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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]
More ...

Serbia

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

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

Travel News Headlines WORLD NEWS

Date: 29 Aug 2018
Source: DW [edited]

Health officials in Serbia have reported new deaths from West Nile virus, where over 200 people are confirmed to be infected. The disease has also claimed lives in several EU countries.

Serbian authorities announced on Wednesday [29 Aug 2018] that 6 people have died after being infected by the West Nile virus last week, bringing the current death toll to 21. Serbia, with 213 infected cases, is the European country worst-hit by the disease.

At the same time, Greece reported 5 deaths due to the West Nile virus during the past week. The overall toll now stands at 16, with 130 registered cases of infection.

At least 9 people have died from the disease in Italy and another 6 people in Romania. Two fatalities have also been reported in Kosovo.

The exact number of cases is likely much larger, as humans infected with the mosquito-borne virus typically show no signs of disease and require no treatment. Only about 20 percent of those infected exhibit symptoms similar to influenza, such as fever, headaches, fatigue and swelling of the lymph nodes. Less than one percent of patients develop encephalitis or meningitis, which could potentially lead to death.

The virus has been present in Serbia since 2012, according to infectious disease specialist Dragan Delic, as cited by the Serbian daily Blic. He warned that global warming is likely to boost the spread of other tropical diseases into new areas, including "malaria and dengue fever."

Health experts believe the West Nile virus expanded its foothold in Europe through migratory birds. While there is no vaccine for it, doctors say the risk of infection can be managed by using protection from mosquito bites.
========================
[WNV activity has been higher than in previous years, with cases reported from many countries, and Serbia has reported 213 cases to date according to the ECDC update in section [1] above.

Vector control and community mobilization, awareness, and support are the key steps to controlling disease transmission for WNV, as with other vector borne diseases such as dengue and chikungunya - ProMED Mod.UBA]

[HealthMap/ProMED maps available at:
Date: Mon, 18 Jun 2018 05:25:56 +0200
By Katarina SUBASIC

Belgrade, June 18, 2018 (AFP) - "Join us comrade!" tourists are warmly greeted, as they climb into a vintage car that is no longer produced for a visit back in time to a country that no longer exists.   As a symbol of the former Yugoslavia, the Yugo car is back in vogue on Belgrade's streets.  Like in other places once stranded behind the detested Iron Curtain, the Serbian capital has found a unique way to cater for a surge in interest and even nostalgia for life under communism.

On a three-hour tour, visitors see some of Yugoslavia's most significant sites, seated in one of the once ubiquitous Yugos, ending up at the Museum of History of Yugoslavia which holds dictator Josip Broz Tito's mausoleum.   "People come to experience rides in an iconic car and it is something they cannot experience anywhere else in the world actually," Jovana Stojiljkovic, who manages the Yugotour travel agency, told AFP.   The last Yugo cars were produced a decade ago, but, says Stojiljkovic, they are still a hit among tourists for the "Rise and Fall of a Nation" tour, on which most clients are foreigners.   "It's something similar to a Trabant (East German car) tour in Berlin," she says.

- Made in Yugoslavia -
For vintage car aficionados, Belgrade has a lot to offer, with sightings of American Chryslers or Ford limousines not uncommon.   And for the handful of "Made in Yugoslavia" makes of car, thousands still rumble around on Balkans roads more than 25 years after Yugoslavia's collapse.   As well as the Yugo, the small Fica and Zastava 101, all produced at the Zastava plant in the central town of Kragujevac, were the pride of communist Yugoslavia.

They were highly popular due to their low price.   But the Yugo car was also often the butt of jokes over its design and unreliability.   It even appeared in the 1995 Hollywood blockbuster "Die Hard With a Vengeance" with Bruce Willis and Samuel L. Jackson.   Now it is tourists from all over the world climbing into the Yugos, which in their heyday were exported from Yugoslavia to 74 countries, including Egypt, India and even the United States.   Described by the communist authorities as the "deal of the century" for the US market, the Yugo had only limited success there, however.

- 'View of history' -
When Stojiljkovic was born in 1992, Yugoslavia had already fallen apart in a series of bloody wars and most of its republics were already independent states.   But by the age of 25, she had launched a career in preserving the memory of the Socialist Federal Republic of Yugoslavia (SFRJ) and telling its story, coinciding with a wave of "Yugonostalgia" among some for a period viewed as having enjoyed peace and relative prosperity before the onset of the conflicts.   Dennis Bertelsen, a 38-year-old Dane on a weekend visit to the city, was among the hundreds of thousands of tourists descending on Belgrade -- it hosted one million last year, 835,000 of whom were from abroad, according to
official figures.

With his three friends, he said he took the tour "to get a view of the history and what actually had been the development and downfall of Yugoslavia".   The itinerary includes passing by the famous Hotel Jugoslavija on the Danube river bank, one of the country's most luxurious at the time.   Guests included US presidents Richard Nixon and Jimmy Carter as well as Britain's Queen Elizabeth II.   The hotel has been out of service since it was hit in a 1999 NATO bombing campaign to force the then Serbian strongman Slobodan Milosevic to withdraw his troops from Kosovo but the building still has a mythical status.

- 'Commercialisation' -
Polish student Dominik Wojciechowski came across the tour while researching the Fica car for his photo-art project on so-called Yugonostalgia, a feeling still present in all the countries that emerged after Yugoslavia's collapse, although much less in Croatia where a national sense of being Croat is ultra dominant.

"I am interested in this process of commercialisation of Yugonostalgia and how people today are trying to preserve knowledge of Yugoslavia, while the older generation even (attempts) to return to these times," the 25-year-old said.   For him, the most impressive part of the tour was a 30-floor twin tower called Genex, or Western Gates of Belgrade, still among the tallest in the city.   "You stand below it and look up how big it is and feel this grandiosity of Yugoslavia and how powerful it was," he said.   Most tourists know very little about Yugoslavia, its 22 million people and dictator Tito who led it from the end of World War II until his death in 1980.

A decade later, the federation comprising six republics -- Bosnia, Croatia, Macedonia, Montenegro, Serbia and Slovenia -- collapsed in a series of wars that claimed more than 130,000 lives.   Although Stojiljkovic never lived in Yugoslavia she said she nevertheless knows a lot about it.   "I have heard all the stories from my parents, their friends and the rest of my family, so based on their experience it was a really nice time, they had a good time," she said.   And she herself is now the proud owner of two Fica cars, which, she said, was "to show to the rest of the world what they meant to us".
Date: Tue, 20 Mar 2018 18:47:46 +0100

Belgrade, March 20, 2018 (AFP) - Serbian authorities said Tuesday they have launched an initial investigation of some public opponents of vaccination after 12 people, including two children, have died in an outbreak of measles.   "The prosecutor's office for high-tech crime is looking into whether there is criminal accountability by a number of public persons, opponents of vaccination of children," the Serbian prosecutors's office said in a statement.

The probe came about after a group of 270 parents last month accused 43 people of "causing panic", including a famous folk singer Jelena Krleusa, a writer and even a doctor who have publicly spoken against vaccination, local media has reported.   The prosecutor did not reveal the names of those being investigated.    According to Serbia's Institute of Public Health, more than 3,800 cases of measles, including a 15-day-old baby, have been recorded since the beginning of the outbreak in October.   The 12 people who died of the disease included two children, aged two and four, the Institute said on its web site.

Earlier this month Serbian Health Minister Zlatibor Loncar urged parents to vaccinate their children, saying "the outbreak of measles would have never happened  if they had listened to doctors and not celebrities."   The vaccination, including against measles, is mandatory for children in Serbia, but courts have rarely issued fines that are 30,000 to 150,000 dinars (250 to 1,250 euros/$300 to $1,550).   Measles has also struck in neighbouring Romania as well as Italy, France, Germany and Greece.
Date: Wed 27 Dec 2017, 10:41 AM
Source: B92 [edited]

A 20-year-old man from Belgrade has died in a hospital's intensive care unit from complications caused by measles, RTS is reporting. He is the first victim of measles in Serbia. The patient had not been inoculated against the infectious disease.

Since October [2017], a total of 630 persons in central Serbia and in Serb-majority areas in Kosovo and Metohija contracted the disease, the Public Health Institute Batut announced on [Tue 26 Dec 2017].

A total of 91 percent of those have either not been vaccinated against the disease, or have incomplete or uncertain vaccination status.

Since the measles epidemic was reported in late October [2017], there had been 259 cases in Serb and non-Albanian municipalities in Kosovo.

In early November [2017], an epidemic of the disease was also reported in central Serbia.
=================
[Measles can be a serious illness in all age groups. However, children younger than 5 years of age and adults older than 20 years of age are more likely to suffer from measles complications. Some people may suffer from pneumonia (infection of the lungs) and encephalitis (swelling of the brain). They may need to be hospitalized and can die.

According to the CDC:
As many as 1 out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children. About 1 child out of every 1000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or with intellectual disability. For every 1000 children who get measles, 1 or 2 will die from it.

Measles may cause pregnant woman to give birth prematurely, or have a low-birth-weight baby.

(Excerpted/edited from

A Healthmap/ProMED of Serbia may be found at
Date: Thu 9 Nov 2017 16:03 CET
Source: b92; Tanjug News Agency report [edited]

The Institute of Public Health of Serbia on [Wed 8 Nov 2017] reported an epidemic of measles in the city of Belgrade. This came after tests confirmed the presence of the virus in 5 patients.

The Institute explained on [Thu 9 Nov 2017] that this does not mean an epidemic has been declared.

The Institute stated on [Wed 8 Nov 2017] that none of these patients have been in contact with persons from the territory of Kosovo and Metohija, nor with persons exhibiting a similar clinical picture in the territory of their residence.

The patients have either not been vaccinated against this contagious disease, or are of unknown vaccination status. One patient has pneumonia -- a serious complication of measles.

There have been 65 cases of measles in the territory of Serbia since early October [2017]: in Serb enclaves in Kosovo, as well as in Bujanovac, Kraljevo, and Belgrade.

Measles is a disease slated for eradication, and in such circumstances, even a single case is considered an epidemic.
=================
[Maps of Serbia can be seen at
More ...

Colombia

Colombia - US Consular Information Sheet
August 13, 2008

COUNTRY DESCRIPTION:
Colombia is a medium-income nation of some 44 million inhabitants.
Its geography is very diverse, ranging from tropical coastal areas and rainforests t
rugged mountainous terrain.
Tourist facilities in Colombia vary in quality and safety, according to price and location.
Security is a significant concern for travelers, as described in the Department of State’s Travel Warning for Colombia.
Read the Department of State Background Notes on Colombia for additional information.

ENTRY/EXIT REQUIREMENTS:
All U.S. citizens who are not also Colombian citizens must present a valid U.S. passport to enter and depart Colombia, and to return to the United States.
Dual U.S-Colombian citizens must present a Colombian passport to enter and exit Colombia, and a U.S. passport to return to the United States.
Be aware that any person born in Colombia may be considered a Colombian citizen, even if never documented as such.
U.S. citizens born in Colombia or who otherwise have Colombian citizenship, will need both a Colombian passport and a U.S. passport for the trip.
U.S. citizens traveling to Colombia do not need a Colombian visa for a tourist stay of 60 days or less.
Travelers entering Colombia are sometimes asked to present evidence of return or onward travel, usually in the form of a round-trip plane ticket.
Americans traveling overland must enter Colombia at an official border crossing.
Travelers arriving by bus should ensure, prior to boarding, that their bus will cross the border at an official entry point.
Entering Colombia at unauthorized crossings may result in fines or incarceration.
Travelers planning to enter Colombia over a land border should carefully read our information on Traffic Safety and Road Conditions below.
The length of stay granted to travelers is determined by the Colombian immigration officer at the point of entry and will be stamped in your passport.
Extensions may be requested by visiting an office of the Colombian immigration authority, known as the Departamento Administrativo de Seguridad, or DAS, after arrival in Colombia.
Fines are levied if a traveler remains in Colombia longer than authorized, and the traveler cannot leave Colombia until the fine is paid.
Any traveler possessing a Colombian visa with more than three months’ validity must register the visa at a DAS immigration office within 15 days of arrival in Colombia or face fines.
The DAS immigration office in Bogota is located at Calle 100 and Carrera 11B.
No arrival tax is collected upon entry into Colombia, but travelers leaving by plane must pay an exit tax at the airport, in cash.
The tax varies with the dollar/peso exchange rate, but is usually between $50 and $70.
Some airlines include all or a portion of this tax in the cost of your airline ticket; check with your airline to find out how much you will have to pay at the airport.
U.S. citizens whose U.S. passports are lost or stolen in Colombia must obtain a new U.S. passport before departing.
They must then present the new passport, along with a police report describing the loss or theft, to a DAS office.
Information about obtaining a replacement U.S. passport in Colombia is available on the U.S. Embassy’s website at http://bogota.usembassy.gov.
Contact information for DAS is available in Spanish at http://www.das.gov.co.
The Embassy in Bogotá or the U.S. Consular Agency in Barranquilla can provide guidance on contacting DAS when you apply for your replacement passport.
For further, specific guidance on Colombian entry requirements, including information about Colombian visas, travelers should contact the Colombian Embassy at 2118 Leroy Place NW, Washington, DC 20008; telephone (202) 387-8338; website: http://www.colombiaemb.org; or the nearest Colombian consulate.
Consulates are located in Atlanta, Boston, Chicago, Houston, Los Angeles, Miami, New Orleans, New York, San Francisco, and San Juan, Puerto Rico.

Also see the Department of State’s general information on Entry and Exit Requirements.
Visit the Embassy of Colombia website at http://www.colombiaemb.org for the most current visa information.
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
ADDITIONAL EXIT REQUIREMENTS FOR MINORS:
To prevent international child abduction, Colombia has implemented special exit procedures for Colombian children under 18 who are departing the country without both their mother and their father or a legal guardian.
These procedures apply even if the child is also a U.S. citizen.
Complying with the procedures can be complex and time-consuming, especially if an absent parent is outside Colombia at the time.
Advance planning is essential.

The procedures are as follows: Upon exiting the country, the person traveling with the child (or the child him/herself) must present a certified copy of the child’s birth certificate, along with written, signed authorization from the absent parent(s) or legal guardian.
The authorization must explicitly grant permission for the child to travel alone, with one parent, or with a third party, by name.
When a parent is deceased, a notarized copy of a death certificate is required instead of written authorization.
When one parent has sole custody of the child, that parent may present a custody decree instead of the other parent’s written authorization.
If the documents to be presented originated in the United States, they must first be translated into Spanish and then signed in front of a Colombian consul at a Colombian consulate.
Then, upon arrival in Colombia, the documents must be presented to the Colombian Ministry of Foreign Affairs for certification of the consul’s signature.

Alternatively, the documents can be translated into Spanish, then notarized by a notary public in the United States, and authenticated by requesting an apostille from the competent authority in the state where the documents were prepared.
The document, translation, and apostille can then be presented to immigration officers at the airport when the child travels.
If the documents originated in Colombia and are written in Spanish, only notarization by a Colombian notary is required.
For documents originating in countries other than the United States or Colombia, please inquire with the Colombian embassy serving that country.
In cases where the absent parent refuses or is unable to provide consent, the other parent can request assistance from the Colombian child protective service, Instituto Colombiano de Bienestar Familiar (ICBF).
In appropriate cases, ICBF will investigate and may issue a document that will allow the child to travel without both parents’ consent.
This process may take a significant amount of time and is not within the control of the U.S. government.
SAFETY AND SECURITY:
Violence has decreased markedly in many urban destinations, including the cities of Bogota, Medellin, Barranquilla, and Cartagena.
Cali has made less progress combating crime than most other large cities.
The level of violence in Buenaventura remains high.
Small towns and rural areas of Colombia can be extremely dangerous due to the presence of narco-terrorists.
Common crime remains a significant problem in many urban and rural areas, as described in the section on crime below.

The incidence of kidnapping in Colombia has diminished significantly from its peak at the beginning of this decade.
Nevertheless, terrorist groups, including the Revolutionary Armed Forces of Colombia (FARC), and other criminal organizations, continue to kidnap and hold civilians for ransom or as political bargaining chips.
No one is immune from kidnapping on the basis of occupation, nationality, or other factors.
On July 2, 2008, the GOC effected a successful military rescue of three Americans, Ingrid Betancourt, and eleven members of the Colombia security forces. President Uribe called on the FARC to release the remaining hostages and seek peace. Although the U.S. government places the highest priority on the safe recovery of kidnapped Americans, it is U.S. policy not to make concessions to kidnappers.
Consequently, the U.S. government’s ability to assist kidnap victims is limited.

Official and personal travel by U.S. Embassy employees outside most urban areas is subject to strict limitations and reviewed by security officers on a case-by-case basis.
U.S. Embassy employees are allowed to travel by air, but inter- and intra-city bus transportation is off limits to them.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ website at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Although the threat of terrorism has decreased in most of Colombia’s cities, they nevertheless experience much of the same crime that is seen in comparably sized cities throughout the region.
Robbery and other violent crimes, as well as scams against unsuspecting tourists, are common in urban areas.
Generally speaking, if you are the victim of a robbery, you should not resist.
Some of the most common methods used by criminals in Colombia are noted below:
Robberies of ATM customers:
Tourists and others have been robbed after using automatic teller machines (ATMs) on the street.
In some cases, robbers have used motorcycles to approach their victims and later flee the scene.
Americans are urged to use ATMs only inside shopping malls or other protected locations.
Driving to and from the location – rather than walking – provides added protection.
When using an ATM, you should be on the lookout for anyone watching or following you.

Robberies of taxi passengers:
Robbery of taxi passengers is a serious problem in Bogota.
Typically, the driver – who is one of the conspirators – will pick up the passenger and then stop to pick up two or more armed cohorts, who enter the cab, overpower the passenger, and take his/her belongings.
If the passenger has an ATM card, the perpetrators may force the passenger to withdraw money from various ATM locations.
Such ordeals can last for hours.
In almost every case of taxi-related crime, the victims have been riding alone and have hailed taxis off the street.
Rather than hailing a taxi, you should use the telephone dispatch service that most taxi companies offer.
Many hotels, restaurants, and stores will call a taxi for you, and the taxi usually arrives within minutes.
When a taxi is dispatched by telephone, the dispatcher creates a record of the call and the responding taxi.

Robberies while departing airports:
U.S. citizens arriving at major Colombian airports have occasionally been victimized by armed robbery while en route from the airport to their hotel or home.
The perpetrators typically scout out victims at the airport and then follow their vehicles before robbing the occupants at a stoplight.
Travelers should remain vigilant at airports and report to local airport police if they suspect they are being observed.
Robberies on Hiking Trails:
Several U.S. citizens were robbed in 2007 while hiking on nature trails in and around Bogota.
Because hiking trips generally take place in isolated settings, participants are especially vulnerable.
Hikers in Colombia are more protected if they travel in large groups.
Use of disabling drugs:
The Embassy continues to receive reports of criminals in Colombia using disabling drugs to temporarily incapacitate tourists and others.
At bars, restaurants, and other public areas, perpetrators may offer tainted drinks, cigarettes, or gum.
Typically, victims become disoriented or unconscious, and are thus vulnerable to robbery, sexual assault, and other crimes.
Avoid leaving food or drinks unattended at a bar or restaurant, and be suspicious if a stranger offers you something to eat or drink.
Counterfeit money scam:
U.S. citizens in Colombia routinely fall victim to a scam in which purported undercover police officers approach them on the street and request to examine their money, supposedly to determine if it is counterfeit.
The “officers,” who are in fact criminals, then flee with the money.
In a variation of this scam, the thieves may ask to see jewelry.
Legitimate Colombian police officers do not make such requests.

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 are 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 Colombia is 112 for police and 119 for fire.
There will not be an English speaker answering the phone[g1] .

See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care is adequate in major cities but varies greatly in quality elsewhere.
Emergency rooms in Colombia, even at top-quality facilities, are frequently overcrowded and ambulance service can be slow. Many private health care providers in Colombia require that patients pay for care before treatment, even in an emergency.
Some providers in major cities may accept credit cards, but those that do not may request advance payment in cash.
Uninsured travelers without financial resources may be unable to obtain care, or relegated to seeking treatment in public hospitals where care is far below U.S. standards.
The Embassy regularly receives reports of U.S. citizens in Colombia who have died or suffered complications from liposuction and other elective surgeries intended to treat obesity.
Before undergoing such a procedure in Colombia, the Department of State recommends that you consult with your personal physician, research the credentials of the provider in Colombia, and carefully consider your ability to access emergency medical care if complications arise.
It is important to confirm that your medical insurance provides coverage in Colombia, to include treatment of complications from elective procedures or medical evacuation if necessary.
Should you suffer complications as a result of medical malpractice, collecting damages from your surgeon may be difficult.
Colombia has seen a recent increase in the use of unregulated drugs that purport to enhance sexual performance.
Several American tourists recently died after using these substances, which come in liquid, powder, or tablet form.
You are urged to seek guidance from a physician before ingesting any such substances in Colombia.
Travelers to the capital city of Bogota may need time to adjust to the altitude of 8,600 feet, which can affect blood pressure, digestion, and energy level, and cause
mild dyspnea with exercise, headaches, sleeplessness, , and other discomfort.
Travelers should drink liberal fluids to maintain hydration,, and should avoid strenuous exercise unti they have acclimated to the altitude.
Travelers with circulatory or respiratory problems should consult a physician before traveling to Bogota or other high-altitude locations.
Information on vaccinations and other health precautions, such as safe food and water and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s website at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) website at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.

Colombia has imposed HIV/AIDS travel restrictions on groups of travelers subject to restrictions or bans.
Entry is restricted to PLWHA (customs officials on the lookout). A waiver may be requested from the Colombian embassy (Source: NAM April 2006, USSD December 06).
Please inquire directly with the Embassy of Colombia at http://www.colombiaemb.org before you travel.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm that 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 Colombia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Due to the security environment in Colombia, U.S. government officials and their families are not permitted to travel by road between most major cities.
They also cannot use inter- or intra-city bus transportation, or travel by road outside urban areas at night.
All Americans in Colombia are encouraged to follow these same precautions.
Traffic laws in Colombia, including speed limits, are often ignored and rarely enforced, creating dangerous conditions for drivers and pedestrians in major cities.
Under Colombian law, seat belts are mandatory for front-seat passengers in a private vehicle.
Car seats are not mandatory for children, but a child under ten is not permitted to ride in a front seat.
It is against the law to talk on a cellular phone while driving in Colombia, and violators may be fined.
While driving outside major cities, it is mandatory to drive with your lights on.
If an accident occurs, the involved parties must remain at the scene and not move their vehicles until the authorities arrive; this rule is strictly enforced, and moving a vehicle or leaving the scene of an accident may constitute an admission of guilt under Colombian law.
Americans seeking to import their own vehicles into Colombia should consult with their nearest Colombian consulate for information on Colombian taxes and licensing rules, which can be complicated and bureaucratic.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Colombia’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) safety standards for oversight of Colombia’s air carrier operations.
For more information, please visit the FAA’s website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES:
Colombia employs strict screening procedures for detecting narcotics smuggling at its international airports.
Americans and other travelers are occasionally questioned, searched, fingerprinted, and/or asked to submit to an abdominal x-ray upon arrival or departure.
Most airport inspectors do not speak English, and travelers who do not speak Spanish may have difficulty understanding what is asked of them.
Please refer to the section on Criminal Penalties for further information on the strict enforcement of Colombia’s drug laws. Please see our Customs Information.
CUSTOMS REGULATIONS:
Travelers generally must not enter or exit Colombia while carrying cash or other financial instruments worth more than 10,000 U.S. dollars.
Colombian authorities may confiscate any amount over $10,000, and may initiate a criminal investigation into the source of the money and the traveler’s reasons for carrying it.
Recovery of the confiscated amount requires a lengthy, expensive legal process and may not always be possible.
Americans wishing to send large sums of money to or from Colombia should contact their nearest Colombian consulate, or speak with Colombian customs officials, and should also consider seeking advice from an attorney or financial professional.

Colombian law prohibits tourists and business travelers from bringing firearms into Colombia.
Illegal importation or possession of firearms may result in incarceration.

In many countries around the world, counterfeit and pirated goods are widely available. Buying or selling them is illegal in Colombia, and bringing them back to the United States may result in forfeitures and fines.

Colombian law forbids the export of pre-Columbian objects and other artifacts protected by cultural patrimony statutes.
Under an agreement between the United States and Colombia, U.S. customs officials are obligated to seize pre-Columbian objects and certain colonial religious artwork when they are brought into the United States.
Please contact the Embassy of Colombia in Washington or one of Colombia's consulates in the United States for detailed customs guidance.
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 Colombia’s laws, even unknowingly, may be expelled, arrested, or imprisoned.
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.

If you are arrested, the U.S. government cannot request your release.
Colombia and the United States do not have a prisoner transfer agreement, and so any sentence for a crime committed in Colombia is ordinarily served in a Colombian prison.
Penalties for possession, use, or trafficking of illegal drugs in Colombia are severe, and convicted offenders can expect long prison sentences under harsh conditions, with significant expense and great hardship for themselves and their families.
Colombian police make multiple arrests daily for drug trafficking at major airports, and have sophisticated means for detecting illegal drugs in baggage or on your person.
Travelers are sometimes requested to undergo an x-ray to ensure that they are not smuggling narcotics within their own bodies.
There are more than 30 Americans incarcerated in Colombia for attempting to smuggle drugs out of the country.

The hardships resulting from imprisonment do not end even after release from prison:
Colombian law requires that serious offenders remain in the country to serve a lengthy period of parole, during which the offender is given no housing and may lack permission to work.
As a result, family members must often support the offender, sometimes for more than a year, until the parole period expires.
DISASTER PREPAREDNESS: Colombia is an earthquake-prone country.
Flooding and mudslides also sometimes occur in parts of the country.
General information about natural disaster preparedness is available from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.
If a serious natural disaster occurs in Colombia, the Embassy will publish important information for American citizens on its website at http://bogota.usembassy.gov.

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 residing or traveling in Colombia are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Colombia.
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 Calle 24 Bis No. 48-50 Bogotá, D.C. Colombia.
Mailing address:
Carrera 45 No. 24B-27 Bogotá, D.C. Colombia.

In case of a serious emergency that jeopardizes the health or safety of an American citizen in Colombia, please call the Embassy at (571) 315-0811; Embassy fax: (571) 315-2197;
Consular Section phone: (571) 315-1566. The Embassy’s American Citizens Services office provides routine information at http://bogota.usembassy.gov.
For questions not answered there, inquiries may be sent by email to ACSBogota@state.gov.
Email messages are answered by the next business day.
The Embassy’s American Citizens Services office is open for passport applications, notary services, and routine in-person inquiries from 8:30 a.m. to 12:00 noon Monday through Thursday, excluding U.S. and Colombian holidays.
Inquiries concerning Social Security and other federal benefits can be made in-person from 2:00 to 3:00 p.m. Monday through Thursday, except holidays.
The American Citizens Services fax number is (571) 3152196/7.
The U.S. Consular Agency in Barranquilla, which accepts passport applications and performs notarial services, is located at Calle 77B, No. 57-141, Piso 5, Centro Empresarial Las Americas, Barranquilla, Atlantico, Colombia; telephone (575) 353-2001; fax (011-57-5) 353-5216.
The Consular Agency is not staffed to respond to after-hours emergencies; in case of an emergency in the Barranquilla/north coast area, please contact the Embassy in Bogota at (571) 315-0811.
*

*

*
This replaces the Country Specific Information issued May 29, 2008, to update sections throughout.

Travel News Headlines WORLD NEWS

Date: Sat 2 Mar 2019
Source: Outbreak News Today [edited]

Health officials are reporting a malaria outbreak in Cauca department in southwestern Colombia, according to a RCN Radio report (computer translated).

The outbreak has affected 322 people in the rural areas of Guapi and Timbiqui: (the towns of Calle larga, Belen, San Agustin, Pascualero, and Cascajero (in Guapi) and in the mining area of Santa Maria, Chacon Playa, and Coteje (in Timbiqui).

The strain of malaria was identified as _Plasmodium falciparum_. The report notes it was indicated that the presence of malaria was recorded in sites never considered endemic, which would be related to factors such as climate change and issues associated with mining that exacerbated the situation.

"This required an immediate displacement of our surveillance team to deal with this outbreak. Visits were made to the area where the cases were presented to make diagnoses with rapid tests and to initiate immediate treatments, "said the department's Health Secretary, Hector Andres Gil Walteros.

On the other hand and as a preventive action, 402 mosquito nets were delivered to 107 homes, benefiting more than 600 inhabitants in the outbreak areas, and treatment was given to the affected people.
=======================
[The Cauca Department is located south of Cali and is considered a malaria risk area by the CDC, see map here:
<https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/yellow-fever-malaria-information-by-country/colombia#5317>.

According to the text an outbreak is highly unusual in the area and mining is mentioned as a likely explanation. Mining especially illegal gold mining create numerous new breeding sites and there is usually a lack of control in the form of larvicidal spraying. - ProMED Mod. EP]

[Maps of Colombia:
Date: Tue, 11 Dec 2018 22:14:43 +0100

Bogota, Dec 11, 2018 (AFP) - The abandoned building where Colombian drug lord Pablo Escobar lived will be covered in posters paying tribute to the victims of his Medellin Cartel before it is torn down next year.   The exhibition is part of a move by municipal authorities to tell the other side of Escobar's story -- that of his victims -- to counter a surge of television series glamorizing his life and that of his cartel.   "Respect our pain, honour our victims (1983-1994). 46,612 fewer lives," reads the message on one of the posters that now greet Medillin's "narco-tourists" flocking to the Monaco apartment block.

Portraits of slain journalist Guillermo Cano, gunned down in 1986, former presidential candidate Luis Carlos Galan and police chief Valdemar Quintero -- both murdered in 1989 -- are emblazoned over a message that reads, in English: "It is not fiction, it is reality."   Mayor Federico Gutierrez told reporters that the tourist site had become a "symbol of illegality."   "Now, there are messages that should lead us to reflect," he said.   The posters will remain affixed to the building until municipal workers tear it down on February 22, more than 25 years after Escobar was shot dead by police in 1993.     The former luxury block will be replaced by a municipal park.
Date: Tue 4 Dec 2018 08:48 AM COT
Source: El Tiempo [in Spanish, machine trans., abridged, edited]

Department health authorities turned on the alarms in Santander after the National Institute of Health confirmed the 1st case of measles in a 6-year-old child from Venezuela residing in Bucaramanga.

The Secretary of Health of Santander, Luis Alejandro Rivero Osorio, explained that "this minor who arrives from Venezuela does not have any vaccines. Fortunately, in the department we try to make sure that parents have their children up to date with their vaccinations."

Rivero Osorio emphasized that the protocols of treatment and follow-up were already activated in the event cases are presented from the Hospital Local del Norte, where the minor from the state of Valencia [Venezuela] was treated, to give attention also to the family and to avoid the spread of the virus.

In Santander there are about 50 possible cases of measles pending confirmation, and since the beginning of this 2018 hospitals and health centres remain alert to the risk posed by the massive arrival of Venezuelans to the region without the complete set of vaccines.
=====================
[Vaccinations are scarce in Venezuela with the current economic situation. As a consequence, vaccine-preventable diseases such as measles are being spread as people leave Venezuela seeking work or new lives in neighboring countries. See next report. - ProMED Mod.LK]

[HealthMap/ProMED-mail maps:
Date: Wed 21 Nov 2018
Source: Outbreak News Today [extracted, edited]

A measles outbreak in Colombia has prompted the Centers for Disease Control and Prevention (CDC) to issue a travel notice last week.

Between March and October this year [2018], Colombia has reported 129 confirmed measles cases.

Of the 129 confirmed cases, 45 were imported, 75 were import-related (25 cases of secondary transmission among persons coming from Venezuela and 50 related to imported cases among Colombians), and 9 with the source under investigation. No deaths have been reported.

The cases were reported in the departments of Antioquia, Arauca, Atlantico, Bolivar, Cauca, Cesar, La Guajira, Magdalena, Norte de Santander, Risaralda, Sucre, and in the districts of Barranquilla, Bogota, Cartagena, and Santa Marta.

Cartagena District and Norte de Santander Department account for 65 percent of the total confirmed cases.

CDC says travellers to Colombia should make sure they are vaccinated against measles with the MMR (measles, mumps, and rubella) vaccine.
Date: Thu, 11 Oct 2018 18:45:51 +0200

Bogota, Oct 11, 2018 (AFP) - Eleven people were killed when a landslide swept away part of a town in central Colombia's coffee-growing region amid heavy rainfall, emergency officials reported Thursday.   Colombia's UNGRD disaster risk management unit said seven females and four males were buried in the landslide that struck the Los Andes suburb of the town of Marquetalia.   Four other people were injured.

Searches for possible missing persons were suspended because of continued heavy rains, it said.   The town is located in the coffee-growing department of Caldas.   "Of the 11 people dead, four were minors, six aged between 20 and 50 years old and one was an older adult," the UNGRD said in statement.   Marquetalia Mayor Luis Carlos Betancourt told journalists the mountain town had been hit by torrential rainfall late Wednesday.   The South American country is currently experiencing its second rainy season, with mountainous regions and part of the Caribbean coast on alert.
More ...

World Travel News Headlines

Date: Fri, 23 Aug 2019 18:13:17 +0200 (METDST)

London, Aug 23, 2019 (AFP) - British Airways pilots on Friday said they will strike for three days in September in a dispute over pay, in a move that could affect tens of thousands of travellers.   The strikes on September 9, 10 and 27 were announced by the British Airline Pilots Association (Balpa), which said there had been a 93-percent vote in favour of industrial action.   "It is completely unacceptable that Balpa is destroying the travel plans of tens of thousands of our customers with this unjustifiable strike action," said the airline.   "We are extremely sorry that after many months of negotiations, based on a very fair offer, Balpa has decided on this reckless course of action," it said.

British Airways said it would change schedules to try and ensure as many people as possible can take their flights but warned that "many" customers will not be able to travel.   "We will be offering refunds and re-bookings for passengers booked on cancelled flights," it said.   Balpa said the strikes were "a last resort" but added that pilots had made "sacrifice after sacrifice" in recent years.   Balpa estimated each day of strike action would cost the company around £40 million (44 million euros, $49 million).
Date: Fri, 23 Aug 2019 15:08:04 +0200 (METDST)
By Obert SIMWANZA

Lusaka, Aug 23, 2019 (AFP) - Children living in a central Zambian mining town are still exposed to high levels of toxic lead 25 years after the mine closed, Human Rights Watch said Friday, as lawyers announced plans to take legal action.   Decades of lead mining have left Kabwe, around 150 kilometres (95 miles) north of Lusaka, severely polluted, with serious health implications for residents.   The mine, which operated from the early 1900s until its closure in 1994, was at one time the world's largest lead mine. It was run by the Zambian government from the early 1970s when the mining industry was nationalised.     In a report published Friday, HRW said the town in the Copperbelt area still has extreme levels of contamination and children continue to be exposed to high levels of toxic lead in soil and dust around their homes, schools and play areas.

HRW's children's rights fellow and report author Joanna Naples-Mitchell described the situation in Kabwe as "a public health emergency" and said the government was "not responding with the sense of urgency that is warranted".    "The Zambian government is aware that Kabwe has been severely contaminated... since the 1990s and efforts to clean up have been inadequate," she told AFP.   A class action suit is being prepared to demand compensation for poisoning from Anglo American South Africa, a former investor in the mine, London-based law firm Leigh Day announced Friday. The law firm deals in human rights issues.   The case will be brought in courts in South Africa, where the mining firm is based, said the lawyers, who are acting on behalf of some 200 children who have been treated for lead poisoning.   Anglo American on Friday said in a statement it did not believe it was "in any way responsible for the current situation" in Kabwe.    "We were concerned to learn of the situation at Kabwe as reported by the press," it said, adding "the nationalisation more than 40 years ago effectively placed these issues under the control of the Zambian Government".

- 'Severely contaminated' -
The HRW report said that although lead and zinc mining have stopped in the town, various medical studies conducted over the past seven years show children there still had elevated levels of lead in their blood.   Between 2003 and 2011, the World Bank funded a government project to decontaminate Kabwe's affected townships, and to test and treat children. But some 76,000 people, or a third of the town's population, still live in contaminated areas.   One recent study published last year and cited by HRW estimated that more than 95 percent of children in the townships surrounding the lead mine have elevated blood lead levels and that about half of them require medical intervention.   "This is the worst environmental disaster I have seen in 30 years of practice," said lawyer Richard Meeran of Leigh Day.    Johannesburg-based collaborating lawyer Zanele Mbuyisa said they will argue that "the environmental damage created has potentially contaminated almost three generations of men, women and children".

- Insufficient resources -
Three years ago, the government launched another five-year World Bank-funded project to get rid of the lead and carry out new rounds of testing and treatment.   The project targets around 10,000 people including children, pregnant women and mothers.   "We think this a very important opportunity for the Zambian government to find a lasting solution to this problem," said Naples-Mitchell.   She urged Zambia to find new and effective methods to clean up the lead, adding that their 2018 study indicated that pollution levels were "as high they had been in the 1970s".    In a letter last month, the government indicated to HRW that it does not have enough resources to address the full scale of the contamination.   The government did not immediately comment on the report.   Children are more vulnerable to lead poisoning since they absorb four to five times as much as an adult and this can retard their growth and IQ, while in worst cases it can result in brain damage or even death.
Date: Fri, 23 Aug 2019 14:02:01 +0200 (METDST)

Khartoum, Aug 23, 2019 (AFP) - Rain and flash floods have killed 54 people in Sudan since the start of July and affected nearly 200,000, the United Nations said Friday.   The worst affected area is While Nile state in the south but Khartoum and other regions have also been affected.   "More than 37,000 homes have been destroyed or damaged," the UN said, quoting figures from the government body it partners with in the crisis response.   "Humanitarians are concerned by the high likelihood of more flash floods," it said, adding that most of the 54 recorded deaths were due to collapsed roofs and electrocution.

The floods are having a lasting humanitarian impact on communities, with cut roads, damaged water points, lost livestock and the spread of water-borne diseases by insects.   The UN Office for the Coordination of Humanitarian Affairs said an extra $150 million were needed from donors to respond to the floods, in addition to the $1.1 billion required for the overall humanitarian situation in Sudan.
Date: Thu, 22 Aug 2019 21:40:50 +0200 (METDST)

Warsaw, Aug 22, 2019 (AFP) - At least five people, including two children, were killed and more than 100 others were injured Thursday during a sudden thunderstorm in Poland and Slovakia's Tatra mountains, according to rescuers and officials.   Most of the victims were on the Polish side, where lightning struck a large metal cross on top of Mount Giewont and a metal chain near the summit, rescuers said. One person died in Slovakia.   "There were a lot of incidents involving lightning strikes today in the Tatras," Polish mountain rescue service chief Jan Krzysztof told Poland's PAP news agency.    "More than 100 people are injured," Poland's Prime Minister Mateusz Morawiecki said after arriving in the nearby mountain resort town of Zakopane.

Rescuers believe many hikers were nearby when lightning struck the cross on Giewont's summit.   They had set out to climb Poland's highest mountains when the skies were clear earlier in the day.    "We heard that after (the) lightning struck, people fell... the current then continued along the chains securing the ascent, striking everyone along the way. It looked bad," Krzysztof said.    Lightning also struck on the nearby Czerwone Wierchy mountain massif, injuring a Portuguese citizen.
Date: Wed 21 Aug 2019
Source: Forbes [edited]

A Missouri county has imposed mandatory hepatitis A vaccinations for food handlers. Franklin County, Missouri, joins a handful of jurisdictions across the country with mandatory hepatitis A vaccine programs aimed at preventing further cases. This development is part of a larger trend aimed at expanding vaccinations for hepatitis A and addressing future outbreaks of the disease.

Hepatitis A is a contagious liver disease that can cause symptoms ranging from fever to jaundice and, in extreme cases, liver failure and death. According to the Centers for Disease Control and Prevention, the virus is most commonly spread in the USA via the fecal-oral route, meaning that a person unknowingly ingests something contaminated with the faeces of an infected person.

Hepatitis A is a particularly insidious virus, as an infected person is most contagious 2 weeks before symptoms develop, and those symptoms can take as long as 50 days after exposure to develop. Fortunately, hepatitis A is preventable by vaccine.

CDC is investigating outbreaks of hepatitis A across 29 states. According to CDC, 233 individuals have died from hepatitis A between 2016 and 2019 out of over 24 000 reported cases. Several states, including Kentucky, Florida, Ohio, and West Virginia, have seen thousands of cases.

In an effort to curb the increase in reported cases of hepatitis A, many local jurisdictions are considering mandatory hepatitis A vaccines for food service workers. For example, Missouri has reported 387 cases of hepatitis A in the past 2 years. Over 50 of these cases are from Franklin County, which has a population of about 100,000 residents. Franklin County officials have imposed mandatory vaccinations for individuals who handle food. Food establishments, including restaurants, have 90 days to ensure their employees are vaccinated. Nearby St Louis County, Missouri enacted a mandatory vaccine requirement nearly 20 years ago. Similar ordinances requiring vaccines for food service workers were enacted in Kentucky's Ashland and Boyd Counties in 2018.  [byline: Tommy Tobin]
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[A campaign to protect the patrons of restaurants from acquiring hepatitis A from the food as being done now in this county in Missouri is more than reasonable, as has been stated here previously. In addition to the recent outbreak of 23 cases of HAV linked to a New Jersey golf club (see alsos below), the following is an only partial list of recent reports of restaurant employees acquiring HAV:

Washington 16 Aug 2019
Hepatitis A forces Lynnwood restaurant to temporarily close

New York 16 August 2019
Confirmed case of hepatitis A in Platinum Pizza employee, vaccines to be made available to patrons

Florida 6 Aug 2019
Ocala restaurant employee infected with hepatitis A, officials say

Tennessee, Ohio 1 Aug 2019
National epidemic of hepatitis A outbreaks puts restaurant customers at risk

Mississippi 24 Jul 2019
Health officials investigating possible hepatitis A exposure at Mississippi restaurant

HealthMap/ProMED map available at:
Missouri, United States: <http://healthmap.org/promed/p/227>]
Date: Sun 18 Aug 2019
Source: Associated Press [edited]

Health officials in Las Vegas are using the word "outbreak" to describe a sharp spike in hepatitis A cases reported mostly among homeless people and drug users. The Southern Nevada Health District reported on Wednesday [14 Aug 2019] that from November [2018] to June [2019] it tallied 83 cases of the virus that causes liver damage and can lead to death.

That's far more than the 58 cases reported in 2016, 2017, and 2018, combined. The district says more than 80% of reported patients were people without a permanent place to live, and 92% use drugs, whether intravenous or not.

Clinical services chief Dr Fermin Leguen told the Las Vegas Review-Journal recently that the numbers are alarming. He noted that cases are being reported nationwide. Public health emergencies have been declared in cities including Miami and Philadelphia, and the Centers for Disease Control and Prevention is tracking outbreaks in 27 states. An outbreak of hepatitis A among homeless people in San Diego killed 20 in 2017.

Clark County officials announced in July 2019 that during a 2-day count in January 2019, almost 5300 people were tallied living on sidewalks, vacant lots, parks, and drainage tunnels in and around Las Vegas. That was down from about 6100 in 2017. The Southern Nevada Health District said the trend in hepatitis A cases has been upward: 6 reported cases in 2016; 13 cases in 2017; and 39 in 2018.

The Review-Journal accompanied a crisis intervention team visiting hepatitis A "hot spots" in Las Vegas to offer vaccine shots. The vaccine for the hepatitis A virus is effective soon after inoculation, although a 2nd dose is required after 6 months for full coverage.

Fuilala Riley, president of Help of Southern Nevada, told the newspaper that access to running water for people to wash their hands is important in preventing spread of the virus. Hepatitis A is most often transmitted through consumption of water or food contaminated with faeces.
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[Nevada has yet to be listed in the CDC site following this unnecessary outbreak.  As the number of cases continues to rise in a number of states, and news of smaller (so far) outbreaks occur in others, the question at the end of ProMED-mail post http://promedmail.org/post/20190104.6241686 by a Kentucky official -- "This is a disease of developing countries. One has to ask: Why are we seeing it in the USA?" -- is more and more relevant. We are seeing these outbreaks because of the inability to deal with marginalized populations in our midst. The dramatic cutbacks in public health infrastructure in some of these states clearly feed the fire of these outbreaks. They must be addressed by bolstering public health resources and education and directly addressing the needs of these marginalized populations. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Las Vegas, Nevada, United States:
Date: Wed 21 Aug 2019
Source: Bring Me the News [edited]

There have now been 69 people to have fallen sick from the _Escherichia coli_ outbreak at Lake Nokomis. Health officials put out an alert earlier this month [August 2019] after 3 children became sick with the bug after swimming at the lake, prompting the closure of both its beaches.

The Minnesota Department of Health said on Friday [16 Aug 2019] it had received 49 confirmed cases of _E. coli_-related illness since the outbreak, and on Tuesday [20 Aug 2019] revealed that this number had grown to 69. Those affected went swimming at the south Minneapolis lake between 16 Jul and 11 Aug 2019, with the Shiga-toxin producing _E. coli_ taking up to 16 days to show symptoms. [We generally consider 10 days to be the long end of the incubation period. - ProMED Mod.LL]

Both beaches at the lake have been closed and will remain that way for the rest of the season, as part of MDH's response to contain the outbreak. Of the total cases, 20% affected children aged 10 and younger. Fortunately, nobody has required hospitalization.

The Star Tribune reports that with other beach closures at Bde Maka Ska and Lake Hiawatha, among others, this summer, it is the most beach closures seen in the city since it started testing for bacteria in 2003. The MDH advises anyone showing symptoms of a Shiga-toxin _E. coli_ infection -- diarrhea (often bloody), stomach cramps, no or low-grade fever -- should see a healthcare provider.  [byline: Adam Uren]
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[This has become a substantial outbreak.  It is important to understand that there are many different kinds of _E. coli_. The organism is an important component of the human intestinal tract and can perform important functions helpful to its host. These strains can cause human infections if they "escape" from the usual location into the urinary tract, gall bladder, or abdominal cavity. They are also what are mentioned when a beach is closed for _E. coli_ contamination. In this circumstance, officials are measuring the organism or "coliforms" in the water to reflect human sewage contamination.

In addition, some strains of _E. coli_ can produce toxins that can induce diarrhea, and much of so-called travelers' diarrhea is caused by these strains. All of these strains are human bacteria, not zoonotic organisms, that is, not spread from animal hosts. One _E. coli_ group called Shiga toxin producing or enterohemorrhagic _E. coli_ (EHEC), the organism likely to be involved here, is zoonotic. Spread in a number of ways, including via undercooked ground beef, contaminated vegetables, and direct or direct contact with farm animals including contaminated water, EHEC can cause significant disease and even death.

In the spring of 2000, in Walkerton, a town of 5000 in southern Ontario, an outbreak of _E. coli_ O157:H7 infection claimed 7 lives -- 6 adults and a child -- and over 200 were seen at local area hospitals.

Swimming-associated transmission is illustrated in the following references:

1. Keene WE, McAnulty JM, Hoesly FC, et al. A swimming-associated outbreak of hemorrhagic colitis caused by _Escherichia coli_ O157:H7 and _Shigella sonnei_. N Engl J Med. 1994; 331(9): 579-84; available
2. CDC. Lake-associated outbreak of _E. coli_ O157:H7 - Illinois. MMWR 1996; 45(21): 437-9; available at
3. Ackman D, Marks S, Mack P, et al. Swimming-associated hemorrhagic colitis due to _Escherichia coli_ O157:H7 infection: evidence of prolonged contamination of a fresh water lake. Epidemiol Infect. 1997; 119:1-8; available at

[HealthMap/ProMED-mail map of Lake Nokomis, Minnesota, United States:
28 Jul 2019

As many as 13 have died while 6677 have been infected across Tanzania. In Dar es Salaam region alone, 6631 cases and 11 deaths have occurred.

HealthMap/ProMED-mail map of Tanzania:
8 Aug 2019

Dengue-type1 outbreak was declared on the 27 Feb 2019 following a laboratory (NZLabPlus) confirmation of 7 dengue type 1 cases. From 28 Jan-4 Aug 2019, a cumulative number of 78 dengue cases have been reported (22 confirmed, and 56 probable-NS1Ag positives). Rarotonga and Aitutaki are the only islands affected and most of the cases have been from the main island of Rarotonga. Aitutaki has managed to contain its number of cases to 3. The last case was reported on 18 Apr 2019. A total of 42 cases have been hospitalised and given free mosquito nets to take and use at home. Apart from some severe cases, the hospitalisation was also an effort to contain and minimise the spread of the infection into the community. Unfortunately, some cases refused to be admitted but were given some health advice and mosquito precautionary measures. No deaths reported.

- Cook Islands. 17 Aug 2019. 78 dengue cases have been reported in Cook Islands since the outbreak began early in the year [2019]. The Cook Islands News reports the Ministry of Health saying 22 were confirmed cases while 56 have been deemed probable positives.

HealthMap/ProMED-mail map of Cook Islands:
19 Aug 2019

358 indigenous cases and 2 imported cases of dengue 2 have been confirmed since the beginning of 2019, according to the latest Health Watch bulletin. Tahiti is still in an epidemic phase: all communes are affected except Mahaena, Pueu, and Teahupoo. In the islands, Bora-Bora is in epidemic phase (at least 3 cases without epidemiological link): Vaitape and Faanui are affected. Moorea is in an epidemic phase: The communes of Afareaitu, Haapiti, and Paopao are affected. Six islands are in the alert phase: Nuku-Hiva (Taiohae), Fakarava, Raiatea, Rangiroa, Huahine, and Hiva Oa (Atuona). Since dengue type 2 has not circulated in the country since the year 2000, the population is poorly immunized, and the epidemic may be large. People under 20 or arriving in French Polynesia after 2000 are most at risk of becoming infected.

HealthMap/ProMED-mail map of French Polynesia: