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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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Samoa

General:
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Cuba is an independent island country situated in the Caribbean. It is the largest of the islands and covers 42,000sq miles. The climate is sub tropical throughout the year with most of the rainfall in
the northern parts of the country. Temperatures of between 20C to 35C are fairly standard throughout the year. Generally the winter effects of the American continent only last for short periods.
Safety & Security:
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The majority of tourists visiting Cuba will have no difficulty but bag snatching and other street crime appears to be increasing. The old Havana area and other major tourist resorts may be particular areas of concern in this regard. On arrival be careful to only use your recognised tour operator. If you are taking a taxi at any stage make sure it is a registered one and not a private vehicle. It is unwise to carry large quantities of money or jewellery away from your hotel and try not to flaunt wealth with your belongings. Pickpockets are too common an occurrence on buses and trains and at train stations so be careful with your essential documents and credit cards. Valuables should not be stored in suitcases when arriving in or departing from Havana as there have been a number of thefts from cases during the time the cases are coming through baggage handling. There is an airport shrink-wrap facility for those departing Havana which reduces the risk of tampering. Remember to carry a photocopy of your main documents (passport, flight tickets etc).
Road Safety:
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Following a number of serious road accidents involving tourists, you are advised not to use mopeds for travelling around Cuba or in Havana. Also, if you are involved in any accident a police investigation will be required to clear you and this may significantly delay your travel plans. On unlit roads at night there have been a number of accidents associated with roaming cattle (sounds like Ireland!). The traffic moves on the right side of the roads. There is a main highway running the length of the country but many of the country roads are in poor repair.
Local Laws & Customs:
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When arriving into Cuba make sure you are not carrying any items which could be considered offensive. Any illicit drug offense is treated very seriously and Cuban law allows for the death penalty to be used under these circumstances. If you require personal medication for your health, make sure it is in original packing and carry a letter from your doctor describing the medication. Never agree to carry any item for another individual and always secure your cases once they are packed. Taking photographs of military or police installations or around harbours, rail and airport facilities is strictly forbidden.

Currency:
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Since 1993 it is now possible to use US dollars for all transactions within Cuba. Remember, there is a 20$ airport departure tax. Certain travellers cheques and credit cards may not be acceptable within Cuba. This is particularly true of American Express cheques and cards but check your situation with the travel operator before departure.
Health Facilities:
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Generally healthcare facilities outside of Havana are limited and many standard medications may not be available. It is important to carry sufficient quantities of any medications which may be required for the duration of your time in Cuba.
Food & Water:
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The level of food and water hygiene varies throughout the country and between resorts. On arrival check the hotel cold water supply for the smell of chlorine. If it is not present then use sealed bottled water for both drinking and brushing your teeth throughout your stay. Cans and bottles of drinks are safe but take care to avoid pre-cut fruit. Peel it yourself to make sure it is not contaminated. Food from street vendors should be avoided in most cases. Bivalve shellfish are also a high risk food in many countries and Cuba is no exception in this regard. (Eg Mussels, Oysters, Clams etc)
Malaria & Mosquito Borne Diseases:
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Malaria transmission does not occur within Cuba and so prophylaxis is not required. However, a different mosquito borne disease called Dengue has begun to reoccur in the country over the past few years. This viral disease can be very sickening and even progress to death. It is rare for tourists to become infected but avoiding mosquito bites is a wise precaution.
Swimming, Sun & Dehydration:
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The extent of the Cuban sun (particular during the summer months (April to October) can be very excessive so make sure your head and shoulders are covered at all times when exposed. Watch children carefully as they will be a significant risk. Drink plenty of fluids to replace what will be lost through perspiration and, unless there is a reason not to,
take extra salt either on your food or in crisps, peanuts etc. Take care if swimming in the Caribbean to stay with others and to listen to local advice. Never swim after a heavy meal or alcohol.
Rabies Risk in Cuba:
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This viral disease does occur throughout Cuba and it is essential that you avoid any contact with all warm blooded animals. Dogs, cats and monkeys are the most commonly involved in spreading the disease to humans. Don't pick up a monkey for a photograph! If bitten, wash out the wound, apply an antiseptic and seek urgent medical attention.
Vaccinations for Cuba:
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There are no essential vaccines for entry / exit if coming from Ireland. However, for your own personal protection travellers are advised to have cover against the following;
*
Tetanus (childhood booster)
*
Typhoid (food & water borne disease)
*
Hepatitis A (food & water borne disease)
For those planning a longer or more rural trip vaccine cover against conditions like Hepatitis B and Rabies may also need to be considered.
Summary:
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Cuba is becoming a popular destination for tourists and generally most will stay very healthy. However commonsense care against food and water borne disease is essential at all times. Also take care with regard to sun exposure, dehydration and mosquito bites.

Travel News Headlines WORLD NEWS

Date: Thu, 5 Dec 2019 00:51:07 +0100 (MET)
By Neil SANDS

Wellington, Dec 4, 2019 (AFP) - Samoa entered a two-day lockdown Thursday as authorities launched an unprecedented mass vaccination campaign to contain a deadly measles outbreak that has devastated the Pacific island nation.   Officials ordered all businesses and non-essential government services to close, shut down inter-island ferry services and told private cars to keep off the roads.

Residents were advised to stay in their homes and display a red flag if they were not yet immunised as hundreds of vaccination teams fanned out across the nation of 200,000 in the early hours of the morning.   The operation, carried out under emergency powers invoked as the epidemic took hold last month, is a desperate bid to halt an inexorably rising death toll that reached 62 on Thursday, most of them young children.   "I've seen mass mobilisation campaigns before, but not over an entire country like this," UNICEF's Pacific island chief Sheldon Yett told AFP.   "That's what we're doing right now. This entire country is being vaccinated."

Immunisation rates in Samoa were about 30 percent before the outbreak and have risen to more than 55 percent since a compulsory mass vaccination campaign began a fortnight ago.   Yett said the aim of this week's two-day drive was to push the rate above 90 percent, which should help curb the current outbreak and stop future epidemics.   He said the normally busy streets of the capital Apia were almost deserted early Thursday.   "It's very, very quiet out here. I can just hear a few barking dogs. The streets are empty. There are no cars," he said.   "People are staying at home waiting for the vaccination campaign. The teams are getting their supplies together and getting ready to go out."   Even Prime Minister Tuilaepa Sailele Malielegaoi's residence had a red flag fluttering outside it, with the leader saying his nephew had recently arrived from Australia and needed a measles shot.

Malielegaoi said he was angered by anecdotal reports that some parents were encouraging their children to hide from the vaccination teams to avoid the mandatory immunisation injection.    "The message is that we have vaccinated a lot of people and they are OK," he told reporters.   "The only cure for this is vaccination... having your children vaccinated is the only way."   Children are the most vulnerable to measles, which typically causes a rash and fever but can also lead to brain damage and death.

The latest figures show that 54 of the 62 dead were aged four or less and infants account for most of the 4,217 cases recorded since the outbreak began in mid-October.   There have also been measles epidemics in neighbouring Fiji and Tonga, but higher immunisation rates mean they have been more easily contained, with no fatalities.
Date: Tue, 3 Dec 2019 06:07:45 +0100 (MET)

Wellington, Dec 3, 2019 (AFP) - The World Health Organisation warned of a "slide back" in global efforts to eliminate measles Tuesday, as the death toll from an outbreak that has killed dozens of children in Samoa continued to climb.   A total of 55 people have died since the epidemic began in mid-October, 50 of them children aged four or under, officials in the Pacific nation said Tuesday.   Another 18 infants are critically ill in hospital and the crisis shows no sign of slowing, with 153 new cases in the past 24 hours, taking the national total to 3,881 in a population of 200,000.   Emergency measures including compulsory mass immunisations and school closures have so far done little to stop the virus spreading in a country that was particularly vulnerable to measles due to low vaccination rates of about 31 percent.

World Health Organisation (WHO) medical officer for the western Pacific, Jose Hagan, said it was a grim reminder of the danger posed by "probably the most infectious disease that we know of".   "Unfortunately the case (to) fatality rate of measles is much higher than people realise," he told Radio New Zealand.   "This is quite a severe disease and we just aren't used to seeing it, so it comes as quite a surprise when we see how fatal it can be."   He said the fatality rate in Samoa was less than two percent but had been known to reach five percent in developing countries.

Hagen said increased access to measles vaccines was estimated to have saved 21 million lives over the past 20 years.   "But we are starting to have a slide back and there are outbreaks happening all over the world in all WHO regions and it's leading to the virus being exported through international travel," he said.   Cases have skyrocketed in Europe, leading to Britain, Greece, the Czech Republic and Albania all losing their measles-free status in August.   The United States narrowly maintained its "measles eliminated" status a few months later, despite experiencing its worst outbreak since 1992.   The WHO has pointed to various reasons for declining immunisation rates including lack of access to healthcare and complacency about the need to vaccinate.

Another major factor, which has been cited by the WHO as a reason for the severity of the Samoa outbreak, is misinformation about immunisation from anti-vaccine campaigners.   Prime Minister Tuilaepa Sailele Malielegaoi this week said vaccination was the only answer to the epidemic.   He has ordered the government to cease non-essential operations on Thursday and Friday so public servants can help a mandatory vaccination campaign that aims to give anti-measles jabs to everyone aged below 60.
Date: Mon, 2 Dec 2019 08:16:50 +0100 (MET)

Wellington, Dec 2, 2019 (AFP) - Samoa ordered a government shutdown to help combat a devastating measles outbreak Monday, as five more children succumbed to the virus, lifting the death toll in the tiny Pacific nation to 53.   The government said almost 200 new measles cases had been recorded since Sunday, with the rate of infection showing no sign of slowing despite a compulsory mass vaccination programme.   The scheme has so far focussed on children but Prime Minister Tuilaepa Sailele Malielegaoi said it was time to immunise everyone in the 200,000 population aged under 60.

To achieve the goal, he said government services and departments would close on Thursday and Friday this week in order to allow all public servants to assist with the mass vaccination campaign throughout the country.   He said only electricity and water utility workers would be exempt and called on the nation to stand together to contain the outbreak.   "In this time of crisis, and the cruel reality of the measles epidemic, let us reflect on how we can avoid recurrence in the future," Malielegaoi said in a national address.

Since the crisis began in mid-October, there have been 3,728 measles cases, accounting for almost two percent of the population.   Infants are the most vulnerable and form the bulk of infections, with 48 of the fatalities aged four or less.   A state of emergency was declared in mid-November, with schools closed and children banned from public gatherings, such as church services, to minimise the risk of contagion.

The outbreak has been exacerbated by Samoa's low immunisation rates, which the World Health Organisation blames on overseas-based anti-vaccine campaigners.   Malielegaoi was unequivocal in his message, telling his people "vaccination is the only cure... no traditional healers or kangen (alkaline) water preparations can cure measles".   "Let us work together to encourage and convince those that do not believe that vaccinations are the only answer to the epidemic," he said.    "Let us not be distracted by the promise of alternative cures."

Officials say the anti-vaccination message has resonated in Samoa because of a case last year when two babies died after receiving measles immunisation shots.   It resulted in the temporary suspension of the country's immunisation programme and dented parents' trust in the vaccine, even though it later turned out the deaths were caused when other medicines were incorrectly administered.
Date: Wed, 27 Nov 2019 17:25:19 +0100 (MET)
By Nina LARSON

Geneva, Nov 27, 2019 (AFP) - A measles epidemic raging in Samoa has killed 37 people, the World Health Organization said Wednesday, blaming an anti-vaccine messaging campaign for leaving the Pacific island nation vulnerable to the spread of the virus.   The UN health agency warned that a steep decline in vaccination rates in Samoa, a Pacific Ocean island nation halfway between Hawaii and New Zealand, had paved the way for a "huge outbreak", with more than 2,500 cases in a country of just 200,000 people.   The death toll has been rising steadily since the country declared a national measles epidemic in mid-October. WHO said another five people had died Wednesday, bringing the total number of deaths to 37.   Measles is caused by a virus and can lead to serious complications including pneumonia and inflammation of the brain that can do permanent damage and be deadly, especially in small children.

Kate O'Brien, director of the WHO's immunisation department, told reporters in Geneva that "very low coverage of measles vaccine" was to blame for allowing the highly contagious disease to rapidly spread in the country.   In 2018, only 31 percent of children under five had been immunised, she said.   "When measles enters a country like that, there is a huge group of people who are not immune," she said.   The tragedy, she said, was that immunisation rates used to be far higher in Samoa, with coverage measured at 84 percent just four years ago.

- Misinformation taking toll -
Officials have blamed the low rates in part on fears sparked last year when two babies died after receiving measles vaccination shots.   This resulted in the temporary suspension of the country's immunisation programme and dented parents' trust in the vaccine, even though it later turned out the deaths were caused when other medicines were incorrectly administered.   O'Brien said that an anti-vaccine group had been stoking these fears further with a social media campaign, lamenting that "this is now being measured in the lives of children who have died in the course of this outbreak."   Misinformation about the safety of vaccines, she said, "has had a very remarkable impact on the immunisation programme" in Samoa.    Ian Norton at WHO's Emergency Medical Team Unit meanwhile warned that the outbreak was taking a heavy toll on the small country's entire health system.   "It has really spiked dramatically," he told reporters, pointing out that more than 200 new cases arrive at hospital every day.

Apia's main hospital, which normally has just four beds in its intensive care unit, currently has 14 children on ventilators, Norton said, stressing that this poses "a huge, huge burden".   He said mass vaccination was the only way to rein in epidemic.   The UN children's agency UNICEF has sent than 110,000 doses of measles vaccine and medical teams from Australia and New Zealand are helping administer them.   Norton said Britain was also preparing to send a support medical team, adding that WHO has sent out an appeal to other countries in the region to send medical teams.   Samoa is not the only place struggling with measles.

WHO data for the first six months of 2019 shows the highest number of measles cases reported worldwide since 2006, and there are currently several large outbreaks raging in places like the Democratic Republic of Congo, Madagascar and Ukraine.   And the UN health agency has been sounding the alarm over vaccination rates around the globe as the anti-vaccine movement gains steam, driven mainly by fraudulent claims linking the MMR vaccine against measles, mumps and rubella to a risk of autism in children.
Date: Tue, 26 Nov 2019 06:49:36 +0100 (MET)

Wellington, Nov 26, 2019 (AFP) - The death toll from a measles epidemic in Samoa rose to 32 on Tuesday as infection rates continue to soar out of control in the Pacific island nation, official data showed.   According to government figures, 28 of the dead were children aged four or under. The total number of measles cases was 2,437.   Samoa has declared a state of emergency but overstretched medical services are struggling to contain the outbreak, which has been exacerbated by the country's low vaccination rates.   The number of cases has risen five-fold in the past week and fatalities have more than tripled, despite the government launching a compulsory vaccination programme.

A total of 57,000 people in the nation of 200,000 have been vaccinated in recent weeks but Prime Minister Tuilaepa Malielegaoi said every citizen needed to be vaccinated.   "We have come a long way in a matter of days but there is more to done," he said late Monday.   "We cannot afford to relax our response until everyone is vaccinated."   Children are the most vulnerable to measles, which typically causes a rash and fever but can also lead to brain damage and death.   Schools and kindergartens have been closed and children have been banned from public gatherings, such as church services, to minimise the risk of contagion.
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Burundi

Burundi US Consular Information Sheet
April 21, 2008
COUNTRY DESCRIPTION:
One of the poorest countries in the world, Burundi is a small, densely populated central African nation bordering Lake Tanganyika, Rwanda, Tanzania and the Democrati
Republic of Congo. After more than 12 years of civil and ethnic strife, an electoral process deemed free and fair resulted in the installation of a democratic government in 2005. Years of fighting have devastated a historically fragile economy that depends largely on subsistence agriculture. Poor public health and education, weather disasters such as drought and floods, crop diseases and lack of infrastructure exacerbate the effects of conflict and delay recovery. Facilities for tourism, particularly outside the capital, are limited. Read the Department of State Background Notes on Burundi for additional information.

ENTRY/EXIT REQUIREMENTS: A passport, visa and evidence of immunization against yellow fever are required for entry. Travelers with an expired visa are not permitted to leave the country without acquiring an exit visa prior to departure. The latest information about visas may be obtained from the Embassy of the Republic of Burundi, Suite 212, 2233 Wisconsin Avenue NW, Washington, DC 20007, telephone (202) 342-2574, or from the Permanent Mission of Burundi to the United Nations in New York at telephone (212) 499-0001 thru 0006.
For information about dual nationality or the prevention of international child abduction, please refer to related web pages at http://travel.state.gov. For further information about customs regulations, please read our Customs Information sheet.

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

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

The Department of State urges American citizens to take responsibility for their 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: Crime, often committed by groups of armed bandits, poses a high risk for foreign visitors to Bujumbura and Burundi in general. Common crimes include mugging, purse-snatching, pick pocketing, burglary, automobile break-ins and carjacking. Many criminal incidents involve armed attackers. Armed criminals often ambush vehicles, particularly on the roads leading out of Bujumbura. Criminals in Bujumbura often operate in pairs or in small groups involving six or more individuals. Due to insufficient resources, local authorities in any part of Burundi are often unable to provide timely assistance in case of need.
U.S. Government personnel are prohibited from walking on the streets during the hours of darkness and using local, public transportation. Foreigners, whether in vehicles or at home, are always potential crime targets. Americans should exercise common sense judgment and take the same precautions as one would in any major city.

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

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical facilities in Burundi generally do not meet Western standards of care. Travelers should carry an ample supply of properly-labeled prescription drugs and other medications with them, as certain medications and prescription drugs are unavailable or in short supply. Sterility of equipment is questionable, and treatment is unreliable. Ambulance assistance is non-existent. Hospital care in Burundi should be considered in only the most serious cases and when no reasonable alternatives are available.
Malaria prophylaxis is recommended for travel to all parts of Burundi.

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 companies prior to traveling abroad to confirm whether their policies apply overseas and/or cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS: When in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Burundi is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
While travel on most roads is generally safe during the day, travelers must maintain constant vigilance. There have been regular reports of violent attacks on vehicles traveling the roads throughout the country outside of Bujumbura. U.S. Government personnel are required to travel upcountry via two-vehicle convoys and have their trips pre-approved by the Regional Security Officer. The Embassy recommends that Americans not travel on the national highways from dusk to dawn. Drivers without valid permits, and the ease with which a driver's license can be acquired without training, make Burundian drivers less careful, predictable, or mindful of driving rules than Western drivers may expect.
There are no traffic signals in Bujumbura, and virtually nothing of the kind elsewhere in the country. Roadways are not marked, and the lack of streetlights or shoulders makes driving in the countryside at night especially dangerous. Additionally, drivers may encounter cyclists, pedestrians, and livestock in the roadway, including in and around the capital. Mini-vans used as buses for 18 persons should be given a wide berth as they start and stop abruptly, often without pulling to the side of the road.
Large holes or damaged portions of roadway may be encountered anywhere in the country, including in Bujumbura; when driving in the countryside, it is recommended that travelers carry multiple spare tires. During the rainy season, many side roads are passable only with four-wheel drive vehicles. Burundi’s supply of gasoline and diesel fuel are imported predominantly from Kenya and Tanzania, and are relatively expensive due to high transportation costs. Service stations are rare outside of the major cities.

Third-party insurance is required, and it will cover any damages (property, injury, or death). If you are found to have caused an accident, you automatically will be fined 10,000 Burundian francs (approximately $10 U.S.) and your driver's license will be confiscated until the police investigation is completed. Although the law provides for the arrest of drunk drivers, in practice, the police do not act on this law. In the city of Bujumbura, the number for police assistance is 22-22-37-77; there is no comparable number outside the capital. If you are involved in an accident causing death, it is advised that you leave the scene of the accident and proceed to the nearest police station.

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 Burundi, the U.S. Federal Aviation Administration (FAA) has not assessed Burundi’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
There are no ATMs located in the country and most Burundian hotels and businesses do not accept credit cards. Many hotels in Bujumbura accept payment in U.S. dollars or Euros from non-Burundians. Travelers should be aware that Burundian banking practices prohibit acceptance of U. S. currency printed before the year 2003.
The Embassy recommends that visitors do not photograph airports, military installations, or other government buildings, and obtain permission from individuals before taking their photographs. 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 Burundian laws, even unknowingly, may be expelled from the country, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Burundi 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 on intercountry adoption and international parental child abduction see our Office of Children’s Issues web pages

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Burundi are encouraged to register with the U.S. Embassy through the State Department’s travel registration website so that they can obtain updated information on travel within Burundi and the Embassy’s current security policies, including areas that are off-limits to U.S. Government personnel for security reasons. 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 on Avenue des Etats-Unis, telephone (257) 22-22-34-54, fax (257) 22-22-29-26. The Embassy's web site is http://burundi.usembassy.gov/.
* * *
This replaces the Country Specific Information for Burundi dated July 18, 2007, to update sections on Country Description, Entry/Exit Requirements, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Wed, 14 Aug 2019 17:49:51 +0200 (METDST)

Nairobi, Aug 14, 2019 (AFP) - The World Health Organization (WHO) said Wednesday that Burundi had begun vaccinating frontline workers against Ebola at its border with the Democratic Republic of Congo, where an outbreak of the virus has killed close to 1,900 people.   The campaign to vaccinate at-risk staff against the deadly hemorrhagic fever started Tuesday at Gatumba, the main crossing point from Burundi to its much-larger neighbour, WHO said.

Burundi has received doses of the rVSV-ZEBOV vaccine, an unlicensed product that has been shown to be effective against the Zairian strain of the virus raging in DR Congo.   It would be administered to those at greatest risk such as health workers along the border, laboratory staff and burial teams, WHO said.   "The vaccination of health and frontline staff is a significant step forward in preparing for the response to this disease," said Dr Kazadi Mulombo, WHO representative in Burundi. 

The vaccine, developed by US pharmaceutical group Merck, proved "highly effective" in a trial conducted in Guinea in 2015 during the Ebola epidemic in West Africa, he added.    The vaccination campaign will be overseen by WHO and Burundi's health ministry.   The Ebola outbreak in eastern DR Congo is the second-worst in history. A total of 1,892 deaths have been recorded since the outbreak began on August 1 2018.   No cases of Ebola have been recorded so far in Burundi, a tiny nation of 11 million.    But its border with DR Congo is 236 kilometres (147 miles) long and considered highly porous, and the whole region is on high alert.

In June, three people from one family died in Uganda from Ebola after returning from DR Congo via an unofficial crossing point.   Burundi also shares a border with Rwanda and Tanzania.   The Congo outbreak is the first where vaccines have been rolled out on a large-scale.   The rVSV-ZEBOV vaccine has already been administered to some 170,000 people, especially frontline workers, in DR Congo.   This week, US researchers announced that two prototype drugs being tested among Ebola patients in eastern DR Congo boost chances of surviving the disease.
Date: Thu 8 Aug 2019 05.00 BST
Source: The Guardian [edited]

A serious outbreak of malaria in Burundi has reached epidemic proportions, killing almost as many people as the Ebola crisis in the nearby Democratic Republic of the Congo.  The outbreak in the tiny Great Lakes country has infected almost half the total population, killing about 1800 people since the beginning of the year [2019].  According to figures gathered by the World Health Organisation, almost 6 million cases have been recorded since the 1st week of January to the end of July [2019], with infections reaching crisis levels in May. The figures look on course to outstrip the epidemic of 2017, when more 6 million cases were recorded for the whole year. The situation has continued to worsen as the government of Burundi has refused to declare an emergency.

The scale of the outbreak was described in the latest report for the UN's office for the Coordination of Humanitarian Affairs, which warned that the outbreak had reached "epidemic" proportions.  "The national malaria outbreak response plan, which is currently being validated, has highlighted a lack of human, logistical, and financial resources for effective response," reported the organisation.  The organisation and other experts have blamed a number of issues for the crisis, including low use of preventative measures and a vulnerable population with low levels of resistance. Experts have also noted an increase in drug resistant strains of the disease in common with other parts of the world.

The climate crisis has been cited as a contributing factor. Mosquitoes, which spread the disease, are reaching higher altitudes in the mountainous country, and have displayed behavioural changes including more aggressive feeding habits.  The country's agricultural policies have also encouraged an increase in rice production that has seen farmers encroach on mosquito-infested areas.  While Burundi has long struggled with malaria, the figures for the current outbreak suggest a 50% increase compared to the equivalent period last year [2018]. The UN organisation noted bleakly that the number of health districts that have passed the epidemic threshold had continued to increase.

Although Burundi declared a national health emergency in 2017 after 1.8 million cases and 700 deaths were recorded, it has declined to declare one for the current outbreak, apparently concerned of the potential impact ahead of elections slated for next year [2010]…  [Byline: Peter Beaumont]
========================
[The WHO profile of malaria in Burundi can be found at

In 2017, the entire population of an estimated 10.9 million people lived in _Plasmodium falciparum_ high-endemic areas. In 2017 the annual incidence of _P. falciparum_ was estimated at 800 cases per 1000 population (WHO 2017 as above).

In 2017 there was an estimated 2.1M [range: 1.3M, 3.4M] cases with an estimated number of deaths of 5300 [range: 4300, 6200] (WHO). The 1st line treatment is artesunate-amodiaquine (AS-AQ) introduced in 2003. Malaria control relies on insecticide treated nets (ITN) but only around 30% of the population used a net the previous night one survey found (WHO 2017 as above) and it was also found that 80% of the mosquitoes were resistant to pyrethroids, the usual class of insecticides used for impregnating nets.

In 2005 the annual incidence was estimated at less than 50 cases per 1000 population (WHO 2017 as above) illustrating that since then the national malaria control programme has failed to improve the situation.

It is particularly worrying that the report above mentions treatment failure and possible drug resistance. With artemisinin resistance spreading in southeast Asia (see ProMED post http://promedmail.org/post/20190723.6583616) any signs of a slow parasite clearance need to be followed up by molecular analysis looking for mutations in key genes. No studies have looked at mutations in key genes predicting reduced susceptibility to the artemisinins or the 4-aminoquinolones (amodiaquine).

Since Burundi's independence in 1962, 2 genocides have taken place in the country: the 1972 mass killings of Hutus by the Tutsi-dominated army (<http://www.preventgenocide.org/edu/pastgenocides/burundi/resources/>), and the mass killings of Tutsis in 1993 by the Hutu majority. Both were described as genocides in the final report of the International Commission of Inquiry for Burundi presented in 2002 to the United Nations Security Council (<https://en.wikipedia.org/wiki/Burundi>). - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Burundi:
Date: Tue, 6 Aug 2019 10:38:45 +0200 (METDST)

Nairobi, Aug 6, 2019 (AFP) - Malaria has killed more than 1,800 people in Burundi this year, the UN's humanitarian agency says, a death toll rivalling a deadly Ebola outbreak in neighbouring Democratic Republic of Congo.   In its latest situation report, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) said 5.7 million cases of malaria had been recorded in Burundi in 2019 -- a figure roughly equal to half its entire population.   Of those cases, a total of 1,801 died from the mosquito-born disease in Burundi between January 1 and July 21, OCHA said.

The tiny country of 11 million people in the African Great Lakes region has still not declared a national emergency, despite OCHA saying the outbreak crossed "epidemic proportions" in May.   "The national malaria outbreak response plan, which is currently being validated, has highlighted a lack of human, logistical and financial resources for effective response," OCHA said in its latest weekly bulletin on humanitarian emergencies.   "All stakeholders, including the national authorities and partners are called upon to provide the requisite resources to mount a robust response to this event before it escalates."   A lack of preventative measures like mosquito nets, climatic changes and increased movements of people from mountain areas with low immunity to malaria were driving the crisis, OCHA said.

- 'Many crises' -
An OCHA official told AFP that "the decision to declare an epidemic is the sovereignty of the Burundian state".   The country declared a malaria epidemic in March 2017, when the country had recorded 1.8 million cases and 700 deaths, but was resisting doing the same now.   A senior government official, who declined to be named, said the government did not want to admit weakness with elections set for 2020.   "We are less than a year away from the presidential election. (President Pierre) Nkurunziza, who is facing many crises, does not want to recognise what could be considered a failure of his health policy," the official told AFP.   Burundi has been in crisis since 2015, when Nkurunziza ran for a third term and was re-elected in elections boycotted by most of the opposition.

At least 1,200 people were killed and more than 400,000 displaced in violence the UN says was mostly carried out by state security forces.   Nkurunziza announced in 2018 that he would not stand again, confounding critics who accused him of working to extend his grip on power.   UN investigators said in July that "drastic" steps were needed to boost democratic freedoms in Burundi if the government wanted the elections to be considered credible.

Burundi, one of the poorest countries in the region, abuts DR Congo, where the second-worst Ebola outbreak in history has killed more than 1,800 people amid fears the infectious fever could spread beyond its borders.   But malaria is a much bigger killer on the continent.   The World Health Organization recorded nearly 220 million cases of the parasitic illness in 2017, with an estimated 435,000 deaths. More than 90 percent of malaria cases and deaths were in Africa.
Date: Fri, 16 Mar 2018 14:39:07 +0100

Nairobi, March 16, 2018 (AFP) - Nine workers at a construction site outside Burundi's capital Bujumbura were killed in a landslide on Friday, police said.   Heavy seasonal rains caused the hillside next to the Gasenyi river, east of the city, to collapse burying the workers who were building a channel to redirect the river's floodwaters.   Police said in a statement that nine bodies had so far been found, while rescue efforts continue.
Date: Sat 7 Oct 2017 11:52:12 CAT
Source: Global Times, Xinhua News Agency report [edited]

At least 5 cases of cholera were reported this week [week of 2 Oct 2017] in Rugombo town in Cibitoke province, 72 km [about 45 mi] northwest of the Burundian capital Bujumbura, the Burundi News Agency reported Fri 6 Oct 2017. All those 5 cholera cases were reported at Rusiga, adding that lack of clean water is the origin of the propagation of cholera in that area, the state-run agency reported.

The Burundi Red Cross has deployed its agents to distribute drugs in infected households at Rusiga to avoid the propagation of the epidemic, it reported. Cibitoke Governor Joseph Iteriteka on [Fri 6 Oct 2017] held a meeting with health and administration officials based in Cibitoke province to look at ways of curbing the propagation of cholera in Rugombo and Cibitoke town, according to the report. During the meeting, they urged the country's Water and Electricity Company (REGIDESO) to supply water to the 2 towns -- Rugombo and Cibitoke -- as they are the worst threatened, reported the agency.

The Burundian Imbo western lowlands extending from the north in Cibitoke province to the south in Makamba Province near Lake Tanganyika are vulnerable to cholera every year in the dry season, especially between August and October. By the end of August 2017, the east African country's health ministry confirmed 24 cholera cases in Nyanza-Lac in the south-western province of Makamba, which originated from a fisherman who had come from the Democratic Republic of the Congo with symptoms of cholera.
===================
[Cibitoke province is one of the 18 provinces of Republic of Burundi. It is located in extreme northwest Burundi and can be seen on a map at <http://www.un.org/Depts/Cartographic/map/profile/burundi.pdf>. - ProMED Mod.LL]

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

Armenia US Consular Information Sheet
January 05, 2009
COUNTRY DESCRIPTION:
Armenia is a constitutional republic with a developing economy. Tourist facilities, especially outside Yerevan, the capital, are not highly developed, and many of
he goods and services taken for granted in other countries may be difficult to obtain. Read the Department of State’s Background Notes on Armenia for additional information.
ENTRY/EXIT REQUIREMENTS: A passport and visa are required. U.S. citizens may purchase visas in advance for a stay of up to 120 days online at http://www.armeniaforeignministry.am/ for the fee of USD 60; however, this visa is valid only for entry at Zvartnots airport in Yerevan. At this time a visa valid for 120 days may also be obtained upon arrival at the port of entry for the fee of 15,000 Armenian Drams (approx. USD 50). Visas for up to 120 days may be purchased at the Armenian Embassy in Washington, D.C. or the Consulate General in Los Angeles for the fee of USD 69. For further information on entry requirements, contact the Armenian Embassy at 2225 R Street NW, Washington, DC 20008, tel. (202) 319-1976 and (202) 319-2983; the Armenian Consulate General in Los Angeles at 50 N. La Cienega Blvd., Suite 210, Beverly Hills, CA 90211, tel. (310) 657-7320, or visit the Armenian Embassy’s web site at http://www.armeniaemb.org for the most current visa information.

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

SAFETY AND SECURITY:
A cease-fire has been in effect since 1994 around the self-proclaimed “Republic of Nagorno-Karabakh,” an unrecognized ethnic Armenian enclave within Azerbaijan. However, intermittent gunfire along the cease-fire line and along the border with Azerbaijan continues. Because of the existing state of hostilities, consular services are not available to Americans in Nagorno-Karabakh. Travelers should exercise caution near the Armenia-Azerbaijan border and consult the Country Specific Information for Azerbaijan if considering travel to Nagorno-Karabakh from Armenian territory. Armenia's land borders with Turkey, Azerbaijan, and the Nakhichevan Autonomous Republic of Azerbaijan remain closed and continue to be patrolled by armed troops who stop all people attempting to cross. There are still land mines in numerous areas in and near the conflict zones.

Political rallies in the aftermath of the February 2008 presidential elections turned violent. Clashes between government security forces and opposition demonstrators resulted in dozens of casualties, including 10 fatalities, in early March 2008. While the opposition continued to hold periodic protests over the summer and early fall, there have been no violent confrontations since the March events.
Americans should be mindful that even demonstrations intended to be peaceful could turn confrontational and possibly escalate into violence. American citizens are urged to avoid the areas of demonstrations if possible, and to exercise caution if within the vicinity of any demonstrations.

Armenia is an earthquake- and landslide-prone country. In addition to these natural disasters, there exists the possibility of chlorine gas spills and radiation poisoning due to industrial accidents.
The Soviet-era Armenia Nuclear Power plant is located in Metsamor, approximately 30 kilometers southwest of Yerevan.
Armenia is currently under international pressure to close the plant permanently, due to safety concerns.

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

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s A Safe Trip Abroad.

CRIME: Crime against foreigners is relatively rare in Armenia. Break-ins, particularly of vehicles, and theft are the most common crimes, but there have been instances of violent crime as well.
While the incidence of violent crime remains lower than in most U.S. cities, American citizens are urged to exercise caution and to avoid traveling alone after dark in Yerevan. Several American investors have also reported being involved in disputes over property ownership, and have had to seek legal recourse through a long, and in the majority of cases, unsuccessful court proceeding.
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 U.S. Embassy. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy for assistance. The Embassy 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. For information on assistance in the U.S. including possible compensation, see our Victims of Crime.
The local equivalents to the “911” emergency line in Armenia are: 101 - fire emergency; 102 - police emergency; 103 - medical emergency; and 104 - gas leak.
MEDICAL FACILITIES AND HEALTH INFORMATION: Though there are many competent physicians in Armenia, medical care facilities are limited, especially outside the major cities. The U.S. Embassy maintains a list of English-speaking physicians in the area. Most prescription medications are available, but the quality varies. Elderly travelers and those with existing health problems may be at risk due to inadequate medical facilities.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Armenia.

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 (CDC) 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 Armenia is provided for general reference only and may not be totally accurate in a particular location or circumstance.
Travel in Armenia requires caution. Public transportation, while very inexpensive, may be unreliable and uncomfortable. Travel at night is not recommended, and winter travel can be extremely hazardous in mountain areas and higher elevations.
Travelers should avoid the old highway between the towns of Ljevan and Noyemberyan in the Tavush region, as well as the main highway between the towns of Kirants and Baghanis/Voskevan. The U.S. Embassy has designated this portion of the road off-limits to all U.S. Government personnel because of its proximity to the cease-fire line between Armenian and Azerbaijani forces, a line which has seen numerous cease-fire violations over the years.

On weekends, there are an increased number of intoxicated drivers on Armenian roads. American citizens are urged to exercise particular vigilance while traveling on the main highway from Yerevan to the resort areas of Tsaghkadzor and Sevan. Traffic police will attempt to stop individuals driving erratically and dangerously, but police presence outside of Yerevan is limited.

Armenia does have emergency police and medical services, but they may take time to reach remote regions.
With the exception of a few major arteries, primary roads are frequently in poor repair, with sporadic stretches of missing pavement and large potholes. Some roads shown as primary roads on maps are unpaved and can narrow to one lane in width, while some newer road connections have not yet been marked on recently produced maps.
Secondary roads are normally in poor condition and are often unpaved and washed out in certain areas. Street and road signs are poor to nonexistent. Truck traffic is not heavy except on the main roads linking Yerevan to Iran and Georgia, i.e. the roads virtually all travelers need to use when traveling overland to those countries. Minibuses are considered more dangerous than other forms of public transportation. Travelers who choose to ride minibuses should exercise caution because these vehicles are often overcrowded and poorly maintained, commonly lack safety measures including seatbelts, and are frequently involved in accidents.

People driving in Armenia should be aware that “road rage” is becoming a serious and dangerous problem on Armenian streets and highways.
For safety reasons drivers are encouraged to yield to aggressive drivers.
Incidents of physical aggression against drivers and pedestrians have occurred

Though crime along roadways is rare, the police sometimes seek bribes during traffic stops. Drivers in Armenia frequently ignore traffic laws, making roadways unsafe for unsuspecting travelers.
Pedestrians often fail to take safety precautions and those driving in towns at night should be especially cautious. In cities, a pedestrian dressed in black crossing an unlit street in the middle of the block is a common occurrence.

The quality of gasoline in Armenia ranges from good at some of the more reliable stations in cities to very poor. The gasoline and other fuels sold out of jars, barrels, and trucks by independent roadside merchants should be considered very unreliable.

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 Armenia, the U.S. Federal Aviation Administration (FAA) has not assessed Armenia’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
Travelers on Armavia International Airways may experience prolonged delays and sudden cancellations of flights. Air travel to Armenia via European carriers is typically more reliable. Ticketed passengers on flights leaving Yerevan should reconfirm their reservations 24 hours prior to departure.
SPECIAL CIRCUMSTANCES:
Armenia remains largely a cash-only economy. Credit cards are accepted at some businesses, including major hotels and restaurants in Yerevan, but rarely outside of the capital. Limited facilities exist for cashing traveler's checks and wiring money into the country. There are a number of ATMs in the center of Yerevan. Dollars are readily exchanged at market rates. Travelers may experience problems with local officials seeking bribes to perform basic duties.

Armenian customs authorities may enforce strict regulations concerning temporary importation into or export from Armenia of items such as firearms, pornographic materials, medication, and communications equipment. For export of antiquities and other items that could have historical value, such as paintings, carpets, old books, or other artisan goods, a special authorization is required in advance from the Armenian Ministry of Culture. It is advisable to contact the Embassy of Armenia in Washington, DC or Consulate General in Los Angeles for specific information regarding customs requirements.

Please see our Customs Information.

Dual Nationals: Changes to Armenian legislation now permit Armenian citizens to hold dual citizenship. This means that U.S. citizens who emigrated from Armenia to the U.S. and subsequently acquired U.S. citizenship without explicitly giving up their Armenian citizenship may be able to (re)acquire Armenian citizenship along with all the associated rights and duties, e.g. the right to vote in Armenian elections and/or the duty for certain males to perform military service. The new law also means that dual citizens need to enter and leave Armenia on their Armenian passport, i.e. they would no longer need an Armenian visa. U.S. citizens interested in obtaining Armenian citizenship must register their dual citizenship with Passport and Visa Department of the Police of the Republic of Armenia (formerly OVIR) by simply presenting proof of their other citizenship (e.g. passport). For more information, please consult with Passport and Visa Department of the Police (tel.: +37410-501439) and/or http://www.armeniaforeignministry.am.

Compulsory Military Service: In addition to being subject to all Armenian laws affecting U.S. citizens, dual nationals are also subject to other laws that impose special obligations on Armenian citizens. Male U.S. citizens over the age of 18 who are also considered to be Armenian citizens may be subject to conscription and compulsory military service upon arrival, and to other aspects of Armenian law while in Armenia.
Armenian authorities have regularly detained U.S. citizens on these grounds upon their arrival in or departure from Armenia. In most cases, ethnic Armenian travelers who are accused of evading Armenian military service obligations are immediately detained and later found guilty of draft evasion. Penalties for those convicted are stiff and include jail time or a substantial fine. Those who may be affected are strongly advised to consult with Armenian officials and inquire at an Armenian embassy or consulate to their status before traveling. For additional information on dual nationality, see our dual nationality flyer.
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 offences. Persons violating Armenian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Armenia 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 Armenia are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, and to obtain updated information on travel and security within Armenia. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. The American Citizen Services section of the U.S. Embassy in Yerevan maintains a computer terminal in the consular waiting room available to U.S. citizens for registration. The U.S. Embassy provides Internet access to the general public through the American Corners program and through the U.S. Embassy's Information Resource Center. American Corners are located in Yerevan (2 Amiryan Street, tel. +374-10-56-13-83), Gyumri (68 Shirakatsi Street, tel. +374-312-22153), Vanadzor (25, Vardanants Street, tel. +374-322-21672), and Kapan (6, Shahumyan Street, tel. +374-285-22151). By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy in Yerevan is located at 1 American Avenue, tel. +374-10-46-47-00 and fax: +374-10-46-47-42. The Consular Section is open from 9:00 a.m. until 5:00 p.m., with time reserved for American citizen services from 1:30 p.m. until 4:30 p.m., Monday through Friday, except for official U.S. Embassy holidays. For more information, see the Embassy's web site at http://yerevan.usembassy.gov/
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This replaces the Country Specific Information dated June 9, 2008 to update sections on Entry and Exit Requirements, Safety and Security, Traffic Safety and Road Conditions, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Tue 20 Aug 2019, 4:29 PM
Source: Arka News Agency [edited]

Anthrax cases have been reported in Geghhovit community of Armenia's Gegharkunik province, the press office of Armenia's health ministry reported on [Tue 20 Aug 2019]. According to the ministry's press release, 2 residents of the community came to a medical centre in Martuni with sores on their fingers. The patients told doctors that they had taken part in butchering a cow of a fellow villager.

The health ministry has dispatched its experts to the community. As a result of joint efforts with local medical centres' workers, 6 other infected people have been found. All the patients are being treated now, and the community is under medical control now. The Armenian Food Safety Agency has been informed.
===================
[Gegharkunik province is on the eastern border of Armenia and pokes into Azerbaijan; see:
<http://legacy.lib.utexas.edu/maps/commonwealth/armenia_pol_2002.jpg>

Geghhovit is south of Sevana Lich (lake); see:

When the dust settled there were 2 initial cutaneous cases subsequent to them butchering a neighbour's cow, which would have been sick or dead. The first report suggests that they might have butchered a number of "cattle" carcasses, though the 2nd report has a single cow. And in due course another 6 villagers came down with cutaneous anthrax as they were sent to the local hospital merely for diagnostic confirmation.

Anthrax is sporadic in Armenia and thus the risks of butchering sick and dead animals are only realised after the onset of human anthrax lesions. And the number of human cases can exceed the indirectly reported livestock cases. - ProMED Mod.MHJ]

[HealthMap/ProMED map available at:
Date: Fri 8 Mar 2019
Source: Nouvelles Armeni Magazine [in French, trans. ProMED Corr SB, abridged, edited]

A 2nd case of measles infection was reported in Armenia on Wednesday [6 Mar 2019], the country's Ministry of Health press office reported. A person infected with this disease arrived on 20 Feb [2019] in Armenia through the territory of Georgia. Clinical symptoms became visible on 25 and 26 Feb [2019], which was initially explained as drug intolerance, but later, on 6 Mar [2019], a laboratory test diagnosed measles disease.

According to the Ministry of Health, the 1st measles infection was reportedly found in Armenia by a Ukrainian citizen who arrived in Yerevan by plane from Kiev on 24 Feb [2019].

The 2 infected people had contact with many people, particularly those in the airport lobby and at the hospital.
17th February 2019

- National. 14 Feb 2019. 57 cases of dengue in Armenia [have been] recorded to date; the figure increased in 2019 compared to the year 2018. The increase in records so far in 2019 is 25.
Date: Sun, 29 Jul 2018 12:23:52 +0200
By Mariam HARUTYUNYAN

Arinj, Armenia, July 29, 2018 (AFP) - When Tosya Gharibyan asked her husband to dig a basement under their house to store potatoes, she had little idea the underground labyrinth he would eventually produce would prove to be one of Armenia's major tourist draws.   Their one-storey house in the village of Arinj outside the capital Yerevan may not look like much but today it brings in visitors from all over the globe after a 23-year labour of love by Tosya's late husband, Levon Arakelyan.   They come to see a twisting network of subterranean caves and tunnels known as "Levon's divine underground."

In the cold and quiet, Tosya leads tourists through corridors that connect seven chambers adorned with Romanesque columns and ornaments like those on the facades of mediaeval Armenian churches.   "Once he started digging, it was impossible to stop him," she said of the project that began in 1995. "I wrangled with him a lot, but he became obsessed with his plan."   A builder by training, Levon would toil for 18 hours a day -- only pausing to take a quick nap and then rush back to the cave, confident that he was being guided "by heaven".   "He never drew up plans and used to tell us that he sees in his dreams what to do next," his widow told AFP.

Over more than two decades he hammered out the 280-square-metre (3,000 square-foot) space, 21 metres deep into strata of volcanic rocks -- only using hand tools.   "My primary childhood recollection is the loud knock of my father's hammer heard at night from the cave," said his 44-year-old daughter Araksya.   At the start he had to break through a surface layer of black basalt, but at the depth of a few metres Levon reached much softer tufa stone and the work progressed.   He pulled out 600 truckloads of rocks and earth, using only hand-held buckets.   Levon died in 2008 at the age of 67 from a heart attack after destroying the last wall that separated two tunnels.

- 'Amazing place' -
A decade on from the project's completion, Tosya also runs a small museum commemorating her husband's work in the village of some 6,000 people.   The underground complex has several analogues in the world.   An eccentric man named William Henry "Burro" Schmidt spent more than three decades digging a half-a-mile tunnel to transport gold through a granite mountain in California, beginning his work in the early 1900s during the state's gold rush.

In Ethiopia a man named Aba Defar began carving churches on a mountainside after claiming divine inspiration from years of dreams.   Today the Armenian cave features prominently in travel brochures, regularly drawing busloads of visitors.   Milad, a 29-year-old Iranian tourist, called the maze an "amazing place".   He said it made him realise just "how boundless the spiritual and physical capabilities of a person can be".
Date: Fri 18 May 2018
Source: Armenpress [edited]

The investigation into a foodborne incident in Armenia's Armavir province continues. The suspected cause -- food poisoning -- has been confirmed through lab tests. Salmonellosis has been discovered in all victims.

63 from the overall 88 victims of the food poisoning have already been treated and discharged. The healthcare ministry says they confirm that the cause was food poisoning. Earlier, the state service for food safety has dispatched agents to Armavir province to probe the suspected food poisoning incident in the plant of Tierras de Armenia, a viticulture and winemaker known for its Karas wines. Earlier, doctors said they suspected the cause of the poisoning to be a lunchtime snack, which all of the employees consumed in the cafeteria of the plant.

Agents have taken samples from the facility and sent them for laboratory analysis. Food safety agents also ceased the operation of a businesswoman's food supply business in relation to the incident as a precaution. The businesswoman, Alvina Melkonyan, supplied Tierras de Armenia with lunch-time food on the day when the incident happened. A company, who in turn is supplying Melkonyan, is also under investigation. All patients are in satisfactory states, doctors say.

The likely cause of the mass poisoning in Armavir province is thought to be lunch-time snacks containing chicken, cheese and potatoes, which the victims have consumed in the cafeteria of the plant, a doctor of the Armavir medical center told Armenpress. Earlier, it was unclear whether the poisoning was food-related.
======================
[The specific food is not yet stated, but chicken is a common vehicle, either undercooked or cross-contaminated after cooking. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Armavir Province, Armenia: <http://healthmap.org/promed/p/46276>]
More ...

Slovenia

Slovenia US Consular Information Sheet
March 02, 2009
COUNTRY DESCRIPTION:
Slovenia operates under a parliamentary democracy.
In May 2004, Slovenia became a member of the European Union.
Tourist facilities are widely available th
oughout the country.
Read the Department of State’s Background Notes on Slovenia for additional information.

ENTRY/EXIT REQUIREMENTS:
Slovenia is a party to the Schengen agreement.
As such, U.S. citizens may enter Slovenia for up to 90 days for tourist or business purposes without a visa.
The passport should be valid for at least three months beyond the period of stay.
For further details about travel into and within Schengen countries, please see our Schegen fact sheet.

Slovene authorities may confiscate passports with signs of damage, such as missing pages, as suspicious documents, potentially causing travel delays.
American citizens entering and exiting Slovenia by personal vehicle are required to have a valid U.S. and International Driver’s License (See our Road Safety page for further information) or they may be refused entry into the country and/or fined.

All non-EU citizens staying longer than 3 days in Slovenia must register with the local police within 3 days of arrival and inform the office about any change in their address. Registration of foreign visitors staying in hotels or accommodations rented through an accommodation company is done automatically by the hotelier or accommodation company, but visitors staying with family members must register themselves.
Registration is available 24 hours a day at police stations and is free of charge. Failure to register can result in a significant fine of up to 400 euros.

For further information on entry requirements for Slovenia, travelers may contact the Embassy of Slovenia at 2410 California Street, NW, Washington, DC
20008, tel. (202) 386-6610; the Consulate General of Slovenia in New York City, tel. (2l2) 370-3006; or the Consulate General in Cleveland, Ohio, tel. (216) 589-9220.
Visit the Embassy of Slovenia’s web site 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:
Slovenia remains largely free of terrorist incidents.
This assessment takes into account historical data relevant to terrorist activities and recent reporting indicating whether acts could be conducted without prior advance warnings.
However, like other countries in the Schengen area, Slovenia shares open borders with its Western European neighbors, allowing the possibility of terrorist groups entering/exiting the country with anonymity.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

There are occasional political demonstrations in city centers in Slovenia.
They occur most often in central Ljubljana in areas around Kongresni Trg (Congress Square), in front of the Parliament building, around other government facilities, and, at times, near the American Embassy.
These demonstrations are usually peaceful and generally are not anti-American in nature.
However, there have been demonstrations that voiced anti-American sentiments.
American citizens should keep in mind that even demonstrations intended to be peaceful can turn confrontational and possibly escalate into violence.
American citizens are therefore urged to avoid the areas of demonstrations if possible, and to exercise caution if within the vicinity of any demonstrations.
For additional information, Americans are encouraged to check the Embassy’s website or call the Embassy at 386-1-200-5595 or 200-5599 (200-5556 after hours and on weekends/holidays).

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

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

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

CRIME:
Slovenia’s overall crime rate is low and violent crimes are relatively uncommon.
Most crimes tend to be non-violent and directed towards obtaining personal property, such as purse-snatching, pick-pocketing, and residential and vehicle break-ins.
Visitors should take normal security precautions and are requested to report any incidents to the local police.

Vehicle break-in/theft is a continuous problem in Slovenia.
Individuals should always lock vehicles, use vehicle anti-theft devices, park in well-lighted areas, and secure vehicles in residential or hotel garages.

Residential burglaries occur where there are security vulnerabilities and/or where residents are not implementing residential security practices.
American citizens should ensure their residence is properly secured at all times, as recent burglary reports indicate access was gained when doors were not secured with an appropriate lock.

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 Slovenia is: 113.
Please see our information on Victims of Crime, including possible victim compensation programs in the United States.

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 Slovenian laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Slovenia 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.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Adequate medical care is readily available.
Travelers to Slovenia may obtain a list of English-speaking physicians at the U.S. Embassy.
Antibiotics, as well as other American-equivalent prescription medications are available at local pharmacies.
In Slovenia all medications, including drugs considered over-the-counter and first aid supplies, are dispensed through pharmacies (“lekarna”).
For those persons who engage in outdoor activities, a vaccine to prevent tick-borne encephalitis is recommended.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Slovenia.
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 (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site.
For information about outbreaks of infectious diseases abroad, consult the World Health Organization’s (WHO) web site.
Further health information for travelers is available from the WHO.

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

Slovenia has a well-developed road network that is safe for travel.
Highways connect to neighboring cities and countries and are clearly sign-posted; road signs and traffic rules are consistent with those used throughout Europe.
As the number of cars in Slovenia continues to rise, roads are becoming more heavily congested during the weekends on major routes and during rush hours.
Parking is difficult and can be expensive in the center of Ljubljana.
Traffic moves on the right.
Third-party liability insurance is required for all vehicles; coverage is purchased locally.
Travelers should be alert to aggressive drivers both in cities and on highways.
Many of the serious accidents in Slovenia occur as a result of high-speed driving.
Emergency roadside help and information may be found by dialing 1-987 for vehicle assistance and towing services, 112 for an ambulance or fire brigade, and 113 for police.
By Slovene law, the maximum legal blood-alcohol content limit for drivers is 0.05%.

U.S. visitors or U.S. residents in Slovenia must be in possession of both a valid U.S. driver’s license and an International Driver’s License in order to drive in Slovenia.
International Driver’s Licenses are valid for a maximum of one year, after which residents of Slovenia are required to obtain a Slovene driver's license.
Current information about traffic and road conditions is available in English by calling (01) 530-5300 and online from the Automobile Association of Slovenia and the Traffic Information Center for Public Roads.

The speed limit is 50kph/30 mph in urban areas, 130 kph/80 mph on expressways (the avtocesta).
Motorists are required to have their headlights on during the daytime; drivers and passengers alike must wear seat belts; motorcyclists and their passengers must wear approved helmets.
The use of handheld cellular telephones while driving is prohibited in Slovenia.

Highway vignettes are obligatory for all vehicles with the permissible maximum weight of 3,500 kg on motorways and expressways in Slovenia.
A one-year vignette costs EUR 55; a half-year vignette costs EUR 35; for motorcycles, the one-year vignette is EUR 27,50 and the half-year vignette is EUR 17,50.

A one-year vignette for the current year is valid from December 1st of the previous year to January 31st of the next year (a total of 14 months). The half-year vignette is valid for six months following the day of its purchase.
Using motorways and expressways without a valid and properly-displayed vignette in a vehicle is considered a violation of the law; violators may be fined between EUR 300 and 800. In addition to this fine, a new sticker must be purchased and displayed on the vehicle.
Vignettes can be purchased in Slovenia at petrol stations, newsstands, automobile clubs, post offices (Posta Slovenije), and some toll stations, and also at petrol stations in neighboring countries.

Please refer to our Road Safety page for more information.
Current information is also available at the website of Slovenia’s national tourist office, which is the national authority responsible for road safety.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Slovenia, the U.S. Federal Aviation Administration (FAA) has not assessed Slovenia’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s website.

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 Slovenia are encouraged to register with the U.S. Embassy or through the State Department’s travel registration website so that they can obtain updated information on travel and security within Slovenia.
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located at Presernova 31, Ljubljana 1000, Tel: (386)(1) 200-5500 or Fax: (386)(1) 200-5535.
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This replaces the Country Specific Information for Slovenia dated July 29, 2008, to update the
Entry/Exit Requirements and Traffic Safety and Road Conditions sections.

Travel News Headlines WORLD NEWS

Date: Mon, 6 Aug 2018 12:06:36 +0200
By Bojan KAVCIC

Markovec, Slovenia, Aug 6, 2018 (AFP) - When he used to go hunting, Miha Mlakar would dream of killing a bear. But today the 33-year-old from Slovenia makes his living watching the animals, peacefully, in their natural forest environment.   The turnaround to shooting bears with a camera, not a rifle, puts Mlakar, who runs bear observation tours, in step with wider efforts in the small Alpine nation to promote the coexistence of humans and bears.

Once on the verge of extinction, Slovenia's brown bear population is booming, with the number roaming the sprawling forests having doubled in the last decade to around 1,000.   As a result, encounters with bears have increased -- not that it seems to unduly worry everyone.   "If you run into a bear, you have to step back... (But) there is no danger. The bear also prefers to move away," Ljubo Popovic, a 67-year-old pensioner who lives in the village of Banja Loka in the southern Kocevje region, told AFP.   Lying an hour to the west, near Markovec village, Mlakar has built 20 hides in a remote patch of forest reachable only by off-road vehicle and takes visitors, including foreign tourists, to observe the bears.   "I cannot imagine this forest without bears. Bears make the forest wild and pristine, natural, like it was a few hundred or thousand years ago... I feel a connection with bears," he tells AFP.

- Managing bears -
Slovenian bears are even sought after abroad.    Between 1996 and 2006, eight Slovenian bears were released in the French Pyrenees, and France currently has a population of about 40 bears, whose presence divides opinion in regions where they live.   In Slovenia, more than 60 percent of respondents in a 2016 survey carried out in areas where bears live said they were in favour of the bears' presence, even if many also said they would like to see the numbers regulated.   "We have an average of one to three cases of physical contact between bears and humans per year," Rok Cerne, of the Slovenia Forest Service in charge of wildlife, told AFP.

"Fortunately, we haven't registered any serious incident over the last years," he added, stressing they were "very active in preventive measures".   Removing food sources that could attract bears has been one such step.    In villages close to bear habitats, local authorities have replaced regular plastic waste and compost bins, which can be easily opened or flipped by the animals, with containers protected by heavy metal cages.

Meanwhile, damage to cattle from bear forays has remained stable, at up to 200,000 euros ($231,500) a year, despite the bear population increasing, Cerne said.   Farmers are entitled to an 80-percent subsidy for using electric fences to protect flocks and the loss of cattle due to bears is compensated.   If a bear becomes a habitual visitor to a village, special intervention groups step in to kill or relocate the animal with the help of local hunters.   Regular culling also keeps the population under control to ensure long-term cohabitation, Cerne said. This year, authorities have proposed culling 200 bears, twice as many as last year.

- Romania's 'Van Damme' bear -
Slovenia's approach could inspire neighbouring Romania, home to about 6,000 bears or 60 percent of Europe's estimated bear population, where tourists to villages in the Carpathian Mountains often post pictures online of bears waiting to be hand-fed.   Bears rummaging through waste containers on the outskirts of cities, such as Brasov in central Romania, have become a common sight.   And on a central motorway construction site, workmen have christened a regularly spotted sturdy male bear Van Damme after the Hollywood star.

Beyond tourists' anecdotes however, Romania has seen a "growing number of attacks" by bears, highlighted in a conservation plan published last month that recommends hunting to keep numbers at optimum levels.   Use of reinforced bins, as well as a proposal for building work to be limited in regions where bears live, are also included in the government plan.   Since the beginning of last year, 31 people, mostly shepherds, have been attacked, one of them fatally. 

Meanwhile, some 940 forays by bears into populated areas were registered last year, including attacks on sheep flocks and entry into gardens; so far this year, the figure is 120.   But environmental campaigners fear that "hunting will be the main instrument to keep bear populations under control", when other measures could work, said Livia Cimpoeru, of the WWF Romania.   The government has proposed 4,000 bears as the ideal number in the country of 20 million people.   Learning simple rules, such as how to avoid startling bears and not feeding them, as well as efficient management like accurate counting to ascertain trends, is crucial for reducing conflicts with humans, said Mareike Brix, of German-based EuroNatur foundation.   "There is a risk, and there can be problems... But it's also great (to have bears). Wild nature has become so rare in Europe," she tells AFP.
Date: Thu 13 Jun 2018
Source: STA [not open access; edited]

The UKC Maribor hospital has registered 3 new cases of measles infection, including a doctor and a nurse who treated 1 of the 3 patients who got measles earlier.

The rest of this story is by subscription....
===================
[A HealthMap/ProMED-mail map of Slovenia can be found at
Date: Mon 17 Oct 2016
Source: Outbreak News Today [edited]

The vaccine-preventable disease, tetanus, has been considered eradicated among children in the Central European country of Slovenia for the past 20 years; health officials report a case in an unvaccinated child as reported in local media Fri, 14 Oct 2016.

The National Public Health Institute (NIJZ) says while the disease has been considered eradicated among children for the past 2 decades, a few cases are reported every year among the elderly, who grew up before systemic vaccination against the disease was introduced. Tetanus vaccination has been available in Slovenia since 1951.

Tetanus is caused by a very potent toxin produced by the anaerobic bacterium, _Clostridium tetani_. The spores of this organism are very resistant to environmental factors and are found widely distributed in soil and in the intestines and feces of horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens. Manure-treated soil may contain large numbers of spores. In agricultural areas, a significant number of human adults may harbor the organism.

These spores are usually introduced into the body through a puncture wound contaminated with soil, street dust, animal bites or animal or human feces, through lacerations, burns or trivial unnoticed wounds or by injecting contaminated drugs. So many times you hear about concern over stepping on a rusty nail; however the rust has nothing to do with tetanus. At this point the spores germinate into bacteria which multiply and produce toxin. Depending on the extent of the wound, the incubation of tetanus is around 10-14 days.

Some of the common symptoms of tetanus are lockjaw, followed by stiffness of the neck, difficulty swallowing, and rigidity of abdominal muscles. Other symptoms include fever, sweating, elevated blood pressure, and episodic rapid heart rate. Spasms may occur frequently and last for several minutes. Spasms continue for 3-4 weeks. The typical features of a tetanus spasm are the position of opisthotonos and the facial expressions known as "risus sardonicus". The death rate for this disease ranges from 10 to 80 percent depending on age and quality of care.

There are really no laboratory findings that are characteristic of tetanus. The diagnosis is entirely clinical and does not depend upon bacteriologic confirmation. This disease in not transmitted from person to person. Even if you had tetanus and recovered, this potent toxin produces no immunity.  [Byline: Robert Herriman]
======================
[Tetanus is a potentially fatal disease characterized by skeletal muscle rigidity and painful convulsive spasms, which are caused by a potent neurotoxin, tetanospasmin, produced by the vegetative form of _Clostridium tetani_, an anaerobic spore-forming Gram-positive bacillus. _C. tetani_ is a member of the normal intestinal flora of animals, including humans. Tetanus usually occurs following contamination of wounds by soil or animal feces in which the spores of _C. tetani_ can be found.

A newly published article demonstrates that the extracellular matrix proteins called nidogens (or entactins) appear to be the receptor for the tetanus neurotoxin to enter the neuromuscular junction (Bercsenyi K, Schmieg N, Bryson JB, et al: Tetanus toxin entry. Nidogens are therapeutic targets for the prevention of tetanus. Science. 2014;346(6213):1118-23. doi: 10.1126/science.1258138, abstract available at:  <http://science.sciencemag.org/content/346/6213/1118.long>).

Abstract:
"Tetanus neurotoxin (TeNT) is among the most poisonous substances on Earth and a major cause of neonatal death in nonvaccinated areas. TeNT targets the neuromuscular junction (NMJ) with high affinity, yet the nature of the TeNT receptor complex remains unknown. Here, we show that the presence of nidogens (also known as entactins) at the NMJ is the main determinant for TeNT binding. Inhibition of the TeNT-n idogeninteraction by using small nidogen-derived peptides or genetic ablation of nidogens prevented the binding of TeNT to neurons and protected mice from TeNT-induced spastic paralysis. Our findings demonstrate the direct involvement of an extracellular matrix protein as a receptor for TeNT at the NMJ, paving the way for the development of therapeutics for the prevention of tetanus by targeting this protein-protein interaction."

Tetanus may follow surgical procedures, burns, deep puncture wounds, crush wounds, otitis media, dental infection, animal bites, abortion, and pregnancy. The presence of necrotic tissue and/or foreign bodies increases risk for tetanus because they favor growth of _C. tetani_. Tetanus can also follow injection of contaminated illicit drugs. Neonatal tetanus occurs usually in developing countries in infants with infection of the umbilical stump who are born to a non-immune mother. Infants of actively immunized mothers acquire passive immunity that protects them from neonatal tetanus. Tetanus is not directly transmitted from person to person.

Tetanus occurs in people who are inadequately immunized, i.e., people who have not completed the primary series and received appropriate boosters. Recovery from tetanus is not necessarily associated with immunity, and primary immunization is indicated after recovery from tetanus. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Tue, 12 Jan 2016 20:27:43 +0100

Ljubljana, Jan 12, 2016 (AFP) - The Slovenian army on Tuesday began removing sections of a razor-wire border fence, erected to control the inflow of migrants from Croatia, due to flooding by the Kolpa river, local media reported.   Slovenian soldiers removed 200-300 metres of the fence in the Griblje and Dragatus areas, villages some 110 kilometres (70 miles) south of Ljubljana, after the Kolpa burst its banks and floodwaters threatened to tear down the fence, the STA news agency reported.

Since mid-November Slovenia has built over 150 kilometres of razor-wire fence along its border with Croatia, hoping to prevent an uncontrolled inflow of migrants across the "green border".   Over 400,000 migrants have crossed into Slovenia since mid-October, most hoping to carry on to Austria or Germany.

The Slovenian government's information office said Monday that the border fence would be removed in areas where the stream of the Kolpa river was strongest and replaced, in the near future, by a more resistant fence.   Situated in one of Slovenia's most attractive natural parks, the Kolpa river marks over 100 kilometres of the 670 kilometre-long Slovenia-Croatia border.   The fence has been criticised by environmentalists and civil groups in Slovenia and Croatia which claim the razor wire is a threat to wildlife.
Date: 4 Jan 2016
From: Maja Socan, M.D. Maja.Socan@nijz.si

In response to the request for information in the ProMED mail post "Undiagnosed gastroenteritis - Slovenia (GO): international athletes, RFI http://promedmail.org/post/20151228.3896510, the following information was received 4 Jan 2016 [edited]:

As a response to the ProMED request for information on 28 Dec 2015 quoting izvestia.ru from 19 Dec [2015] that 3 teams were affected by a viral epidemic during Biathlon World Cup in Pokljuka, Slovenia, an investigation has been carried out. Regional epidemiologists contacted the organizers, the hotel where athletes were staying, local outpatient clinics/emergency teams and both hospitals nearby. 
 
The organizers of the Biathlon World Cup in Slovenia were not aware of any communicable diseases affecting biathlon teams during the cup. One of the athletes was admitted to the hospital but the reason for the admission was non-infectious. Another athlete lost consciousness during the competition.
 
Neither emergency medical teams nor nearby hospitals were contacted for any health intervention except for the above-mentioned situations.
 
The hotel where the teams were staying was not informed about any gastrointestinal problems among its guests during the competition.
 
The findings of our investigation do not preclude that some of the athletes had health problems during the competition but apparently not severe enough to contact local health services. We assume that if high numbers of athletes had become ill with gastrointestinal problems the organizer would have been informed. According to the national algorithm for mass gatherings (with emphasis on the international ones), the National Institute of Public Health is obligated to provide in advance the information to the organizers about possible health issues during mass gatherings and measures which must be taken to stop the spread of communicable diseases or at least to mitigate the outbreak.
 
To conclude, we were not able to identify an outbreak of acute gastrointestinal or respiratory infection among competing athletes during the Biathlon World Cup in Pokljuka, Slovenia.
-------------------------------------------
Maja Socan, M.D.
Senior consultant
Communicable Diseases Centre
National Institute of Public Health
Ljubljana, Slovenia
========================
[ProMED thanks Dr. Socan for the thorough investigation into this report and for sharing the information with the ProMED community.

A HealthMap/ProMED-mail map can be accessed at:
More ...

World Travel News Headlines

Date: Tue, 10 Dec 2019 10:50:09 +0100 (MET)

Sydney, Dec 10, 2019 (AFP) - The death toll from New Zealand's White Island volcano eruption rose to six late Tuesday, after an injured person died in an Auckland hospital, police said.   "Police can confirm a further person has died following the eruption on Whakaari/White Island, bringing the official toll to six," a police statement said.   Eight more people who remain missing are presumed dead after the volcano erupted Monday.
Date: Tue, 10 Dec 2019 09:27:57 +0100 (MET)
By Andrew BEATTY, with Daniel de Carteret in Gosford

Sydney, Dec 10, 2019 (AFP) - Toxic haze blanketed Sydney Tuesday triggering a chorus of smoke alarms to ring across the city and forcing school children inside, as "severe" weather conditions fuelled deadly bush blazes along Australia's east coast.   Fire engines raced office-to-office in the city centre with sirens blaring, as inland bushfires poured smoke laden with toxic particles into commercial buildings.   Emergency services responded to an "unprecedented" 500 automatic call-outs inside a few hours according to New South Wales Fire and Rescue's Roger Mentha.

A regional fire headquarters miles from the nearest blazes was itself evacuated while throngs of mask-wearing commuters choked their way through thick acrid air and the organisers of a harbour yacht race declared it was unsafe to proceed.   "The smoke from all the fires is just so severe here on the harbour that you just can't see anything, so it's just too dangerous," said spokeswoman Di Pearson of an event that normally foreshadows the famed Sydney-Hobart yacht race. "The vision is just so poor."   Some of the city's commuter ferries were also cancelled "due to thick smoke" and school kids were kept inside at breaktime and sent home early as pollution levels soared far above "hazardous" levels.

For weeks the east of the country has been smothered in smoke as drought and climate-fuelled bushfires have burned. But the scale of the problem on Tuesday shocked even hardened residents.   Bruce Baker -- an 82-year-old who lives in Gosford, north of Sydney -- said he was skipping his daily morning walk because of the smoke.   "This is the worst it's been, for sure," he told AFP. "It dries your throat. Even if you're not asthmatic, you feel it."   Authorities recommended that the vulnerable cease outdoor activity altogether and that everyone stay inside as much as possible, although one couple braved the toxic air to get married on the waterfront in front of Sydney Harbour Bridge shrouded in smog.

A cricket match between New South Wales and Queensland also went ahead, despite a barely visible ball.   Tuesday had been expected to bring strong winds and high temperatures that made for "severe conditions where embers can be blown ahead of the fire into suburbs and threaten properties."   But New South Wales Rural Fire Service said "deteriorating fire conditions have been delayed by a thick blanket of smoke" over the east of the state.   As the day developed there were nearly 100 bushfire incidents in the state of New South Wales alone and dozens more in Queensland.   Total fire bans were put in place across much of the east of the country and in large parts of western Australia.   Temperatures in some inland areas eased past 44 degrees Celsius (111 Fahrenheit).

- The 'big dry' -
To the northwest of Sydney, several fires already burning for weeks have combined to create a "megafire" that has already destroyed 319,000 hectares (788,000 acres) of land, mostly inside national parks.   Prime Minister Scott Morrison  -- who for weeks has not commented on the smoke haze -- defended his government's handling of the fires and said there were no plans to professionalise the countryside's largely volunteer force.    "Our policy is sensible when it comes to addressing and taking action on climate change. Our actions on climate change are getting the results they're intended to get," he said.   Morrison's conservative coalition has been criticised by former fire chiefs for failing to heed warnings about climate change.   The crisis has been propelled by a prolonged drought that has made vegetation tinder dry.

The Bureau of Meteorology has reported that Australia experienced its driest November on record this year.   The "big dry" has left farmers desperate and small towns facing the prospect of running out of water completely.   A swathe of the east of the country has seen "rainfall deficiencies" since early 2017 -- almost three years.   Many dams in New South Wales are empty and almost all are well below capacity.   Firefighters south of Brisbane recently reported 1,000 litres of water were stolen from tanks at their station.   Amid the shortage, Tuesday also saw the toughest water restrictions in a decade being introduced for Sydney -- with curbs on everything from hosepipe use to washing cars.
Date: Tue, 10 Dec 2019 03:09:17 +0100 (MET)
By Allison JACKSON

Sao Paulo, Dec 10, 2019 (AFP) - Gripping the deadly snake behind its jaws, Fabiola de Souza massages its venom glands to squeeze out drops that will save lives around Brazil where thousands of people are bitten every year.   De Souza and her colleagues at the Butantan Institute in Sao Paulo harvest the toxin from hundreds of snakes kept in captivity to produce antivenom.    It is distributed by the health ministry to medical facilities across the country.

Dozens of poisonous snake species, including the jararaca, thrive in Brazil's hot and humid climate.    Nearly 29,000 people were bitten in 2018 and more than 100 died, official figures show.   States with the highest rates of snakebite were in the vast and remote Amazon basin where it can take hours to reach a hospital stocked with antivenom.   Venom is extracted from each snake once a month in a delicate and potentially dangerous process.

Using a hooked stick, de Souza carefully lifts one of the slithering creatures out of its plastic box and maneuvers it into a drum of carbon dioxide.    Within minutes the reptile is asleep.    "It's less stress for the animal," de Souza explains.    The snake is then placed on a stainless steel bench in the room where the temperature hovers around 27 degrees Celsius (80 degrees Fahrenheit).    De Souza has a few minutes to safely extract venom before the snake begins to stir.      "It's important to have fear because when people have fear they are careful," she says.

- Antivenom 'crisis' -
The snakes are fed a diet of rats and mice that are raised at the leafy institute and killed before being served up once a month.   After milking the snake, de Souza records its weight and length before placing it back in its container.    The antivenom is made by injecting small amounts of the poison into horses -- kept by Butantan on a farm -- to trigger an immune response that produces toxin-attacking antibodies.

Blood is later extracted from the hoofed animals and the antibodies harvested to create a serum that will be administered to snakebite victims who might otherwise die.   Butantan project manager Fan Hui Wen, a Brazilian, says the institute currently makes all of the country's antivenom -- around 250,000 10-15 millilitre vials per year.

Brazil also donates small quantities of antivenom to several countries in Latin America.    There are now plans to sell the life-saving serum abroad to help relieve a global shortage, particularly in Africa.    About 5.4 million people are estimated to be bitten by snakes every year, according to the World Health Organization (WHO). 

Between 81,000 and 138,000 die, while many more suffer amputations and other permanent disabilities as a result of the toxin.   To cut the number of deaths and injuries, WHO unveiled a plan earlier this year that includes boosting production of quality antivenoms.   Brazil is part of the strategy. It could begin to export antivenom as early as next year, Wen says.   "There is interest for Butantan to also supply other countries due to the global crisis of antivenom production," she says.
Date: Mon, 9 Dec 2019 14:14:15 +0100 (MET)

Dec 9, 2019 (AFP) - New Zealand, struck by a deadly volcanic eruption Monday, lies in a zone where Earth's tectonic plates collide, making it a hotspot for earthquakes and volcanic activity.   In one of its worst natural disasters, a huge mass of volcanic debris from the eruption of Mount Ruapehu triggered a mudslide in 1953 that washed away a bridge and caused a passenger train to plunge into a river with the loss of 151 lives.  After Monday's eruption on New Zealand's White Island, here is a recap of some of the deadliest volcanic eruptions around the world in the past 25 years.

- 2018: Indonesia -
In December the Anak Krakatoa volcano, a small island in the Sunda Strait between Java and Sumatra, erupts and a section of its crater collapses, sliding into the ocean and generating a tsunami. More than 420 people are killed and 7,200 wounded.

- 2018: Guatemala -
The June eruption of the Fuego volcano, about 35 kilometres (22 miles) from the capital, unleashes a torrent of mud and ash that wipes the village of San Miguel Los Lotes from the map. More than 200 people are killed.

- 2014: Japan -
The sudden eruption in September of Mount Ontake, in the central Nagano region, kills more than 60 people in Japan's worst volcanic disaster in nearly 90 years. The mountain is packed with hikers at the time. In 1991 an eruption of the southwestern Unzen volcano kills 43.

- 2014: Indonesia -
At least 16 people are killed on the island of Sumatra in February by a spectacular eruption of Mount Sinabung, which had lain dormant for 400 years before roaring back to life five months earlier. In 2016 villages are scorched and farmland devastated after another eruption kills seven.

- 2010: Indonesia -
Indonesia's most active volcano, Mount Merapi on Java island, starts a series of explosions in October, eventually killing more than 320 people. An 1930 eruption of the volcano killed 1,300 people and one in 1994 claimed more than 60 lives.

- 2002: DR Congo -
The eruption in July of Mount Nyiragongo in the eastern Democratic Republic of Congo destroys the centre of Goma town, along with several residential areas, and kills more than 100 people.

- 1997: Montserrat -
The capital of the small British colony, Plymouth, is wiped off the map and 20 are killed or left missing in avalanches of hot rock and ash clouds when its volcano erupts in June.

- 1995: The Philippines -
At least 70 are killed and another 30 missing after the crater of the Parker volcano in the south of the island of Mindanao collapses. Five years earlier the eruption of Mount Pinatubo, 80 kilometres north of the capital Manila, kills more than 800 people.

- Worst ever -
The explosion of Indonesia's Krakatoa volcano in 1883 is considered the worst ever seen. The eruption sent a jet of ash, stones and smoke shooting more than 20 kilometres (12 miles) into the sky, plunging the region into darkness, and sparking a huge tsunami that was felt around the world. The disaster killed more than 36,000 people.

The most famous eruption in history is that of Mount Vesuvius in modern-day Italy in 79 AD, which destroyed the towns of Herculaneum, Stabiae and Pompeii, wiping out an estimated 10 percent of the population of the three cities.
Date: Mon 9 Dec 2019
Source: Fox 29 Philadelphia [edited]

A total of 31 people have been sickened by salmonellosis at 4 health care facilities in south-eastern Pennsylvania. A majority of those cases occurred after individuals ate pre-cut fruit from New Jersey-based Tailor Cut Produce. The Food and Drug Administration (FDA) announced the salmonellosis outbreak in conjunction with the Pennsylvania Department of Health (DOH) on [Fri 6 Dec 2019]. The North Brunswick distributor has recalled its fruit mix with cantaloupe, honeydew, pineapple and grapes as a result.

Tailor Cut Produce reports that its products may be found in restaurants, banquet facilities, hotels, schools and institutional food service establishments in Pennsylvania, New Jersey and New York. "We recommend that any facility who use Tailor Cut Produce pre-cut fruit to immediately stop and throw it away," Pennsylvania Secretary of Health Dr. Rachel Levine said.

Salmonellosis is an infection caused by _Salmonella_ bacteria that generally affects the intestinal tract. People usually become infected by either eating or drinking contaminated food or water, by contact with infected people or animals, or through contact with contaminated environmental sources.
Date: Mon 9 Dec 2019
Source: Sixth Tone [edited]

Dozens of researchers in northwestern China's Gansu province have been infected with brucellosis, an animal-borne disease that causes flu-like symptoms and, potentially, lingering problems. In a statement [Fri 6 Dec 2019], the Lanzhou Veterinary Research Institute, an affiliated institute of the Chinese Academy of Agricultural Sciences, said that the 1st few grad students from the institute's foot-and-mouth disease prevention team tested positive for brucellosis antibodies on [28 Nov 2019]. The labs affected have been closed, the institute said, and national and local health authorities have assembled a team to investigate the outbreak.

Li Hui, an official at the health commission in Lanzhou, the provincial capital, told Sixth Tone on [Mon 9 Dec 2019] that the total number of brucellosis cases at the institute had climbed to 96. None have shown clinical symptoms, according to domestic media, and it remains unclear how they were exposed to the bacteria.

Brucellosis -- also known as Malta, Mediterranean, or undulant fever -- is a zoonotic disease that mainly affects animals, including livestock and dogs, which can in turn transmit the bacteria to humans through direct contact. Symptoms include fever, chills, sweating, lethargy, and aches and pains, according to the WHO. In the absence of early diagnosis and treatment, brucellosis can become a chronic condition that is difficult to cure.

In China, brucellosis is a Class B disease, ranking below a more serious category that includes cholera and plague. Human-to-human transmission has only been known to occur between lactating mothers and their babies. According to state broadcaster China National Radio, the brucellosis outbreak at the Gansu veterinary institute has prompted health checks among local students and staff who fear that they may have come into contact with infected animals.

One of the last brucellosis outbreaks in China occurred in 2011, when an agricultural university in the northeastern Heilongjiang province reported 28 cases stemming from infected goats being used in lab research. The school publicly apologized, fired 2 administrators, and offered each of the students' affected monetary compensation.

Scientific labs are subject to different experimental standards depending on their biosafety level, according to a researcher surnamed Yang at the Shanghai Institutes for Biological Sciences, an affiliate of the Chinese Academy of Sciences.

"If the protection levels don't keep pace (with biosafety levels), there will be a risk of infection," Yang, who studies viruses and works in a Biosafety Level 2+ lab, told Sixth Tone. As a result, labs generally require researchers to undergo safety training or even pass an exam to earn a certification, said Yang, who only used her surname because she was not authorized by her employer to speak to media.

The Lanzhou Veterinary Research Institute describes itself as "China's only authorized research center for working with the live virus that causes foot-and-mouth disease," a highly contagious disease affecting livestock. The institute is reportedly also one of the few in China with Biosafety Level 3 labs, which are required for _brucella_ pathogen studies, according to the National Health Commission.

As the local agriculture department tries to ascertain the source of the recent infections, Lanzhou's health commission said [Fri 6 Dec 2019], it is implementing precautionary measures so that brucellosis does not pose a threat to neighbouring communities. [Byline: Yuan Ye]
=================
[An earlier report suggested that 4 persons were clinically ill but this is not confirmed here.  Brucellosis (<http://www.medicinenet.com/brucellosis/article.htm>) is a disease that is thought to have existed since ancient times, as it was 1st described more than 2000 years ago by the Romans and Hippocrates. It was not until 1887 that a British physician, Dr. David Bruce, isolated the organism that causes brucellosis from several deceased patients from the island of Malta. This disease has had several names throughout its history, including Mediterranean fever, Malta fever, Crimean fever, Bang's disease, and undulant fever (because of the relapsing nature of the fever associated with the disease).

The symptoms and signs of brucellosis may develop from days to months after the initial exposure to the organism. While some individuals may develop mild symptoms, others may go on to develop long-term chronic symptoms. The signs and symptoms of brucellosis are extensive, and they can be similar to many other febrile illnesses, so recognition of potential exposure -- from ingestion of unpasteurized milk or cheese, employment as a veterinarian or veterinary student, in a slaughter house or meat processing plant, or working in a microbiology lab -- is vital. In this outbreak, it is not clear what symptoms the students had or whether they were just seropositive. ProMED would like more information about this episode. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Gansu Province, China: <http://healthmap.org/promed/p/333>]
Date: Tue 3 Dec 2019
Source: Outbreak News Today [edited]

In late November [2019], Uganda health authorities notified the World Health Organization of a fatal Rift Valley fever (RVF) case from Obongi district.  The case was a 35-year-old man from South Sudan who was living in the Palorinya Refugee camp in Obongi district, Uganda. The case had travel history to South Sudan between 12 and 19 Nov 2019 to harvest cassava. While in his home country, he developed fever and other symptoms and was treated for malaria; however, his condition got worse.  He later returned to the refugee camp in Uganda and his symptoms progressed and he was hospitalized. Viral hemorrhagic fever was suspected. Samples were collected and sent to the Uganda Virus Research Institute; however, the patient died. A safe and dignified burial was performed on 22 Nov 2019. As of 24 Nov 2019, a total of 19 contacts were recorded during the active case search including 10 healthcare workers.
===================
[The circumstances and specific location under which the man became infected with Rift Valley fever (RVF) virus in South Sudan is not mentioned. It is worth noting that there was an RVF outbreak in the Eastern Lakes region of South Sudan during the 1st 3 months of last year (2018). At the end of that outbreak, the OIE's follow-up report no. 3 reported: "The event cannot be considered resolved, but the situation is sufficiently stable. No more follow-up reports will be sent. Information about this disease will be included in the next 6-monthly reports."

There were more human cases than animal ones in that outbreak, prompting Mod.AS to comment: "Unfortunately, during the recent South Sudan RVF event, as in most -- if not all -- previous RVF events in other African countries, humans served as sentinels. Improved surveillance in animals is desperately needed in Africa, to allow timely measures applied, predominantly preventive vaccination, before the development of a full-blown epizootic involving secondary infection in humans." Intensified surveillance is needed in South Sudan in those localities where the affected man had been prior to his return to Uganda.

It is likely that RVF virus has persisted in this area in transovarially infected eggs of _Aedes_ mosquito vectors. These eggs can remain viable for long periods of time and hatch when flooded during future rain events, with the subsequent emergence of infected females ready to transmit the virus. This risk provides justification for maintaining livestock of the area well vaccinated into the future. This may have accounted for the reappearance of RVF in South Sudan in 2018, after nearly 2 years without additional reported cases in humans or livestock and again with this human case in 2019. - ProMED Mod.TY]

Obongi district, Uganda is located approximately 50 km (30 mi) from the South Sudan border.
HealthMap/ProMED-mail maps:

According to OIE's data, a total of 2 outbreaks of RVF affecting animals have been reported from Sudan during the event. The 1st outbreak started in the Arabaata dam area, Red Sea state, on 25 Sep 2019, affecting goats. The 2nd (and, so far, last) outbreak started 10 Oct 2019 in the River Nile state, affecting sheep and goats. Both outbreaks have been declared as 'resolved' on 14 Nov 2019.

Outbreak summary:
Total outbreaks = 2 (Submitted)
Species / Susceptible / Cases / Deaths / Killed and disposed of / Slaughtered
Goats / 1700 / 37 / 7 / 0 / 0
Sheep / 1550 / 37 / 5 / 0 / 0

According to the recent (5 Dec 2019) OCHA (UN Office for the Coordination of Humanitarian Affairs) update, the (human) RVF situation in Sudan, as of 26 Oct 2019, was the following: "a total of 345 suspected RVF cases -- including 11 related deaths -- reported in the states of Red Sea (128), River Nile (212), Khartoum (1), White Nile (1), Kassala (2), and Gedaref (1). The most affected age group is 15 to 45 years, which accounts for 83% of the total suspected cases. The male to female ratio is 2.6, with a high proportion of the cases being farmers (37.5 per cent). RVF is endemic in Sudan and 3 outbreaks affecting people have been documented in 1973, 1976, and 2008. During the outbreak in 2008, a total of 747 laboratory-confirmed cases were reported, including 230 deaths."

Egypt suffered its 1st RVF outbreak in 1977/78 with serious human disease and death as well as severe losses in livestock; several additional events have been recorded since. A recent historical review paper [1] concluded: "due to the availability and abundance of the potential vectors, the suitability of environmental conditions, continuous importation of livestock's from Sudan, and the close association of susceptible domestic animals with humans, the RVF virus could possibly occur and circulate in Egypt."   (https://tinyurl.com/whz3pz5)

Reference
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1. Kenawy MA, Abdel-Hamid YM, Beier JC. Rift Valley fever in Egypt and other African countries: Historical review, recent outbreaks, and possibility of disease occurrence in Egypt. Acta Trop. 2018; 181: 40-49; <https://doi.org/10.1016/j.actatropica.2018.01.015>  - ProMED Mods.AS/TY]
Date: Fri 6 Dec 2019 5:53 PM MST
Source: CTV News [edited]

A syphilis outbreak is worsening in Alberta [Canada], and the majority of new cases are in the Edmonton zone. Edmonton saw 1186 of the 1753 infectious syphilis [primary, secondary and early latent syphilis] cases reported in Alberta in 2019, a total of 68 per cent.

Alberta Health Services [AHS] declared an outbreak in July 2019, saying cases had 'increased dramatically' in the province since 2014. The number increased again in July [2019]  [<https://edmonton.ctvnews.ca/alberta-declares-province-wide-syphilis-outbreak-1.4510737>].

AHS sent a new public health alert to doctors on [27 Nov 2019], asking for their help to control the outbreak [<https://www.albertahealthservices.ca/assets/info/hp/phys/if-hp-phys-moh-ez-syphilis-outbreak.pdf>]. "It's very significant," said Dr Ameeta Singh, a clinical professor in infectious diseases. "That's an alarming rise in new syphilis cases in Alberta." She said it's the highest number of cases the province has seen since the 1940s.

According to Dr Singh, the increase in cases being reported is partially due to a greater number of people getting tested. "We know more people are coming in to get tested, but if we look a bit closer at the data we have, we do see there's, in fact, a [bigger] rise in the number of cases than we would expect to see," said Singh.

Another factor could be the rise in methamphetamine use in Edmonton. "I believe this is a major factor. Meth also stimulates risky sexual behaviour and increases the chance people will engage in multiple, usually casual or anonymous partners as well and not use precautions such as condoms to protect themselves during sex," she said.

What's also alarming, Singh said, is the spike in cases of congenital syphilis, where the disease is passed on to newborns. According to AHS, there have been 38 cases of congenital syphilis in 2019, 31 of which were in the Edmonton area. That accounts for more than half of the 61 cases of congenital syphilis reported since 2014.

"Those are not numbers we should be talking about in Canada ever...in a country that has universal access to health care, in a major city in Canada where syphilis testing is offered to all pregnant women who access prenatal care," she said. "What we're seeing with the congenital syphilis cases is many of the women are not accessing prenatal care until they come into the hospital to deliver and then the tests are being done."
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[A recent ProMED-mail post (Syphilis - Canada (04): (AB) RFI http://promedmail.org/post/20190718.6574300) reported a rise in "infectious syphilis" cases over a 4-year period: from 2014 to 2018 but made no mentioned of contributing factors. As illicit drug use has been cited as a contributing factor to recent increases in syphilis cases in the Canadian provinces of Ontario and Manitoba, I questioned in this prior ProMED-mail post if use of illicit drugs, in particular, methamphetamine, could similarly be contributing to the rise of syphilis cases in Alberta. The news article above reports that the rise in methamphetamine use in Edmonton, as well as increased testing for syphilis, are thought to be contributing factors in Alberta.

Methamphetamine can be swallowed, snorted, smoked or injected by needle and syringe

When methamphetamine is injected, transmission of syphilis may occur as a consequence of sharing a needle/syringe contaminated with infected blood from somebody who has primary or secondary syphilis (<https://ucsdnews.ucsd.edu/archive/newsrel/health/04-28TransmissionSyphilis.asp>); but syphilis can also be acquired by direct contact with an infected lesion during oral, vaginal, or anal sex when the drug is taken by any route of administration. Methamphetamine use is associated with sexual behaviors that increase the risk for acquiring syphilis and other sexually transmitted diseases, including having multiple sex partners, inconsistent condom use, and exchange of sex for drugs or money (<https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a4.htm>).

The linkage of methamphetamine use and syphilis transmission is reminiscent of the increase in syphilis among heterosexuals during the crack cocaine epidemic of the 1980s and 1990s, when the practice of trading sex with multiple partners for drugs, especially crack cocaine, played a major role in the transmission of syphilis. Under these circumstances, the identities of sex partners are often unknown, which weakens the traditional syphilis-control strategy of partner notification.

Bacteremia due to _Treponema pallidum_, the cause of syphilis, which occurs during primary, secondary, and latent syphilis, can result in transplacental transmission of this organism to the fetus during pregnancy and cause congenital syphilis. An increase in the incidence of syphilis in women in the population is commonly accompanied by increasing rates of congenital syphilis.

Edmonton, with a population of 932 546 residents in 2016, is the capital of the Canadian province of Alberta
(<https://en.wikipedia.org/wiki/Edmonton>).

A map showing the location of Edmonton can be found at
<https://goo.gl/maps/Rfq6XC2vvwi19ypb6>. - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Alberta, Canada:
9 December 2019
https://www.who.int/bangladesh/news/detail/09-12-2019-cholera-vaccination-campaign-launched-to-protect-635-000-people-in-cox-s-bazar

Cox’s Bazar, Bangladesh

Over 635,000 Rohingya refugees and Bangladeshi host community will be vaccinated against cholera in a 3-week-long campaign beginning today at the refugee camps in Cox’s Bazar and nearby areas, to protect vulnerable population against the deadly disease amidst increasing number of cases of acute watery diarrhoea (AWD).


The Oral Cholera Vaccination (OCV) campaign will be implemented in the refugee camps from 8-14 December to reach 139,888 Rohingya aged 1 year and less than 5 years. In the host community, the campaign will take place from 8-31 December and aims to reach any person older than 1 year (495,197). In total, 635,085 people are expected to be reached.

Led by the Ministry of Health and Family Welfare, with support of the World Health Organization (WHO), UNICEF and other partners, the campaign aims to reach people who missed some or all previous cholera vaccination opportunities. The campaign, including operational costs, is funded by Gavi, the Vaccine Alliance.

“We want to equip these populations with more protection against diarrheal diseases. Despite the progresses made to ensure access to quality water and sanitation, such diseases remain an issue of concern: approximately 80% of host community living near the camps have not been targeted in previous OCV campaigns and are still vulnerable”, says Dr Bardan Jung Rana, WHO Representative in Bangladesh.

Earlier rounds of cholera vaccination, which have taken place since the beginning of the emergency response in 2017, have helped prevent outbreaks of the disease. To this date, over 1 million people were vaccinated against cholera.
6th December 2019
https://www.theguardian.com/world/2019/dec/06/flooding-hits-new-zealand-tourist-hubs-of-wanaka-and-queenstown

Heavy rain has led to rivers bursting their banks, forcing the closure of shops and restaurants

Streets in the South Island tourist towns of Wanaka and Queenstown were slowly going under water on Friday, after Lake Wanaka and Lake Wakatipu burst their banks earlier in the week, flooding businesses and sewerage systems.

Water and large debris closed the main street of Wanaka, a popular spot with Instagrammers thanks to its famous tree that appears to have grown out of the lake. On Friday businesses were sandbagging as heavy rain continued to fall.

Sewerage systems in the town were also at risk of contaminating the lake, with the Queenstown Lakes District council taking the precautionary measure of shutting down the sewer connection to a handful of premises.

Wanaka residents were told to be on “high alert” with heavy rain predicted all weekend.

The streets of the usually bustling tourist town were largely empty, and the popular cafes and restaurants on the lake shore were closed.