set of tests to determine whether anything the 3 Americans consumed may have led to their deaths, Brito said.  [Byline: Arelis R. Hernandez]
Date: 31 May 2019
Source: 4 News [edited]

The Alachua County Health Department is warning residents that there are 12 confirmed cases of mumps, primarily from college students at the University of Florida.  "This is a little more than usual," says Steve Orlando, University of Florida spokesman.

Alachua County normally receives around 2 reported cases a year, and UF believes more students could be infected.  "So, it's curious because these are individuals who are vaccinated, and that's what we are seeing nationwide," says Paul Myers, Alachua County Health Department administrator.

Officials say it is still unclear why there has been an uptick with the virus. So far, the CDC shows 736 people have contracted mumps nationwide in 2019.

"The sharing of the utensils, sharing of the cups, sharing of the water bottles, you know it is a very common thing for students to share those things, and that's exactly the kind of thing that could lead to transmission," says Orlando.
Date: Sat 8 Jun 2019
Source: Business Standard [edited]

As many as 14 children have died due to acute encephalitis syndrome (AES) in the district, while over a dozen are admitted in hospitals with high fever and other symptoms of the infection.

Sunil Shahi, Superintendent of Shri Krishna Medical College and Hospital (SKMCH), told ANI, "We have received 38 patients so far; most of them have a deficiency of glucose in their blood. Of these, 2 have also tested JE [Japanese encephalitis] positive; the overall casualty till now is 14."

Dr Gopal Sahni, head of Critical Care Unit, said, "When heat and humidity rise, the body's sweat cannot evaporate. The humidity level is over 50 per cent in the last few days. We have about 15 such children admitted in the hospital currently, and 89 such cases come regularly."

Encephalitis is a viral infection, which causes mild flu-like symptoms such as a fever or a headache.
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[Again, this year (2019), cases of AES and JE are appearing in north-western India. Of the 14 AES cases, 2 tested positive for JE. The aetiology of the remaining cases is not stated, but the majority are reported as hypoglycaemic. As noted previously, frequently, in reports of JE cases in India, acute encephalitis syndrome (AES) of undefined aetiology is often mentioned with JE cases that are a minority of those hospitalized.

The determination of the aetiology or aetiologies of AES has been confusing and elusive. Various etiological agents have been proposed in recent years as responsible for AES cases. 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_). Recently, scrub typhus has been implicated in many AES cases. A recent publication (reference below) states that dengue virus is one of the 3 most common agents identified in acute encephalitis syndrome (AES). Unfortunately, existing surveillance for AES does not include routine testing for dengue. Dengue accounts for 5% of AES cases in India, especially in the absence of laboratory evidence for other pathogens tested. Dengue should be added to the list of possible AES etiological agents.

Reference:
Vasanthapuram Ravi, Shafeeq Keeran Shahul Hameed, Anita Desai, Reeta Subramaniam Mani, Vijayalakshmi Reddy, 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. International Journal of Infectious Diseases. 2019. doi: <https://doi.org/10.1016/j.ijid.2019.01.008>.

Maps of India:

[HealthMap/ProMED map available at: