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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]
=====================
[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: Thu, 16 Jan 2020 02:45:27 +0100 (MET)
By Ivelisse RIVERA, con Leila MACOR en Miami

Yauco, Puerto Rico, Jan 16, 2020 (AFP) - Living out in the open, their nerves on edge after a series of earthquakes that have shaken Puerto Rico, some 5,000 people are hoping that their president, Donald Trump, will heed the island's plea to be designated a disaster zone and free up much-needed aid.   Since December 28, more than 1,000 tremors have rattled the US island territory in the Caribbean, which just two years ago was devastated by two powerful hurricanes in quick succession.

In Yauco, one of the areas worst hit by the earthquakes, dozens of people were sitting on cot beds Wednesday in the parking lot of a municipal stadium, sheltered from the sun by white tents and blue tarps handed out by the federal disaster management agency, known as FEMA.  "The most difficult thing is the psychological aspect," said Wilfredo Rodriguez, 31. His house had been fractured by the seismic movement and he has spent a week living with his kids, aged six and 10, under an awning.    "We are living in constant fear of another powerful tremor," he said.

He only returns to his house to wash, then hurries back to the shelter. "We worry that there'll be a more powerful tremor while we are inside the house," he said.   Throughout the day, volunteers arrive to hand out food and toys for the children who fill the shelters: schools have been suspended because the buildings are not sturdy enough to withstand another quake.    The island's earthquake detection system has registered 1,104 tremors in the past two weeks alone, of which 186 could be felt by the population. By comparison, during the whole of 2019 there were 6,442 tremors, of which just 62 could be felt by people on the island.

Further south, in Guanico, Juan Santiago decided to move into a shelter on Saturday after a tremor of 5.9 on the Richter scale hit the island. "The mountain shook and rocks and earth started to come down," said the 30-year-old.  "My house has a crack in it and is about to fall down," he added. His home had weathered the Category Five winds of Hurricane Maria in September 2017 and of Hurricane Irma which followed it just two weeks later.   "It's different to a hurricane. What is happening now is much nastier," he said.

As he was talking the earth shook again, a tremor of 5.2 magnitude. Vehicles rocked like hammocks in the wind, but the quake-hardened victims barely reacted.   The houses in this part of the island are mostly rudimentary constructions built by the people who live in them with scant resources available in the mountains, where no regulations stipulate that buildings should be earthquake resistant.    The government of Puerto Rico said that as of Monday, there were 4,924 people living in 28 shelters in 14 municipalities. There were no figures on how many buildings had been damaged or destroyed.

- Seeking disaster designation -
Puerto Rico's governor Wanda Vazquez Garced called on Trump to declare the earthquake a disaster and clear the way for desperately needed aid. Trump had declared an emergency days before, but the governor wanted more.   The declaration of an emergency frees up to $5 million dollars in aid for the island, although Congress can bump that figure up. But if the situation is designated a disaster, there is no ceiling on funding, a FEMA spokesman said.   On Wednesday, the government said it would release $8.2 billion in delayed hurricane relief that had been stalled after the president threatened to divert Puerto Rico's emergency funds to help pay for his wall on the US-Mexico border.

In the past few days there have been growing calls among Democratic lawmakers for Trump to declare the situation in Puerto Rico a disaster.   It is a delicate subject, as Trump has accused the government of Puerto Rico of incompetence and of siphoning off hurricane relief money, triggering a public spat between the president and the mayor of San Juan, Carmen Yulin Cruz, as well as the former governor Ricardo Rossello, who was forced to step down last summer amid massive protests.   The Puerto Rican leaders accused Trump of treating the population of the island like second class citizens.
Date: Sat, 11 Jan 2020 15:43:12 +0100 (MET)

Washington, Jan 11, 2020 (AFP) - A 5.9 magnitude earthquake rocked Puerto Rico Saturday, the latest in a series of powerful tremors that have shaken the US territory in recent days, the US Geological Survey reported.

The latest quake occurred at 8:54 am local time (1254 GMT) around 13 kilometres (eight miles) southeast of Guanica, a town on the island's southern Caribbean coastline that was hard hit by earlier quakes.   The USGS revised its initial report of a 6.0 magnitude quake to 5.9.   It follows a 6.4 magnitude quake Tuesday that killed one person, knocked
out electric power and caused widespread damage.

Puerto Rico Governor Wanda Vazquez declared a state of emergency after Tuesday's quake, which forced an automatic shutdown of the power grid.    Puerto Rico's electric power authority reported outages in the towns of Ponce, Lares, Adjuntas and San German after the latest quake.   The Pacific Tsunami Information Center in Hawaii issued a statement saying there was "no significant tsunami threat" but a small possibility of tsunami waves along coasts nearest the epicentre.

The island is still recovering from Hurricane Maria, which came ashore more than two years ago as a devastating Category 4 storm.   Starting December 28, a wave of tremors have swept the island, putting residents on edge.   The 6.4 quake on January 7 came a day after a 5.8 magnitude quake; it was followed by major aftershocks.   Saturday's quakes were also preceded by a string of smaller tremors.
Date: Tue, 7 Jan 2020 23:44:45 +0100 (MET)
By Ricardo Arduengo

Guayanilla, Puerto Rico, Jan 7, 2020 (AFP) - Puerto Rico's governor declared a state of emergency on Tuesday after a powerful 6.4 magnitude earthquake killed at least one person in the south of the island and caused widespread damage.   Governor Wanda Vazquez said the declaration would allow for the activation of National Guard troops in the US territory still recovering from a devastating 2017 hurricane.   The US Geological Survey said the quake struck at 4:24 am (0824 GMT) with the epicenter off the coast of the southern city of Ponce, and was followed by more than a dozen aftershocks.

Tuesday's quake was the most powerful in a series of tremors that have shaken the island since December 28.   Scientists initially sent out an alert about a potential tsunami but it was later canceled.   The island's electricity authority said the quake had forced an automatic shutdown of the power grid, already severely damaged by Hurricane Maria more than two years ago.   The worst damage appeared to be in towns on the southwest coast, including Ponce, Guayanilla and Guanica.   El Nuevo Dia newspaper said a 73-year-old man died after a wall fell in his home in Ponce. Eight others there were reported injured.

Two power plants in Guayanilla sustained major damage, the Puerto Rico Electric Power Authority said. The city could be without power for two weeks, its mayor Nelson Torres Yordan said.   Celebrity chef Jose Andres announced that a charity he runs, World Central Kitchen, had started serving meals and distributing solar-powered lamps in quake-hit areas.   Vazquez announced that $130 million in emergency aid funding will be disbursed.   On social media, people wrote of being shaken awake by the force of the quake.   One woman on Twitter said she had been "wrenched from sleep."   "Everybody is awake & scared all over," she posted.   In Guayanilla, the Inmaculada Concepcion church, built in 1841, was heavily damaged.   Volunteers salvaged statues and other valuable items from the ruins as a priest consoled distraught parishioners.

- 'Be safe' -
A 5.8 magnitude quake on Monday toppled some structures, caused power outages and small landslides, but did not result in any casualties.   It also destroyed a popular tourist landmark, Punta Ventana, a natural stone arch that crumbled on the island's southern coast.   Vazquez, the governor, said government employees were being given the day off on Tuesday to take care of their families.   "We want everyone to be safe," she said.   She said ports were undamaged and there are several weeks' supply of gasoline, diesel and natural gas stored so people need not worry about shortages.

The White House said President Donald Trump had been briefed and Pete Gaynor, head of the Federal Emergency Management Agency (FEMA), had been in touch with the governor.   Trump's administration came under severe criticism for its response to Hurricane Maria.   The Category 4 storm destroyed the island's already shaky power grid, overwhelmed public services, left many residents homeless and claimed several thousand lives, according to government estimates.
Date: Tue, 7 Jan 2020 12:52:34 +0100 (MET)

Washington, Jan 7, 2020 (AFP) - A strong earthquake struck south of Puerto Rico early Tuesday, the US Geological Survey said, the latest in a series of tremors that have shaken the island since December 28.   The shallow 6.5 magnitude quake struck 13.6 kilometres (8.5 miles) south of the city of Ponce, the USGS said, revising down its initial reading of 6.6.   The quake struck just off the US territory's southern Caribbean coastline at 4:24 am local time (0824 GMT).   "The whole island is without power," the director of Puerto Rico Electric Power Authority, Jose Ortiz, told local media.

Puerto Rico's governor Wanda Vazquez Garced posted on Twitter that the government's security protocols had been activated.   She said government employees were not expected at work, adding: "We want everyone to be safe."   On social media, people wrote of being shaken awake by the force of the quake.   One woman on Twitter said she had been "wrenched from sleep", adding "Everybody is awake & scared all over."

Dramatic images also shared on social media appeared to show widespread damage in the town of Guayanilla, home to around 20,000 people, as well as nearby Guanica.   The mayor of Guayanilla told local news channel NotiUno that the town's church had collapsed in the incident.

An alert issued by the Tsunami Warning Center immediately following the earthquake was later cancelled.   Tuesday's quake was the strongest of a series of tremors that have shaken the island since December 28, topping Monday's 5.8 quake.   That earthquake toppled houses and caused power outages, but there were no reports of casualties.
Date: Mon, 6 Jan 2020 18:04:21 +0100 (MET)

Miami, Jan 6, 2020 (AFP) - A 5.8-magnitude earthquake shook Puerto Rico Monday, toppling houses and causing power outages and small landslides but there were no reports of casualties, the US Geological Survey said.   The quake, just off the US territory's southern Caribbean coastline, was felt throughout much of the island, including the capital San Juan.

Some 250,000 customers were hit by electric power outages after the quake, which struck at 6:32 am local time (1032GMT).   Images posted on social media showed houses tumbled from their supporting pillars, cracks in walls, cars crushed under collapsed houses and small scale landslides.   The quake was the strongest of a series that have rippled through the island since December 28, and it was followed by at least eight aftershocks, officials said.   No tsunami alerts were issued.
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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)
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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: Tue 7 Jan 2020
Source: Xinhuanet [abridged, edited]

Samoa's Ministry of Health confirmed on Tuesday [7 Jan 2020] 2 more deaths in the island nation's measles epidemic, bringing the death toll to 83 since the measles outbreak in mid-October [2019]. The Samoan Ministry of Health said that the 2 fatalities, an infant and [an] adult, died between 29 Dec last year [2019] and 5 Jan this year [2020].

A total of 5697 measles cases have been reported to the Disease Surveillance Team so far, with 30 new cases recorded during the same period. A total of 16 people with measles are currently hospitalized in the island nation, including 4 critically ill children.

Currently, there are no travel restrictions or vaccination requirement for those travelling to Samoa.

With the latest measles case, the reopening of day-care centres in Samoa has now been delayed until next week, but public schools will resume on Tuesday [7 Jan 2020] as planned. Death may occur in up to 5-10% of infected young children in developing countries.
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.
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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: Thu 8 Jan 2020
Source: Outbreak News Today [edited]

In a follow-up on the malaria situation in Burundi in 2019, the World Health Organization reports a progressive increase in cases in the past year across all 46 districts of Burundi.

Since the beginning of the year [2019], 8 392 921 malaria cases, including 3113 deaths have been reported. The population in the landlocked country in Southeast Africa is estimated at 11.53 million in 2019.

Malaria has been a scourge in Burundi in recent years. In fact, World Vision International reports since 2015, more than 19.7 million cases of malaria have been recorded in Burundi through 2017. With a population of 11.5 million, that's the equivalent of nearly every Burundian getting malaria twice in those 2 years.
=======================
[Please see our extensive comment to the malaria situation in Burundi in the ProMED posting http://promedmail.org/post/20190808.6611871 from the 8 Aug 2019. - ProMED Mod.EP]

[HealthMap/ProMED map available at:
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.
More ...

Czech Republic

Czech Republic US Consular Information Sheet
May 31, 2007
COUNTRY DESCRIPTION:
The Czech Republic is located in the heart of Europe. Tourist facilities in Prague are at the level of those found in most European capitals, while travelers ca
expect lower standards outside of Prague. Travelers are encouraged to be vigilant as pick-pocketing and petty theft occurs often in crowded tourist areas, restaurants and on public transportation. More information can be found in the section on crime. Please read the Department of State Background Notes on the Czech Republic for additional information.

ENTRY REQUIREMENTS: A passport is required and must be valid for 3 months beyond the intended stay. Visas are not required for U.S. citizens for tourist, short study or business visits of up to 90 days. Visas are required for longer stays and for any gainful activity. See our Foreign Entry Requirements brochure for more information on the Czech Republic and other countries.
Visit the Embassy of the Czech Republic’s website at http://www.mzv.cz/washington for the most current visa information.
The Czech Government requires that proof of finances to pay for your stay and for you to have travel/health insurance and is requiring proof of medical insurance for travelers to the Czech Republic. Minimum coverage of the insurance has to be at least $35,000.

According to the Czech Government, a health insurance card or an internationally recognized credit card with health insurance included will generally be accepted as proof of insurance to enter the Republic.

The health insurance requirement does not apply to those who have visas permitting them to work.
See Entry and Exit Requirements for more information pertaining to dual nationality and the prevention of international child abduction.
Please refer to our Customs Information
to learn more about customs regulations.

SAFETY AND SECURITY:
Civil disorder is rare in the Czech Republic, although strikes and demonstrations may occur. U.S. citizens should be vigilant in protecting their security, bearing in mind that even demonstrations meant to be peaceful may turn violent. Americans are advised to avoid street demonstrations.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s Internet web site, where the current Worldwide Caution Public Announcement, Travel Warnings and Public Announcements can be found.

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

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

CRIME:
The Czech Republic generally has a low rate of crime. However, street crime-particularly pick-pocketing and occasional mugging-is a problem, especially in major tourist areas in Prague. Travelers are encouraged to be especially vigilant in Prague’s restaurants, train stations, and on public transportation around the city center.
Incidents of pick pocketing were reported in significant numbers during 2006. Incidents of violent crime, while still relatively infrequent, are becoming more common in Prague. Travelers should be aware of the reported use of rohypnol, and other “date rape” drugs in the Czech Republic. Caution should be used when accepting open drinks at bars or clubs. Travelers should be very careful while riding trains, trams or metro, where most crime occurs. Travelers should keep a copy of their passport in a safe place separate from the passport itself; this copy can help you to apply for a new passport if yours is lost or stolen. Visitors should be alert to the potential for substantial overcharging by taxis, particularly in areas frequented by tourists. Radio-dispatched taxis are often much more reliable. It is also advisable to set the price in advance.

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 or Consulate staff can, for example, assist you to find appropriate medical care, to 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 for Victim’s of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Prague has good Western-style medical clinics with English-speaking doctors and dentists. However, staff members at the majority of Czech medical facilities do not speak English. Doctors and hospitals often expect cash payment for health services, though some facilities do accept credit cards. Hospitalization in the Czech Republic is much more liberal that in the United States; conditions that would be treated on an outpatient basis in the United States are often treated on an inpatient basis in the Czech Republic.
Ambulance services are not on a par with U.S. standards. Response time can sometimes be slow, and different ambulances are dispatched depending on the perceived severity of the patient’s condition.
Many ambulance companies expect payment at the time of delivery. Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars or more.
Please note that because euthanasia is not permitted under Czech law, U.S. living wills providing for no exceptional interventions to prolong life cannot be honored in the Czech Republic.

People traveling from April through October who plan to participate in camping or hiking in long grass or woodlands run the risk of both tick-borne encephalitis and Lyme disease. All travelers should take precautions to prevent tick bites. There is a vaccine for the former, but not for Lyme disease.

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-TRTP (1-877-394-8747) or via the CDC’s Internet site at http://www.cdc.gov/travel.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) website at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.

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

Travelers should note that road fatalities are occurring at an increasing rate in the Czech Republic, placing it amongst the most lethal places to drive in Europe. First-class roads in the Czech Republic generally meet European standards. However, on side roads, drivers should be prepared to encounter uneven surfaces, irregular lane markings and sign placements that are not clear. Streets in towns are not always in good condition. U.S. drivers should pay special attention to driving on cobblestone and among streetcars in historic city centers. Traffic lights are placed before the intersection and not after as in the United States. Speed limits are 50 km/h in towns, 90 km/h outside of towns and 130 km/h on highways. An International Driving Permit (IDP), available from AAA (in the United States only), must accompany a U.S. driver’s license; failure to have the IDP with a valid license may result in denial of an insurance claim after an accident.

Persons driving into the Czech Republic should be aware that a road usage tax sticker is required to drive legally on major highways. Signs stating this requirement are posted near the border, but they are easy to miss. The stickers are available at gasoline stations. The fine for failing to display a motorways toll sticker is assessed on the spot.

For specific information concerning Czech requirements for driver’s permits, vehicle inspection, road tax and mandatory insurance, please contact the Czech Tourist Authority offices in New York by telephone at (212)288-0830 or via email at infor@czechcenter.com.

Visit the websites of the Czech Republic’s national tourist office and national authority responsible for road safety at http://www.turistik.cz and http://www.mdcr.cz .

Please refer to our Road Safety page for information.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Czech Republic’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization international aviation safety standards for oversight of the Czech Republic’s air carrier operations.
For more information, travelers may visit the FAA’s Internet web site at www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Czech customs authorities enforce strict regulations concerning temporary importation into or export from the Czech Republic of items such as firearms, antiquities, medications, business equipment, etc. It is advisable to contact the Embassy of the Czech Republic in Washington, D.C, or the Consulates General of the Czech Republic in New York and Los Angeles for specific information regarding customs requirements.

Please see our information on Customs Regulations.

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 Czech Republic laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in the Czech Republic are strict and convicted offenders can expect 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 international adoption of children and international parental child abduction, see the Office of Children’s Issues website.

REGISTRATION/EMBASSY AND CONSULATE LOCATIONS:
Americans living in the Czech Republic are encouraged to register with the U.S. Embassy through the State Department’s travel registration website, and to obtain updated information on travel and security within the Czech Republic.
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 in Prague is located at Trziste 15, 118 01 Prague, Czech Republic; telephone (420)257 530 663; for after-hours emergencies only, telephone (420 257 532 716; Consular Section’s fax (420) 257 534 028; webpage: www.usembassy.cz.
*

*

*
This replaces the Consular Information Sheet dated October 31, 2006, to update information in the Crime section.

Travel News Headlines WORLD NEWS

Date: Fri 24 May 2019
Source: Radio Praha [edited]

The Czech Republic recorded the highest number of tick-borne encephalitis (TBE) cases in the EU last year [2018]. In the whole of Europe, only Russia recorded more cases of the potentially deadly disease.

There were 712 recorded TBE cases in the country last year [2018], the highest number since 2011, a Czech member of the International Scientific Working Group on TBE (ISW-TBE) said in a press release on Thursday [23 May 2019].

Only about one-quarter of inhabitants of the Czech Republic are vaccinated against TBE, a low percentage compared to other EU countries. Within the bloc, the 2nd-highest number of TBE cases was recorded in Germany, which has a population 8 times larger.

Encephalitis patients suffer from fever, headache, aching joints, and muscles. It can develop into meningitis.  [Byline: Brian Kenety]
========================
[Given the large number of tick-borne encephalitis (TBE) virus infection in the Czech Republic last year (2018), it seems curious that the above report makes no mention of preventive measures such as vaccination and avoidance to tick bites that could be taken currently to avoid infection. The TBE virus transmission season is beginning at this time. TBE virus is endemic in the Czech Republic, and cases occur there annually. A 2016 ProMED-mail post indicated that although Central and Eastern Europe countries are endemic for the European subtype of TBE virus and cases occur there yearly, cases have declined significantly in Austria and remain low in Germany, Poland, and Slovakia, while remaining high in recent years in the Czech Republic [see Tick-borne encephalitis - Czech Republic (02): background http://promedmail.org/post/20160210.4009410].

WHO has stated that "Approximately 10 000-12 000 clinical cases of tick-borne encephalitis are reported each year, but this figure is believed to be significantly lower than the actual total. Immunization offers the most effective protection. Currently, there are 4 widely used vaccines of assured quality: FSME-Immun and Encepur, manufactured in Austria and Germany, respectively, and based on European strains of the virus; and TBE-Moscow and EnceVir, manufactured in the Russian Federation and based on Far-Eastern strains. The 4 vaccines are considered to be safe and efficacious" (<https://www.who.int/immunization/diseases/tick_encephalitis/en/>).

TBE is a virus infection caused by one of 3 TBE virus subtypes belonging to the Flaviviridae family: Central European, Siberian, and Far Eastern (formerly known as Russian spring-summer encephalitis). It is transmitted to humans through the bite of infected _Ixodes_ ticks. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Date: Sat 27 Apr 2019
Source: Food Safety News [edited]

_Salmonella_ in chicken has been linked to over 70 cases in the Czech Republic. Health authorities in the city of Zlin reported the outbreak in the middle of March 2019 at Tomase Bati Regional Hospital. A total of 68 people, of whom 38 were patients and 30 staff, were found to be connected with the salmonellosis outbreak. In addition, 4 people -- 1 staff member and 3 other patients -- were hospitalized in the town of Uherske Hradiste.

A common vehicle of infection was a chicken and rice dish served for lunch on 14 Mar 2019. An epidemiological survey found that all patients consumed this lunch. The alarm was raised on 15 Mar 2019 by the hospital in a message to health authorities. The next day, _Salmonella_ Enteritidis was detected in faecal samples. Samples of raw materials and swabs from the kitchen and storage areas were taken. Sanitation and disinfection of all kitchen and storage areas were ordered. The chicken used in the meals was also destroyed.

Symptoms of _Salmonella_ infection usually appear 12 to 72 hours after infection and include fever, abdominal pain, diarrhoea, nausea and sometimes vomiting. The illness usually lasts 4 to 7 days, and most people recover without treatment. The laboratory analysis at the Institute of Public Health in Ostrava and in the State Veterinary Institute in Olomouc did not confirm _Salmonella_ in any sample of frozen chicken available during the investigation. Clinical material from patients was sent to the lab of the Veterinary Research Institute in Brno.

In an updated statement concluding the investigation, health authorities in Zlin reported that _ S._ Enteritidis, identical to the strain grown from clinical cases, was confirmed in a chicken and rice sample.

In a statement, officials from the hospital said they had introduced strict measures for food after the _Salmonella_ infection, including strengthening controls on the defrosting and cooking of meat so procedures are monitored consistently. Officials said while the hospital cannot influence the incidence of _Salmonella_ in raw materials supplied to the hospital, they want to focus consistently on the correct procedures for processing. The hospital is also considering buying cameras and putting them in areas where hospital food is being prepared so human error can be detected in time and eliminated in the future.
=======================
[Hospital food remains a particular problematic source for foodborne pathogens given the cohort of individuals who may consume it and their comorbidities. Minimizing salmonellosis spread from fowl requires adequate cooking and appropriate kitchen hygiene. - ProMED Mod.LL]

[HealthMap/ProMED-mail maps:
Zlin District, Czech Republic: <http://healthmap.org/promed/p/62211>]
Date: Tue, 2 Apr 2019 14:58:37 +0200

Prague, April 2, 2019 (AFP) - Czech veterinary authorities said Tuesday they had detected another 510 kilos of chicken breast from Poland tainted with the dangerous salmonella bacteria, following a rift over meat imports.   "The meat has been distributed and... most probably consumed," the State Veterinary Administration (SVS) said in a statement.   Meat from Poland caused a stir in the Czech Republic after local vets slapped mandatory laboratory checks on Polish beef in February following the discovery of a salmonella-tainted batch.

That same month, vets said they had found 1,200 kilos (some 2,600 pounds) of Polish chicken containing salmonella, part of which had already been distributed.   They lifted the measure last week but insisted they would continue random sample checks on imports, especially of beef and poultry from Poland.   SVS spokesman Petr Vorlicek told AFP that vets were not contemplating mandatory lab checks on Polish poultry now.   He noted that salmonella is not uncommon in poultry.   "We are closely monitoring all imports, that's why we have also detected this batch," he added.

The scandal erupted when the TVN24 commercial news channel aired footage of apparently sick or lame cows being butchered at a small slaughterhouse in northeast Poland in secret late at night when veterinary authorities were unlikely to visit.   In January, Poland exported 2.7 tonnes of suspect beef to around a dozen fellow EU members, triggering a probe.   Poland is a leading producer and exporter of meat in Europe, turning out around 600,000 tonnes of beef per year and exporting most of it to the EU, according to meat producer associations.
Date: Thu 20 Dec 2018
Source: Radio Praha [edited]

More than 690 people in the Czech Republic were infected with tickborne encephalitis between January and November this year [2018], which is more or less the same as for the whole of 2017. The figure is also the highest since 2006, according to data published by the National Institute of Public Health on Thursday [20 Dec 2018].

The Czech Republic, along with the Baltic States, has the highest number of tickborne encephalitis cases in Europe. There is no cure for encephalitis, but an increasing number of Czechs get themselves vaccinated against the disease.  [byline: Ruth Frankova]
==========================
[Tickborne encephalitis (TBE) virus is endemic in the Czech Republic, and cases occur there annually. A 2016 ProMED-mail post indicated that although Central and Eastern Europe countries are endemic for the European subtype of TBE virus and cases occur there yearly, cases have declined significantly in Austria and remain low in Germany, Poland, and Slovakia, while remaining high in recent years in the Czech Republic [see Tick-borne encephalitis - Czech Republic (02):  background http://promedmail.org/post/20160210.4009410].

WHO has stated that "Approximately 10 000-12 000 clinical cases of tick-borne encephalitis are reported each year, but this figure is believed to be significantly lower than the actual total. Immunization offers the most effective protection. Currently, there are 4 widely used vaccines of assured quality: FSME-Immun and Encepur, manufactured in Austria and Germany, respectively, and based on European strains of the virus; and TBE-Moscow and EnceVir, manufactured in the Russian Federation and based on Far-Eastern strains. The 4 vaccines are considered to be safe and efficacious"  (<https://www.who.int/immunization/diseases/tick_encephalitis/en/>).

TBE is a virus infection caused by one of 3 TBE virus subtypes belonging to the _Flaviviridae_ family: Central European, Siberian, and Far Eastern (formerly known as Russian spring-summer encephalitis). It is transmitted to humans through the bite of infected ixodes ticks. - ProMED Mod.TY]

[HealthMap/ProMED-mail map: Czech Republic:
Date: Sun 16 Dec 2018
Source: Radio Praha [edited]

While last year [2017], 142 cases of measles were detected in the Czech Republic, 182 cases had been detected as of 4 Dec 2018, according to the State Health Institute. Doctors warn that although it is mandatory to vaccinate children against measles, many are not [vaccinated]. The disease is preventable through 2 doses of a safe and effective vaccine.

The highly contagious, airborne disease experienced an unprecedented resurgence in 2017 in the Americas, Eastern Mediterranean and Europe, according to the World Health Organization. It can cause debilitating or fatal complications, including encephalitis (an infection that leads to swelling of the brain), severe diarrhoea and dehydration, pneumonia, ear infections and permanent vision loss.  [byline: Brian Kenety]
More ...

Mali

Mali - US Consular Information Sheet
December 19, 2008
COUNTRY DESCRIPTION:
Mali is a developing country in western Africa with a stable and democratic government.
The official language is French.
The capital is Bamako.
Faci
ities for tourism are limited.
Read the Department of State Background Notes on Mali for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and visa are required.
All travelers must have international vaccination cards with a current yellow fever immunization.
Travelers should obtain the latest visa information and entry requirements from the Republic of Mali Embassy at 2130 R Street NW, Washington, DC
20008, telephone (202) 332-2249.
Inquiries can be made at the nearest Malian embassy or consulate.
Visit the Embassy of Mali web site at http://www.maliembassy.us/ 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: The U.S. Embassy in Bamako strongly advises American citizens to avoid traveling to the northern regions of Mali.
U.S. Government employees serving in Mali, including those on temporary duty, are required to have approval from the Chief of Mission prior to traveling to areas north of the Niger River, including Timbuktu and areas or north of Timbuktu.
Travelers should exercise caution when traveling in any isolated areas.

In August 2007, Tuareg dissidents attacked and kidnapped civilian and military convoys near the Mali-Niger border.
On January 3, 2008, four Italians were robbed at gunpoint near Araouane, 150 miles north of Timbuktu, by assailants whose affiliation remains unknown.
Tuareg rebels in the Kidal region attacked Malian military units in Tinzawaten and Boughessa in March 2008, in Abeibara in May 2008, and in Tessalit in July 2008.
On October 16, 2008, bandits in the Kidal region of Mali carjacked two vehicles belonging to the International Committee for the Red Cross.

Al-Qaeda in the Land of the Islamic Maghreb (AQIM) has a presence in northern Mali.
AQIM began as a terrorist group seeking the overthrow of the Algerian government, and has been designated as a terrorist organization by both the United States and the European Union.
On October 31, 2008, in northern Mali, AQIM freed two Austrian tourists kidnapped in Tunisia eight months earlier.
The group has declared its intention to attack Algerian and Western targets.

This recent activity and the porous nature of Mali’s northern borders with Mauritania and Algeria, as well as its eastern border with Niger, reinforce long-standing concerns about security for travel in northern Mali.
The Department of State strongly urges citizens to reconsider traveling to northern Mali, including Timbuktu and Essakane.
Northern Mali hosts several annual music festivals in the desert, including one north of Timbuktu at Essakane, one north of Kidal at Essouk, and another near Menaka.
These are official events sanctioned by the Government of Mali.
Americans planning to attend these festivals or otherwise travel to the northern regions of Mali, despite this caution, are urged to notify the U.S. Embassy about their plans by e-mail at consularbamako@state.gov.
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.
Current information on safety and security can also be obtained by calling 1-888-407-4747 toll-free within the U.S. and Canada, or, for callers outside of the U.S. and Canada, on a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Violent crime in Mali is infrequent, but petty crimes, such as pick pocketing and simple theft, are common in urban areas.
Passports and wallets should be closely guarded when in crowded outdoor areas and open-air markets.
Individuals traveling on the Bamako-Dakar railroad are advised to be vigilant for pickpockets, especially at night.
Criminals will not hesitate to use violence if they encounter resistance from their victims.
There are sporadic reports of nighttime robberies occurring on the roads outside of the capital; tourists should not drive outside of Bamako at night.
Travelers should stay alert, remain in groups, and avoid poorly lit areas after dark.

Sporadic banditry and random carjacking have historically plagued Mali's vast desert region and its borders with Mauritania and Niger.
While banditry is not seen as targeting U.S. citizens specifically, such acts of violence cannot be predicted.

On July 1, 2008, six people working as USAID contractors were robbed of their vehicle and all belongings, at gunpoint, by three bandits between the villages of Temera and Bourem, approximately 120 km (75 miles) northeast of Gao along the Niger River.

From May 2008 until July 2008, there were a series of attacks at various Malian government installations.
While most of these have been in eastern Mali, on May 6, bandits attacked a military outpost in Diabali, 175 km (110 miles) north of Segou.
While these actions appear directed exclusively at government security facilities, including military, gendarmerie and national guard bases, bandits have been known to stop cars at gunpoint while making their escape.
Those traveling or living in Mali are strongly encouraged to register with the Embassy to allow e-mail notification should further attacks occur.
Please see the Registration/Embassy Location information at the end of this article.

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 Mali is:
1212
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Mali are limited, especially outside of the capital, Bamako.
Psychiatric care is non-existent.
The U.S. Embassy in Bamako maintains a list of physicians and other healthcare professionals who may see U.S. citizen patients.
The Embassy cannot guarantee these services or specifically recommend any physicians.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to, or foreign residents of, Mali.
Many American medicines are unavailable; French medications are more easily found.
Available medications can be obtained at pharmacies throughout Bamako, and are usually less expensive than those in the U.S.
Travelers should carry with them an adequate supply of needed medication and prescription drugs, along with copies of the prescriptions, including the generic names for the drugs.
Caution should be taken to avoid purchasing potentially dangerous counterfeit medications when buying on the local market in Mali.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Mali is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
U.S. citizens traveling by road in Mali should exercise caution.
Mali has paved roads leading from Bamako to Segou, Mopti and Sikasso.
During the rainy season from mid-June to mid-September, some unpaved roads may be impassable.
On many roads outside of the capital, deep sand and ditches are common.
Four-wheel drive vehicles with spare tires and emergency equipment are recommended.
The Embassy strongly urges all travelers to avoid traveling after dark on roads outside of urban centers.
The roads from Gao to Kidal and Menaka, and the roads around Timbuktu, are desert tracks with long isolated stretches.
Travelers must be prepared to repair their vehicles should they break down or become stuck in the sand.
Travelers should also carry plenty of food and water.
Drivers drive on the right-hand side of the road in Mali.
Speed limits range from 40-60 km per hour (25-40 miles per hour) within towns, to 100 km per hour (60 miles per hour) between cities.
Road conditions often require lower speeds.
Due to safety concerns, the Embassy recommends against the use of motorbikes, van taxis, and public transportation.
Excessive speeds, poorly maintained vehicles, lack of street lighting and roving livestock pose serious road hazards.
Many vehicles are not maintained well and headlights are either extremely dim or not used.
Driving conditions in the capital of Bamako can be particularly dangerous due to limited street lighting, the absence of sidewalks for pedestrians, and the number of motorcycles, mopeds and bicycles.
Please refer to our Road Safety page for more information.
The Malian authority for road safety is the Compagnie Nationale de Circulation Routiere in Bamako at telephone (223) 20-22-38-83.
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Mali, the U.S. Federal Aviation Administration (FAA) has not assessed Mali’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:
Mali is signatory to the Treaty on Cultural Property, which restricts exportation of Malian archeological objects, in particular those from the Niger River Valley.
Visitors seeking to export any such property are required by Malian law to obtain an export authorization from the National Museum in Bamako.
It is advisable to contact the Embassy of Mali in Washington or the nearest Malian consulate for specific information regarding customs requirements.
U.S. Customs and Border Protection may impose corresponding import restrictions in accordance with the Convention on Cultural Property Implementation Act.
Currency exchange facilities are slow and often involve out-of-date rates.
The U.S. Embassy cannot provide exchange facilities for private Americans.
There are a few ATMs in Bamako that accept American credit cards and debit cards with a Visa logo only.
Maximum withdrawals are generally limited to $400, and local banks charge up to $20 per transaction for use of their ATMs.
There are no ATMs outside of Bamako.
Credit cards are accepted only at major hotels, a few travel agencies, and select restaurants.
Cash advances on credit cards are available from only one bank in Mali, the BMCD Bank in Bamako, and the only card they accept for this is Visa.

The U.S. Embassy does not always receive timely notification by Malian authorities of the arrest of Americans.
U.S. citizens are encouraged to carry a copy of their passport with them at all times, so that proof of identity and citizenship are readily available in the event of questioning by local authorities.
If arrested, U.S. citizens should always politely insist they be allowed to contact the U.S. Embassy (see section on Registration/Embassy Location below).
Photographing military subjects is restricted.
One should also obtain explicit permission from the Malian government before photographing transportation facilities and government buildings.
Taking a photograph without permission in any public area may provoke a response from security personnel or offend the people being photographed.
Taking photos of the U.S. Embassy is also prohibited.
International telephone calls are expensive, and collect calls cannot be made from outside of Bamako.
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 that are available to individuals under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Mali’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Mali 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 Mali are encouraged to register with the U.S. Embassy or through the State Department’s travel registration web site so that they can obtain current information on travel and security within Mali.
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 in ACI 2000 at Rue 243, Porte 297.
The Embassy's mailing address is B.P. 34, Bamako, Mali.
The telephone number is (223) 20-70-2300.
The consular fax number is (223) 20-70-2340.
The Embassy web page is at http://mali.usembassy.gov
* * *
This replaces the Country Specific Information for Mali dated February 7, 2008, to update the sections on Safety and Security, Crime, Information for Victims of Crime, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Thu 26 Dec 2019
Source: WHO Emergencies preparedness, response [edited]

From 3 Nov through 8 Dec 2019, 3 laboratory-confirmed cases of yellow fever including 2 deaths (case fatality rate = 67%) were detected through the national surveillance system in Mali. The 1st case-patient was a 15-year-old girl from a village in Kati district, Koulikoro region, Mali. The 2nd and 3rd cases were in 17- and 25-year-old men, nationals from Cote d'Ivoire, living in the district of Bouguimi, Sikasso region, Mali. All 3 cases tested positive for yellow fever by immunoglobulin M (IgM) and reverse-transcriptase polymerase chain reaction (RT-PCR) on 3 Dec 2019 at Institute Pasteur Dakar (IPD). The 1st case was not vaccinated against yellow fever and had no travel history outside of Kati district. Meanwhile, the vaccination status for the other 2 cases was unknown.

Additionally, there were 9 suspected and 3 probable cases reported from the Bouguimi district, including 3 deaths among the probable cases. The age of the suspected, probable, and confirmed cases ranges between 1 and 33 years, and the male-to-female ratio is 2:1. Among the reported symptoms, fever, jaundice, and vomiting were the most common. There are 8 health areas of Bouguimi health district that have been affected, with Manakoro (4 cases) and Mafele (3 cases) reporting the highest number. One suspected case is pending for confirmation at the Institute Pasteur Dakar laboratory.

On 5 Dec 2019, the government of Mali officially declared a yellow fever outbreak in 2 regions of Sikasso and Koulikoro.

Public health response
- An emergency operations centre (EOC) for public health coordination of the outbreak in the regions of Sikasso, Koulikoro, and the affected districts has been set up. In addition, an EOC has been activated in
Bamako city.
- A multidisciplinary rapid response team was deployed to conduct investigations in the affected districts of Sikasso and Koulikoro regions. A plan to conduct an in-depth entomological survey is underway.
- Enhanced epidemiological surveillance, including active case finding in both the affected districts, has been strengthened.
- A comprehensive response plan is being developed with specific objectives, including the preparation for an international-coordination-group (ICG) request to conduct a yellow fever reactive mass-vaccination campaign.
- Risk communication capacity through involvement of relevant stakeholders [is being provided], as well as public communication and awareness efforts on yellow fever (signs, symptoms, and vaccinations), including prevention measures.
- On 3 Dec 2019, a joint investigation team (WHO Country Office and Ministry of Health) was deployed to characterize the risk and develop an intervention plan. Field investigations indicate vaccination coverage under 80% in Kati and 88% in Manakoro districts.

WHO risk assessment
Although population immunity in the southern regions of Mali has benefited from large-scale preventive mass vaccination campaigns in 2008 (5.8 million people protected) combined with nationwide children routine immunization since 2002, the overall national routine immunization coverage for yellow fever in 2018 was estimated to be 67%, with estimates nearly 80% in the non-desert areas (including the recently affected Koulikoro and Sissako regions). This is below herd immunity thresholds and may indicate the presence of pockets of low immunity in the country. Kati district in Koulikoro region is located proximal to the capital city, Bamako, an urban city with more than 2 million inhabitants, and Bouguimi district in Sikasso region borders with Cote d'Ivoire.

The high population movements within Mali and across borders increases the risk of national and regional spread, and this may have diluted the population immunity. The geographical distribution of the virus, coupled with suboptimal vaccination coverage, and the presence of susceptible populations presents a risk of amplification. Furthermore, the protracted humanitarian crisis and concomitant ongoing outbreaks of epidemic-prone diseases (measles, dengue) may impact the response due to competing limited resources.

Based on available information, WHO assesses the overall risk as high at the national level, moderate at the regional level, and low at the global level.

WHO advice
Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes and has the potential to spread rapidly and cause serious public health impact. There is no specific treatment, although the disease is preventable using a single dose of yellow fever vaccine, which provides immunity for life. Supportive care to treat dehydration, respiratory failure, and fever, and antibiotic treatment for associated bacterial infections, is recommended.

Mali is a high-priority country for the Eliminate Yellow Fever Epidemic (EYE) strategy. Vaccination is the primary intervention for prevention and control of yellow fever. In urban centres, targeted vector control measures are also helpful to interrupt transmission. WHO and partners will continue to support local authorities to implement interventions necessary to control the current outbreak.

WHO recommends vaccination against yellow fever for all international travellers more than 9 months of age going to areas south of the Sahara Desert in Mali. The vaccine is contraindicated in children aged less than 6 months and is not recommended for those aged 6-8 months, except during epidemics when the risk of infection with yellow fever virus may be very high. Other contraindications for yellow fever vaccination are severe hypersensitivity to egg and severe immunodeficiency. Caution is recommended before vaccinating people aged above 60 years against yellow fever.

WHO does not recommend vaccination for travellers whose itineraries are limited to areas within the Sahara Desert. Vaccination is recommended, if indicated, for pregnant or breastfeeding women travelling to endemic areas when such travel cannot be avoided or postponed. Mali requires as a condition of entry a yellow fever vaccination certificate for all travellers aged one year or over.

Yellow fever vaccines recommended by WHO are safe and highly effective and provide life-long protection against infection. In accordance with the IHR (2005) 3rd edition, the validity of the international certificate of vaccination against yellow fever extends to the life of the person vaccinated with a WHO-approved vaccine. For both existing or new certificates, revaccination or a booster dose of yellow fever vaccine cannot be required of international travellers as a condition of entry into a state party, regardless of the date their international certificate of vaccination was initially issued.

On 1 Jul 2019, WHO updated the areas at risk of yellow fever transmission and the corresponding recommendations for vaccination of international travelers. The list of countries at risk and revised recommendations for vaccination against yellow fever are available on the WHO website (International travel and health (ITH),  <https://www.who.int/ith/en/>).

WHO encourage its member states to take all actions necessary to keep travellers well informed of risks and preventive measures including vaccination. Travellers should also be made aware of yellow fever signs and symptoms and instructed to seek rapid medical advice should they develop signs of illness. Travellers returning to Mali who may be infected with possible high levels of the virus in the blood may pose a risk for the establishment of local cycles of yellow fever transmission in areas where the competent vector is present.

WHO does not recommend any restrictions on travel or trade to Mali on the basis of the information available on this outbreak.
=======================
[This updated report includes information about 9 suspected and 3 probable yellow fever (YF) cases that were not mentioned in previous reports, indicating that the outbreak was more extensive than originally stated, with an outbreak declared by government authorities in the 2 regions. These additional cases may have been a result of the additional surveillance that has been undertaken. Since vaccination coverage has been found to be less than 80% and 88% in Kati and Manakoro districts, respectively, presumably the preventive measures mentioned will include vaccination. The entomological survey will be an important factor in risk assessment. The presence of abundant populations of the mosquito vector, _Aedes aegypti_, would be of concern, raising the possibility of urban transmission of YF virus that might get out of hand quickly. - ProMED Mod.TY]

[HealthMap/ProMED-mail maps:
Date: Sun 8 Dec 2019
Source: WHO Weekly Bulletin on Outbreaks and Other Emergencies [edited]

On 3 Dec 2019, WHO was informed through internal communication of 3 yellow fever cases in Mali, including one death. Of these, 2 of the cases are from Wogouna and Keregoura villages, Bougoni district, Sikasso region in the South of Mali and one from Nanakenieba village, Kati district, Koulikoro region in the south west of Mali.

The reported cases are young adults (15-25 years), one female and 2 males, with onset of symptoms in early November 2019.

The cases tested yellow fever IgM and PCR positive at Institute Pasteur Dakar on 3 Dec 2019.

The vaccination status of the cases is being investigated (2 of the cases reported vaccination in the past). The latest vaccination campaign in the country was performed in 2008 including the affected areas where the vaccination coverage was reported to be between 50 and 9% in 2008. The average national vaccination coverage for 2017 has been reported at 65% (data from Imperial College). The YF routine vaccination in the country was introduced in 2002.

A field investigation is ongoing. According to historical data, 10 cases were detected in Mali in 2015.
======================
[This report provides some additional details in that 2 patients were male and one female along with their vaccination status, which were not included in the original post (see Yellow fever - Africa (25): Mali (BA, SK), Cote d'Ivoire http://promedmail.org/post/20191207.6827680). As in the original report, no mention is made of plans to vaccinate in the localities where the cases became infected. Vaccination in those areas is an effective preventive measure especially since, as the report notes, the mosquito vector, _Aedes aegypti_, is abundant enough to transmit dengue viruses. Yellow fever can spread rapidly and quickly get out of hand in susceptible populations with abundant mosquito vectors, as it did in Angola in 2016. - ProMED Mod.TY]

[HealthMap/ProMED-mail maps:
Date: Thu 5 Dec 2019
Source: Ministry of Health and Social Affairs [in French, trans.,
edited]

Communication from the Ministry of Health and Social Affairs on yellow fever cases in Mali
-----------------------------------------------------
The Ministry of Health and Social Affairs declares the occurrence of 3 confirmed cases of yellow fever on Tue 3 Dec 2019.

Of the 3 cases, one resides in Sirakoro-Meguetana in the health district of Kati [Bamako region, Mali], the 2nd in Manankoro in the health district of Bougouni [Sikasso region, Mali], and the 3rd in the village of Keregouana in Cote d'Ivoire [unable to locate this village on a map, but presumably it is near the border of Mali and Cote d'Ivoire. - ProMED CopyEd.TW].

In accordance with International Health Regulations, the outbreak has been reported to the World Health Organization.

The Ministry of Health and Social Affairs immediately analyzed the situation and took the following necessary measures:
- sending investigative teams to the field to better understand the epidemiological situation in order to quickly halt the spread of the epidemic,
- strengthening epidemiological surveillance,
- strengthening the response capacity of health workers, and
- disseminating awareness messages.

The Ministry of Health and Social Affairs invites people to observe the following measures:
- destroy larval breeding sites (old tires or any other abandoned objects containing water),
- protect against mosquito bites,
- sleep under insecticide-impregnated mosquito nets,
- keep households and housing clean, and
- get vaccinated before any trips abroad.

The Minister of Health and Social Affairs calls for calm and vigilance and reassures the population that appropriate measures are underway to control the situation.

Bamako, 4 Dec 2019
P / The Minister / PO
The Secretary General
Dr Mama Coumare
Knight of the National Order
===================
[An outbreak of yellow fever has been recognized in Mali by official sources. The statement from the Ministry of Health specifies the number of cases, the location of the cases detected, the measures taken, the recommendations, and the notification of the outbreak to WHO, as stipulated by International Health Regulations.

Cases of haemorrhagic fevers have recurred in Mali. Last month [November 2019], cases of dengue were diagnosed in Bamako, the capital of Mali.

_Aedes aegypti_, (but also to a lesser extent _Aedes albopictus_) is the vector that transmits these haemorrhagic fevers (dengue, chikungunya, yellow fever, and Zika).

Health authorities must use all channels of communication to raise awareness and get people to seek consultation in case of fever or muscle aches. Caregivers, especially clinicians, should consider haemorrhagic fevers (dengue or yellow fever) in any case of fever with a negative thick smear (or negative RDT) for malaria, or in any case of presumptive malaria that does not respond to appropriate antimalarial treatment. - Mod.BM, from ProMED-FRA archive no. http://promedmail.org/post/20191205.6824988, in French, trans., edited]

[The occurrence of yellow fever (YF) in different locations is a serious concern, and the measures to increase surveillance are prudent. It is curious that no mention is made of vaccination, whether the population of individuals is already vaccinated or whether there are plans to vaccinate in the localities where the cases became infected. Vaccination in those areas is an effective preventive measure especially since, as the report notes, the mosquito vector, _Aedes aegypti_, is abundant enough to transmit dengue viruses. YF can spread rapidly and quickly get out of hand in susceptible populations with abundant mosquito vectors, as it did in Angola in 2016. - ProMED Mod.TY]

[HealthMap/ProMED-mail maps:
Date: Tue, 3 Sep 2019 21:09:12 +0200 (METDST)

Bamako, Sept 3, 2019 (AFP) - Fourteen bus passengers were killed Tuesday by a road mine in central Mali, the bus company said, in an attack bearing the hallmarks of jihadists who plague the region.   The vehicle was en route from the central town of Douentza to the northern town of Gao, Oumar Ould Mamoud of the Sonef bus company told AFP.   "The new toll is 14 dead and eight injured," he said, adding that there had been about 50 people on the bus.

Police earlier had given a toll of eight dead and 13 injured, and said the blast occurred 30 kilometres (18 miles) from Douentza.   Another police official said "terrorists" had set down the mine.   A Malian military unit by coincidence had been travelling on the same road and was able to provide assistance to the passengers, the source said, and Sonef said it had sent a second bus to pick up them up.   The UN stabilization force in Mali, MINUSMA, condemned the attack which it said had caused "many deaths and 30 injuries," adding that some of the injured were helicoptered out.

MINUSMA spokesman Olivier Salgado said on Twitter that two women and two children were among the injured.   Northern Mali fell into the hands of jihadists in 2012 before the militants were forced out by a French-led military intervention.   But much of the region remains chronically unstable and since 2015 violence has spread to the centre of the country, an ethnic mosaic.   Jihadists have carried out dozens of hit-and-run raids and mine attacks, striking troops as well as civilians.   In January 2018, 24 Malian and Burkinabe citizens, including women and children, were killed in a blast in central Mali as they headed to a weekly fair.   The insurgents have also inflamed tensions between rival communities, particularly nomadic Fulani herders and sedentary farmers. Hundreds of lives have been lost in tit-for-tat assaults.
Date: Thu, 16 May 2019 18:37:39 +0200

Bamako, May 16, 2019 (AFP) - Heavy floods claimed 15 lives Thursday in the Malian capital Bamako along with serious property damage, authorities said.   A statement said the flooding claimed a "provisional toll" of 15 dead and two injured.   "Teams are in place to rescue the distressed people," the government said, calling on residents to be "prudent" in the face of the disaster.   Flooding is common in Mali, located in the semi-desert Sahel region.
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Senegal

Senegal - US Consular Information Sheet
July 08, 2008
COUNTRY DESCRIPTION: The Republic of Senegal is a developing West African country.
The capital is Dakar.
Facilities for tourists are widely available but vary in quality.
Read
the Department of State Background Notes on Senegal for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport is required.
For U.S. passport holders, a visa is not required for stays of less than 90 days.
Current yellow fever vaccination is mandatory to enter Senegal and meningitis vaccination is highly recommended if the traveler is arriving from or has recently traveled to an endemic area.
Travelers unable to provide proof of vaccinations may be required to pay for and receive vaccinations at the Dakar airport.
Travelers should obtain the latest information on entry requirements from the Embassy of Senegal, 2112 Wyoming Avenue NW, Washington, DC 20008, telephone (202) 234-0540, and at the Senegal Tourism Authority's official web site, http://www.senegal-tourism.com.
Overseas inquiries should be made at the nearest Senegalese embassy or consulate.
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:
Public demonstrations, political gatherings, and student protests are relatively common in Senegal, both in Dakar and in outlying regions, particularly on Friday afternoons. In the past, these events have sometimes turned violent.
Due to the potential for violence, U.S. citizens should avoid political gatherings and street demonstrations, and maintain security awareness at all times.
For guidelines on dealing safely with public demonstrations, please see the American Citizen Services page of the U.S. Embassy Dakar web site at http://dakar.usembassy.gov/service.html.
Lac Rose (Pink Lake) is a popular tourist destination in Senegal.
The Lac Rose area has a large number of tourists and isolated beach areas, but lacks multiple exit and entry points.
The U.S. Embassy recommends that all visitors to Lac Rose and its surrounding beaches be particularly vigilant and not travel alone.
Banditry occurs with some regularity on the main highways after dark, particularly in the central and eastern area of Senegal, including around Tambacounda and Matam. Bandits often target RN2 (National Road) between Ndioum and Kidira and occasionally target RN1 between Kidira and Tambacounda.
The U.S. Embassy recommends that U.S. citizens avoid non-essential travel to the Casamance region west of the city of Kolda, except direct air travel to the Cap Skirring resort area or to the city of Ziguinchor.
If travel is deemed essential, the U.S. Embassy recommends that U.S. citizens carefully monitor the security situation before traveling.
There are currently instances of fighting in the Casamance region (composed of the Ziguinchor and Kolda regions) involving factions of the Casamance separatist MFDC (Mouvement des Forces Démocratiques de la Casamance) in southern Senegal and the Senegalese military. Some military and political leaders in the Casamance region have been killed.
In May 2008, rebels kidnapped 16 local residents 5 kilometers from Ziguinchor and then cut off their left ears before releasing them.
That same month two soldiers and a peasant were killed in other clashes near the same area.
Reports of banditry in the area remain high.
In addition, vehicles have been attacked by armed bandits even during daylight hours on well-traveled roads.
On February 14, 2007, four people were killed when their bus was attacked after being stopped at a roadblock.
Landmine explosions continue to plague inhabitants of the Casamance, with fatalities and serious injury continuing into 2008.
One man was killed in Tounkara, approximately 70 kilometers north of Ziquinchor.
A Senegalese soldier was injured by a landmine near Boutoupa-Camaracounda, on the border with Guinea Bissau.
Since 1990, more than 1,000 people have been killed by land mines in the Casamance. The U.S. Embassy strongly recommends that U.S. citizens remain on well-traveled routes at all times.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affair’s Internet site at http://travel.state.gov, where the current Travel Warnings and Public Announcements, 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 pamphlet A Safe Trip Abroad.

CRIME:
Minor street crime is very common in Senegal, particularly in cities.
Most reported incidents involve pickpockets and purse-snatchers, who are especially active in large crowds and around tourists. Aggressive vendors, panhandlers and street children may attempt to divert the victim’s attention while an accomplice carries out the crime.
To avoid theft, U.S. citizens should avoid walking alone in isolated areas or on beaches, particularly at night, lock their doors and close their windows when driving, and avoid public transportation.
Americans should not walk on dark streets at night, even in groups.
To minimize inconvenience in the event of theft, U.S. citizens should carry copies, rather than originals, of their passports and other identification documents.
U.S. citizens should carry a credit card only if it will be used soon, rather than carrying it as a routine practice.
There is traditionally an increase in crime before major religious holidays.
U.S. citizens are encouraged to use common sense and situational awareness to ensure personal safety and to reduce the risk of becoming a crime victim.
Always be aware of the surroundings, especially in large cities and crowded places such as markets and taxi parks.
Keep a low profile, remain vigilant, and avoid potential conflict situations.
Do not wear flashy clothing or jewelry, and be cautious about displaying any amount of currency in public.
Use common sense when faced with something out of the ordinary or if someone is following you.
While violent crime is not common in Senegal, it does occur.
There have been incidents in the past year of Americans in groups of two or three being robbed at knife-point.
If confronted by criminals, remember that cash and valuables can be replaced, but life and health cannot.
U.S. citizens are encouraged to walk away from a criminal confrontation no matter the material cost.
Break-ins at residential houses occur frequently as in major cities everywhere.
Persons who plan to reside in Senegal on a long-term basis should take measures to protect their dwellings.
Long-term residents should consider installation of window grilles, solid core doors with well-functioning locks, and an alarm system.
In the past year, a number of American citizen residences have experienced burglaries.
No violence or personal injuries have been reported in these cases, in which the burglars appear to have been exclusively seeking financial gain.
Fraud is prevalent in Senegal and U.S. citizens are often the target of scams that may cause both financial loss and physical harm.
Typically, business scam operations begin with an unsolicited communication (usually by e-mail) from an unknown individual who describes a situation that promises quick financial gain, often by the transfer of a large sum of money or valuables out of West Africa.
The perpetrators of these scams often claim to be victims of various western African conflicts (notably refugees from Sierra Leone) or relatives of present or former political leaders.
There are many variations of these business scams.
In some cases, a series of “advance fees” must be paid in order to conclude the transaction, such as fees to open a bank account, or to pay certain taxes.
In fact, the final payoff does not exist since the purpose of the scam is simply to collect the advance fees.
Another common variation consists of a request for the U.S. citizen's bank account information, purportedly to transfer money into the account.
Once the perpetrator obtains this information, however, he or she then simply transfers all money out of the victim's account.
Other variations include apparently legitimate business deals requiring advance payments on contracts and offers to sell gold at a very low price.
In the last case, the seller may present real gold to be verified then substitute fake gold and disappear with the payment.
The best way to avoid becoming a victim of advance-fee fraud or business scam is to use common sense:
If an offer seems too good to be true, it is probably a scam.
You should carefully research any unsolicited business proposal originating in Senegal before you commit funds, provide goods or services, or undertake travel.

Visa scams take advantage of people who wish to travel to the U.S.
Generally, these scams "guarantee" a U.S. visa for participants who pay a large sum of money to register for a conference or attend an event in the United States.
In fact, only consular officers of the U.S. State Department may issue visas, so any offer that guarantees a U.S. visa is a scam.
Please refer to the State Department web site at http://travel.state.gov or the web site of the U.S. Embassy in Dakar at http://dakar.usembassy.gov/visas.html for authoritative information about the visa process and the costs involved.
In addition to business and visa scams, personal and dating scams are also prevalent. U.S. citizens should be wary of persons claiming to live in Senegal who profess friendship or romantic interest over the Internet.
A chat or e-mail exchange which quickly moves to discussion of intimate matters is often an indication of a scam.
Beware of any request or appeal for money.
In a typical personal scam, the scammer typically asks the U.S. citizen to send money for essential purposes: living or travel expenses, medical treatment, visa costs or bribes to free unjustly imprisoned family members.
Scammers often claim emergency circumstances, hoping that the intended victim will send money quickly and without careful consideration.
Many variations of these scams exist, all with the principal goal of soliciting money from the victim.
Several U.S. citizens in West Africa have reported losing thousands of dollars through such scams.
The anonymity of the Internet means that the U.S. citizen cannot be sure of the real name, age, marital status, nationality or even gender of the correspondent.
In some cases, the correspondent is a fictitious persona created only to lure the U.S. citizen into sending money.
U.S. citizens may prepay for a plane ticket directly with an airline rather than wiring money for transportation to the traveler.
U.S. citizens may also research the legitimate immigration process with the United States Citizenship and Immigration Services (USCIS) web site at http://www.uscis.gov.
U.S. citizens who are victims or witnesses of a crime are encouraged to report crimes to the police by telephoning 800-00-20-20; 800-00-17-00, Senegal's police hotline numbers. Another 24 hour phone number for the police in Senegal is 33-821-2431.
The Government of Senegal has also created a tourist police unit, which may be reached at (+221)33 860-3810.

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 Senegal is 800-00-20-20 and 800-00-17-00. See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Several hospitals and clinics in the capital, Dakar, can treat major and minor injuries and illnesses.
There is inadequate inpatient psychiatric care and limited office-based psychiatric treatment.
Public hospitals do not meet U.S. standards.
Medical facilities outside Dakar are limited.
French medications are far more readily available than American pharmaceuticals, and drugs in stock are often listed under the French trade name.
Medications may be obtained at pharmacies throughout Dakar and in other areas frequented by tourists, and are usually less expensive than in the U.S. Travelers should carry a supply of any needed prescription medicines, along with copies of the prescriptions, including the generic name for the drugs, and a supply of preferred over-the-counter medications.
Malaria is a serious risk to travelers in Senegal.
Travelers should consult their physician to discuss the benefits and risks of taking anti-malarial medication.
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and tell the physician their travel history and what anti-malarial medications they have been taking.
For additional information on malaria, protection from insect bites, and anti-malarial drugs, visit the CDC Travelers' Health web site at http://www.cdc.gov/malaria/faq.htm.
Water supplies in Senegal are not consistently free of disease-causing microorganisms.
For this reason, the Embassy recommends drinking filtered or boiled water, particularly for babies under one year of age.
Raw vegetables and fruits should be washed in a bleach solution before eating.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.

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

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Senegal is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Driving in Senegal is very different from driving in the United States.
Many U.S. citizens find the traffic in Senegal chaotic, particularly in Dakar.
Drivers tend to exceed speed limits, follow other vehicles closely, ignore lane markings and attempt to pass even when facing oncoming traffic.
Many vehicles are not well-maintained; headlights may be either extremely dim or not used at all. Roadways are poorly lit and poorly marked and many sections have deteriorated surfaces.
Some roads have sidewalks or sufficient space for pedestrian traffic; others do not, and pedestrians are forced to walk along the roadway.
Due to limited street lighting, pedestrians are difficult to see at night.
Drivers in both rural and urban areas may expect to frequently encounter and share the road with motorcycles, bicyclists, pedestrians, livestock and animal carts.
Caution and defensive driving techniques are strongly recommended.
While most main roads in Senegal are in relatively good condition for daytime driving, smaller roads are poor by American standards.
During the rainy season, many roads are passable only with four-wheel drive vehicles.
Travelers may be stopped at police roadblocks throughout the country, where their vehicles and luggage may be searched.
Service stations are available along main roads.
Due to poor road conditions and the risk of crime, driving outside major cities at night is not recommended.
Due to language barriers (outside Dakar, relatively few Senegalese speak French) and the lack of roadside assistance, receiving help may be difficult in the event of distress.
For safety reasons, the Embassy recommends against the use of motorbikes, van taxis ("cars rapides"), and public transportation.
They can be dangerous due to overloading, careless driving, inadequate maintenance, and the lack of basic safety equipment such as seat belts.
Regulated orange-striped sedan auto taxis are safer, but make sure to agree on a fare before beginning the trip.
In Senegal, one drives on the right-hand side.
Vehicles give priority to traffic coming from the right, except at traffic circles, where vehicles already in the circle have the right of way.
Before January 2005, however, cars entering traffic circles had the right of way.
This change is not well known, so drivers should exercise extreme caution at traffic circles.
All drivers are expected to carry the following documents in their vehicles and present them at any time at the request of the police:
(1) valid driver's license; (2) valid insurance papers; (3) vehicle registration/immatriculation card ("carte grise"); (4) "vignette" tax disc for the current year; and (5) valid identification.
If Americans carry a copy of their U.S. passport, the copy must be clear enough to identify the driver of the vehicle.
Third-party insurance is required and will cover any damages if you are involved in an accident resulting in injuries, and found not to have been at fault.
If you are found to have caused an accident, the penalty ranges from five months to two years in prison, with a possible fine.
If you cause an accident which results in a death, the penalty can be as high as five years in prison.
For guidance on what to do if you are in an automobile accident in Senegal, please see the American Citizen Services page of the U.S. Embassy Dakar web site at http://dakar.usembassy.gov/service/living-in-senegal-and-guinea-bissau/driving-in-senegal.html.
Senegalese law prohibits the use of cell phones while driving, unless the driver is using “hands-free” equipment.
Protective helmets are mandatory for all bicycle, moped, scooter and motorcycle drivers/riders and passengers.
When police officers stop a vehicle for a traffic violation, the police officer will generally confiscate the driver’s license or ID card until the fine is paid.
We encourage you to comply with the request. Sometimes, police officers try to solicit bribes instead of or in addition to the fine.
The U.S. Embassy does not encourage paying bribes. 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 Senegal, the U.S. Federal Aviation Administration (FAA) has not assessed Senegal’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:
Senegalese law requires that all persons carry personal identification at all times, and all Senegalese law enforcement officials have the authority to challenge suspicious activity and to request personal identification.
Be aware that they may request personal identification even without cause, which is generally not the case in the U.S.
If a U.S. citizen does not cooperate and provide identification, s/he may be detained for up to 48 hours without the filing of formal charges.
The U.S. Embassy does not always receive timely notification by Senegalese authorities of the arrest of U.S. citizens. U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times, so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available. If arrested, U.S. citizens should always ask to be allowed to contact the U.S. Embassy.
You may not bring several types of items into Senegal without clearance by Senegalese customs officials: these include computers and computer parts, video cameras and players, stereo equipment, tape players, auto parts, and various tools and spare parts.
Airport customs officials may hold such items if brought in as baggage or carry-on luggage.
Travelers should check with the Embassy of Senegal in Washington, DC, regarding these restrictions. (See Entry Requirements Section above for contact information.)
Senegalese customs authorities encourage the use of an ATA (Admission Temporaire/Temporary Admission) Carnet for the temporary admission of professional equipment, commercial samples, and/or goods for exhibitions and fair purposes.
ATA Carnet Headquarters, located at the U.S. Council for International Business, 1212 Avenue of the Americas, New York, NY 10036, issues and guarantees the ATA Carnet in the United States.
For additional information, call (212) 354-4480, send an email to atacarnet@uscib.org or visit http://www.uscib.org for details.
Travelers can obtain cash from some ATMs in Senegal.
Travelers can get cash and/or traveler's checks through international credit cards, such as Master Card, Visa, and American Express, by presenting their credit card at a local financial institution sponsoring their card. 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 Senegalese laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Senegal 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 Senegal are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Senegal.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at Avenue Jean XXIII, Dakar; the mailing address is B.P. 49, Dakar, Senegal.
The telephone number is (221) 33 829-2100; after hours (221) 33 829 2209.
The U.S. Embassy web site is http://dakar.usembassy.gov/.
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This replaces the Country Specific Information Sheet for Senegal dated November 08, 2007 to update sections on Country Description, Entry/Exit Requirements, Crime, Safety and Security, Information for Victims of Crime, Medical Facilities and Health Information, and Registration and Embassy Location.

Travel News Headlines WORLD NEWS

Date: Sat 23 Nov 2019
Source: Leral net [in French, trans. Corr.SB, edited]

A case of Crimean-Congo haemorrhagic fever has been reported in Kaolack commune. According to the health services of the region quoted by the daily "L'As", the infected carrier comes from the department of Koungheul and is a vehicle driver in his state. The victim is currently hospitalized at the Ibrahima Niasse regional hospital in Kaolack. According to the newspaper health authorities say they have taken all steps to prevent the spread of the disease.

According to a specialized site "mesvaccins.net", the Crimean-Congo haemorrhagic fever virus is of the genus _Nairovirus_, of the family Bunyaviridae. It can be responsible for serious epidemics of viral haemorrhagic fever. It causes high fever, pain, nausea, and vomiting usually 3-4 days after infection. It can be responsible for severe bleeding forms with a lethality rate of 10 to 40 per cent.

Human transmission of the virus is by tick bite (_Hyalomma_) or by contact with blood (or body fluids SB) containing the virus or animal tissues immediately after slaughter. The majority of cases occur among those involved in the livestock industry, such as farm workers, slaughterhouse employees, and veterinarians. A nosocomial exposure in health care facilities may also occur.

The Crimean-Congo haemorrhagic fever virus is endemic in Africa, the Balkans, the Middle East, and Asian countries south of the 50th parallel north. Hosts of Crimean-Congo haemorrhagic fever virus include a wide range of wild and domesticated animals such as cattle, sheep, and goats.
====================
[Previous seroprevalence studies have highlighted that CCHF is focally endemic throughout Senegal and neighbouring countries

Sporadic human infections may be expected in people with regular contact with livestock in endemic areas, but these are preventable through use of repellents, protective clothing, and gloves to prevent tick bites, and avoiding contact with blood and body fluids of livestock.

To prevent outbreaks of CCHF, public awareness campaigns aimed at the populations most at risk -- livestock farmers, butchers, and health personnel -- must be conducted, and the epidemiologic alert systems must be strengthened. In addition, conditions that enhance maintenance of the virus in nature and its transmission to humans must be better understood so adequate control measures can be developed. - ProMED Mod.UBA]

[The URL above appears to be inactive now. An alternative source is

[HealthMap/ProMED-mail map of Senegal:
Date: Wed, 18 Sep 2019 01:36:21 +0200 (METDST)

Dakar, Sept 17, 2019 (AFP) - Four people died after a boat carrying dozens of tourists capsized during heavy storms in Senegal, authorities and emergency services said Tuesday.   The death toll could rise as three passengers were said to be missing after the accident.  The boat was carrying several Senegalese nationals, six French people, two Germans, two Swedes and one person from Guinea-Bissau, when it turned over Monday in driving rain and a heavy swell, fire department chief Papa Angel Michel Diatta said.   All the dead were Senegalese, officials and emergency services said.

Two worked in a national park, one was a woman and the other victim was a child, Diatta said.   The boat was heading for the Madeleine islands, site of an offshore national park popular with tourists who travel from Dakar, coastal capital of the West African country.   Senegalese President Macky Sall appealed for "greater caution and respect for existing security norms duing the rainy season" in a tweet.

Emergency services continued to look for those missing on Tuesday. AFP journalists saw a dozen divers at the scene. Distressed families were waiting on the shore to get news of their loved ones.    "The gendarmerie called us at 5:00 am (GMT and local time). My brother was on the boat. The worst thing is not knowing," said Aminata Diop, who was among the relatives on the beach.   There are "four dead bodies and between three and four people are missing. Thirty-five people were on the boat. Search and rescue operations are continuing this morning," Interior Minister Aly Ngouille Ndiaye told AFP by telephone.

The causes of the accident were unclear. The interior minister told Senegalese media overnight that several tourists were worried about the heavy rains and wanted to return to the pier but others wanted to stay on the boat.   The survivors spent the night on the island, Ndiaye told local radio on Tuesday. Blankets and food were sent to them and they were to be ferried back to the mainland in the morning, he added.   The rainy season arrived late this year and heavy storms have resulted in several casualties this month.    Two fishermen were killed on their canoe in the same area nearly two weeks ago.
- National. 12 Nov 2018

Suspected cases totalling 2123 with 216 confirmed have been reported across 6 regions, with one death confirmed, as of 3 Nov 2018. The CDC has issued a travel warning. The 6 regions currently reporting confirmed cases are Diourbel (169), Fatick (34), St. Louis (6), Dakar (3), Louga (3) and Thies (1).

- National. 9 Nov 2018. The US Centers for Disease Control and Prevention (CDC) has issued a Level 1, Practice Usual Precautions, for the African country of Senegal, on 7 Nov 2018. Senegal, which is located on the north-west coast of central Africa, is an important partner of the US in promoting peace and security. Because dengue is a viral disease and spread by mosquito bites, all travellers to Senegal should prevent mosquito bites by using insect repellent and wearing protective clothing when outdoors, and sleeping in an air-conditioned or well-screened room or under an insecticide-treated bed net, said the CDC. Moreover, half of the world's population living in 128 countries is at risk of dengue.

[HealthMap/ProMED-mail map of Senegal:
Date: Sun, 21 Oct 2018 16:38:21 +0000
A ProMED-mail post

- National. 19 Oct 2018. In the capital of Sine, there are currently 31 cases. In the capital of Mouridism, there are 8 cases; 6 cases were counted in Rosso, Senegal.

- National. 15 Oct 2018. Dengue fever worries the population in several localities of Senegal. Fatick area has 3 cases. Currently, at least 23 dengue cases have been confirmed in the same region of Fatick (center), following tests on 487 suspected cases, revealed the chief of the commune, Mamadou Sarr at the beginning of October 2018.

In Senegal, dengue fever is concentrated this year [2018] in the Fatick region. In September 2018, 3 cases had been counted; the number rose to 23 cases in October 2018. According to the chief medical officer of the local area relayed by the Senegalese press agency: "Following tests on 487 suspected cases, at least 23 dengue cases were confirmed, and the average age of people affected by the disease varies between 20 and 40 years old. Most are women.

This is the 4th dengue epidemic in Senegal. On 19 Oct 2017, the disease was revealed to the public in the Louga region. The Institut Pasteur in Dakar confirmed the diagnosis of 9 cases of dengue fever out of a total of 24 samples received on 6 and 12 Oct 2017, respectively, which had been carried out at the Santhiaba health post in Louga commune, in northwest Senegal. On 27 and 28 Oct 2018, 2 other confirmed cases were recorded in the commune of Dahra, next to that of Louga. On 6 Nov 2017, the Senegalese health authorities recorded 79 confirmed cases out of 510 samples tested: 70 in Louga, 6 in Dahra, 2 in Coki, 1 in Keur Moma Sarr. "No serious case is noted so far. All the patients have been treated as outpatients," said the Ministry of Health and Social Action.

This is not the 1st time that an outbreak of dengue fever has been reported in the country. There were outbreaks also in 1981, 1984 and 2009, said Dr. Abdoulaye Bousso of the Center for Emergency Health Operations (COUS), an entity under the supervision of the Ministry of Health and Social Action in 2017. As of 30 Oct 2017, a total of 232 suspected patients, out of 36 positive cases (34 in Louga and 2 in Dahra), had been enumerated by the Senegalese health authorities. "No complication was noted in these patients; all patients diagnosed positive are doing well and have resumed their daily activities," said the Ministry of Health. For this year [2018], the number increased to 32 confirmed cases.
Date: Thu, 3 May 2018 17:48:15 +0200

Ziguinchor, Senegal, May 3, 2018 (AFP) - Armed men tried to blow up a key bridge in a touristy part of Senegal's restive Casamance region, killing a fisherman, a military source said on Thursday.   The overnight attack on the Niambalang bridge near the Casamance capital Zinguinchor was the first on the bridge since 1998.   "Armed men tried to blow up the bridge with explosives" but failed, a military source told AFP.

They torched the huts of eight fishermen living underneath the bridge, killing one, the source said. A relative of the fisherman confirmed this.   The bridge links Zinguinchor to the beach resort of Cap Skirring, which is popular with Western tourists.   Tensions have mounted in Casamance following the massacre of 14 young men in execution-style killings in a protected forest on January 6.   The bloodbath caused some to blame a group that has led a 35-year armed campaign for the region's independence.
More ...

World Travel News Headlines

Date: Fri 17 Jan 2019
Source: Front Page Africa [edited]

The Surveillance Officer of Grand Bassa County Health team has confirmed to FrontPage Africa that there is a Lassa fever outbreak in District 4, Grand Bassa County leading to 3 deaths and 20 others confirmed infected with the virus.

Gabriel B. Kassay said over 60 specimens were taken to Monrovia for testing as a result of the outbreak.  "Out of the 60 plus, over 20 specimens were confirmed affected with Lassa fever," he said, adding that 3 persons have died from the disease at the Liberia Agricultural Company (LAC) concession area in Wee Statutory District.

Kassay said there were several incidents of Lassa fever in the LAC plantation area in 2019.  "According to the Liberia health law, one confirmed case of Lassa fever is considered an outbreak, and so since August 2019, there have been lots of people affected in the LAC area," he said while expressing concern that "the lack of awareness is a major factor" for the frequent cases of the virus in the county.  "The Grand Bassa Health Team has been very instrumental in helping to curtail the spread of the disease in the affected area, but there is a need for awareness in the entire county."

Kassay said the spread of Lassa fever might increase if the citizens are not trained to know the cause and effects of Lassa fever.
=====================
[The number of cases has increased from 9 on 2 Dec 2019 (See Lassa fever - West Africa (43): Liberia http://promedmail.org/post/20191207.6828798) to 20 confirmed cases now. The reported number of deaths remains at 3. The previous ProMED-mail post (see Lassa fever - West Africa (31): Liberia http://promedmail.org/post/20190902.6653653) reported that according to MoH data, a total of 92 suspected cases between 1 Jan-25 Aug 2019, including 21 deaths, have been reported. Of these, 25 cases have been confirmed by RT-PCR (Nimba (9), Bong (10), Grand Bassa (5), and Grand Kru (1)), while 9 remain suspected cases, the release recorded. The case-fatality rate among confirmed cases in that report was stated as 36% (9 deaths out of 25 confirmed cases). Males are mostly affected by the disease (56%) of confirmed cases as compared to females.

Occurrence of Lassa fever cases in areas outside the usual "Lassa fever belt" is of concern, and the Ministry of Health is wise to increase public information and advize citizens about measures that should be taken to avoid infection with the virus. Occurrence of Lassa fever in Liberia is not new, and cases have occurred there sporadically for several years. Between 1 Jan and 27 Jun 2018, 20 cases were laboratory confirmed (see archive no. http://promedmail.org/post/20180711.5898495). Apparently, all those Lassa fever virus infections were acquired by contact with infected rodents or their excretions. Lassa fever virus can be acquired from infected rodents or patients in the hospital. Transmission can occur in health facilities when personal protective equipment is not employed or barrier-nursing practices or biocontainment facilities in the laboratory are not adequate to protect staff from blood and secretions of infected patients.

As mentioned in previous posts, Lassa fever virus transmission to humans occurs when people are in contact with the reservoir rodent host, the multimammate mouse (_Mastomys natalensis_ and _M. erythroleucus_) and the African wood mouse (_Hylomycus pamfi_) or their excreta, as was likely the situation in many of these cases. Rodent control has to be undertaken at the village level with individual households employing the preventive measures listed above. This requires an extensive and continuous public education effort.

Images of the _Mastomys natalensis_ mouse, the rodent reservoir of Lassa fever virus, can be seen at
_M. erythroleucus_ and _Hylomycus pamfi_ at

Date: Sun 19 Jan 2019
Source: Outbreak News Today [edited]

With the arrival of summer when the occurrence of diseases transmitted by mosquitoes, such as yellow fever, increases, the Brazilian Ministry of Health is alerting the population to get vaccinated against the disease.  The alert is mainly focused on the population that lives in the South and Southeast regions of the country due to the confirmation of 38 monkey deaths in the states of Parana (34), Sao Paulo (3), and Santa Catarina (1). In total, 1087 reports of suspected monkey deaths were recorded in the country.

The alert is given because the regions have a large population and a low number of people vaccinated, which directly contributes to the cases of the disease.

The target public for vaccination is people from 9 months of age and 59 years of age who do not have proof of vaccination.

Regarding human cases, 327 suspected yellow fever cases were reported in the same period, of which 50 remain under investigation and one has been confirmed.

The yellow fever vaccine is offered in the National Vaccination Calendar and distributed monthly to the states. In 2019, more than 16 million doses of the yellow fever vaccine were distributed throughout the country. Despite this availability, there is a low demand from the population for vaccination. For 2020, the portfolio acquired 71 million doses of the vaccine, enough to serve the country for more than 3 years.

In 2020, the Ministry of Health will gradually expand yellow fever vaccination to 1101 municipalities in the Northeast states that were not yet part of the vaccination recommendation area. Thus, the whole country now has a vaccine against yellow fever in the routine of services.

Another change in the calendar was that the children started to have a booster vaccine at the age of 4. The decision came because recent scientific studies have shown a decrease in the child's immune response, which is vaccinated very early, at 9 months, as predicted in the child's National Vaccination Calendar. Since 2017, the Ministry of Health has followed the guidelines of the World Health Organization (WHO) to offer only one dose of the yellow fever vaccine in a lifetime.
=========================
[The current expansion of yellow fever in South America raises concern for public health and also about potential conservation problems for susceptible non-human primate species in the continent. Yellow fever virus was introduced into the Americas approximately 400 years ago, yet the complex interactions that were established after its introduction are far from being elucidated. There is a need for more research on the eco-epidemiology of the disease in the continent, especially in the presence of the persistent anthropogenic global environmental change. - ProMED Mod.PMB]

[HealthMap/ProMED-mail map of Brazil:
Date: Sat 18 Jan 2020 03:15 WAT
Source: Actualita [in French, machine trans., edited]
<https://actualite.cd/2020/01/18/rdc-une-maladie-inconnue-fauche-des-vies-kiri-5-morts>

An unknown disease has already killed 5 people at Kiri General Hospital, in the province of Mai-Ndombe, in the west of the Democratic Republic of the Congo (DRC), according to the authorities. The provincial minister of public health has said that all measures are underway to detect [diagnose?] the mysterious disease. "Admittedly, this was an abnormal situation; however, the situation is manageable because we have just gone into this health facility and we have tried to carry out investigations. My collaborators and I took some samples which have quickly been sent to the National Institute for Biomedical Research (INRB) in Kinshasa for the appropriate medical tests which can give us accurate [diagnosis] on this abnormal situation," declared the minister Jean Claude Bola. First, added the same official, "it is not an Ebola epidemic, contrary to the rumour circulating in the Kiri territory and in the social networks."

In an exclusive interview with actualita.cd, the provincial authority also confirmed the deaths. "However, I warn all those who broadcast through the various media and social networks that there is Ebola in Mai-Ndombe that they have neither qualification nor competence to do so, because the only authority having jurisdiction in the provinces to declare an epidemic is the provincial governor," declared Paul Mputu Boleilanga. "Severe and disciplinary sanctions will be reserved against usurpers of power," he threatened. According to provincial authorities, a team from the National Institute of Biomedical Research (INRB), a team is expected in the Kiri territory for "rapid" management of all patients and to determine the disease underlying deaths in this region.
=============================
[Other than the number of deaths and the geographical location of the cases there is no additional information to permit reasonable speculation as to the aetiology or dates of illnesses. ProMED Mod.MPP noted that Ebola denial leads one to suspect this is a viral haemorrhagic fever.

Laboratory tests should confirm or rule out diseases such as yellow fever or Lassa fever. However, there is no indication that these cases are due to a virus or other infectious agent. Toxicants should also be ruled out. Additional information about these or new cases would be appreciated. - ProMED Mod.TY]

[Maps of DR Congo: <http://goo.gl/DM2AT8> and
<http://healthmap.org/promed/p/194> and
<http://healthmap.org/promed/p/65284>]
Date: Fri, 17 Jan 2020 17:48:09 +0100 (MET)

Barcelona, Jan 17, 2020 (AFP) - Spain's Balearic Islands passed a bill Friday aimed at clamping down on alcohol-fuelled holidays in the Mediterranean archipelago which bans happy hours when drinks are offered a discount and open bars.   "This is the first law adopted in Europe which restricts the sale and promotion of alcohol in certain touristic areas," the regional government of the Balearic Islands which have long been a magnet for young German and British tourists, who often drink heavily and enjoy rowdy late-night clubbing.

The restrictions will apply to three areas with a reputation for excess: San Antoni on the island of Ibiza and El Arenal and Magaluf -- which has been nicknamed "Shagaluf" because of its reputation for drunken casual sex -- on Mallorca, the largest of the Balearic's four islands.   The law, which was drawn up in consultation with the tourism industry also bans pub crawls and two-for-one drink offers, prohibits the sale of alcohol in shops between 9:30 pm and 8 am and forbids advertising party boats in the designated areas.   Establishments that break the new rules risk fines of up to 600,000 euros ($669,000) and the threat of being closed down for three years.

The new law also takes aim at the so-called "balconing" craze, the term given to holidaymakers who decide to jump into a swimming pool from a hotel or apartment balcony, a stunt which claims several lives every year.   It bans "balconing" across the entire archipelago and requires hotels to evict anyone who does it. Those caught jumping from balconies face fines of up to 60,000 euros ($67,000).   Up until now only some resorts on the Balearics imposed fines for "balconing".

The regional government of the Balearics said the law, which stiffens measures already introduced in 2015, will "fight excesses in certain tourist zones" and "force a real change in the tourism model of those destinations".   Magaluf made global headlines in 2014 after a video showing a young woman performing oral sex on several men on the dance floor of a nightclub went viral.   Local shops sell souvenir T-shirts with the catchphrase "On it 'till we vomit".

The four islands which make up the Balearics -- Palma de Mallorca, Ibiza, Menorca and Formentera, received nearly fourteen million tourists in 2018, drawn by their crystal clear waters, and in many cases by all-inconclusive package holidays.   The archipelago is Spain's second most visited region. Spain is the world's second most visited country after France.
Date: Fri, 17 Jan 2020 12:55:16 +0100 (MET)

Rennes, France, Jan 17, 2020 (AFP) - Several oyster farmers along France's Atlantic and Mediterranean coasts have been forced to halt sales since December after their sites were contaminated by the highly contagious norovirus, which they blame on overflowing sewage treatment plants.   Authorities ordered the suspensions at 23 of the country's 375 designated fields, and recalls of affected oysters as well as mussels and clams, after tests revealed the virus, which can cause severe vomiting and diarrhoea.

The move came just before the year-end holidays, when oysters are a traditional delicacy on millions of French tables.   "The oysters are not sick. They're carrying the virus because it's in the water they are constantly filtering," Philippe Le Gal, president of France's national shellfish council (CNC), told AFP this week.   "They were in the wrong place at the wrong time," he said, adding the ban had prompted many people to stop eating oysters altogether.   Local officials say oyster farmers are paying the price of insufficient spending on wastewater treatment, with facilities strained to the limit even as development of coastal areas has surged in recent years.

Heavy rains before Christmas prompted treatment basins to overflow, they say, spilling tainted water into rivers.   "This was predictable -- they've kept issuing building permits even though treatment sites are already at full capacity," said Joel Labbe, a senator for the Morbihan region in Brittany.   Oyster farmers are demanding compensation, and a delegation met with agriculture ministry officials in Paris last week warning that more than 400 businesses had been impacted by the sales ban.

This week, angry growers dumped trash bins full of oysters and mussels in front of the offices of the regional ARS health authority in Montpellier over the decision to halt sales from a nearby basin on the Mediterranean coast.   "We're the victims, and we shouldn't have to suffer any financial damages," Le Gal said.
Date: Fri, 17 Jan 2020 04:44:41 +0100 (MET)

Suva, Fiji, Jan 17, 2020 (AFP) - Fiji opened evacuation centres and warned of "destructive force winds" Friday as a cyclone bore down on the Pacific island nation for the second time in three weeks.   Two people were missing after attempting to swim across a swollen river late Thursday when heavy rain fell ahead of the advancing Cyclone Tino, police said.   On the outer islands, locals prepared to go to emergency shelters while many tourists fled beach resorts and made their way to the capital Suva before regional flights and inter-island ferry services were suspended.

The Fiji Meteorological Service said Tino was strengthening as it headed for Fiji's second-largest island, Vanua Levu, warning of wind gusts of up to 130 kilometres per hour (80 mph), heavy rain, coastal flooding and flash flooding in low lying areas.    "I'm preparing to go to an evacuation centre soon with my family and wait for the cyclone to pass," Nischal Prasad, who lost his home in northern Vanua Legu when Cyclone Sarai struck just after Christmas, told AFP.   "Sarai destroyed my house and almost left my family homeless. My daughters had to hide under their bed from the strong winds. It was a scary experience," he said.

Russian tourist Inna Kostromina, 35, said she sought safety in Suva after being told her island resort was in the path of the cyclone.   "We didn't want to get stuck in there and with the authorities warning of coastal flooding, anything can happen. So we decided to move to Suva for now. I think we will be much safer here."    Police said a man and his daughter, believed to be aged nine or 10, were attempting to swim across a flooded river when they were caught in the strong currents.    The incident happened on Thursday before the storm developed into a tropical cyclone, but a police spokesman linked the tragedy to "heavy rain brought about by the current weather system (which) raised the river level".   Although the Pacific islands are popular tourist destinations in summer it is also the cyclone season, and Fiji is being targeted for the second time in three weeks.

In late December, Tropical Cyclone Sarai left two people dead and more than 2,500 needing emergency shelter as it damaged houses, crops and trees and cut electricity supplies.    On its present track, Tino would hit Tongatapu, the main island of neighbouring Tonga, on the weekend.    Two years ago, Tongatapu was hit by Cyclone Gina, with two people killed and nearly 200 houses destroyed.
Date: Thu, 16 Jan 2020 16:38:39 +0100 (MET)
By Hiroshi HIYAMA

Tokyo, Jan 16, 2020 (AFP) - Japan has confirmed a case of a mystery virus that first emerged in China and is from the same family as the deadly SARS pathogen, authorities said Thursday.   It appears to be only the second time the novel coronavirus has been detected outside China, after the World Health Organization (WHO) confirmed a case in Thailand.   Japan's health ministry said a man who had visited the central Chinese city of Wuhan, the apparent epicentre of the outbreak, was hospitalised on January 10, four days after his return to Japan. He reported a persistent fever.

Tests on the patient, who was released from hospital on Wednesday, confirmed he was infected with the new virus.   "This is the first domestic discovery of a pneumonia case related to the new coronavirus," the ministry said in a statement.   "We will continue active epidemiological research while also coordinating efforts with the World Health Organization and related agencies to conduct a risk assessment."   The outbreak has killed one person so far, with 41 patients reported in Wuhan.

The outbreak has caused alarm because the new virus is from the same family as the pathogen that causes SARS (Severe Acute Respiratory Syndrome), which killed 349 people in mainland China and 299 in Hong Kong in 2002 and 2003.   Authorities in Wuhan said a seafood market was the centre of the outbreak. It was closed on January 1.   Japanese authorities said the man had not visited the market and that it was possible he had been in contact with a person infected with the virus while in Wuhan.

- Outbreak in Japan 'unlikely' -
Health ministry official Eiji Hinoshita told reporters that the risk of the disease spreading from the patient was considered low, with careful checks done on those who had been in close contact with him.   "At this point, we feel it is unlikely this will lead to a dramatic outbreak," he said, adding that the patient was no longer suffering a fever and was recuperating at home.

Officials declined to give further information on the man, including his nationality, citing privacy concerns.   Local media said the patient was a Chinese national in his 30s living in Kanagawa, just southwest of Tokyo.   Public broadcaster NHK said he had already recovered and was resting at home, as quarantine officials at Tokyo's Narita airport boosted health checks on all travellers.

The health ministry urged people who develop a cough or fever after visiting Wuhan to wear a surgical mask and "swiftly visit a medical institution".   Hinoshita said Japan would need to be on guard ahead of the Lunar New Year, a popular travel period in China.   "It is expected that Japan will see many visitors from China," he said.   It is not yet clear whether the mystery virus can be transmitted between humans, but on Wednesday authorities said it was possible it had spread inside a family.

The woman diagnosed in Thailand, who is in a stable condition, also said she had not visited the Wuhan seafood market.   And WHO doctor Maria Van Kerkhove on Tuesday said she "wouldn't be surprised if there was some limited human-to-human transmission, especially among families who have close contact with one another".   Hong Kong authorities on Tuesday said several dozen people had been hospitalised with fever or respiratory symptoms after travelling to Wuhan, but no cases of the new virus have so far been confirmed.
Date: 20 Jan 2020
Source: News Joins [In Korean, machine trans. edited]
----------------------------
An unexplained pneumonia in China caused the Korean quarantine authorities to strengthen the quarantine, and a fever-sensing camera is installed to monitor the body temperature of Chinese tourists who entered Korea at Incheon Port 1 International Passenger Terminal. 

Pneumonia confirmed by the new coronavirus, which is prevalent in Wuhan, China, was confirmed for the first time on [20 Jan 2020]. According to health officials, a Chinese woman, A, who arrived at Incheon International Airport on a plane from Wuhan last weekend, was confirmed with pneumonia. The patient showed signs of pneumonia, including high fever and cough. The health authorities entered the airport at the same time, confirmed the symptoms of high fever, suspected pneumonia, and went into quarantine and testing. The Centers for Disease Control immediately quarantined A and entered treatment with a nationally designated quarantine bed. The Centers for Disease Control will hold an emergency press conference at 1:30 pm on [20 Jan 2020] and release the reporter A.
 
Meanwhile, Beijing's Daxing District Health and Welfare Committee said 2 fever patients who had been to Wuhan were confirmed as a new pneumonia patient on [19 Jan 2020]. They are currently being treated at a designated hospital and said they are stable. Daxing District is where Beijing New Airport opened last year [2019]. The Guangdong Provincial Health and Welfare Committee said on [19 Jan 2020] that a 66-year-old man who had visited a relative's home in Wuhan showed fever and lethargy and was diagnosed with Wuhan pneumonia. Confirmation patients have also emerged in Shenzhen, a neighbouring Hong Kong province in southern China, raising concerns that the new pneumonia has already spread throughout China.
 
The Chinese government has said that "there is no basis for human-to-human propagation," but domestic experts pointed out that "the nature of coronavirus is less likely to prevent human-to-human propagation."   [Byline: Esther Toile]
========================
[This is now the 4th international identification of the 2019-nCoV (novel coronavirus) associated illness reported outside of China.  To date, all 4 cases have reported being in Wuhan China in the 14 days preceding onset of illness.  Illness in each involved a history of fever and dry cough.  Cases were reported by Thailand (2 cases) and Japan, and now South Korea.  An update following a Ministry of Health Korea press conference mentioned that there were 5 individuals accompanying this woman, none of whom were currently showing symptoms. (<http://news1.kr/articles/?3821049>).

As mentioned in an earlier post (see Novel coronavirus (10): China (HU, GD, BJ) http://promedmail.org/post/20200119.6898567), there have also been cases confirmed in China outside of Wuhan City, with cases reported in Beijing, Guangdong and possibly Shanghai. It is becoming more difficult to conclude that there has been limited person-to-person transmission as the case numbers are climbing both inside of Wuhan City, elsewhere in China, and in individuals travelling from Wuhan China to other countries (Japan, Thailand and South Korea).

A map of South Korea can be found at:
Date: 15 Jan 2020
Source: Fox News [edited]

CDC is facing criticism over its response to a polio-like illness. The Centers for Disease Control and Prevention has confirmed 10 additional cases of acute flaccid myelitis.  An Ohio teen is determined to walk again despite doctors' warnings that she may not after she contracted a rare polio-like illness that's left her paralyzed from the waist down.  IK, a catcher on her middle school's softball team, said it started with what felt like a cramp in her leg on Christmas. "I just thought, 'Oh gosh, it's just growing pains or a Charley horse,'" NK, the 13-year-old's mother, told News 5 Cleveland.  But the next day, IK couldn't stand on her own, and her worried parents rushed her to Akron Children's Hospital, where she was diagnosed with acute flaccid myelitis (AFM). It's a rare but serious condition that affects the nervous system, specifically the grey matter of the spinal cord, which weakens the body's muscles and reflexes.

Health officials have noticed an increase of cases in children occurring every 2 years since 2014, according to the Centers for Disease Control and Prevention (CDC). And while it often is referred to as a "polio-like" illness, tests so far have tested negative for poliovirus.  Symptoms typically begin with sudden onset of arm or leg weakness and loss of muscle tone and reflexes, but can also include facial droop or weakness, difficulty moving eyes, drooping eyelids, difficulty swallowing,  slurred speech, and pain in the arms and legs.  Severe symptoms may include respiratory failure, or serious neurological complications, according to the CDC. Parents are encouraged to seek medical care right away if a child is suspected of developing any symptoms

Since her diagnosis, IK has been working in physical therapy and has received steroid treatments as well as multiple plasma exchange, according to the news outlet. Her mother said it's been like "a bad dream" for the family as they watch her struggle to gain strength.  "It's a lot, but I just try to go with the flow, just to push through," IK, who has received support from her teammates, classmates and members of the community, told News 5 Cleveland.  [Byline: Alexandria Hein]
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[Acute flaccid myelitis (AFM) is a rare but serious condition. It affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak.

In 2019, there were 33 total confirmed cases in 16 US states
[<https://www.cdc.gov/acute-flaccid-myelitis/cases-in-us.html>].

The case definition for AFM is based on clinical and lab criteria

Clinical Criteria: An illness with onset of acute flaccid limb weakness.
Laboratory Criteria:
Confirmatory Laboratory Evidence: a magnetic resonance image (MRI) showing spinal cord lesion largely restricted to grey matter and spanning one or more vertebral segments. Supportive Laboratory Evidence: cerebrospinal fluid (CSF) with pleocytosis (white blood cell count over 5 cells/mm3) Case Classification:
- Confirmed: Clinically compatible case AND Confirmatory laboratory evidence: MRI showing spinal cord lesion largely restricted to grey matter and spanning one or more spinal segments.
- Probable: Clinically compatible case AND Supportive laboratory evidence: CSF showing pleocytosis (white blood cell count over 5 cells/mm3)

With the high number of cases reported in 2018 and 2019, CDC enhanced AFM surveillance through collection of data at the national level by encouraging healthcare providers to recognize and report to their health departments all patients whom they suspect may have AFM; health departments are being asked to send this information to CDC to help us understand AFM activity nationwide. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
Date: Sat 18 Jan 2020
From: Guido Calleri <guidocalleri@aslcittaditorino.it> [edited]

90 persons presented to the Infectious Diseases Hospital Amedeo di Savoia, Torino, North-West Italy between 24 Dec 2019 and 10 Jan 2020 after consuming raw sausages from a wild boar hunted in the area of Susa Valley, 50 km [31.1 mi] away from Torino, in late November 2019.

All of them either were symptomatic (fever, muscle and/or abdominal pain, nausea) or had peripheral blood eosinophilia over 500/cmm, or both. IgG serology for trichinella was performed by immunoblot (Trichinella E/S IgG kit, EFFEGIEMME, Milan, Italy) and resulted positive in 48/90 (53.3%), allowing a diagnosis of confirmed trichinella infection.

Otherwise, a diagnosis of suspected trichinella infection was made with a negative serology, probably due to performing the test too early, before the development of antibodies or possibly a false negative result. In a few cases (under 10 cases) an alternative diagnosis was considered.

All patients were treated with oral albendazole 400 mg twice daily for 10 days and prednisone 50 mg/day.

Most likely, all patients were infected after eating meat from a single animal, given the low prevalence of the infection in this area: no human case has ever been detected in Torino province, and only one wild boar has been found positive for trichinella at microscopy in Susa valley in the last 10 years.
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Guido Calleri, Filippo Lipani, Giovanna Paltrinieri, Silvia Faraoni,
Valeria Ghisetti
ASL Citta di Torino, Infectious Diseases Unit and Microbiology Lab,
and ASL TO3,
Department of Prevention
Torino, Piedmonte, Italy
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[ProMED thanks Guido Calleri, Filippo Lipani, Giovanna Paltrinieri, Silvia Faraoni, and Valeria Ghisetti for sending us this information. The report underlines that _Trichinella_ are found in wild boars in Europe and should be assessed by a certified laboratory for _Trichinella_ before used for human consumption. Sausages made of smoked meat are especially dangerous, because the temperatures seldom reach what is needed to kill the trichinella larvae. - ProMED Mod.EP]

[HealthMap/ProMED map available at: