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Andorra

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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;
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Tetanus (childhood booster)
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Typhoid (food & water borne disease)
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Hepatitis A (food & water borne disease)
For those 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 10 Jul 2018
Source: MSN [edited]

Samoa has issued an immediate recall of the vaccine for mumps, measles and rubella (MMR) following the deaths of 2 infants who reportedly passed away just hours after receiving their shots. The 2 children, a boy and a girl, were both aged about 12 months. They were not related, came from different communities and were vaccinated on [Fri 6 Jul 2018] using the same batch of the MMR vaccine.

Australian forensic experts will fly into the country tonight to help investigate the incident, which happened at the Safotu District Hospital on the island of Savai'i.

In a statement, Samoan Prime Minister Tuilaepa Sailele expressed condolences to the children's families and called for a full inquiry."There are already processes that will determine if negligence is a factor," Mr. Tuilaepa said. "And if so, rest assured those processes will be implemented to the letter to ensure that such a tragedy will not be repeated and those responsible will be made to answer."

Health officials said testing was underway to see if the vaccine was responsible, and it has been recalled nationwide as a precautionary measure. The Government has called on the World Health Organisation (WHO) for assistance. Rasul Baghirov, the WHO's Samoa Representative, told the ABC's Pacific Beat program the situation was serious, but it was too early to determine exactly what caused the deaths.

"These deaths are a tragedy and the Government is committed to understanding exactly what happened, for the families of those children, but also to ensure the ongoing safety of the immunisation program," Dr Baghirov said.

He said the investigation would examine the vaccine itself, the injecting equipment and the storage arrangements for the vaccine. The training and conduct of staff would also be looked at, as well as the medical history of the infants' families. An autopsy team from the Victorian Institute of Forensic Medicine in Melbourne will arrive in Samoa tonight to assist the investigation.

Severe vaccine reaction 'very, very rare'. Dr Baghirov said there have been no other reported cases of children dying after being vaccinated using the batch supplied to Samoa.

The vaccines were from India, were safety checked by the WHO and supplied by the United Nations Children's Fund (UNICEF).

"The MMR immunisation is the best way to reduce a child's risk of getting these highly infectious diseases," Dr Baghirov said. "It has been used around the world for many years, providing more than 2 billion children with protection against these diseases. The severe reaction following the administration of MMR vaccine is very, very rare -- that's why we want to really investigate and find out what caused the deaths here in Samoa."

UNICEF's Pacific Representative Sheldon Yett said it was important for people concerned by the case to remember that vaccines are safe.  "Stopping immunisation would be a disaster for children in the South Pacific and around the world," he said. "It does make sense to pause, and do a complete investigation to know what specifically happened here. "But stopping immunisation of course would be a very wrong approach to pursue here."  [Byline: Catherine Graue & Michael Walsh]
======================
[The very unfortunate death of these 2 infants should be investigated immediately, but it is a mistake to completely stop vaccination, which would result in more morbidity and possibly mortality. All vaccines carry a minimal risk, which generally is mild and only very rarely severe. It is not clear whether there were underlying conditions such as a weakened immune system or allergies in these 2 infants that led to complications from the MMR vaccine, or even whether the vaccine was truly the cause of death. The enquiry will look into the vaccine itself, equipment, storage of the vaccine and its administration. It is important to monitor the safety of this very commonly used vaccine, as appears to have been done by WHO in this case. Only a strong monitoring program will reassure the public.

According to CNN report (<https://www.cnn.com/2018/07/10/health/samoa-mmr-baby-deaths-intl/index.html>), "Vaccines prevent almost 6 million deaths worldwide every year, according to the World Health Organization. In countries that widely use vaccines, diseases such as measles have been nearly eradicated, with a 99 percent reduction in cases."

Typically given in 2 doses in early childhood, the MMR vaccine protects against 3 diseases: measles, mumps, and rubella.

One dose is about 93 percent effective at preventing measles if the person is exposed to the virus, while 2 doses are about 97 percent effective, according to the US Centers for Disease Control and Prevention (CDC).

Dr. Sanjay Gupta: Benefits of vaccines are a matter of fact.

"Most children in the world receive this vaccine or similar vaccines to this," Helen Petousis-Harris, a vaccinologist at the University of Auckland, told CNN. "We have safety data on the vaccine, we understand the effects really well. This type of case is exceedingly rare."

Furthermore, she said, child mortality has gone down in many countries that use these vaccines.

"Every country has a vaccine program that has been demonstrated to be very safe," she added. "At the moment we need to understand what's happened so we can work out strategies to ensure it doesn't happen again. There's a lot we don't know about (the deaths)." - ProMED Mod.LK]

[HealthMap/ProMED map available at:
Date: Thu, 12 Jul 2018 03:45:09 +0200

Wellington, July 12, 2018 (AFP) - International health experts launched an investigation Thursday into why two Samoan infants died shortly after receiving childhood vaccination injections in a tragedy that has rocked the close-knit Pacific nation.

The tiny country has suspended its vaccination programme and seized all doses for testing after the deaths at the Safotu District Hospital last Friday.   The health department said two one-year-old babies, a boy and a girl, died soon after being administered a vaccine for measles, mumps and rubella (MMR).   A World Health Organisation expert has arrived to investigate and a specialist from UNICEF was also en route, along with a forensic pathologist to carry out autopsies, it added.

"We will investigate the cause and will take the appropriate actions to ensure that the lives of Samoan children will not be compromised in the future," the director-general of health Take Naseri said.   Samoa Prime Minister Tuilaepa Sailele Malielegaoi expressed his condolences at the deaths, which have rattled the nation of 195,000 people.   Malielegaoi, who almost lost his grandson several years ago under similar circumstances, said an inquiry would look at whether negligence was a factor.

Medical experts say the cause of the deaths remains unknown and have warned the tragedy should not be exploited by anti-vaccination activists.   "The message is -- please understand vaccination is very safe, it's very appropriate and everyone should still continue with their appointments as currently planned," Australian Medical Association president Tony Bartone told Sky News.

University of Auckland vaccinologist Helen Petousis-Harris said almost every child in the world received an MMR vaccine or a similar jab and deaths were extremely rare.   "There are two main reasons why something like this might happen," she said.   "Medical error, where the vaccine is prepared for injection incorrectly and the wrong substance is injected, (or) contamination of the vaccine due to leaving it at room temperature for a long period of time."

WHO data shows measles kills about 134,000 children a year and rubella causes some 100,000 children to be born with birth defects such as deafness.   Concerns about the MMR vaccine surfaced in 1998 when a British study, since discredited, linked it with autism.   While the study was found to be a fraud and the autism link debunked, vaccination rates have dropped in some countries as parents prevent children receiving their shots.
Monday 16th April 2018

- Samoa. 9 Apr 2018. Serotype 2 Outbreak in Samoa, 2017/2018. The cumulative total as of 18 Mar 2018 is 3255, with a national attack rate of 16.6 per 1000 population. Dengue fever continues to spread geographically, mostly in the Apia Urban and North West Upolu regions. A majority of those affected are 5-9-year-old children, which make up 31 percent of the total cases. There have not been any dengue related deaths reported, hence the total dengue-related mortality remains at 5.
Date: Mon 15 Dec 2014
Source: Radio New Zealand [edited]

The number of people infected with chikungunya in Samoa has reached more than 3000.

Ministry of Health figures up until the last week of November [2014] show 3135 cases of the mosquitoborne virus. The ministry says 333 people reported to hospitals that week, the most number of people showing symptoms of the disease in one week since the initial outbreak in July [2014].

The latest numbers mean that 1.7 per cent of Samoa's population has contracted "chik", whose symptoms include fever, sore joints, and a rash. The ministry says the largest clusters of chikungunya are within the Faleata and Vaimauga districts and more women than men have been affected.

There have been no deaths from chikungunya in Samoa. In French Polynesia, 5 people have died and more than 35 000 people have been affected by the disease.
=================
[The chikungunya outbreak continues to grow in Samoa, from 269 cases reported on 25 Aug 2014, to 626 cases on 20 Sep 2014, to an estimated 2500 on 24 Nov 2014, and now to 3135 cases, with cases reported throughout Samoa. Vigilance alone will not halt the outbreak. The Ministry of Health and the public will need to cooperate in the elimination of the breeding sites of the vector mosquitoes.

A map showing the location of Samoa in the Pacific Ocean can be accessed at
a HealthMap/ProMED-mail map can be accessed at
Date: Wed 10 Dec 2014
Source: Outbreak News Today [edited]

The chikungunya outbreak in the Pacific Islands continue to balloon, particularly in French Polynesia, where health authorities report seeing an estimated 9000 new cases during the past week.

According to numbers released by the Auckland Regional Public Health Service in New Zealand, as of [1 Dec 2014], the following island countries are battling an on-going chikungunya outbreak: French Polynesia: 18,352 cases, American Samoa: 1148 cases, Samoa: more than 2500 suspected cases and Tokelau: 159 suspected cases.

Radio New Zealand reported more up-to-date numbers today [10 Dec 2014] showing the French Polynesia outbreak is actually up to 27,000 cases and 5 deaths.

Chikungunya is a viral disease transmitted by the bite of infected mosquitoes such as _Aedes aegypti_ and _Aedes albopictus_, the same mosquito vector that transmits dengue fever. It can cause high fever, joint and muscle pain, and headache.

Chikungunya does not often result in death, but the joint pain may last for months or years and may become a cause of chronic pain and disability. There is no specific treatment for chikungunya infection, nor any vaccine to prevent it.  [Byline: Robert Herriman]
======================
[Pending the development of a new vaccine, the only effective means of prevention is to protect individuals against mosquito bites.

The chikungunya outbreak in the Pacific islands, especially in French Polynesia, continues with increasing numbers of cases. So far, attempts to halt transmission through mosquito vector control have not prevented the increase in case numbers. There is a dengue outbreak in French Polynesia as well, and those viruses are transmitted by the same mosquito vector. In the absence of available vaccines, mosquito vector control and avoidance of mosquitoes bites are the only preventive measures available. These measures would require active public collaboration through education.

A HealthMap/ProMED-mail map showing the location of the islands in French Polynesia can be accessed at <http://healthmap.org/promed/p/31048>; maps showing the location of American Samoa and Samoa can be accessed at <http://www.worldatlas.com/webimage/countrys/oceania/wsnewz.gif> and <http://healthmap.org/promed/p/2>; maps of Tokelau, a New Zealand territory, can be accessed at <http://www.worldatlas.com/webimage/countrys/oceania/tk.htm> and <http://healthmap.org/promed/p/6767>. - ProMED Mod.TY]
More ...

Morocco

General
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Morocco is a North African country and a favourite destination for many Irish tourists. The climate, relative shortness of the flights and the idyllic swimming conditions encourage many to vis
t.
Safety & Security
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The border regions of the country can be volatile and travellers planning to visit away from the main tourist routes should take extra precautions. The Western Sahara region is still in dispute though there has been an official cease-fire in place since 1991. The possibility of unexploded mines exists though it should be remembered that this area is many miles away from the normal tourist resorts. The level of street crime in Morocco is low but growing. Busy market places, parks and beaches are popular locations for petty criminals. Tourists should take care not to flaunt personal wealth and to avoid travelling away from the main tourist zones late at night. Travelling alone is a particular risk and only authorised guides and taxis should be used. Tourists have been threatened with serious injury at knife point if they have refused to purchase cannabis.
Laws & Customs
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It is an Islamic country and ladies in particular should take care to dress modestly. Islamic festivals can cause significant changes to occur which affect tourists including the holy month of Ramadan when all street cafés close until 5.30pm each day as strict Muslims do not eat during the daylight hours. The main tourist hotels continue to serve food as normal but many shops will remain closed. During these times tourists will need to carefully check their tickets and any travel arrangements may need to be changed. Banks and larger shops will remain open between 9am and 3pm Monday to Friday. Drug offences are treated very seriously and those visiting the Rif Mountains should realise this is a major cannabis growing area. Visitors with Arabic Bibles or those involved in any perceived outreach activity may find they are subjected to prolonged interrogation.
Health Facilities
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The level of health care available in many of the main hotels and resorts is perfectly adequate but care should be taken if your illness necessitates admission. Communication in English may be difficult and many medications will be unavailable. Frequently small private hospitals are used where standards vary greatly. Check that your travel insurance provides adequate cover for repatriation if required.
Food & Water Facilities
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The food and water provided in many of the main tourist resorts is very satisfactory but variations can easily occur and travellers should be careful at all times. Lettuce, undercooked bivalve shellfish (mussels, oysters, clams etc) and untreated water are all frequently implicated in sickness among travellers. Eating previously peeled fruit is also unwise and should be avoided. Bottled water purchased from main shops or hotels should be used for drinking and brushing your teeth.
Insect Bites & Mosquitoes
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There is only a very small risk of malaria transmission throughout Morocco and prophylaxis is not recommended for the majority of tourists. However, sandflies do abound during the summer months and can transmit a nasty disease known as Leishmaniasis. These small flies tend to hover close to the ground in shaded areas and can easily bite without the individual noticing. It is essential to use good insect repellent when at risk and to report any slow healing bite or sore to a doctor after your return home.
Sun Exposure
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The level of sun exposure in Morocco during the summer months can be intense. Take care to avoid the midday sun and use high sun blocking creams at all relevant times. Take particular care of children while in such a hot climate. Extra water and salt will be required to replace the amounts lost through perspiration. Salted crisps and nuts will be a useful source of salt.
Water Sports & Activities
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Many tourist locations in Morocco offer extended water sport facilities for tourists. Always check out what the standard of care is before agreeing to take part. Ask tourists who arrived before you and check with your holiday representative if possible. Confirm that good safety procedures are in place and that your travel insurance covers any accidents as a result of your activities.
Cash Facilities
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Traveller’s cheques and credit cards are accepted in many of the main tourist resorts. ATM machines are available in Casablanca and Rabat. It may be difficult to reconvert Moroccan money back to sterling and so care should be taken not to change too much initially until you clarify your expenses.
Travel by Train
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To visit other parts of the country many travellers use the train journey south from Tangier. However, be wary of any invitation from fellow passengers to alight at Asilah rather than continuing the journey south. A number of tourists have been held hostage and forced to make credit card transactions or cash withdrawals before being freed.
Road Transport
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Many tourists to Morocco hire motorbikes or cars to see more of the country. This is regarded as a high-risk activity and special care will be required at all times. Driving practices throughout Morocco are poor and traffic signals do not always function. Modern freeways link the main cities of Tangier, Rabat, Fez and Casablanca. Flash flooding can occur during the rainy season (November – March).
Rabies
********************************************
Rabies does occur in Morocco and it is essential that you avoid any and all contact with at risk animals. Typically this includes dogs, cats and monkeys but this viral disease can infect any warm-blooded animal. Take particular care to warn children to avoid animals and to report any contact as soon as possible.
Vaccinations
********************************************
There are no essential vaccines for entry into Morocco from Ireland. However most tourists are advised to consider adequate cover against:
*
Poliomyelitis (childhood booster)
*
Tetanus (childhood booster)
*
Typhoid (food and water disease)
*
Hepatitis A (food and water disease)
Those planning a longer or more rural trip will also need to consider cover against diseases like Hepatitis B and Rabies.
Summary
********************************************
The majority of tourists visiting Morocco will remain very healthy and well. However, following simple precautions against food and water disease and sun exposure will be essential.

Travel News Headlines WORLD NEWS

Date: Sat, 2 Feb 2019 14:22:56 +0100

Rabat, Feb 2, 2019 (AFP) - An outbreak of swine flu in Morocco has left nine people dead in the past week, the kingdom's health minister said Saturday.   The spread of the H1N1 virus was "normal" for the time of the year, said Anas Doukkali, quoted by Morocco's official MAP news agency.   The first death in Morocco from the influenza-type virus was reported by local media on Wednesday, since when anxious rumours have spread on social media.   "Vigilant efforts continue to detect possible cases in different hospitals across the kingdom," said government spokesman Mustapha Khalfi.

H1N1 is a respiratory disease contracted through contact between humans and pigs and transmitted between people through inhalation.   A major H1N1 outbreak sparked a World Health Organization pandemic alert in June 2009. It killed around 18,500 people in 214 countries before the alert was lifted in August 2010.
Date: Thu, 20 Dec 2018 13:44:40 +0100

Paris, Dec 20, 2018 (AFP) - Here is a recap of previous attacks targeting foreign tourists holidaying in North Africa, after Moroccan authorities arrested three suspects in the murder this week of two Scandinavian hikers.

- Morocco -
On April 28, 2011, a bomb attack on a popular tourist cafe in the city of Marrakesh kills 17 people, 11 of them European citizens, and wounding dozens of others.   The two men responsible for the attack are sentenced to death and seven others handed jail sentences ranging from two to 10 years.  The bombing is the deadliest in Morocco since attacks in the coastal city of Casablanca in 2003 that killed 33 people and 12 bombers.

- Tunisia -
On March 18, 2015, two men gun down 20 foreign tourists and a policeman at the Bardo National Museum in Tunisia. Among the dead are French, Italian and Japanese nationals.   The two attackers are shot dead by security forces.    The carnage, claimed by the Islamic State (IS) group, is the deadliest assault on foreigners in Tunisia since 2002.   Twenty-five people are being tried for the attack and could face the death sentence.   On June 26, 2015, a Tunisian student goes on a shooting spree at the Riu Imperial Marhaba Hotel in the beach resort of Sousse, killing 38 foreign tourists including 30 from Britain. The attack is claimed by IS.   The trial begins in May 2017 with 26 Tunisian nationals prosecuted including six members of the security forces accused of not assisting people in danger.

- Algeria -
On September 21, 2014 French national Herve Gourdel, 55, is kidnapped while hiking in a national park in the northeastern Kabyle region of Algeria.   Three days later the IS-linked Jund al-Khilifa, or "Soldiers of the Caliphate", claims to have beheaded Gourdel in a video posted online after Paris rejected their demand to halt air strikes in Iraq.  Gourdel's body is found three months later.
Date: Tue, 18 Dec 2018 11:59:06 +0100

Rabat, Dec 18, 2018 (AFP) - Moroccan authorities on Tuesday arrested a suspect following the murder of two Scandinavian women in the High Atlas mountains, a popular trekking destination for tourists.   Other suspects are being sought over the killings of the Danish and Norwegian hikers who were found dead on Monday with cuts to their necks, the interior ministry said.   The bodies were discovered in an isolated mountainous area 10 kilometres (six miles) from the tourist village of Imlil in the High Atlas range.   Imlil is a starting point for trekking and climbing tours of Mount Toubkal, which at 4,167 metres is the highest summit in North Africa.

The suspect was arrested in the former imperial city of Marrakesh, a tourist hub located at the foot of the mountains about 60 kilometres north of Imlil, and held in custody for questioning, the ministry said.   The Moroccan authorities described it as a "criminal act" but did not give further details about the circumstances of the murders.   The Danish victim, Louisa Vesterager Jespersen, 24, "had her throat cut," her mother Helle Petersen was quoted by the Danish newspaper B.T. as saying.   Her family had warned her against going to Morocco "because of the chaotic situation," she added.   According to her Facebook page, Jespersen had studied in Norway to be a guide.

- 'Every precaution' -
Norwegian media named the other victim as 28-year-old Maren Ueland.   "Her priority was safety. The girls took every precaution before going on this trip," her mother Irene Ueland told Norwegian broadcaster NRK.   The two women studied at a university in southern Norway and had planned to travel together for a month, she said, adding that her last contact with her daughter was on December 9.

A Norwegian policeman from the embassy in Rabat is travelling to Marrakesh to act as a liaison between the authorities.   Security was stepped up in the region and hiking suspended following the discovery of the bodies, Moroccan media said.   "It's very bad for the region. There will undoubtedly be cancellations," a local guide, Hossein, told AFP from Imlil.   Tourism is a cornerstone of Morocco's economy and the kingdom's second-largest employer, after agriculture.   The sector accounts for 10 percent of national income and is one of the country's main sources of foreign currency.   After several years of near-stagnation, Morocco welcomed a record 11.35 million visitors in 2017, exceeding the 11-million mark for the first time.
Date: Mon 12 Nov 2018, 9.54 AM EST
Source: The Guardian [edited]

A Briton has died after contracting rabies while visiting Morocco, public health officials have said. The UK resident was infected with the disease after being bitten by a cat, Public Health England (PHE) said on [Mon 12 Nov 2018]. PHE did not release any further details but reassured the public there was no wider risk. It said health workers and close contacts of the deceased were being assessed and offered vaccination where necessary.

Jimmy Whitworth, the professor of international public health at the London School of Hygiene and Tropical Medicine, told the Press Association: "My understanding is that this is somebody who had contact with a cat that was behaving abnormally and sought care, I believe in Morocco and in the UK, but unfortunately didn't receive vaccination until it was too late. I believe that the cat bit this person a few weeks ago."

He said that symptoms typically took 2 to 3 months to appear but could materialise in as little as a week. "That's why seeking prompt care and getting vaccination is so important," he said. "In this tragic case the person didn't get the vaccine in time." Given the lack of information, Whitworth said it was impossible to know whether the delay was in the UK or Morocco but it illustrated the importance of health workers being aware of the possibility of the disease.

There are no documented instances of direct human to human transmission of rabies. The disease does not circulate in either wild or domestic animals in the UK, although some species of bats can carry a rabies-like virus.

[Rabies] is common elsewhere, including in parts of Asia and Africa. PHE said the case was a reminder to travellers to rabies-affected countries to avoid contact with dogs, cats and other animals wherever possible, and seek advice about the need for a rabies vaccine prior to travel.

Dr Mary Ramsay, the head of immunisations at PHE, said: "This is an important reminder of the precautions people should take when travelling to countries where rabies is present. If you are bitten, scratched or licked by an animal you must wash the wound or site of exposure with plenty of soap and water and seek medical advice without delay."

It is only the 6th case of human rabies in the UK since 2000, all but one caused by animal exposure overseas. The last was in 2012, when a woman in her 50s died in London after being bitten by a dog in South Asia. She was reportedly turned away twice by doctors at a hospital in Kent before she was finally diagnosed.  [byline: Haroon Siddique]
======================
[According to another media source, the victim, a 58 year old man from Aylesbury Bucks, was staying 30 miles away from the Moroccan capital Rabat, visiting family, when he was infected with the disease. He did receive treatment but allegedly was not given anti-rabies serum in time;  <https://www.dailymail.co.uk/news/article-6382379/PICTURED-British-father-two-died-rabies-UK.html>.

The following statistics on rabies in animals were submitted by
Morocco for 2016 (last available annual report):
Official vaccinations in dogs: 71 759
Rabies outbreaks: 76

species / cases / deaths / killed
dogs / 41 / 28 / 13
cats / 12 / 11 / 1
bovine / 71/ 62 / 9
equine / 44/ 38/ 6
ovine / 6 / 5 / 1

The numbers of human cases, as reported to the OIE for the years 2010-2015, were 19, 18, 19, 24, 20, and 19, respectively. The number of human cases during 2016 (the most recent available data) was 17.

The tourism industry is well developed in Morocco; in 2017, Morocco was Africa's top tourist destination, with 10.3 million tourist arrivals, most of them from Europe, predominantly France and Spain. In the past, cases of rabies in animals illegally introduced from Morocco with returning visitors were recorded in France

The event is being investigated. - ProMED Mod.AS]

[HealthMap/ProMED maps available at:
England, United Kingdom: <http://healthmap.org/promed/p/279>
Date: Mon, 12 Nov 2018 15:54:12 +0100

London, United Kingdom, Nov 12, 2018 (AFP) - A Briton has died after being bitten by a cat with rabies in Morocco, officials said Monday, only the seventh known case in the United Kingdom since 2000.   England's health service issued a reminder Monday for travellers to avoid coming into contact with animals when travelling to rabies affected countries, particularly those in Asia and Africa.

Rabies has been effectively eradicated in Britain, although they do still spread among some bats.   "There is no risk to the wider public in relation to this case but, as a precautionary measure, health workers and close contacts are being assessed and offered vaccination when necessary," said Mary Ramsay, the health service's chief of immunisation.   The Press Association news agency said the person was bitten a few weeks ago and not given potentially life-saving treatment early enough.

Rabies is a viral disease that causes an inflammation of the brain. It is usually fatal by the time the first symptoms emerge.   England's health service said that no cases of humans acquiring the disease from any animal other than a bat have been recorded within the country since 1902.   One person acquired it from a bat in Scotland in 2002, and five people contacted while travelling between 2002 and 2017, the health service said.
More ...

World Travel News Headlines

Date: Sun, 16 Jun 2019 12:02:50 +0200

Patna, India, June 16, 2019 (AFP) - Severe heat has left dozens dead over a 24-hour period in India's Bihar state, as the country enters a third week of searing temperatures, officials said Sunday.   The deaths occurred in three districts of the poor northern state, where temperatures have hovered around 45 degrees Celsius (113 Fahrenheit) in recent days, senior health official Vijay Kumar told AFP.

Forty-nine people died in three districts of the Magadh region that has been hit by drought, he said.   "It was a sudden development on Saturday afternoon. People affected by heatstroke were rushed to different hospitals," Kumar added.   "Most of them died on Saturday night and some on Sunday morning during treatment."   Kumar said about 40 more people were being treated at a government-run hospital in Aurangabad.   "Patients affected by heat stroke are still being brought, the death toll is likely to increase if the heatwave continues."

Most of the victims were aged above 50 and were rushed to hospitals in semi-conscious state with symptoms of high fever, diarrhoea and vomiting.   Twenty-seven people died in Aurangabad district, 15 in Gaya and seven in Nawada district, officials said.    State Chief Minister Nitish Kumar has announced a compensation of 400,000 rupees ($5,700) for the family of each victim.   Harsh Vardhan, India's health minister, said people should not leave their homes until temperatures fall.    "Intense heat affects brain and leads to various health issues," he said.

Large parts of northern India have endured more than two weeks of sweltering heat. Temperatures have risen above 50 degrees Celsius (122 Fahrenheit) in the desert state of Rajasthan.   A heatwave in 2015 left more than 3,500 dead in India and Pakistan.   In 2017, researchers said South Asia, which is home to one fifth of the world's population, could see heat levels rise to unsurvivable levels by the end of the century if no action is taken on global warming.
Date: Sun, 16 Jun 2019 01:30:52 +0200

Wellington, June 15, 2019 (AFP) - A powerful 7.4 magnitude earthquake stuck near the uninhabited Kermadec islands northeast of New Zealand Sunday, the US Geological Survey said as authorities monitored for signs of a tsunami.   New Zealand's civil defence organisation said it was monitoring the situation and if a tsunami was generated it would take at least two hours to reach the country.   The Pacific Tsunami Warning Center said "hazardous tsunami waves from this earthquake are possible within 300 km of the epicentre along the coasts of the Kermadec islands."   The earthquake struck at 10:55am (2255 GMT Saturday) some 928 kilometres (575 miles) north-northeast of the New Zealand city of Tauranga in North Island at a depth of 34 km.
Date: Sun, 16 Jun 2019 00:59:42 +0200

Wellington, June 15, 2019 (AFP) - A magnitude 6.1 earthquake struck Sunday centred 97 kilometres (60 miles) north-east of Ohonua, on the Pacific island of Tonga, the US Geological Survey reported.   The quake hit at 2156 GMT Saturday with an epicentre depth of 10 kilometres, the US global quake monitor said.   The Pacific Tsunami Warning Centre issued no alerts, and there were no immediate reports of damage or casualties.   The reported epicentre lies within the so-called Pacific Ring of Fire, an area of regular seismic activity.   In February 2018, a 7.5 magnitude earthquake in Papua New Guinea killed 150 people and destroyed hundreds of buildings.
Date: Sun, 16 Jun 2019 00:19:43 +0200

Geneva, June 15, 2019 (AFP) - A woman has drowned in Lake Geneva when her sightseeing boat sank as a violent storm battered parts of Switzerland on Saturday, police said.   A man who was in the same boat was able to swim to another vessel from where he fired "two flares", Joanna Matta, police spokeswoman for the canton (region) of Geneva, told AFP.   The man told officers that the woman had been "passing through Geneva" and that the storm had taken them "by surprise", Matta said.   Three police boats and emergency services rushed to the scene. Police divers later retrieved the woman's body from the lake.

The victim, whose nationality remains unknown, was then taken to a hospital in Geneva where she was declared dead.   In a separate incident, the storm also damaged some of the 465 boats taking part in the 81st edition of the Bol d'Or, an annual regatta on Lake Geneva, the event's press service said.   Heavy rain and strong winds lashed the participants on Saturday afternoon, causing boats to capsize although nobody was injured.

However, the storm broke the mast of the ultra-fast "Real Team" catamaran, which had been in the lead and was forced to pull out of the race.   The bad weather struck western Switzerland on Saturday afternoon, bringing hail and winds reaching up to 110 kilometres (70 miles) per hour, according to the national forecaster MeteoSwiss.   In the neighbouring French region of Haute-Savoie the storm also caused damage and left a 51-year-old German tourist dead after a tree came down at a campsite.
Date: Sat, 15 Jun 2019 16:27:09 +0200

Windhoek, June 15, 2019 (AFP) - Drought-hit Namibia has authorised the sale of at least 1,000 wild animals -- including elephants and giraffes -- to limit loss of life and generate $1.1 million for conservation, the authorities confirmed Saturday.   "Given that this year is a drought year, the [environment] ministry would like to sell various type of game species from various protected areas to protect grazing and at the same time to also generate much needed funding for parks and wildlife management," environment ministry spokesman Romeo Muyunda told AFP.

The authorities declared a national disaster last month, and the meteorological services in the southern African nation estimate that some parts of the country faced the deadliest drought in as many as 90 years.    "The grazing condition in most of our parks is extremely poor and if we do not reduce the number of animals, this will lead to loss of an animals due to starvation," Muyunda said.

In April, an agriculture ministry report said 63,700 animals died in 2018 because of deteriorating grazing conditions brought on by dry weather.   Namibia's cabinet announced this week that the government would sell about 1,000 wild animals.   They include 600 disease-free buffalos, 150 springbok, 65 oryx, 60 giraffes, 35 eland, 28 elephants 20 impala and 16 kudus -- all from national parks.   The aim is to raise $1.1 million that will go towards a state-owned Game Products Trust Fund for wildlife conservation and parks management.

The government said there were currently about 960 buffalos in its national parks, 2,000 springbok, 780 oryx and 6,400 elephants.   The auction was advertised in local newspapers from Friday.   Namibia, a country of 2.4 million people, has previously made calls for aid to assist in the drought emergency that has already affected over 500,000 people.   In April the government announced that it will spend about $39,400 (35,200 euros) on drought relief this year to buy food, provide water tankers and provide subsidies to farmers.
Date: Fri, 14 Jun 2019 18:27:56 +0200
By Rosa SULLEIRO

Sao Paulo, June 14, 2019 (AFP) - A nationwide strike called by Brazil's trade unions disrupted public transport and triggered road blocks in parts of the country Friday, ahead of protests against far-right President Jair Bolsonaro's pension reform.   Hours before the opening match of the Copa America in Sao Paulo, some metro lines in the country's biggest city were paralyzed as professors and students also prepared to take to the streets over the government's planned education spending cuts.    It will be the latest mass demonstration against Bolsonaro since he took office in January, but the timing could not be worse for the embattled president as Brazil prepares to play Bolivia in South America's showcase football tournament.

Bolsonaro was expected to attend the opener at Morumbi stadium where police sharpshooters will be deployed as part of increased security for the competition.    One of Brazil's main trade unions estimated 45 million workers had taken part in the strike.   Some 63 cities had been affected by the stoppage, with more than 80 cities recording demonstrations, G1 news site said.   The number of protesters is expected to balloon in the afternoon with demonstrations planned in Brazil's major cities.   Protesters have already blocked some roads in several cities, including Rio de Janeiro and Sao Paulo, where G1 said police had used tear gas to disperse demonstrators and clear the streets.   Brazilians were divided over the partial strike.   "This current government wants to destroy everything that we built decades ago so that's why I'm in favor (of the strike) and I am fighting against social inequality," Vania Santos, 49, told AFP in Rio.    In Sao Paulo, Flavio Moreira opposed the stoppage, however, saying it "hurts the commercial part" of the city.

- Pension savings cut -
Bolsonaro's proposed overhaul of Brazil's pension system -- which he has warned will bankrupt the country if his plan is not approved -- is seen as key to getting a series of economic reforms through Congress.    But the changes, including an increase in the retirement age and workers' contributions, have faced resistance from trade unions and in the lower house of Congress, where Bolsonaro's ultraconservative Social Liberal Party has only around 10 percent of the seats.    A pared-back draft of the reform presented to Congress on Thursday -- which reduces expected savings from 1.2 trillion reais ($300 billion) in 10 years to around 900 billion reais -- did little to appease union leaders, who vowed to go ahead with the shutdown.   Such savings are seen as vital to repairing Brazil's finances and economy, which were devastated by a 2015-2016 crisis.

Economy minister Paulo Guedes, who is spearheading the government's reform agenda, has threatened to resign if the bill is not passed or is watered down significantly.   It caps a tumultuous six months for Bolsonaro, who has seen his popularity nosedive as he struggles to push his signature reform through a hostile Congress and keep Latin America's biggest economy from sliding back into recession.   More than 13 million people are unemployed, the latest data shows, with a record number giving up looking for a job.     Fighting between military and far-right factions of Bolsonaro's government has fueled chaos in his administration where his sons and right-wing writer and polemicist Olavo de Carvalho wield enormous influence.   Bolsonaro sacked his third minister on Thursday -- retired general Carlos Alberto dos Santos Cruz, who had been the government secretary and seen as a moderate voice.   That came on the same day Bolsonaro broke his silence to defend Justice Minister Sergio Moro, who has been accused of wrongdoing while serving as a judge in the sprawling Car Wash anticorruption investigation.
Date: Fri, 14 Jun 2019 06:02:40 +0200
By Clotilde RAVEL

Abidjan, June 14, 2019 (AFP) - "Cover your goods," Diakaria Fofana, a doctor of public health, warns food vendors as a thick cloud of insecticide spray wafts down a street in Abidjan, Ivory Coast's economic capital.   Men in protective clothes, goggles and masks are disgorging plumes of mosquito-killing chemicals in a bid to roll back an outbreak of dengue.   Two people have died and 130 have fallen ill since the fever returned to the West African state last month.

The toll, so far, is tiny compared with other tropical countries, especially in Southeast Asia, where the painful and sometimes deadly disease is an entrenched peril.   But tackling the outbreak is a major challenge for Ivory Coast, a poor country that is having to resort to time-honoured, labour-intensive methods of spraying and neighbourhood awareness campaigns to prevent its spread.   Female mosquitoes carrying the dengue virus transfer the pathogen when they tuck into a blood meal from someone. 

A vaccine does exist, but is not available in Ivory Coast because "it has many secondary effects (and) it's expensive"," explained Joseph Vroh Benie Bi, director of the National Institute for Public Hygiene (INHP).    Developed by French pharmaceutical group Sanofi Pasteur, the vaccine is recommended for use in people aged nine and older, and only for individuals who have already been infected.    Usually accompanied by flu-like symptoms, dengue makes some people very sick indeed, developing into a haemorrhagic fever that can cause difficulty breathing, heavy bleeding or even organ failure. While a first bout of dengue is rarely fatal, subsequent infections are usually worse.

- 'Fighting the mosquito' -
The UN's World Health Organization (WHO) says there are up to 100 million cases of dengue worldwide every year, and almost half the world's population lives in countries where the disease is endemic.   It kills more than 20,000 people each year. Southeast Asia and the Western Pacific are the worst-hit areas.   There is no cure, and the WHO recommends that patients take paracetamol, rest and drinking plenty of fluids.   Five new vaccines are in development, but in the meantime Fofana says: "The only effective means of fighting (dengue) is fighting the mosquito."   In Ivory Coast, most recorded cases have occurred in Abidjan.

Health workers are striving to enlist the public in tackling the mosquito, targeting its life cycle.   "The larvae multiply in stagnant water, for example inside used tyres," said Fofana, deputy director of the vector control unit at the INHP.   "People should never store water in buckets in the open air and they should regularly throw out the water in plates under houseplants."   But he faces an uphill job in a sprawling port city of 4.4 million people in the middle of the rainy season.   What's more, people who are infected, even without knowing it, and can bring the virus to new areas when they are bitten by local mosquitoes.    The WHO has set a goal to halve the number of dengue deaths by 2020, but incidence of the disease has increased 30-fold in the last 50 years.   "Before 1970, only nine countries had experienced severe dengue epidemics. The disease is now endemic in more than 100 countries," it says.

- 'Malaria's big brother' -
In Ivory Coast, where malaria accounts for a third of all medical consultations, many people self-medicate when they experience symptoms such as high fever, vomiting, nausea or aches and pains.   "This is a real problem, because the symptoms of malaria, dengue, typhus and yellow fever are similar. Doing a blood test is absolutely indispensable," said Fofana.   Treatment with the wrong medicines can worsen the situation, he stressed -- aspirin or ibuprofen can increase the risk of bleeding, for example.   In the meantime, the spraying goes on.    "We know the risks," said Bamba Segbe, an Abidjan resident watching the masked men in action. "It's not for nothing that we call dengue malaria's big brother."
Date: Thu, 13 Jun 2019 17:37:51 +0200
By Grace Matsiko

Mpondwe, Uganda, June 13, 2019 (AFP) - At the bustling Mpondwe border post, a woman crossing from the Democratic Republic of Congo into Uganda is whisked away to an isolation unit after a thermal scanner picks up her high temperature.   Health workers keep Mulefu Kyakimwa, a 32-year-old vegetable oil trader, under observation but later discharge her, once Ebola has been ruled out as the cause of her fever.

The border post is on high alert after a family with suspected Ebola escaped isolation on the Congolese side and entered Uganda, where two of them died this week.   The spread of the deadly virus to Uganda comes after months of efforts in a region of porous borders to contain an outbreak in Congo which has killed 1,400 people, according to the latest official data.    "Since the start of the outbreak, the total number of cases is 2,084, of which 1,990 have been confirmed and another 94 are probable," the Congolese health ministry said in its daily bulletin from Wednesday.   "In all, there have been 1,405 deaths -- 1,311 confirmed and 94 probable -- and 579 people have recovered," the bulletin said, adding that 132,679 people had been vaccinated.

- 'We expected it' -
Few people seem to be surprised that Ebola would eventually make its way to Uganda -- which has experienced outbreaks in the past.   "The outbreak is not a surprise. We expected it. People cross the borders all the time and interact a lot," said Dorcus Kambere, a 29-year-old Ugandan bar attendant who feels her job puts her at risk.

At Mpondwe -- where 25,000 people cross daily -- travellers undergo rigorous health checks to detect the lethal virus, which attacks the organs and leads to internal and external bleeding.   Soldiers carrying automatic rifles guide travellers through the screening process, making sure they wash their hands with disinfectant.   The travellers then pass through a shelter with a thermal scanner that feeds people's body temperatures into a computer.   "This is a situation we go through every day since the Ebola outbreak," said Ambrose Nyakitwe, 34, a Ugandan trader returning from the Congo side.   "It is good. I have a family. I have to see that they don't get affected," he added, after passing through the scan.   Outside the busy border post, business carries on as usual, with children swimming and playing in the muddy Lhubiriha river that draws a natural boundary between the two nations.

- 'Not safe' -
A woman serves pancakes with her bare hands from a bucket as pot-bellied money changers lounging next to her carry out their trade.   However, while some carry on seemingly oblivious to the dangers posed by the virus, others are increasingly suspicious.   "It is not safe. If they say people with Ebola crossed into Uganda, how sure are we there are not many who will infect us and are yet to be got?" asked Bernadette Bwiso, 41, a trader.    "Government must do a house-to-house search," she said.   Meanwhile, Nyakitwe is anxious about how the infected patients managed to cross into Uganda despite heightened surveillance.   A Congolese woman -- who is married to a Ugandan -- her mother, three children and their nanny had travelled to DRC to care for her ill father, who later died of Ebola.

The World Health Organization said 12 members of the family who attended the burial in Congo were placed in isolation in the DRC, but six "escaped and crossed over to Uganda" on June 9.   The next day, a five-year-old was checked into hospital in Bwera vomiting blood. Tests confirmed he had Ebola and the family was placed in an isolation ward.   His three-year-old brother was also confirmed to have Ebola, as was their grandmother who died late Wednesday.   Uganda and the RDC are discussing what can be done to intensify collaboration between the two countries to prevent the spread, the Congolese authorities said.

- No surveillance -
Uganda's health ministry said that the surviving travellers and the Ugandan father -- five people in total -- had agreed to be repatriated to DRC on Thursday for treatment and "family support and comfort" from relatives on the other side of the border.   However, three unrelated patients are still in a Ugandan hospital awaiting the result of Ebola tests.

Uganda's Health Minister Jane Ruth Aceng said challenges remained at "unofficial entry points" between Congo and Uganda, which share a porous 875-kilometre (545-mile) border.   These unauthorised border crossings, known as "panyas" in the local Lukonzo language, are often merely planks laid down across a point in the river, or through forests and mountains where there is no surveillance.   In a bid to contain the spread of the disease the Ugandan government has suspended market days and urged people to stop shaking hands and hugging.
Date: Thu, 13 Jun 2019 16:33:58 +0200

Madrid, June 13, 2019 (AFP) - Spain will launch a campaign to urge young people to "always carry a condom on them" as the number of sexually transmitted infections (STI) surges, the government said Thursday.   The news comes a week after the World Health Organization expressed alarm at the lack of progress on curbing STI or diseases (STD), with one expert warning of complacency as dating apps spur sexual activity.   In Spain, videos and ads will be posted from Monday on social networks, music platforms and media that 14- to 29-year-olds most follow, the health ministry said.   "It's normal that you want to do it in your parents' bed. What isn't normal is that you want to complicate your life," reads one ad, going on to show the number of new cases of HIV and other infections.

In a statement, the health ministry urged "everyone -- and particularly the young -- to always have a condom on them and use it."   "The use of condoms has dropped among the 15- to 18-year-olds over the last few years," Health Minister Maria Luisa Carcedo told reporters.   She said there was complacency over STI, including infection by the HIV virus that causes AIDS.   The campaign is a "first shock measure" to challenge the rise of STI among young people, the statement said.   The number of cases of gonorrhoea, for instance, has risen an average of more than 26 percent annually between 2013 and 2017, according to the ministry.

Syphilis "has risen less but in 2017, it reached its highest peak since the start of statistics in Spain: 10.61 infections per 100,000 residents compared to 2.57 in 1995."   The highest rates of chlamydia, meanwhile, are among 20- to 24-year-olds and particularly women, the ministry said.   In 2017, Spain registered close to 24,000 cases of infection by gonorrhoea, syphilis, chlamydia and LGV, a sexually-transmitted disease, according to the statement.
Date: Thu, 13 Jun 2019 15:12:32 +0200

Vilnius, June 13, 2019 (AFP) - Lithuanian temperatures have hit record June highs, meteorologists said Thursday, as a heatwave forced school closures and threatened to reduce harvests in the draught-hit Baltic region.   Kaisiadorys in central Lithuania was the hottest place at 35.7 degrees Celsius (96.2 degrees Fahrenheit) on Wednesday, the highest-ever temperature recorded for June in the country, weather forecaster Paulius Starkus told AFP.   Six people drowned in the Baltic EU state on Wednesday, the deadliest day of the year to date, while some schools put classes on hold or cut lessons short due to the heatwave.

Scientists say the extreme weather is in part a result of climate change.   "Lithuania used to have heatwaves but now they occur more often and are more intense due to climate change," Vilnius University climatologist Donatas Valiukas told AFP.   Starkus said a downpour with thunder and hail could follow in some areas on Thursday afternoon.   Agriculture Minister Giedrius Surplys told lawmakers that some areas were experiencing "a real climatic draught" threatening harvests, while hydrologists warned that river water levels posed a threat to fish.   Demand for air-conditioning has also soared in recent weeks.   Lithuania's hot weather is expected to last through the week, then temperatures may ease below 30 degrees Celsius starting Monday.   Fellow Baltic state Latvia is also experiencing unusual heat for June, with temperatures over 32 degrees Celsius.

In recent days, Latvia's western region of Kurzeme saw thunderstorms with hail damaging buildings, smashing greenhouses and tearing power lines.   Two people have been hospitalised in the northern Latvian town of Cesis after a tree fell on their camper van while they were inside.    Fellow Baltic state Estonia had a heatwave last week and is now experiencing rainy and windy weather.   Poland has also been experiencing high temperatures this month, which has resulted in increased air-conditioner use. The power transmission system operator PSE said that on Wednesday there was record electricity demand for a summer morning at nearly 24.10 gigawatts (GW).   Forty-two people have already drowned in Poland this month, according to the government security centre RCB.