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United Arab Emirates

United Arab Emirates US Consular Information Sheet
28th February 2008
COUNTRY DESCRIPTION: The United Arab Emirates (UAE) is a federation of seven independent emirates, each with its own ruler.
The federal government is a constitutional re
ublic, headed by a president and council of ministers.
Islamic ideals and beliefs provide the conservative foundation of the country's customs, laws and practices. The UAE is a modern, developed country, and tourist facilities are widely available. Read the Department of State Background Notes on the United Arab Emirates for additional information.

ENTRY/EXIT REQUIREMENTS: A passport is required. For stays of less than 60 days, U.S. citizens holding valid passports may obtain visitor visas at the port of entry for no fee. For a longer stay, a traveler must obtain a visa before arrival in the UAE. In addition, an AIDS test is required for work or residence permits; testing must be performed after arrival. A U.S. AIDS test is not accepted. For further information, travelers can contact the Embassy of the United Arab Emirates, 3522 International Court NW, Washington, DC 20037, telephone (202) 243-2400.
Visit the web site of the UAE's Ministry of Information regarding tourism, business, and residence in the UAE at http://www.uaeinteract.org.

Unlike other countries in the region that accept U.S. military ID cards as valid travel documents, the UAE requires U.S. military personnel to present a valid passport for entry/exit.

UAE authorities will confiscate any weapons, weapon parts, ammunition, body armor, handcuffs, and/or other military/police equipment transported to or through a civilian airport.
Americans have been arrested and jailed for transporting such weapons and equipment without the express written authorization of the UAE government, even though airline and U.S. authorities allowed shipment on a US-originating flight.

U.S. citizens and citizens of other countries that are not members of the Gulf Cooperation Council (GCC), who depart the UAE via land are required to pay a departure fee. This fee is 20 UAE dirhams and is payable only in the local UAE dirham currency.

Visit the Embassy of the United Arab Emirates web site at http://uae-embassy.org for the most current visa information.

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

SAFETY AND SECURITY: Americans in the United Arab Emirates should exercise a high level of security awareness. The Department of State remains concerned about the possibility of terrorist attacks against U.S. citizens and interests throughout the world. Americans should maintain a low profile, vary routes and times for all required travel, and treat mail and packages from unfamiliar sources with caution. In addition, U.S. citizens are urged to avoid contact with any suspicious, unfamiliar objects, and to report the presence of the objects to local authorities.
U.S. Government personnel overseas have been advised to take the same precautions. In addition, U.S. Government facilities may temporarily close or suspend public services from time to time as necessary to review their security posture and ensure its adequacy.

Taking photographs of potentially-sensitive UAE military and civilian sites, or foreign diplomatic missions, including the U.S. Embassy, may result in arrest, detention and/or prosecution by local authorities.
In addition, engaging in mapping activities, especially mapping which includes the use of GPS equipment, without coordination with UAE authorities, may have the same consequences.

On several occasions in the past three years, small groups of expatriate recreational boaters were detained by the Iranian Coast Guard for alleged violation of Iranian territorial waters while fishing near the island of Abu Musa, approximately 20 miles from Dubai.
The UAE and Iran have had a long-standing dispute concerning jurisdiction of Abu Musa.
Fishing or sailing in these waters may result in seizure of vessels and detention of passengers and crew in Iran.
Obtaining consular assistance in Iran is difficult and can only be done through the Swiss Embassy in Tehran, which acts as a Protecting Power, providing limited U.S. consular services.

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

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

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

CRIME: Crime generally is not a problem for travelers in the UAE. However, the U.S. Embassy advises U.S. citizens to take normal precautions against theft, such as not leaving a wallet, purse, or credit card unattended. Although vehicle break-ins in the UAE are rare, U.S. citizens are encouraged to ensure that unattended vehicles are locked and that valuables are not left out in plain sight.

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, to contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Basic modern medical care and medicines are available in the principal cities of the UAE, but not necessarily in outlying areas.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention's hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747); fax 1-888-CDC-FAXX (1-888-232-3299), or via the CDC's web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning the United Arab Emirates is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

The police emergency number and ambulance number is 999. Mobile phones are widely used throughout the UAE, so passers-by usually request emergency police and medical services quickly. Response time by emergency services is adequate. However, medical personnel emphasize transport of the injured to the hospital rather than treatment on site. Traffic accidents are a leading cause of death in the UAE because drivers often drive at high speeds. Unsafe driving practices are common, especially on inter-city highways. On highways, unmarked speed bumps and drifting sand create additional hazards.

Country-wide traffic laws impose stringent penalties for certain violations, particularly driving under the influence of alcohol.
In the UAE, there is zero tolerance for driving after consumption of alcohol.
Penalties may include hefty jail sentences and fines over $6,000 and, for Muslims (even those holding U.S. citizenship), lashings. Persons involved in an accident in which another party is injured automatically go to jail, until the injured person is released from the hospital. Should a person die in a traffic accident, the driver of the other vehicle is liable for payment of compensation for the death (known as "dhiyya"), usually the equivalent of 55,000 U.S. dollars. Even relatively minor accidents may result in lengthy proceedings, during which both drivers may be prohibited from leaving the country.

In order to drive, UAE residents must obtain a UAE driver's license. Foreign driver's licenses are not recognized. However, a non-resident visitor to the UAE can drive if he/she obtains a valid international driver's license issued by the motor vehicle authority of the country whose passport the traveler holds. The UAE recognizes driver's licenses issued by other Gulf Cooperation Council (GCC) states only if the bearer is driving a vehicle registered to the same GCC state. Under no circumstances should anyone drive without a valid license.

Please refer to our Road Safety page for more information.
You may also visit the web site of the UAE’s national tourist office and national authority responsible for road safety at http://www.uaeinteract.org.

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

SPECIAL CIRCUMSTANCES: The UAE government does not recognize dual nationality.
Children of UAE fathers automatically acquire UAE citizenship at birth and must enter the UAE on UAE passports. UAE authorities have confiscated U.S. passports of UAE/U.S. dual nationals in the past. This act does not constitute loss of U.S. citizenship, but should be reported to the U.S. Embassy in Abu Dhabi or the U.S. Consulate General in Dubai. In addition to being subject to all UAE laws, U.S. citizens who also hold UAE citizenship may also be subject to other laws that impose special obligations on citizens of the UAE.
For additional information, please refer to our Dual Nationality flyer.

U.S. citizens have at times become involved in disputes of a commercial nature that have prompted local firms or courts to take possession of the U.S. citizen's passport. Travel bans may also be enforced against U.S. citizens involved in financial disputes with a local sponsor or firm. Such travel bans, which are rigidly enforced, effectively prevent the individual from leaving the UAE for any reason until the dispute is resolved. Although it is customary for a local sponsor to hold an employee's passport, it is illegal to do so under UAE law. Most contractual/labor disputes can be avoided by clearly establishing all terms and conditions of employment or sponsorship in the labor contract at the beginning of any employment. Should a dispute arise, the UAE Ministry of Labor has established a special department to review and arbitrate labor claims. A list of local attorneys capable of representing Americans in such matters is available from the Consular and Commercial sections of the U.S. Embassy in Abu Dhabi and the U.S. Consulate General in Dubai.

Codes of behavior and dress in the UAE reflect the country's Islamic traditions and are more conservative than those of the United States. Visitors to the UAE should be respectful of this conservative heritage, especially in the Emirate of Sharjah where rules of decency and public conduct are strictly enforced. Female travelers should keep in mind the cultural differences among the many people who coexist in the UAE and should be cognizant that unwitting actions may invite unwanted attention to them. Isolated incidents of verbal and physical harassment of Western women have occurred. Victims of harassment are encouraged to report such incidents to the U.S. Embassy in Abu Dhabi or the Consulate General in Dubai.

American citizens intending to reside and work in the UAE may have to present personal documents authenticated by the Department of State's Office of Authentications in Washington, D.C. before traveling to the UAE. This can be a complex process involving local, state and federal offices and requiring several weeks to complete.
For procedural information, the Office of Authentications may be contacted by telephone from within the United States at 800-688-9889 or 202-647-5002, by fax at 202-663-3636, or by e-mail at aoprgsmauth@state.gov.
In order to meet UAE government requirements for school registrations and residency sponsorship for family members, Americans intending to bring their families to reside with them in the UAE will need to have their marriage certificate and children's birth certificates, or custody/adoption decrees, if appropriate, authenticated by the Department of State in Washington, DC.
The U.S. Embassy and Consulate General cannot authenticate U.S. local- and state-issued personal, academic or professional documents; they will only be able to authenticate the final authentication document from the Department of State.
Additional information on authentication of documents can be found at http://www.state.gov/m/a/auth/.
In terms of employment, a recent change to UAE labor law requires local sponsors to have employees' diplomas, academic and/or occupational/professional certificates validated through a “Degree Verification” process established in the UAE.
Prospective employees will be required to submit photocopies of such documents for verification to a firm under contract to the Ministry of Labor.

In addition, persons in the education and health professions reportedly have to meet two requirements for validation of their educational credentials at this time – the formal “chain” authentication of academic/professional credentials in the U.S. and the “Degree Verification” process in the UAE.
Different UAE Ministries have different requirements in this regard.
Determining these requirements with one’s prospective employer is strongly recommended before arrival in the UAE.

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 UAE laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the UAE are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.

Legislation enacted in January 1996 imposes the death sentence for convicted drug traffickers. Since January 2006, possession of even trace amounts of illegal drugs has resulted in sentences of four years imprisonment for foreign citizens transiting the UAE. American citizens transiting and entering the UAE’s airports and in possession of illegal drugs have been discovered, arrested and prosecuted by UAE authorities.
As mentioned, in such cases the minimum penalty is four years imprisonment.

Some drugs normally taken under a doctor's supervision in the United States, and even some over-the-counter U.S. drugs and medications, are classified as narcotics in the UAE and are illegal to possess.
A doctor's prescription should be carried along with any medication that is brought into the country.
A person may be subject to arrest and prosecution if possession of prescribed medicines (especially those containing codeine and similar narcotic-like ingredients) comes to the attention of local authorities.
The U.S. Embassy’s web site includes an unofficial list of such medicines, obtained from the UAE Ministry of Health.
Most medications available in the U.S. are also available by doctors’ prescription through hospitals and pharmacies in the UAE.

In addition, the UAE's tough anti-narcotics program also includes poppy seeds, widely used in other cultures, including the U.S., for culinary purposes, on its list of controlled substances. The importation and possession of poppy seeds in any and all forms is strictly prohibited. Persons found to possess even very small quantities of controlled substances listed by the UAE are subject to prosecution by the authorities and may be given lengthy prison terms of up to 15 years. Travelers with questions regarding the items on the list of controlled substances should contact the U.S. Embassy in Abu Dhabi or the U.S. Consulate General in Dubai. If suspected of being under the influence of drugs or alcohol, individuals may be required to submit to blood and/or urine tests and may be subject to prosecution.

Crimes of fraud, including passing bad checks and non-payment of bills (including hotel bills), are regarded seriously in the UAE and can result in imprisonment and/or fines. Bail generally is not available to non-residents of the UAE who are arrested for crimes involving fraud.

Drinking or possession of alcohol without a Ministry of Interior liquor permit is illegal and could result in arrest and/or fines and imprisonment. Alcohol is served at bars in most major hotels but is intended for guests of the hotel. Persons who are not guests of the hotel, and who consume alcohol in the restaurants and bars, technically are required to have their own personal liquor licenses. Liquor licenses are issued only to non-Muslim persons who possess UAE residency permits. Drinking and driving is considered a serious offense. Penalties generally are assessed according to religious law.

While individuals are free to worship as they choose, and facilities are available for that purpose, religious proselytizing is not permitted in the UAE.
Persons violating this law, even unknowingly, may be imprisoned or deported.

If arrested, U.S. citizens should contact the U.S. Embassy or Consulate General for assistance. The U.S. Consul will provide information on the local judicial system and a list of local attorneys. In Dubai, the U.S. Consul can also arrange for U.S. citizen detainees to meet with an ombudsman from the Human Rights Department of the Dubai police headquarters, if the detainee believes he or she is not being treated fairly.

CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION/EMBASSY AND CONSULATE LOCATION:
Americans living or traveling in the United Arab Emirates are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site and to obtain updated information on travel and security within the United Arab Emirates. 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 in Abu Dhabi is located at Embassies District, Plot 38, Sector W59-02, Street No. 4, P.O. Box 4009. The telephone number is (971) (2) 414-2200, and the Consular Section fax number is (971) (2) 414-2241. The email address for American Citizens Services inquiries, including passport questions, is abudhabiacs@state.gov. The after-hours telephone number is (971) (2) 414-2500. The Embassy Internet web site is http://uae.usembassy.gov.

The U.S. Consulate General in Dubai is located on the 21st floor of the Dubai World Trade Center, P.O. Box 9343. The telephone number is (971) (4) 311-6000 (for after-hours emergencies, contact the Embassy at (971)(2) 414-2200 for the Dubai Duty Officer, and the Consular Section fax number is (971) (4) 311-6213. The email address for American Citizens Services inquiries, including passport questions, is dubaiwarden@state.gov. The web site for the U.S. Consulate General in Dubai is http://dubai.usconsulate.gov.

The workweek for both the Embassy in Abu Dhabi and the Consulate General in Dubai is Sunday through Thursday.
* * *
This replaces the Country Specific Information for the UAE dated July 06, 2007, to update the sections on Traffic Safety and Road Conditions and Criminal Penalties.

Travel News Headlines WORLD NEWS

Date: Fri, 8 Mar 2019 11:58:53 +0100
By Shatha Yaish

Hatta, United Arab Emirates, March 8, 2019 (AFP) - Just over 100 kilometres (62 miles) from Dubai's skyscrapers, Mohammed al-Kaabi strolls through the tranquil desert with his friends as the sun sets.   Kaabi, 27, hails from a long line of Emiratis, a people with a centuries-old bedouin history tied inextricably to the local desert.    Today, he is among a fast-growing group drawn to a new wave of a tradition of desert camping but with all the trappings of comfort, style and modernity.   With "glamping", short for "glamorous camping", Dubai aims to expand on its renown for luxurious city living and its tradition of camping.

Betting on tourism at a time of low oil prices, Dubai is now offering stays in chic desert trailers, in plush mountainside lodgings and beach camps, as it seeks to put its own mark on the glamping trend that has swept world tourism destinations.   "This place is far from the cities and the high-rises," said Kaabi, sporting the traditional full-length white Emirati robe worn by men.   "Camping is very popular in the UAE, but when you want to bring the family it becomes more complicated," he added, at a campsite in Hatta, near the Omani border.   "But here, safety and comfort are provided for."

- A room with... a bed -
Camping is still a beloved way of life for many Emiratis, who take their equipment and head for the desert from the fall months onwards, when the scorching summer heat has faded.    Tourists and expat residents also increasingly opt to escape the hustle and bustle of the city.

Dubai welcomed a record 15.9 million visitors in 2018, many of whom were drawn to its mega malls, luxurious hotels and pristine beaches.   It hopes to push the figure up to 20 million visitors annually by next year, when it hosts the six-month global trade fair, Expo 2020.    The mountainous eastern Hatta desert has lots to offer "glampers" with a taste for adventure but also for their home comforts.   Near the Hatta dam, campers have a choice between a trailer, caravan or five-star lodge fully equipped with TVs and power points for charging a smartphone.

Seated outside a trailer, Jamil Fahmy, a Dubai resident from Saudi Arabia, said glamping was the perfect way to escape the city without compromising on hygiene.    "It's fun, with the fire and hanging with friends and all that, but I personally prefer to sleep in a room with a bed and a private bathroom, and that's what we get here," he told AFP.    "It's great to be an adventurer and explore and cook fireside, and that's what we did.   "But when the time came, we retreated into the beautiful room and slept on a bed."

- 'Five-star camping' -
Rooms with modern amenities, including bathrooms and beds, start from 400 dirhams (about $110, 100 euros) per night at the Hatta site, which opened in October.    The Hatta camping project, part of Dubai's plan to use tourism to diversify revenues, is also home to a 350-metre zip wire.   Last year, Dubai faced a downturn in the real-estate market due to a supply glut, while oil prices also dropped, affecting the UAE as a whole.    Several glamping sites, some on the beach, have popped up across the UAE in recent years, with options to participate in yoga classes, star gazing or kayaking.

For Jay, a 37-year-old Briton, glamping offers a new experience after a decade in the UAE.    "We're fairly outdoorsy, we came here kayaking before, we did the big zip line," he told AFP, referring to the Hatta zip wire.    But, he added with a laugh that with the usual no-frills style of camping "you haven't got a shower or all the facilities" so glamping is a welcome step-up.   "You get the outdoors and all of that, and nature, and you can barbeque -- but you can also have a shower and get clean!   "It's not five-star hoteling, but five-star camping."
Date: 30 Jan 2019
From: Taiichiro Kobayashi <tkobayashi@cick.jp> [edited]

Two women who returned to Japan from the United Arab Emirates (UAE) were diagnosed with dengue fever (DF). They could be the 1st reported cases of DF infected in the UAE. They live in Japan and travelled together to the UAE from 29 Dec 2018 to 4 Jan 2019. During their stay in the UAE, they mostly stayed in Dubai and were bitten by mosquitoes several times.

They came to Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital on 16 Jan 2019. A 32-year-old woman and a 29-year-old woman complained of high fever for 6 and 4 days, respectively. One revealed an erythematous rash on her trunk, face and extremities, and their tourniquet test results were positive. Their blood examinations revealed leukocytopenia, thrombocytopenia and mild liver dysfunction.

Although the UAE is not known as an endemic country of DF, we suspected the women of having DF because of their history, physical examination and laboratory test results. We performed a rapid diagnostic test of DF (SD BIOLINE Dengue DUO), and their results of non-structural protein 1 (NS1) antigen were positive. Furthermore, dengue virus serotype 3 (DENV-3) genotype III genome was detected from both of their sera with real-time RT-PCR and following viral genome sequence analysis at the Laboratory of Arboviruses, National Institute of Infectious Diseases (NIID), Japan.

These 2 cases may be a signal of the emergence of DF in the UAE, where urbanization progresses and many travellers and immigrants from DF-endemic countries are being accepted.
===============================
Taiichiro Kobayashi
Department of Infectious Diseases
Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome
Hospital
Tokyo, Japan
<tkobayashi@cick.jp>

Yuya Atsuta, Masaru Tanaka, Kazuaki Fukushima, Keishiro Yajima and Akifumi Imamura
Department of Infectious Diseases
Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo, Japan

Takahiro Maeki, Shigeru Tajima, Satoshi Taniguchi, Masayuki Saijo and Chang-Kweng Lim
Department of Virology I, National Institute of Infectious Diseases Tokyo, Japan

[ProMED thanks the colleagues from Japan for sharing this important update on imported dengue fever cases, which were serotyped as DENV-3, from the UAE into Japan.

The worldwide distribution of dengue is expanding, in part due to globalized traffic and trade. _Aedes albopictus_ is a competent vector for dengue viruses (DENV) and is now established in numerous regions of the world. Travellers with viraemia arriving in any country from dengue-affected areas of the world can become proponents of local outbreaks. The above report also highlights the importance of considering dengue in differential diagnosis of fever with suggestive blood picture even in cases presenting in nonendemic areas. - ProMED Mod.UBA]

[HealthMap/ProMED-mail maps:
United Arab Emirates: <http://healthmap.org/promed/p/132]
Date: Wed 5 Sep 2018
Source: BBC [edited]

A total of 19 people have been taken ill after an Emirates airline plane landed in New York, officials say. The plane was quarantined at JFK airport as those on board were checked by health officials. As many as 10 were taken to hospital but others refused treatment.

The US Centers for Disease Control and Prevention (CDC) said that initially about 100 people including some crew had complained of illness. Flight 203 from Dubai landed at 09:10 (13.10 GMT) with 521 passengers.

Emergency vehicles were seen on the runway as it landed. Soon afterwards, Emirates airline tweeted that the sick passengers were being attended to and those who were unaffected would be allowed to leave the plane.

The CDC said in a statement that is was "aware of an Emirates flight from Dubai that arrived this morning at JFK".

"Approximately 100 passengers, including some crew on the flight, complained of illness including cough and some with fever.

"CDC public health officers are working with... officials to evaluate passengers including taking temperatures and making arrangements for transport to local hospitals those that need care."

Later Eric Phillips, spokesman for New York Mayor Bill de Blasio, confirmed that all the passengers were off the plane and the sick people had been taken to hospital.

He said that some of the passengers had originally come from the Saudi Arabian city of Mecca, which was currently experiencing a flu outbreak, and that the passengers' symptoms were "pointing to the flu".
Date: Mon 28 May 2018
Source: EMPRES-I (Global Animal Disease Information System) [edited]

According to an EMPRESS report issued today [Mon 28 May 2018], there was a human case of MERS-CoV infection confirmed by PCR testing in Gayathi, Abu Dhabi, United Arab Emirates. This report was based on an OIE report.

No further information was provided.
=====================
[The most recent confirmed human MERS-CoV infection in the UAE was reported in December 2017 and involved an Omani camel herder who was identified as an asymptomatic infection. This was detected as part of border screening of camels on entry to the UAE following the detection of positive MERS-CoV infection in the camels (see MERS-CoV (01): Malaysia (ex KSA), Saudi Arabia, UAE (ex Oman) http://promedmail.org/post/20180102.5532148).

I was unable to find more information on the case mentioned in the EMPRES report above, from either the HAAD (Health Authority of Abu Dhabi) website, or the OIE or EMPRES websites. Questions that come to mind include: demographics (age, sex); clinical picture (was this based on clinical illness in the human or was this part of screening after identification of MERS-CoV infected camels entering the UAE (where screening is typically done); possible high risk exposures (either contact with camels, contact with other known cases, contact with the health sector before onset of illness, or history of travel to other geographic areas where MERS-CoV circulation is known).

More information from knowledgeable sources would be greatly appreciated.

The HealthMap/ProMED map of the UAE can be found at:
Date: Thu 21 Sep 2017
Source: Eurosurveillance Edition 2017, 22(38) [edited]

ref: Dabrera G, Brandsema P, Lofdahl M, et al. Increase in legionnaires' disease cases associated with travel to Dubai among travellers from the United Kingdom, Sweden and the Netherlands, October 2016 to end August 2017. Euro Surveill. 2017; 22(38): pii=30618.
----------------------------------------------------------------------
Abstract
--------
Between 1 Oct 2016 and 31 Aug 2017, 51 legionnaires' disease (LD) cases from the United Kingdom (UK), Sweden, and the Netherlands were identified with associated travel to Dubai. Cases did not all stay in the same accommodation, indicating that no single accommodation could be the source for all these infections. While local investigations continue into other potential sources, clinicians should remain alert to the possibility of LD among travellers returning from Dubai with respiratory illness.

Introduction
------------
In December 2016, the European Centre for Disease Prevention and Control (ECDC) reported an increase in legionnaires' disease (LD) cases associated with travel to Dubai, United Arab Emirates (UAE) [1] based on cases reported to ELDSNet (European legionnaires' disease surveillance network), an ECDC-operated surveillance system among European Union (EU) countries, Iceland, and Norway [2] for laboratory-confirmed, travel-associated LD (TALD) cases who stayed in commercial accommodation site(s) (such as hotels) during the 2-10-day incubation period.

As this increase in Dubai-associated TALD cases continues, we describe cases reported with symptom onset between 1 Oct 2016 and 31 Aug 2017 among residents from the UK, Sweden, and the Netherlands (the 3 countries that were initially reporting the largest numbers of cases). We describe the ongoing situation as at 18 Sep 2017 to provide further insight into the observed increase and create awareness among physicians and travellers returning with compatible symptoms to consider legionella as a differential diagnosis [1].

[The full Eurosurveillance article can be accessed at the source URL above. - ProMED Mod.ML]
====================
[Dubai is one of the 7 emirates and the most populous city of the United Arab Emirates (UAE) (<http://en.wikipedia.org/wiki/Dubai>). Dubai has become a popular tourist destination. It is said to be the 4th most visited city in world, with over 15 million visitors in 2016, after London, Paris, and Bangkok (<https://www.khaleejtimes.com/listicles/dubai-worlds-fourth-most-popular-destination-in-2016>).

Overnight visitors in Dubai spent almost USD 11 billion in 2014

Dubai can be located on the HealthMap/ProMED-mail interactive map at

In 2009, ProMED-mail first reported legionnaires' disease in 3 travellers to Dubai, one of whom from the UK died (Legionellosis, fatal, hotel - United Arab Emirates: (Dubai) http://promedmail.org/post/20090205.0509). In December 2016, ProMED-mail reported an increase in the number of cases of legionnaires' disease in 2016, compared with previous years, in European travelers returning from Dubai, with 26 cases having their onset of illness since 1 Oct 2016 (Legionellosis - EU: EU travellers, ex United Arab Emirates (Dubai) susp http://promedmail.org/post/20161230.4733569). In June 2017, ProMED-mail reported that an additional 34 cases among European travelers to Dubai, with the most recent case becoming ill in May 2017, suggesting an ongoing exposure risk (Legionellosis - Europe (03): ex United Arab Emirates (Dubai) http://promedmail.org/post/20170602.5079438).

According to the Eurosurveillance report above on 51 legionnaires' disease cases with symptom onset between 1 Oct 2016 and 31 Aug 2017, from the UK, Sweden, and the Netherlands associated with travel to Dubai, of 43 cases staying in commercial accommodation only 15 stayed in sites where there were 2 or more cases, whereas 27 stayed in sites where there were no other cases. In addition, 3 of the 51 cases were associated with a foreign-travel related cluster in other countries.

Of the 51 cases of legionnaires' disease, 50 were infected by organisms speciated as _Legionella pneumophila_. However, the serogroup was known for only 16 cases: 13 of the 16 were serogroup 1, 2 were serogroup 13 and 1 was serogroup 2-14. Sequence-based typing (ST) was available for only 9 cases: 6 cases were ST616, and 3 cases were ST1327. ST616 was only observed in cases associated with travel to Dubai and ST1327 was associated with travel to Dubai for all but one case. Furthermore, 11 cases spent their entire incubation period in Dubai. These findings supported the assertion that at least some of these infections occurred within Dubai. However, the cases for whom sequence-based typing was available were all linked to different accommodations sites.

No increase in pneumonia notifications occurred locally in Dubai between October and December 2016, which suggested an environmental _Legionella_ source in Dubai that might have been frequented more often by foreign travelers than by local residents. Another explanation was that the local Dubai population is predominantly young, with only 8.7 percent in the 50 years or older age group in 2016, and therefore potentially at lower risk for legionnaires' disease than foreign travelers. Also, the investigators noted that the increase in cases of legionnaires' disease among European travelers to Dubai could not be fully explained by an increase in the number of European travelers to Dubai, but so far no environmental sources have been identified in Dubai. - ProMED Mod.ML]
More ...

Congo, Republic of the

Republic of Congo US Consular Information Sheet
August 29, 2008
COUNTRY DESCRIPTION:
The Republic of the Congo (Congo-Brazzaville) is a developing nation in central Africa. The official language is French. The largest cities are the capita
, Brazzaville, on the Congo River, and Pointe Noire on the coast. Civil conflict in 1997 and again in 1998-99 damaged parts of the capital and large areas in the south of the country. The last rebel group still engaged in armed struggled signed a cease-fire accord with the government in March 2003. Facilities for tourism are very limited. Read the Department of State Background Notes on the Republic of the Congo (Brazzaville) for additional information.
ENTRY/EXIT REQUIREMENTS: A passport, visa and evidence of yellow fever vaccination are required for entry. Additional information on entry requirements may be obtained from the Embassy of the Republic of the Congo, 4891 Colorado Avenue NW, Washington, DC 20011, telephone (202) 726-5500, or from the Permanent Mission of the Republic of the Congo to the United Nations, 14 E. 65th St., New York, NY, 10021, telephone (212) 744-7840. Overseas, inquiries should be made at the nearest Congolese embassy or consulate.
Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
As a result of past conflicts, there is extensive damage to the infrastructure in Brazzaville and in the southern part of the country, and the government is working to reconstruct roads and buildings. Fighting broke out in March and June of 2002 when rebel groups launched attacks first in the Pool region, and later, at the Brazzaville airport. The fighting in Brazzaville was quickly contained and the rebels were repulsed. In March 2003, the rebels and the government signed a cease-fire accord, which remains in effect, although there was some violence in Brazzaville in December 2003.

Occasionally, political unrest in neighboring Kinshasa can affect Brazzaville on the other side of the Congo River. For example, in 2007, stray small arms fire originating in Kinshasa landed in Brazzaville.

Continued security awareness remains a key consideration for all visitors. Night travel outside of cities should be avoided. U.S. citizens should avoid political rallies and street demonstrations and maintain security awareness at all times.
In the event of a fire, call the fire brigade at 81-53-87.
The Department of State suspended operations at the U.S. Embassy in Brazzaville in 1997. The Brazzaville U.S. Embassy interim offices are located in the B.D.E.A.C (Central African Development Bank) building in Brazzaville. A new embassy compound is under construction and slated to open in 2009. While Brazzaville is still not fully open for normal operations, Embassy personnel are present in Brazzaville to provide information and guidance to American citizens. Staff can be contacted through the Embassy’s interim offices (see Registration/Embassy Location section below). The reduced staff in Brazzaville has limited ability to provide emergency services and non-emergency services generally take a few days to coordinate through Embassy Kinshasa.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

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

The Department of State urges American citizens to take responsibility for their 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 pamphletA Safe Trip Abroad.

CRIME: In the Congo, petty street crime targeting foreigners is rare. Incidents of mugging and pick pocketing happen frequently near the ports in Pointe Noire and Brazzaville, and sometimes in the Congolese neighborhoods surrounding Brazzaville's city center.

Criminal elements are known to target middle-class and affluent residences without 24-hour guards for burglary. Roadblocks and robberies by armed groups targeting travelers occur in the Pool region south of Brazzaville. Travel to the Pool region is discouraged due to these elements.

Travelers should note that in the case of theft and robbery, legal recourse is limited and therefore, they may wish to leave all valuable items at home.

INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends, and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

While there is no local equivalent to the “911” emergency line in Republic of the Congo, the Rapid Response Police Team can be reached at 665-4804. However, police resources are limited and response to emergency calls is often slow (15 minutes or longer).

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical facilities are extremely limited. Some medicines are in short supply, particularly outside the larger cities. Travelers should carry their own supply of properly labeled medications.
Malaria is a serious and sometimes fatal disease. Plasmodium falciparum malaria, the type that predominates in the Congo, is resistant to the antimalarial drug chloroquine. Because travelers to the Republic of the Congo are at high risk for contracting malaria, the Centers for Disease Control and Prevention (CDC) advises that travelers should take one of the following antimalarial drugs: mefloquine (Lariam™), doxycycline, or atovaquone/proguanil (Malarone™). Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and tell the physician their travel history and what antimalarials they have been taking. For additional information on malaria, including protective measures, see the CDC Travelers’ Health web site at http://wwwn.cdc.gov/travel/yellowBookCh4-Malaria.aspx/.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of the DRC.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.

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

TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning the Republic of the Congo is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Road conditions are generally poor and deteriorate significantly during the rainy season, November-May. Maintenance of the few paved roads is limited. Overland travel off the main roads requires a four-wheel drive vehicle. Poorly marked checkpoints, sometimes manned by undisciplined soldiers, exist in many areas of the countryside.

Taxis are considered an acceptable mode of transport due to availability and low cost. Registered public transportation vehicles are painted green with white roofs and striping. Security is not generally an issue with taxis but buses are often overcrowded and thus less secure. Mechanical reliability of both vehicle types remains in question.
Traffic safety in general is hazardous due to high speeds, aggressive driving, poorly maintained vehicles and general apathy for pedestrians and cyclists.

Roads are narrow, dangerously potholed, frequently wash out during rainy season and are often full of debris, and pedestrians.
Emergency services are limited. Please refer to the medical section above.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in the Republic of the Congo, the U.S. Federal Aviation Administration (FAA) has not assessed the Republic of the Congo’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Ferry service between Brazzaville and Kinshasa normally operates from 8 A.M. to 4 P.M. Monday through Saturday and 8 A.M. to 12 P.M. Sunday, but it may close completely with minimal notice. A special exit permit from the Republic of the Congo’s Immigration Service and a visa from the Democratic Republic of the Congo’s embassy/consulate are required to cross the Congo River from Brazzaville to Kinshasa. Passenger travel on the railroad is discouraged, as there are frequent reports of extortion by undisciplined security forces and robberies by criminal elements along the route.
The Congo is primarily a cash economy and uses the Central African Franc (CFA), a common currency with Gabon, Chad, Cameroon, the Central African Republic, and Equatorial Guinea. U.S. dollars may be exchanged for local currency. Traveler’s checks can be cashed for a fee at some hotels. Two hotels in Brazzaville, and several in Pointe Noire, accept major credit cards, but prefer payment in cash. Prices are usually quoted in CFA or Euros. Other businesses do not normally accept credit cards. Personal checks drawn on foreign accounts are not accepted. Western Union has offices in Brazzaville and Pointe Noire, and one bank in Brazzaville has an ATM.
Airport police and customs officials routinely inspect incoming and outgoing luggage, even for internal travel. For a complete list of prohibited items, please contact the nearest Congolese embassy or consulate. Please see our Customs Information.
Local security forces in areas outside Brazzaville and Pointe Noire may detain foreigners to solicit bribes. Detention of U.S. citizens, particularly in remote areas, may not always be promptly reported to the U.S. Government by Congolese authorities. U.S. citizens are encouraged to carry a copy of their passports with them at all times so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available. If detained or arrested, U.S. citizens should always ask to be allowed to contact the U.S. Embassy. Please see the Registration/Embassy Location section below.
In general there are no restrictions on photography; however photographs of government buildings or military installations, port facilities or the airport should not be taken. When photographing human beings in remote areas where populations adhere to traditional beliefs, it is best to request permission first. If permission is refused, the photo should not be taken.
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 Republic of the Congo’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Republic of the Congo are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.

CHILDREN'S ISSUES: For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Republic of the Congo are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Republic of the Congo. Americans withoutInternet 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 in Brazzaville has interim offices located in the B.D.E.A.C Building, 4th Floor, Place du Gouvernement, Plateau de Centre Ville, Brazzaville. The web site is http://brazzaville.usembassy.gov. The telephone number during regular business hours (7:30 am until 4:30 pm, Monday through Friday) is 242-81-14-81; email is Consular.Brazzaville@state.gov. For after-hours emergencies, call the U.S. Embassy in Kinshasa (see below).

The U.S. Embassy in Kinshasa, Democratic Republic of the Congo (DRC) is located at 310 Avenue des Aviateurs, Gombe; tel. 243-(0)81-225-5872 (do not dial the zero when calling from abroad into the DRC). Entrance to the Consular Section of the U.S. Embassy in Kinshasa is on Avenue Dumi, opposite Ste. Anne residence. The Consular Section of the Embassy in Kinshasa may be reached at cellular tel. 243-(0)81-884-4609, 243-(0)81-884-6859 or 243-(0)81-225-5872; fax 243-(0)81-301-0560. For after-hours emergencies, use 243-81-225-5872. (Cellular phones are the norm, as other telephone service is often unreliable).
* * *
This replaces the Country Specific Information for Republic of the Congo dated August 20, 2008 to update the section on Safety and Security.

Travel News Headlines WORLD NEWS

Date: Wed 26 Sep 2018
Source: WHO Relief Web [edited]

The Republic of Congo, in collaboration with the World Health Organization (WHO) and partners, started today [26 Sep 2018] a vaccination campaign to control the spread of yellow fever in the port city of Pointe Noire and surrounding areas. More than one million people from 9 months of age are expected to be vaccinated in this 6-day campaign.

The vaccination campaign uses doses from the global emergency yellow fever vaccine stockpile managed by the International Coordination Group on Vaccine Provision (ICG) and funded by Gavi, the Vaccine Alliance. The ICG coordinates the timely and equitable provision of vaccines during outbreaks and maintains an emergency stockpile of 6 million doses of yellow fever vaccine, which is continually replenished. Gavi will also cover operational costs for this campaign.

The immunization drive is a response to a laboratory-confirmed yellow fever case, which tested positive on 21 Aug 2018, after the person visited a rural area. Since then, no other case has been confirmed in the country, but more than 200 suspected cases have been reported since the beginning of the year [2018], with most of these notified by the health authority in Pointe Noire. It is possible that there are also undetected cases, as a large proportion of the Pointe Noire population seeks care in the private system; therefore, the national surveillance system may not be receiving notification.

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes that can be deadly but is prevented by an extremely effective vaccine. Urban outbreaks are of particular concern, and Pointe Noire is the country's economic capital, with a population of more than one million people. After declining for many years, yellow fever outbreaks are on the rise globally. The ease and speed of population movements, rapid urbanization and a resurgence of mosquitoes because of global warming have significantly increased the risk of urban outbreaks with international spread.

"Yellow fever has re-emerged as a public health threat in recent years in the African region," said Dr. Ibrahima Soce Fall, WHO's Emergencies Director for Africa. "However, the vaccine is safe and provides life-long immunity. This reactive vaccination campaign is focusing on people who are most at risk and will set up a firewall which will prevent the virus from spreading further."

The neighbouring Democratic Republic of the Congo has shown solidarity with the Republic of Congo by lending more than 700 000 syringes for the vaccination campaign while Pointe Noire health authorities wait for syringes to arrive from the international stockpile next month [October 2018].

The response to this outbreak is part of a comprehensive strategy to eliminate yellow fever epidemics (EYE) globally by 2026. WHO, UNICEF, Gavi, and more than 50 partners are supporting the Government of Congo and 39 other high-risk countries to assess epidemic risk, roll out vaccination campaigns, engage with communities and deliver other response activities, including surveillance and laboratory diagnosis.

Nationwide preventive actions are also needed to ensure the protection of the entire population at risk. Rapid outbreak detection and response and long-term prevention are integral to a sustained control of yellow fever. As part of the EYE Strategy, more than 4 million additional people are expected to be vaccinated in preventive mass campaigns in the Republic of Congo over the few next years.
=====================
[It is encouraging to see that components of a large yellow fever (YF) vaccination campaign have come together to start the effort 2 days ago [26 Sep 2018]. Although there is only one confirmed YF case, considering the 200 suspected cases and the risk of rapid YF virus spread in Pointe Noir, a city with a dense and susceptible human population and abundant mosquito vectors, the vaccination campaign is prudent. A recent report indicated that entomological surveys in the affected area have revealed high densities of mosquito vectors (_Aedes aegypti_) responsible for urban YF transmission, signaling the potential for human-to-human transmission via _Aedes aegypti_ and rapid amplification. Larval sites have been found around the homes of suspected cases, and this situation could worsen with the arrival of the rainy season. WHO is supporting the Ministry of Health and Population in implementing targeted vector control activities for adult mosquitoes and larvae within a 200-metre [660-foot] perimeter of areas where the confirmed case-patient lives and works. YF outbreaks under conditions like these can spread rapidly and get out of control, as occurred in Angola with spillover into the Democratic Republic of the Congo. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Republic of Congo: <http://healthmap.org/promed/p/166>]
Date: Tue 25 Sep 2018
Source: Africa News [edited]
<http://www.africanews.com/2018/09/25/congo-to-launch-immunization-against-yellow-fever-outbreak-the-morning-call/>

On Thursday [27 Sep 2018], the government of the Republic of Congo will begin what it calls a robust and coordinated response against the yellow fever outbreak recorded in some parts of the country. The planned response follows the health ministry's warning last month [August 2018] of "an emerging event of epidemic proportions." According to the head of the government's epidemics unit, Lambert Kitembo, 186 suspected cases of yellow fever have been detected this year [2018], many of which were reported in the western commercial hub of Pointe Noire. [Byline: Jerry Bambi]
===================
[The numbers of reported yellow fever cases in the Republic of the Congo (RC) is growing, especially in the Pointe-Noire area. Pointe-Noire is a port city and oil industry hub with an international airport and links to other large cities. A previous report indicated that a retrospective search in 16 health centre registers in Pointe-Noire found 69 additional suspected cases during 2018 that meet the clinical case definition for yellow fever; 56 of the suspected cases were already recorded in the national surveillance system. Of these, 2 of the suspected cases reported staying in Angola.

The above report indicates that there are now 186 suspected cases. A recent WHO risk assessment reported that the overall public health risk at the national level is high due to the confirmation of a yellow fever case in the densely populated urban city of Pointe Noire (‎1.2 million inhabitants), with suboptimal immunization coverage in the affected community and the potential risk of spread within the Congo, especially to the capital city of Brazzaville.

The Ministry of Health and Population (MoHP) declared a yellow fever outbreak in Pointe Noire on 22 Aug 2018, and the national committee for outbreak management was promptly activated. WHO was notified on 23 Aug 2018, in line with the International Health Regulations (IHR 2005). A recent report indicated that entomological surveys in the affected area have revealed high densities of mosquito vectors (_Aedes aegypti_) responsible for urban yellow fever transmission, signalling the potential for human-to-human transmission and rapid amplification. Larval sites have been found around the homes of suspected cases, and this situation could worsen with the arrival of the rainy season.

WHO is supporting the MoHP in implementing targeted vector control activities for adult mosquitoes and larvae within a 200-metre [660 foot] perimeter of areas where the confirmed case-patient lives and works. It is difficult to assess the risk of an ongoing outbreak without knowing the proportion of the unvaccinated population in the areas where the cases occurred. One hopes that the planned vigorous vaccination campaign will be initiated as planned this week. Yellow fever outbreaks can quickly get out of hand, as occurred in Angola and the DRC in 2016-2017.

Frequent movement of individuals across borders of neighbouring countries and beyond underscores the need for prompt action to prevent spread. - ProMED Mod.TY]

[HealthMap/ProMED map available at: Republic of Congo: <http://healthmap.org/promed/p/166>]
Disease outbreak news
7 September 2018

Event Description
On 5 July 2018, a 20-year-old male living in Bissongo, Republic of the Congo, visited Bissongo health centre in the Loandjili District of Pointe-Noire City, with a fever he had developed the previous day. On 9 July, due to the onset of jaundice and persistent fever, he returned to the same health facility. The patient did not have a history of yellow fever vaccination or haemorrhagic symptoms. The patient had previously travelled to Ngoyo and Tchiamba Nzassi districts two weeks prior to symptom onset; Tchiamba Nzassi is a rural district in Pointe-Noire located along the border with Angola.

He was admitted to the health facility and received antimalarial and antibiotic treatments. As yellow fever was also suspected as a differential diagnosis, a blood sample was collected on 10 July and sent to Institut National de Recherche Biomédicale (INRB) in Kinshasa, Democratic Republic of the Congo, for testing; on 26 July, the sample tested positive for yellow fever by serology. On 30 July, INRB sent a sample to Institut Pasteur de Dakar for confirmation; on 21 August, the sample tested positive for yellow fever by seroneutralization with a high titre.

Following the confirmation of yellow fever, an investigation was conducted in the affected area. A retrospective search in 16 health centre registers in Pointe-Noire found 69 additional suspected cases during 2018 which meet the clinical case definition for yellow fever; 56 of the suspected cases were already recorded in the national surveillance system. Two of the suspected cases reported staying in Angola. Samples were collected from 43 of these cases and sent to INRB; all samples tested negative for yellow fever. Entomological surveys in the affected area have revealed high densities of mosquito vectors (Aedes aegypti) responsible for urban yellow fever transmission, signalling the potential for human-to-human transmission and rapid amplification. Larval sites have been found around the homes of suspected cases, and this situation could worsen with the arrival of the rainy season.

Public health response

The Ministry of Health and Population (MoHP) declared a yellow fever outbreak in Pointe-Noire on 22 August 2018 and the national committee for outbreak management was promptly activated. WHO was notified on 23 August 2018 in line with the International Health Regulations (IHR 2005).

WHO is supporting the country in the preparation of an emergency response plan and an International Coordinating Group (ICG) request for supplies for a reactive mass vaccination campaign targeting the Pointe-Noire area, which has a population of approximately one million people. WHO is also supporting resource mobilization activities, as the country is not eligible for Gavi support.

WHO is supporting the MoHP in implementing targeted vector control activities for adult mosquitoes and larvae within a 200-metre perimeter of areas where the confirmed case-patient lives and works. WHO is also providing technical support to strengthen surveillance at points of entry, case management, and public awareness, as well as recommending the use of mosquito nets during the day time.

WHO risk assessment

The overall public health risk at the national level is high due to the confirmation of a yellow fever case in a densely populated urban city of Pointe-Noire (‎1.2 million inhabitants), with suboptimal immunization coverage in the affected community and the potential risk of spread within the Congo, especially to the capital city of Brazzaville. Entomological surveys in the affected area revealed high densities of Aedes aegypti, responsible for urban transmission of yellow fever, signalling the potential for rapid amplification. The approaching rainy season may potentially increase this risk. Thus, the risk of an urban epidemic needs to be mitigated urgently, although there is no indication of active urban transmission according to the information available.

The risk at the regional level is considered to be moderate due to the lack of information to describe the scope and the dynamics of the outbreak, as well as because of cross-border movements, particularly between to and from Gabon and Cabinda in Angola. Pointe-Noire is a port city and oil industry hub with an international airport and links to other large cities. Angola and the Democratic Republic of the Congo have recently conducted mass preventive and reactive yellow fever vaccination campaigns, respectively. However, population immunity levels in the Democratic Republic of the Congo are low in the zones not targeted by the 2016 reactive campaigns, such as the areas neighbouring Pointe-Noire. No other yellow fever cases related to the outbreak in Pointe-Noire have been reported outside the country at this stage.

The risk at the global level is considered low. Risks need to be closely monitored and regularly reassessed.

WHO Recommendations

Vaccination is the primary means for prevention and control of yellow fever. In urban centres, targeted vector control measures are also helpful to interrupt transmission. WHO and partners will continue to support local authorities to implement these interventions to control the current outbreak.

WHO recommends vaccination against yellow fever for all international travellers above nine months of age going to the Republic of the Congo, as there is evidence of yellow fever virus transmission. The Republic of the Congo also requires a yellow fever vaccination certificate for all travellers aged 9 months or older . Yellow fever vaccination is safe, highly effective and provides life-long protection. In accordance with the IHR (2005), the validity of the international certificate of vaccination against yellow fever extends to the life of the person vaccinated. A booster dose of yellow fever vaccine cannot be required of international travellers as a condition of entry.

WHO encourages its Member States to take all actions necessary to keep travellers well informed of risks and preventive measures including vaccination. Travellers should also be made aware of yellow fever symptoms and signs and instructed to rapidly seek medical advice when presenting with these. Viraemic returning travellers may pose a risk for the establishment of local cycles of yellow fever transmission in areas where the competent vector is present.

WHO advises against the application of any restrictions on travel or trade to the Republic of the Congo in relation to this outbreak, based on the information currently available.
Date: Fri 31 Aug 2018
Source: Business Insider [edited]

Congo Republic will launch a country-wide vaccination campaign to control an outbreak of yellow fever near the border with the Angolan enclave of Cabinda, the health ministry said on Friday [31 Aug 2018].

Earlier this week, the authorities said over 180 suspected cases and one confirmed case of the sometimes deadly mosquito-borne virus had been identified this year [2018], many in the western commercial hub of Pointe Noire.

"Congo (Republic) declared a yellow fever epidemic at Pointe Noire on 24 Aug [2018]," the ministry said in a statement.

In response, it said: "The Health and Population Ministry will organize, in collaboration with partners, a national vaccination campaign." It did not specify when the campaign would begin. The vaccinations will be free of charge. Only children under 9 months, pregnant women and mothers breastfeeding infants under 6 months will not be vaccinated, the statement added.

No deaths have yet been reported in the outbreak.

The disease causes fever, body aches and nausea and can quickly spread in areas with large unvaccinated populations.

A major outbreak in 2016 in Angola and Democratic Republic of Congo killed more than 400 people and was believed to have infected thousands more before it was brought under control through an extensive vaccination campaign.  [Byline: Alessandra Prentice]
======================
[The case numbers and locations are essentially the same as reported in the earlier ProMED-mail post, with no increase in the numbers of suspected cases. A country-wide vaccination campaign is planned in response to these cases. As noted in previous posts, this outbreak is fairly widely distributed geographically across 5 health districts. The dates on which these suspected cases were diagnosed are not given, so we do not have a picture of the timeframe of this outbreak. None of these cases resulted in deaths.

It is difficult to assess the risk of an ongoing outbreak without knowing the proportion of the unvaccinated population in the areas where the cases occurred. One hopes that the planned vigorous vaccination campaign will be initiated as soon as possible. Yellow fever outbreaks can quickly get out of hand, as occurred in Angola and the Democratic Republic of the Congo in 2016-2017. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Republic of Congo: <http://healthmap.org/promed/p/166>]
Date: Tue 28 Aug 2018
Source: Reuters [edited]

Congo Republic has confirmed a case of yellow fever near the border with an Angolan enclave, the health ministry said on Tuesday [28 Aug 2018], and has warned of "an emerging event of epidemic proportions."

In all, 186 suspected cases have been detected this year [2018], many of which were in the western commercial hub of Pointe Noire, the head of the government's epidemics unit, Lambert Kitembo told Reuters.

He said 8 blood samples were sent to Democratic Republic of Congo (DRC) for testing last month [July 2018], one of which came back positive. It was then officially confirmed last week at a laboratory in Senegal.

The sometimes deadly mosquito-borne virus causes fever, body aches and nausea and can quickly spread in areas with large unvaccinated populations.

A major outbreak in 2016 in Angola and the DRC killed more than 400 people and was believed to have infected thousands more before it was brought under control through an extensive vaccination campaign.

The confirmed victim in the case of yellow fever in Congo Republic had traveled in Tchiamba Nzassi district, which lies along the border with the Angolan enclave of Cabinda, 2 weeks prior to the onset of his symptoms, the World Health Organization (WHO) said in a weekly report.

No deaths have been reported, but the situation is being taken seriously by health officials, Kitembo said. He did not say whether authorities had plans to test other blood samples.

"Congo, in general, and the departments of Pointe Noire and Koulou in particular are experiencing since the start of 2018 an emerging event of epidemic proportions," the health ministry said in a statement dated last week.

The WHO said that the confirmed case was detected early last month [July 2018] at a health centre in Pointe Noire, where the patient with fever and jaundice was admitted for treatment.
======================
[The number of suspected cases has gone up from 70 yesterday [27 Aug 2018] to 186 mentioned above. There is now one laboratory confirmation. As noted in the previous post, this outbreak is fairly widely distributed geographically across 5 health districts. The dates on which these suspected cases were diagnosed are not given, so we do not have a picture of the time frame of this outbreak. None of these cases resulted in deaths.

It is difficult to assess the risk of an ongoing outbreak without knowing the proportion of the unvaccinated population in the areas where the cases occurred. One hopes that a vigorous vaccination campaign will be initiated as soon as possible. Yellow fever outbreaks can quickly get out of hand, as occurred in Angola and the Democratic Republic of the Congo in 2016-2017. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Republic of Congo: <http://healthmap.org/promed/p/166>]
More ...

Madagascar

Madagascar - US Consular Information Sheet
November 06, 2008
COUNTRY DESCRIPTION:
Madagascar is a developing island nation off the east coast of Africa.
The primary languages are French and Malagasy.
French is less spoken outside
of major cities.
Facilities for tourism are available, but vary in quality.
Travelers seeking high-end accommodations should make reservations in advance.
Read the Department of State Background Notes on Madagascar for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport and visa are required.
Visas are available at all airports servicing international flights, but travelers who opt to obtain a visa at an airport should expect delays upon arrival.
Visas obtained at the airport cannot be extended.
Most international flights arrive in Antananarivo, but there are some limited international flights to/from the nearby islands of Comoros, Mayotte and Reunion from airports in Mahajanga, Toamasina (Tamatave), Nosy Be, Tolagnaro (Ft. Dauphin) and Antsiranana (Diego Suarez).
There are also direct flights between Italy and Nosy Be.
Evidence of yellow fever immunization is required for all travelers who have been in an infected zone within 6 months of their arrival in Madagascar.

Travelers may obtain the latest information and details on entry requirements from the Embassy of the Republic of Madagascar, 2374 Massachusetts Avenue NW, Washington, DC
20008; telephone (202) 265-5525/6; or the Malagasy Consulate in New York City, (212) 986-9491.
Honorary consuls of Madagascar are located in Philadelphia, and San Diego.
Overseas, inquiries may be made at the nearest Malagasy embassy or consulate.
Visit the Embassy of Madagascar’s web site at http://www.embassy.org/madagascar for the most current visa information.
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
There are random police vehicle checkpoints throughout Madagascar, so all visitors should carry photo identification (i.e., U.S. passport) in the event of police questioning.
These check points are routine in nature, and should not result in vehicle and/or person searches as long as valid identification is shown.
Political demonstrations occur from time to time.
There have been incidents of violence during demonstrations, but these have not been directed against Americans.
Travelers should maintain security awareness at all times and should avoid political gatherings and street demonstrations.
Certain large gatherings such as concerts or scenes of accidents also may pose a threat to foreigners.

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

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the United States and Canada, or, for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
The major concerns for visitors to Antananarivo are crimes of opportunity such as pick pocketing, purse snatching and residential and vehicular theft.
Although these incidents are generally non-violent, incidents involving violence by assailants do occur and are on the rise, particularly when the victim resists, and especially when multiple persons confront the victim.
The Embassy has received reports of physical attacks against foreigners, including Americans, particularly in coastal tourist areas.
A number of these attacks resulted in serious injuries and in some cases, fatalities.
Criminal elements in Antananarivo and throughout Madagascar are becoming bolder when selecting their victims, and are also committing more crimes in areas that are considered to be “safe” – those that are generally well lit and well traveled by pedestrians and vehicles.

To reduce the risk of being victimized, travel in groups and avoid wearing expensive jewelry or carrying high cost electronic items (iPods, digital cameras, or high end cell phones) with you in public. Valuable items should never be left in an unattended vehicle or at a hotel (unless locked in the hotel safe). Walking at night, whether alone or in a group is not considered safe in urban areas, including in the vicinity of Western-standard hotels, restaurants and night clubs. Visitors are strongly discouraged from traveling outside of Antananarivo after dark due to banditry, lack of lighting, and poor road conditions. In the last six months there have been several incidents involving nighttime criminal activity that targeted vehicles outside of town.
These events have involved villages designing a “trap” of sand, a tree log or some other substance or condition that makes the only viable road impassible.
Local villagers then “assist” the stranded vehicle and expect monetary compensation. Others have involved armed criminals who stage a “breakdown” that blocks the roadway, forcing the victimized driver to slow down, and hence become more vulnerable.

Criminal gangs comprised of felons, ex-military and police from the former regime are known to commit home invasions and kidnappings, sometimes targeting foreigners.
Organized gangs of bandits are known to patrol areas where foreigners, who are perceived to be wealthy, tend to congregate.
Crimes such as burglary and robbery do occur in areas outside the capital and the threat of confrontational and violent crime has increased in rural and isolated areas throughout the last year.
Specifically, Amboasary, a town in the southeast, has experienced a surge in armed robberies targeting not-governmental organizations (NGOs).
However, Americans visiting Madagascar should not expect to experience any hostility or aggression solely because of their citizenship.

In major cities, the National Police is charged with maintaining peace and security. Outside of major cities, the Gendarmerie is primarily responsible for these duties. Due to lack of resources available to both law enforcement agencies, police response to victims of a crime is often limited, slow and ineffective.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to local police and to 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, to contact family members or friends and explain how funds can be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
During an emergency, visitors to Antananarivo can contact local police at telephone numbers 117 and 22-357-09/10 or 22-227-35. See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Standards of healthcare throughout Madagascar are well below U.S. standards.
However, there are foreign physicians in Antananarivo representing a broad range of specialties, but their training is variable and often not to U.S. standards.
The hospitals in Antananarivo vary greatly in standards of care.
Medical care outside of Antananarivo is generally well below the care available in the capital city.
Caution and good judgment should be exercised when seeking hospital and medical services.
The Embassy maintains a list of hospitals and specialists.
A Seventh Day Adventist dental clinic offers emergency procedures and x-ray facilities.
Some medications, generally of French origin, are available in Antananarivo.
If you need to refill a prescription from home, it is important to carry a prescription from your doctor listing the medicine's generic name.
There is limited availability of both prescription and over the counter medications, and outside of Antananarivo, medications may not be available.
Travelers should have a supply of any needed medication sufficient for the entire length of a visit before arriving in Madagascar.
Americans who will be carrying medications with them to Madagascar may wish to contact the Malagasy Embassy in Washington, D.C. regarding any restrictions on imports.

Ambulance services are available in Antananarivo with Polyclinique Ilafy at 22-425-66/69 or 033 11 458 48 / 032 07 409 38; Espace Medical at 22-625-66, 22-219-72, or 032-02-088-16 (cellular); and CDU (Centre de Diagnostic Medical d’Urgences) at 22 329 56 or 032 07 822 28 or 033 11 822 28.
However, due to traffic jams, response times are often dangerously slow.

Malaria is prevalent, particularly in the coastal regions.
Using preventive measures and malaria prophylaxis is strongly recommended.
Rabies is endemic and there are many street dogs.
It is recommended travelers have the pre-exposure vaccination series prior to arrival in Madagascar.
If bitten by an animal, the effected area should immediately be washed with soap and running water for ten minutes.
Seek medical care immediately.
Plague is also endemic to Madagascar.
While the reported HIV prevalence rate is low, particularly by African standards, Madagascar suffers from a very high reported incidence of other sexually transmitted diseases.

The East African Indian Ocean islands have seen a rise in the cases of Chikungunya.
As with Malaria, Chikungunya and Dengue are transmitted by mosquitoes.
Every effort should be made to use repellants, proper clothing and barriers that discourage/prevent mosquito bites.
The CDC web site contains further information on chikungunya at http://www.cdc.gov/ncidod/dvbid/chikungunya/ and dengue at http://www.cdc.gov/ncidod/dvbid/dengue/.
Travelers should drink bottled water or carbonated beverages.
Local water is not generally potable.
Water purification tablets may be used as necessary.
Bottled water is readily available in Antananarivo but is less so outside the city.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Madagascar is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
In Madagascar, one drives on the right side of the road, generally yielding the right of way to vehicles coming in from the left.
Some major intersections and traffic circles have police directing traffic.
If a policeman has his back to you at an intersection, you are required to stop.
Laws make seatbelt use mandatory and prohibit cell phone use while driving, even with a hands-free attachment.
Child safety seats and motorcycle helmets are not required in Madagascar.
If you are caught driving under the influence of alcohol, your car will be impounded for a few days and you will have to pay a fine.
If you are involved in an accident involving injuries and/or deaths, there is a mandatory court case.
The losing party of the court case must then pay all costs.

Except for Antananarivo’s main streets and a few well-maintained routes to outlying cities, many roads are in various states of disrepair.
Some may be impassable during the rainy season.
Night travel by private or public transportation outside Antananarivo is strongly discouraged due to poor lighting and road conditions.
Roads tend to be narrow and winding with many one-lane bridges and blind curves.
Most vehicles tend to drive in the center of the road unless another vehicle is present.
It is common to find livestock or human-drawn carts in the middle of the road, even at night.
Local practice is to blow the horn before going around a curve, to let others know of one's presence.
Few pedestrian crosswalks or working traffic signals exist.

Travel within Antananarivo can be difficult with poor road signage, streets congested with pedestrians, bicycles, animal carts, and vehicular traffic, and an abundance of one-way streets.
Taxis are plentiful and are generally reasonably priced.
Bargain for the fare prior to getting into a vehicle.
Most accidents are pedestrian-related, due to narrow roads and lack of sidewalks on many streets.
When traveling between cities, travelers must have clear directions as there are rarely signs indicating where one must turn to reach a destination.
Conditions of rural roads can degrade significantly and with little notice during the rainy season.

Rental cars generally come with a driver who is responsible for maintaining the vehicle and sometimes acts as a tour guide.
Public transportation is unreliable and vehicles are poorly maintained.
Rail services are extremely limited and unreliable.
The Ministry of Public Works, telephone (20) 22-318-02, is Madagascar's authority responsible for road safety.
During an emergency, visitors to Antananarivo can contact local police by dialing 117, 22-227-35, 22-357-09/10.
American citizens can also call the U.S. Embassy at 22-212-57/58/59 if assistance is needed in communicating with law enforcement officials.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Madagascar, the U.S. Federal Aviation Administration (FAA) has not assessed Madagascar’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s Internet web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
Domestic and international air services operate regularly but are subject to delays and occasional breakdowns.
Air Madagascar often changes in-country flight schedules based on demand; flights that are not full may be cancelled with little or no prior warning to passengers.
Overbooking is also common.
Reconfirmation of tickets prior to flight day is recommended, especially when flying from provincial airports.
SPECIAL CIRCUMSTANCES:
It is advisable to contact the Embassy of Madagascar in Washington or one of Madagascar's consulates in the United States for specific information regarding customs requirements.
In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products are illegal and bringing them back to the United States may result in forfeitures and/or fines.
Taking photographs of airports or military installations is prohibited.

Madagascar is renowned for its natural resources.
These include a wide variety of gemstones.
The Government of Madagascar recently imposed restrictions on the export of precious gems; before purchasing or transporting any gemstones it is advisable to seek clarification of the applicable laws.

Madagascar is primarily a cash-driven economy.
Although some high-end establishments catering to tourists accept credit cards, normally only Visa-logo cards, most shops and restaurants are cash only.
Although the government changed the local currency from the Malagasy Franc (FMG) to the Ariary several years ago, many Malagasy still think in terms of FMG.
When talking about prices, it is important to quantify whether the price is in Ariary or FMG. (1 Ariary = 5 FMG).
A few ATMs are available in large cities.
Dollars are not widely accepted. 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 Malagasy laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Malagasy are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States as well as in Madagascar.
Please see our information on Criminal Penalties.

CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Madagascar are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site and to obtain updated information on travel and security within Madagascar.
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 14-16 Rue Rainitovo, Antsahavola, Antananarivo.
The mailing address is B.P. 620, Antsahavola, Antananarivo, Madagascar; telephone [261] (20) 22-212-57; fax [261] (20) 22-345-39.
The Embassy’s web site is located at http://www.antananarivo.usembassy.gov/
*

*

*
This replaces the Country Specific Information dated June 2, 2008, to update the section on Crime.

Travel News Headlines WORLD NEWS

Date: Thu 9 May 2019
Source: UN OCHA, ReliefWeb, UN Children's Fund (UNICEF) report [abridged, edited]

Madagascar: humanitarian situation report, quarter 1 - 2019
-----------------------------------------------------------
Highlights
----------
- Madagascar is facing an unprecedented measles epidemic due to low measles vaccination coverage (58 per cent nationwide). As of 3 Apr 2019 there were 122 840 registered cases, and 1233 reported deaths. The measles epidemic affects 107 out of 114 districts across all 22 regions of Madagascar.

- For the 1st quarter of 2019, UNICEF vaccinated over 1.9 million children under 5 years against measles. UNICEF also prepositioned emergency stocks consisting of medicines and basic equipment in 5 targeted regions.

- The nutritional status of the population of southern Madagascar remains precarious. The October 2018 Integrated Food Security Phase Classification (IPC) results revealed that 970 000 people would be in a food security crisis or emergency between November 2018 and March 2019. From January to March 2019, a total of 6767 severely malnourished children were treated in the UNICEF programme. While, 17 365 mothers were trained in nutrition screening techniques.

- More than 59 166 people gained access to safe water through ongoing water trucking supported by UNICEF and the rehabilitation of 129 boreholes and construction of six new boreholes.

Situation overview and humanitarian needs
-----------------------------------------
Measles
-------
The measles outbreak, which began on 3 Sep 2018, has resulted in 122,840 cases as of 3 Apr 2019. It is a nationwide epidemic, with cases reported across all 22 regions in Madagascar. The epidemic has a national attack rate which is currently 33 042 cases per 1 million inhabitants; demonstrating a high rate of spread. Of concern, measles cases have been exported to Comoros and La Reunion. This epidemic is occurring in a context of poor immunization performance. 2/3 of cases are either unvaccinated or their vaccination status is unknown. There have been 1233 deaths reported among the people with measles. Of these, 640 deaths have been notified in health facilities, and 593 at the community level, of which 191 are measles related and 402 non-classified by the community agents.

In Madagascar, there are basic measures to combat measles as well as good testing expertise, particularly through the Pasteur Institute of Madagascar (IPM). However, due to an overall weak health system, the country does not have the capacity to react to health emergencies of this scale without additional international support.
==================
[HealthMap/ProMED-mail map of Madagascar:
Date: Thu 28 Mar 2019
Source: Outbreak News Toady from International Federation of Red Cross and Red Crescent Society [abridged, edited]

Number of people to be assisted: 1,946,656 people in the 10 targeted districts
- Direct targets: 524,868 children for immunization
- Indirect targets: 1,421,788 for sensitization

Host National Society presence of volunteers: Malagasy red Cross Society (MRCS) with 12 000 volunteers across the country. Some 1030 volunteers 206 NDRT/BDRTs, 10 full-time staff will be mobilized through the DREF in the 10 districts.

Red Cross Red Crescent Movement partners actively involved in the operation: International Federation of Red Cross and Red Crescent Societies (IFRC), International Committee of the Red Cross (ICRC), German Red Cross, Danish Red Cross, Luxembourg Red Cross, French Red Cross through the Indian Ocean Regional Intervention Platform (PIROI).

Other partner organizations actively involved in the operation:
Ministry of Health, WHO, UNICEF

Situation.
In July 2018, the 1st case of measles was notified in the urban health centre of the district of Antananarivo Renivohitra in Madagascar. According to WHO, from 4 Oct 2018 to 7 Jan 2019, 19 539 measles cases and 39 "facility-based" deaths (case fatality ratio: 0.2%) were reported by the Ministry of Public Health (MoH) of Madagascar. Cases were reported from 66 of 114 total districts in all 22 regions of Madagascar.

In February 2019 (weeks 7-8), an overall 774 new cases were recorded in 3 newly affected districts including Andilamena (145 cases in week 7 and 167 cases in week 8); Mahajanga II (142 cases in week 7 and 241 cases in week 8) and Mahanoro (22 cases in week 7 and 57 cases in week 8). Despite stabilizing in some areas, the above-mentioned spikes show that the epidemic is progressing, and the epidemic is now posing significant risk to remote and hard to reach communities as seen in the table below, which summarizes the rate at which the disease has been spreading, with 7288 new cases in March 2019 (weeks 9-12).

Indeed, from the onset of the outbreak until 20 Mar 2019, some 117,075 cases have been recorded with 638 deaths notified by health facilities, while 567 deaths have been reported within the communities (114 deaths related to measles and 453 unrelated deaths as per community volunteers). As per Ministry of Health (MoH), about 56% of cases are unvaccinated or of unknown vaccine status. Most cases have been reported in children under 9 years old. Some 105 districts are currently in epidemic situation in the overall 22 regions of the country. The increase in cases can be seen in graphs in the pdf listed above.

Madagascar has not suffered any measles outbreaks in the last 13 years (since 2005) and was already on the road to eliminating measles.
========================
 [See full report in pdf above. - ProMED Mod.LK]
Date: Wed 13 Mar 2019
Source: Outbreak News Today [abridged, edited]

The number of measles deaths has topped 1100 in Madagascar. In an update on the measles epidemic in Madagascar, UN health officials report 6607 cases of measles, including 41 deaths, in the week ending 24 Feb [2019]. Cases are reported in children aged 1 to 14 years. Of 114 districts in all 22 regions, 104 are in the epidemic phase, officials report.
=======================
[The number of cases and deaths from measles in Madagascar is horrifying, even more so since the disease is vaccine-preventable. There is no information on how the health sector in the country is responding, but clearly the clinics are overburdened during this devastating outbreak. - ProMED Mod.LK]

[HealthMap/ProMED-mail map of Madagascar:
Date: Sat 9 Mar 2019
Source: Outbreak News Today [edited]

Plague is endemic in Madagascar, and a seasonal upsurge, predominantly of the bubonic form, usually occurs yearly between September and April. According to the general secretary of the Madagascar Ministry of Health, between 300 and 600 suspected cases are reported each year, with about 30 cases of pulmonary plague and 10 to 70 deaths.

Since August 2018, Madagascar health officials have reported 105 human plague cases. Of these, 91 cases were identified as bubonic plague, while 14 were pneumonic plague. Of the bubonic plague cases reported to date, 19 people have died; 12 of the 14 pneumonic plague cases also perished.

The districts that include confirmed cases of plague are Manandriana, Tsiroanomandidy, Ambositra, Midongy Atsimo, Ambalavao, Befotaka, Ambatofinandrahana, Miarinarivo, Anjozorobe, Faratsiho, Fianarantsoa, Moramanga, Ankazobe, Arivonimamo, Betafo, and Mandoto.

Plague is an infectious disease caused by the bacterium _Yersinia pestis_. It is found in animals throughout the world, most commonly rats but also other rodents like ground squirrels, prairie dogs, chipmunks, rabbits, and voles. Fleas typically serve as the vector of plague. Human cases have been linked to the domestic cats and dogs that bring infected fleas into the house.

People can also get infected through direct contact with an infected animal, through inhalation, and, in the case of pneumonic plague, person to person. _Y. pestis_ [infection] is treatable with antimicrobials if started early enough.
=======================
[Plague infections on Madagascar have been relatively quiet since the dramatic outbreak in 2017.

The following paragraph is from Chanteau S, Ratsifasoamanana L, Rasoamanana B, et al. Plague, a re-emerging disease in Madagascar. Emerg Infect Dis 1998;4(1):101-4, PMID: 9452403; available at <http://wwwnc.cdc.gov/eid/article/4/1/98-0114_article.htm>.  "Between 1930 and 1990, bubonic plague had 'virtually disappeared' on the island due to efficient pest-control and good health management. However since 1990, an annual 200 cases are being reported and bubonic plague takes on epidemic form, especially in the port of Mahajanga, each year. In the capital city of Antananarivo, more cases are also being notified each year since 1990. Madagascar (pop. 13 million) has accounted for 45% of all the cases of plague in Africa."

Fatalities related to plague usually are caused by spread of the organism from the bubo (the very painful infected lymph node that drains the area where the flea bite occurred) to the bloodstream. The bacteraemia can cause a coagulopathy, producing the purpura seen in the "black plague", and also may spread to the lungs causing a haemorrhagic pneumonia. It is the pneumonia that can facilitate person-to-person transmission.

Madagascar was the location of the isolation of multi-antimicrobial resistant _Yersinia pestis_ in 1995 (Galimand M, Guiyoule A, Gerbaud G, et al. Multidrug resistance in _Yersinia pestis_ mediated by a transferable plasmid. N Engl J Med. 1997;337(10):677-80, PMID: 9278464; available at <http://www.nejm.org/doi/full/10.1056/NEJM199709043371004>). The strain was resistant to chloramphenicol, streptomycin, and tetracycline but sensitive to fluoroquinolones and trimethoprim as well as other aminoglycosides. This was an ominous observation; however, it is not clear whether this naturally occurring strain has persisted or spread. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Madagascar:
Date: Sun 10 Mar 2019
Source: Medical Xpress [abridged, edited]

[F] is aged 2 but weighs no more than a 4 month old, the terrible result of her battle with measles, which is cutting a deadly swathe through Madagascar. Widespread malnutrition and low rates of immunisation on the Indian Ocean island have ramped up the killing power of the highly infectious virus. In the last 6 months, nearly 1000 children have been killed by a resurgent disease that vaccination once appeared to have tamed.

Between last September [2018] and February [2019], there were more than 79,000 cases of measles in Madagascar, 926 of which were fatal, according to the World Health Organization (WHO).

The Anivorano-nord clinic has had 510 patients suffering from "kitrotro" and "kisaosy", the local names for measles. Roughly 100 patients were hospitalised, but only 4 lost their lives, according to official statistics. In Madagascar, where 47% of children under 5 are malnourished, the disease has proved particularly dangerous. "It's often said that malnutrition makes a bed for measles," said Vincent Sodjinou, a WHO representative. "The most serious cases are often reported in malnourished children."

The paediatric ward at Antsiranana's military hospital, north of Anivorano, has been overwhelmed. "Normally we only treat one measles case here every 2 months," said head of medicine Ravohavy Setriny Mahatsangy. "We've had 444 just since December [2018]. The people prefer traditional healers who often advise them to refuse any hospitalisation," said Dr Said Borohany, a health ministry official. "And most villages are hours away from basic medical centres."

The other viable solution, vaccinations, has been complicated by the lack of funds available for such a programme. Until now the nation's vaccination programme has administered only a single dose, when WHO recommends 2. The UN agency estimates that 5.6 million doses would be needed to contain the epidemic. But Madagascar is USD 1.6 million (EUR 1.42 million) short of the USD 11.2 million [EUR 9.96 million] needed to fund such an operation.

Newly elected president, Andry Rajoelina, has promised to vaccinate all children aged between 6 months and 9 years.
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.