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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 ...

Mauritania

Mauritania US Consular Information Sheet
September 23, 2008
COUNTRY DESCRIPTION:
Mauritania is a developing country in northwestern Africa.
Arabic is the official language, but French is widely used and several local languages are als
spoken.
Tourist facilities in the capital, Nouakchott, are adequate, but limited or non-existent elsewhere.
Read the Department of State Background Notes on Mauritania for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport and a visa are required, as is evidence of a yellow fever vaccination.
For the most current visa information, contact the Embassy of the Islamic Republic of Mauritania, 2129 Leroy Place NW, Washington, DC
20008, tel. (202) 232-5700, or the Mauritanian Permanent Mission to the UN, 211 East 43rd Street, Suite 2000, New York, NY 10017, telephone (212) 986-7963 or 8189, or e-mail Mauritania@un.int.
Overseas, inquiries should be made at the nearest Mauritanian embassy or consulate.

See our information on dual nationality, the prevention of international child abduction and Customs regulations.

SAFETY AND SECURITY:
There is increasing activity by the terrorist group Al Qaeda in the Islamic Maghreb (AQIM) in Mauritania.
On December 24, 2007, terrorists shot and killed four French tourists and wounded a fifth near the town of Aleg, in southeastern Mauritania.
On December 26, 2007, terrorists killed four soldiers near the town of El Ghallaouiya in northern Mauritania.
These two attacks were followed by an attack on the Israeli Embassy and an adjoining nightclub frequented by westerners early in the morning of February 1, 2008.
The perpetrators of these attacks are believed to be linked to AQIM.
These are the first attacks that have occurred in Mauritania since June 2005, when members of the terrorist group GSPC (now known as AQIM) attacked a military outpost based at Lemgheity, near the Algerian and Malian borders.
In the attack, they killed or wounded about 35 soldiers.
Travelers should avoid all non-essential travel to the Hodh El Charghi region of southeastern Mauritania due to increased AQIM activities in the border area.
Official Americans continue to travel to the town of Atar, although AQIM has also talked about targeting Westerners there.
Travelers should check http://mauritania.usembassy.gov for current Consular Warden messages concerning Mauritania.

Travelers should exercise prudence and caution when traveling in Mauritania.
They should not venture outside of urban areas unless in a convoy and accompanied by an experienced guide, and even then only if equipped with sturdy vehicles and ample provisions.
The U.S. Embassy in Nouakchott has received reports of banditry and smuggling in the more remote parts of Mauritania.
Landmines also remain a danger along the border with the Western Sahara and travelers should cross only at designated border posts.
The U.S. Embassy recommends that travelers avoid travel in regions north and east of Zouerate, Ouadane, and Tichit unless with a government escort.
Travelers planning overland trips from Mauritania to Morocco, Algeria, Senegal or Mali should check with the U.S. Embassy in Nouakchott before setting out.
For more information about travel in Mauritania, please see the section “Traffic Safety and Road Conditions” below.

The Mauritanian military led a bloodless coup on August 6, 2008.
There has been increased political unrest following the coup, but no violence.
There have also been increased political gatherings and street demonstrations.
The police have been using tear gas to break up some anti-coup demonstrations.
An increased police presence and additional vehicle controls may also be expected.
U.S. citizens should avoid large crowds and maintain security awareness at all times.

In Nouakchott and other major cities in Mauritania, there is an increased security presence and additional checkpoints.
Police routinely conduct road blocks at which they may ask for proof of identity and drivers’ licenses.
These checkpoints should be respected.
Americans visiting Mauritania should be prepared for such inquiries and carry their identification cards at all times.
It is best to drive cautiously and be prepared to stop at short notice.

American citizens should be aware of their surroundings at all times and maintain good personal security practices, including always locking their homes and cars.
They should avoid established patterns and take care not to draw attention to themselves.
When going out, they should avoid being part of large, highly visible groups of Westerners and when in restaurants or cafes, avoid sitting in areas that are easily visible from the street.

Although U.S. citizens are generally welcomed in Mauritania, there were reports of anti-American incidents such as threats and stoning of vehicles, following the 1998 U.S.- and British-led intervention in Iraq, and demonstrations outside the Embassy during the 2003 U.S. intervention in Iraq.
Some Muslim extremists have occasionally perceived Christian non-governmental organizations as a threat.
However, local authorities closely monitor political violence and religious extremist groups.

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

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

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

CRIME:
Crime in Mauritania is moderate but steadily increasing.
Most incidents occur in the cities and larger towns, and are petty crimes such as pick pocketing and the theft of improperly secured and openly visible valuables left in vehicles.
Most criminal activity occurs at night and walking alone at night is not advisable.
Residential burglaries and robberies, particularly at the beaches in Nouakchott, are not uncommon.
In Nouakchott, travelers should avoid the beach at night.
During the day, beach-goers should travel in large groups or stay in popular areas because of the increase in the number of thefts and robberies, some involving injury to victims, reported there in the past several years.
Violent crimes and crimes involving the use of weapons are rare, but increasing.
Rapes and assaults have occurred and, in some instances, involved the American community.
Foreign tourists, including Americans, might be targeted for kidnapping in Mauritania.

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 in finding appropriate medical care, 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.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Mauritania are limited.
There are few modern clinics or hospitals beyond the capital and a few major towns.
At local pharmacies, some medicines are difficult to obtain; travelers are advised to bring their own supplies.

Malaria is a serious and sometimes fatal disease.
Chloroquine-resistant P. falciparum malaria is a severe form of the disease that is found in many parts of western Africa, including Mauritania.
Because travelers to Mauritania are at high risk for contracting malaria, they should take one of the following anti-malarial drugs:
mefloquine (Lariam™), doxycycline, or atovaquone/proguanil (Malarone™).
The Centers for Disease Control and Prevention (CDC) have determined that a traveler who is on an appropriate anti-malarial drug has a greatly reduced chance of contracting the disease.
In addition, other personal protective measures, such as the use of insect repellents, may help to reduce malaria risk.
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and tell the physician their travel history and what anti-malarial drugs they have been taking.
For additional information on malaria, protection from insect bites, and anti-malarial drugs, please visit the CDC travelers’ health web site at http://www.cdc.gov/malaria/.

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.

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

Public transportation is not safe and road conditions in Mauritania are generally poor, particularly in the interior.
Overland travel is difficult and roadside assistance is almost nonexistent.
The country’s size and harsh climate make road maintenance and repair especially problematic.
Mauritania has only about 2,070 km (1,286 miles) of surfaced roads, 710 km (441 miles) of unsurfaced roads, and 5,140 km (3,194 miles) of unimproved tracks.
Drivers should not offer rides to hitchhikers, nor should visitors to Mauritania accept rides offered by strangers.


The traditional route to Nouadhibou, prior to the completion of a paved road, was along the beach during low tide.
Some travelers continue to use this route, as do visitors to coastal fishing villages and other points of interest, and smugglers and others who try to avoid the security checkpoints that are often established along the asphalt roads.
Pedestrian visitors to the beach should exercise caution because of the beach’s use as a route for motorized vehicles.

U.S. citizens traveling overland for long distances in Mauritania should travel in convoys and be sure to have suitable four-wheel drive vehicles, a local guide, an adequate supply of water and food, and a second fuel reservoir.
Multiple vehicles are recommended in case of breakdown.
A Global Position Satellite (GPS) receiver and satellite phone are essential when traveling in remote areas.
Visitors are urged not to travel alone into the desert.

Driving in Mauritania is treacherous, and we encourage travelers to hire a trained local driver.
Traffic patterns differ considerably from American-style “rules of the road,” and many Mauritanians drive without regard to traffic signs or rules.
Roadway obstructions and hazards caused by drifting sand, animals, and poor roads often plague motorists; when combined with the number of untrained drivers and poorly maintained vehicles, heightened caution is imperative at all times.
Drivers should be alert to conditions and always wear their seat belts.
Motorcycle and bicycle riders should wear helmets and protective clothing.
Nighttime driving is discouraged.

The telecommunications infrastructure is limited and cellular telephone coverage is not wide spread.
For those traveling outside the major urban areas, it is recommended to have a satellite telephone readily available.

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 Mauritania, the U.S. Federal Aviation Administration (FAA) has not assessed Mauritania’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 website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Mauritanian customs authorities may enforce strict regulations concerning the temporary import or export of items such as firearms, narcotics, alcoholic drinks and pork products.
Contact the Embassy of Mauritania in Washington, DC for specific information regarding customs regulations.

The local currency is the ouguiya, and it may not be imported or exported.
Credit cards can be used only at a few hotels in the capital, Nouakchott, and the northwestern city of Nouadhibou.
ATM machines are available only in Nouakchott.
Major foreign currencies are changeable in banks and numerous currency exchanges; however, this service is not always available without advanced notice or prior arrangement.
There is a risk of getting fraudulent bank notes even from banks which often do not have the security means to detect fake bank notes.
Furthermore, credit card fraud is a problem, so it is strongly advisable to pay hotel bills in cash.

Islamic ideals and beliefs in the country encourage conservative dress.
Sleeved garments and below-the-knee skirts are recommended, and people should avoid wearing shorts.
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 Mauritania’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession or use of, or trafficking in illegal drugs in Mauritania 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 Mauritania 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 Mauritania. 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 between the Presidency building and the Spanish Embassy on Rue Abdallaye.
The postal address is B.P. 222, Nouakchott, telephone (222) 525-2660/2663, 525-1141/45, or 525-3038 (ext. 5441), and fax (222) 525-1592.
The Consular Section may be contacted by e-mail at ConsularNKC@state.gov
* * *
This replaces the Consular Information Sheet dated April 29, 2008, to update the section on Safety and Security.

Travel News Headlines WORLD NEWS

Date: Mon 30 Apr 2018
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/crimean-congo-hemorrhagic-fever-case-reported-mauritania-28755/>

The Mauritania Ministry of Health has reported a confirmed case of Crimean-Congo haemorrhagic fever [CCHF] in Ould Yengé commune, Guidimaka region located in the southern-most part of the country. The case-patient is a 58-year-old male herder from Elghabra locality who became ill on [16 Apr 2018] (reportedly) after tending to a sick cow days earlier. He presented to a private clinic the same day [16 Apr 2018] with high fever, arthralgia and headache. He was admitted, managed for an unspecified medical condition and discharged on [18 Apr 2018].

The following day [19 Apr 2018], he developed bleeding from the gums and nose, and was admitted to the regional hospital where he was transfused and subsequently discharged on [20 Apr 2018], following an apparent clinical improvement. On [21 Apr 2018], the case-patient's health deteriorated and he was taken to Guerou health centre, from where he was immediately referred to Cheikh Zayed hospital in Nouakchott on [22 Apr 2018].

A blood specimen was obtained and shipped to the national public health laboratory. The test result released on [24 Apr 2018] was IgM positive for Crimean-Congo haemorrhagic fever. A total of 32 close contacts, including 10 health workers and 4 family members, have been listed and are being followed up. Efforts to identify other close contacts are ongoing.

The case-patient used public transportation and a taxi at various stages of his movement during the course of illness. Preliminary investigations also established that all the 4 healthcare facilities that managed the case-patient did not apply appropriate infection prevention and control measures, potentially indicating a higher number of contacts.

According to the WHO, Crimean-Congo haemorrhagic fever is a widespread disease caused by a tick-borne virus (_Nairovirus_) of the _Bunyaviridae_ family. The CCHF virus causes severe viral hemorrhagic fever outbreaks, with a case fatality rate of 10-40 percent. CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north - the geographical limit of the principal tick vector.

The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep and goats. Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites.

Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus _Hyalomma_ are the principal vector. The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. Human-to-human transmission is possible.
=======================
[There is need to emphasize inter-sectoral collaboration involving health, veterinary and entomology/environmental services to map the areas of vector distribution. Furthermore, awareness messages among the high exposure groups should be widespread as CCHF vector propagates from May onwards leading to higher transmission rates in summer. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map:
Guidimaka Region, Mauritania: <http://healthmap.org/promed/p/25044>]
Date: Mon 27 Nov 2017
Source: Outbreak News Today [edited]

Following cases of Crimean-Congo haemorrhagic fever (CCHF) reported this spring and summer [2017], the Mauritania Ministry of Health has reported an addition CCHF case last week [week ending Sun 26 Nov 2017] in a 48-year-old male farmer from Haye Sakin community in Dar Nairn, at the outskirt of the capital city, Nouakchott. He fell sick on the [11 Nov 2017] and was later treated and discharged last week.  The frequency of these events affirms the relative prevalence of the pathogen and the reservoir and vector for CCHF virus (Hyalomma ticks) in the country.

According to the WHO, Crimean-Congo hemorrhagic fever is a widespread disease caused by a tick-borne virus (Nairovirus) of the _Bunyaviridae_ family. The CCHF virus causes severe viral haemorrhagic fever outbreaks, with a case fatality rate of 10-40 percent.  CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north - the geographical limit of the principal tick vector. The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep and goats.

Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus _Hyalomma_ are the principal vector.

The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. Human-to-human transmission is possible.
=========================
[Crimean-Congo hemorrhagic fever (CCHF), an acute viral disease in humans, is characterized by extensive ecchymoses, bleeding, and hepatic dysfunction and is associated with a 30 percent case-fatality ratio (World Health Organization Crimean-Congo haemorrhagic fever. Fact sheet no. 208. Geneva: the Organization; 1998). It is caused by CCHF virus (genus _Nairovirus_, family _Bunyaviridae_).

CCHF is a zoonosis transmitted to large and small mammals and birds by ticks. Although the virus has been isolated from several genera and species of ixodid ticks, the main group of vectors involved in CCHF virus transmission appears to be ticks of the genus _Hyalomma_ (Hoogstraal H. The epidemiology of tick-borne Crimean-Congo haemorrhagic fever in Asia, Europe, and Africa. J Med Entomol. 1979;15(4):307-417.). Immature ticks acquire the virus by feeding on infected small vertebrates. Once infected, they remain infected throughout their development and, when they are mature, transmit the infection to large animals, such as livestock. Transovarian transmission has also been demonstrated.

The circulation of CCHF virus and the high prevalence of infected animals and ticks have been well documented in Mauritanian farming areas since 1983 (Gonzalez JP, LeGuenno B, Guillaud M, Wilson ML. A fatal case of Crimean-Congo haemorrhagic fever in Mauritania: virological and serological evidence suggesting epidemic transmission. Trans R Soc Trop Med Hyg. 1990;84(4):573-6).

Mauritania experienced a fairly large CCHF outbreak in 2003, involving 38 cases with a case fatality rate of 28.6 percent. Over 90 percent of the cases (35/38) were resident in Nouakchott. In 2017, the WHO reported confirmation of a 3rd CCHF case in Boutilimit as well as in 2 patients referred from Mauritania to Dakar, Senegal who tested positive between May and June 2017. These cases had also originated from the capital city Nouakchott. This may be indicative of the relative prevalence of the reservoir and vector for the CCHF virus (Hyalomma ticks) in the country.

Even though the country has established adequate diagnostic capacity, which facilitated rapid confirmation of cases; the national authorities and partners need to carry out extensive outbreak investigations, including seroprevalence studies, to determine the potential risk for continued CCHF outbreaks in humans and institute effective prevention and control measures, with a strong animal health component  (<http://apps.who.int/iris/bitstream/10665/258794/1/OEW34-192582017.pdf>).

The case reported in this report is a farmer admitted in early
November [2017], however no exposure history is mentioned. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map Nouakchott, Nouakchott, Mauritania:
Date: 28 Aug 2017
Source: Outbreak News Today [edited]

On 24 Aug 2017, the Mauritania Ministry of Health notified WHO of a confirmed case of Crimean-Congo hemorrhagic fever (CCHF) in a 47-year-old shepherd, from Arafat Village in Mohammedia, Boutilimit Prefecture, located about 150 km southeast of the capital, Nouakchott.

In May 2017, health officials reported 2 imported cases of Crimean-Congo hemorrhagic fever (CCHF) in Senegal imported from Mauritania. A 3rd imported case was reported in June 2017.

He developed headache, muscle and joints pains and diarrhea on 20 Aug 2017 and sought medical attention. He was treated with anti-malarial medicines and analgesics.

After 2 days, he returned for medical care as his condition worsened. He was tested for CCHF because of bleeding manifestations and was IgM positive for Crimean-Congo haemorrhagic fever by enzyme-linked immunosorbent assay (ELISA). The patient is still hospitalized and in stable clinical condition.

Mauritania experienced a fairly large CCHF outbreak in 2003, involving 38 cases with a case fatality rate of 28.6 percent. According to the WHO, Crimean-Congo hemorrhagic fever is a widespread disease caused by a tick-borne virus (Nairovirus) of the Bunyaviridae family. The CCHF virus causes severe viral hemorrhagic fever outbreaks, with a case fatality rate of 10-40 percent.

CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north, the geographical limit of the principal tick vector. The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep and goats.

Animals become infected by the bite of infected ticks, and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus _Hyalomma_ are the principal vectors.

The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. Human-to-human transmission is possible.  [Byline:  Robert Herriman]
==================
[An outbreak of Crimean-Congo hemorrhagic fever was documented in Nouakchott, the capital of Mauritania in 2003. The index case was detected on 18 Feb 2003. By 21 Mar 2003, the Ministry of Health of Mauritania had reported a total of 35 cases (18 laboratory confirmed) of Crimean-Congo haemorrhagic fever (CCHF), including 6 deaths [Crimean-Congo hemorrhagic fever - Mauritania (04) http://promedmail.org/post/20030324.0732].

In the period from February to August 2003, 38 persons were infected with Crimean-Congo hemorrhagic fever (CCHF) virus; 35 of these persons were residents of Nouakchott. The 1st patient was a young woman who became ill shortly after butchering a goat. She transmitted the infection to 15 persons in the hospital where she was admitted and 4 members of her family. In Nouakchott, 2 disease clusters and 11 isolated cases were identified. Of the patients not infected by the 1st case-patient, almost half were butchers, which suggests that the primary mode of animal-to-human transmission was direct contact with blood of infected animals.

Cattle heavily infested with ticks were more likely to be CCHFV seropositive, and vector control to reduce the tick burden can result in reduced seroprevalence. Cattle are noted as the most sensitive indicator of low-level CCHFV circulation because they tend to be highly infested with _Hyalomma_ spp. ticks, which are the most common vectors of CCHF  [<http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004210>].

The circulation of CCHF virus and the high prevalence of infected animals and ticks have been well documented in Mauritanian farming areas since 1983 [Crimean-Congo haemorrhagic fever and Rift Valley fever in south-eastern Mauritania. Saluzzo JF, Digoutte JP, Camicas JL, Chauvancy G Lancet. 1985 Jan 12; 1(8420):116].

Since then, this is the latest case reported from that country, with history of exposure to livestock. - ProMed Mod.UBA]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/13859>.]
Date: Sat 3 Jun 2017, 11:08 AM
Source: Alakhbar [in French, trans. Mod.AB, edited]

A suspected case of Rift Valley fever (RVF) was discovered at the Nouakchott Hospital Center according to a source for Alakhbar.

The patient is a 37-year-old Mauritanian. He was isolated upon his arrival at the hospital after the 1st medical tests revealed the existence of fever. Further in-depth analyzes are required for confirmation.

The Mauritanian health authorities have often denied the existence of the virus in its 1st appearances.

RVF is a disease that mainly affects animals but can contaminate humans either by mosquito bites or by contact with blood, physiological fluids, or organs of infected animals. The RVF virus was 1st identified in 1931 during an investigation of an epidemic affecting sheep in a Rift Valley farm in Kenya.
=====================
[If this case were to be definitively confirmed in the laboratory, it would have occurred almost 18 months after the series of cases, including 4 fatal cases, which Mauritania had experienced over various provinces in October 2015. At the same time, at least 4 foci of the disease occurred in sheep and goats in Brakna region (Aleg, Tidjikja, Magta-Lahjar, Kiffa).

The recent episode of RVF in Niger (September 2016 to February 2017) could be the cause of the re-emergence of the disease in Mauritania because, although these 2 countries do not share a common border, there is an incessant movement of livestock between the different areas of the Sahel where nomadism is a widespread lifestyle. It would appear that veterinary surveillance in these areas is sub-optimal, and this would explain why the detection of human cases precedes that of animal cases at the origin of these cases. - ProMED Mod.AB]

[RVF virus likely is endemic in parts of Mauritania, with cases of human and domestic animals occurring sporadically there. ProMED Mod AS provided an excellent comment on RVF previously; "Rift Valley fever (RVF) is a peracute or acute zoonotic disease of domestic ruminants. It is caused by a single serotype of a mosquito-borne virus of the _Bunyaviridae_ family (genus _Phlebovirus_). The disease occurs in climatic conditions favouring the breeding of mosquito vectors and is characterised by abortion, neonatal mortality, and liver damage. The disease is most severe in sheep, goats and cattle. Older, non-pregnant animals, although susceptible to infection, are more resistant to clinical disease. There is considerable variation in the susceptibility to RVF of animals of different species. Camels usually have an inapparent infection with RVF virus (RVFV), but sudden mortality, neonatal mortality, and abortion occur, and abortion rates can be as high as in cattle.

"Humans are susceptible to RVFV and are infected through contact with infected animal material (body fluids or tissues) or through bites from infected mosquitoes. RVFV has also caused serious infections in laboratory workers and must be handled with biosafety and biocontainment measures. It is recommended that laboratory workers be vaccinated if possible.

"RVFV is endemic in many African countries and may involve several countries in the region at the same time or progressively expand geographically over the course of a few years. In addition to Africa, large outbreaks have been observed in the Arabian Peninsula and some Indian Ocean Islands. These generally, but not exclusively, follow the periodic cycles of unusually heavy rainfall, which may occur at intervals of several years, or the flooding of wide areas favouring the proliferation of mosquitoes.

"Rainfall facilitates mosquito eggs to hatch. _Aedes_ mosquitoes acquire the virus from feeding on infected animals and may potentially vertically transmit the virus so that new generations of infected mosquitoes may hatch from their eggs. This provides a potential mechanism for maintaining the virus in nature, as the eggs of these mosquitoes may survive for periods of up to several years in dry conditions. Once livestock is infected, a wide variety of mosquito species may act as the vector for transmission of RVFV and can spread the disease.

"Low level RVF activity may take place during inter-epizootic periods. RVF should be suspected when exceptional flooding and subsequent abundant mosquito populations are followed by the occurrence of abortions, together with fatal disease marked by necrosis and haemorrhages in the liver that particularly affect newborn lambs, kids and calves, potentially concurrent with the occurrence of an influenza-like illness in farm workers and people handling raw meat.

"During an outbreak, preventive measures to protect workers from infection should be employed when there are suspicions that RVFV-infected animals or animal products are to be handled.

"The above and much more information is available at

ProMED would appreciate receiving additional information including laboratory results about this case and any new ones that might appear as they become available, in addition to information on presumed location of infection as the diagnosis was made in the capital city, but no mention of where the individual came from. - ProMED Mod.TY]

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

A HealthMap/ProMED-mail map can be accessed at:
Date: Tue 22 Mar 2016
Source: Points Chaud [in French, trans. Mod.MPP, edited]

A Mauritanian who came from Angola with yellow fever died on Monday [20 Mar 2016] at the Friendship Hospital. According to the Mauritanian community in Angola, the deceased had contracted the disease in Angola and decided to return to the country 2 days ago on a plane from a Moroccan company. His situation deteriorated after having been transferred to the Friendship Hospital where he died on Monday [20 Mar 2016].

It's not known whether the health authorities of the country had or did not have any concept of the severity of his disease. It's known that Angola presently has an epidemic of yellow fever ongoing that has already killed [more than] 158 people.

Yellow fever is a serious disease transmitted by insects that proliferate in standing water in dirty locations and places with waste.
=====================
[This is yet another case where a yellow fever virus infected individual travelled to a distant country in Africa. YF-infected individuals have travelled from Angola to the DR Congo and to Kenya. The risk of ongoing transmission in Mauritania is unknown, but health authorities there should be vigilant. - ProMED Mod.TY]

[HealthMap/ProMED-mail maps can be accessed at
More ...

World Travel News Headlines

Date: Tue 18 Jun 2019
Source: The Namibian [edited]

Oyster and black mussel production at Walvis Bay has been halted due to another outbreak of diarrheal shellfish poisoning (DSP), which can be harmful to humans. The Ministry of Fisheries and Marine Resources issued a notice yesterday [17 Jun 2019], warning people not to eat oysters or mussels from Walvis Bay. This comes 3 months after the last outbreak, which was cleared shortly thereafter.

According to the fisheries biologist, contamination is a seasonal occurrence -- mainly during summer from October to April. The recent outbreak could put a dent in the shellfish industry's economy as most exports are to Asia.

The worst affected area is at Walvis Bay's central production sector called "aquaculture production area 1", which is situated near Pelican Point. Once 2 negative results of tested samples are issued, the alert would be withdrawn, and harvesting, consumption and exports would be cleared again. The samples should be taken at 48-hour intervals, the statement from the ministry noted. Marine biotoxins are not destroyed by cooking or freezing.

The statement indicated that DSP symptoms in humans who may have been poisoned might include, as the name suggests, diarrhea, although nausea, vomiting and stomach cramps are also common. These symptoms could manifest themselves after about half an hour of eating the infected shellfish, and could last a day. No deaths have been recorded from DSP to date, the statement indicated. People who show such symptoms should immediately consult a doctor or healthcare centre.  [Byline: Adam Hartman]
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[It is not clear if the term outbreak refers to in the shellfish or in humans.  Diarrheal shellfish poisoning (DSP) (<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20020>) is a gastrointestinal illness caused by the consumption of shellfish contaminated with algal toxins produced by marine dinoflagellates belonging to the genera _Dinophysis_ spp. (_D. fortii_, _D. mitra_, _D. rotundata_, _D. tripos_, _D. acuta_, _D. norvegica_, and _D. acuminata_) and _Prorocentrum_ spp. (_P. lima_, _P. maculosum_, _P. concavum_, and _P. hoffmannianum_).

The DSP toxins, including okadaic acid (OA) and its analogues dinophysistoxin-1 (DTX-1), dinophysistoxin-2 (DTX-2), and dinophysistoxin-3 (DTX-3), belong to the larger group of lipophilic toxins that also includes the azaspiracid, yessotoxin, and pectenotoxin group toxins.

The term diarrhectic (usually diarrhetic) shellfish poisoning (DSP) was used in this report, but this moderator prefers to use diarrheal shellfish poisoning to avoid any confusion between the almost homophones of diarrhetic and diuretic.

DSP is often mistaken for norovirus-like disease. It is treated with rehydration, and affected individuals usually recover in 1 to 2 days. DSP is most commonly found in shellfish in Europe and Japan but can appear anywhere and bears consideration with the appropriate epidemiology. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Date: Wed 19 Jun 2019 [date accessed]
Source: WHO/EMRO Epidemic and pandemic-prone diseases [edited]

MERS situation update, May 2019
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- At the end of May 2019, a total of 2442 laboratory-confirmed cases of Middle East respiratory syndrome (MERS), including 842 associated deaths (case fatality rate: 34.5%), were reported globally; the majority of these cases were reported from Saudi Arabia (2051 cases, including 765 related deaths with a case fatality rate of 37.3%). During the month of May [2019], a total of 14 laboratory-confirmed cases of MERS were reported globally. All 14 cases were reported from Saudi Arabia with 4 associated deaths.

- This month [May 2019], Saudi Arabia has not reported any new cases related to the Al-Khafji city outbreak. The outbreak has presumed to have stopped due to the effective response measures taken by Saudi Arabia. This month [May 2019], one household cluster was reported from Al-Kharj city, including 2 symptomatic national females aged 22 and 44. One 23-year-old national female healthcare worker was also infected this month [May 2019] in Riyadh. All 4 cases that died this month [May 2019] were symptomatic males with one or more co-morbidities.

- The demographic and epidemiological characteristics of reported cases, when compared during the same corresponding period of 2013 to 2019, do not show any significant difference or change.

Summaries:
- Laboratory-confirmed cases reported since April 2012: 2442
- Deaths reported since April 2012 globally: 843
- Number of countries that have reported cases since April 2012: 27
- Number of countries in the Eastern Mediterranean Region that have reported cases since April 2012: 12
- 13 laboratory-confirmed cases reported linked to an outbreak in Saudi Arabia in April [2019]
- The age group 50-59 years continues to be at highest risk for acquiring infection of primary cases. The age group 30-39 years is most at risk for secondary cases. The number of deaths is higher in the age group 50-59 years for primary cases and 70-79 years for secondary cases.
Date: Tue, 18 Jun 2019 06:40:09 +0200
By Sebastien BERGER

Pyongyang, June 18, 2019 (AFP) - On a grey stone column in Pyongyang, a mural shows Chinese and North Korean soldiers rushing into battle against US-led forces in the Korean War. Decades later, the monument is a regular stop for new waves of Chinese going to the North, this time as tourists.   Hundreds of soldiers and workers have been sprucing up the obelisk and its grounds in recent days ahead of a state visit to Pyongyang by Chinese President Xi Jinping this week.   An inscription on it lauds "the Chinese People's Volunteer Army, who fought with us on this land and smashed down the common enemy".   Their "immortal exploits" will "last forever", it proclaims, as will "the friendship forged in blood between the peoples of the People's Republic of China and the Democratic People's Republic of Korea".   Nearly 70 years after Mao Zedong sent millions of soldiers to save Kim Il Sung's troops from defeat as General Douglas MacArthur's men marched up the peninsula, China remains the isolated, nuclear-armed North's key diplomatic backer and main provider of trade and aid.

Now the Friendship Tower, as the monument is known, attracts growing hordes of Chinese tourists -- and the renovations suggest it may also be on Xi's itinerary.   Ordinary Chinese pay travel companies around 2,500 yuan ($360) for a standard three-day trip, arriving overland by train in Pyongyang to tour the capital's highlights, from the Arch of Triumph to Kim Il Sung Square.   The following day they head south to the Demilitarized Zone that has divided the peninsula since the two sides fought each other to a stalemate in 1953, before returning home.   "I'm very interested in North Korea and wanted to come to see what North Korea looks like," said Yu Zhi, a retiree from Anhui province visiting Pyongyang, telling AFP that she had a "special feeling" for the country.   "China is very friendly with North Korea," added her fellow traveller, a woman surnamed Jin. "We have been friends for generations."

- Lips and teeth -
It was not always so. Mao -- whose eldest son Mao Anying was among those killed in what China still calls the "War to Resist US Aggression and Aid the DPRK" -- described the neighbours as "as close as lips and teeth".   Ties then waxed and waned during the Cold War, when founder Kim Il Sung was adept at playing his Soviet and Chinese allies off against each other, and his grandson, the current leader Kim Jong Un, did not visit Beijing to pay his respects for more than six years after inheriting power.   But as he embarked on a flurry of diplomacy last year he made sure that Chinese President Xi Jinping was the first foreign head of state he met, and he has since done so three more times -- more often than Kim has seen any other leader.    Now Xi is going to reciprocate.

At the same time Chinese tourism to the North has reached record highs, according to travel industry sources -- so much so that Pyongyang has imposed a limit on arrivals.   No official figures are available from authorities on either side, but Simon Cockerell, general manager of Koryo Tours, the market leader for Western visitors, said there had been "a huge increase in Chinese tourists".   At peak times 2,000 people a day had been arriving in Pyongyang, he said. "That's far too many because there is no infrastructure to accommodate that many tourists, so problems with train tickets, with plane tickets, hotel space."   As a result North Korean authorities had themselves set a 1,000-a-day cap, he added, although it was unclear whether this applied across the industry or solely to Chinese, who make up the vast majority of arrivals.   "There are issues with just hundreds of people showing up at the same time."

- 'Choices being made' -
China has a proven willingness to use tourism as a geopolitical negotiating weapon -- it banned group tours to South Korea after it deployed a US anti-missile system, THAAD.   With nuclear negotiations at a stalemate the North remains subject to multiple UN Security Council sanctions, and the US imposed a travel ban on its own citizens visiting following the death of student Otto Warmbier, who had been jailed after trying to steal a propaganda poster.   But tourism is not among the sectors targeted by the UN, potentially enabling Beijing to use it as an incentive for its sometimes wayward ally.

The Chinese travel phenomenon is market-driven, rather than prompted by state order -- as well as the market offered by China's huge population, the two countries' border enables cheap overland journeys.   But simply enabling it to take place, said John Delury of Yonsei University in Seoul, meant "We can infer some choices are being made" by Beijing.   "We know it's a lever they can turn on and off," he said.   Even with the diplomatic process at a standstill, he added, "The Chinese think you have to use this window of opportunity to move things forward. There has to be a path on both sides and so something like opening up tourism is a good way to enable that."   At the Monument to the Three Charters for Reunification on the edge of Pyongyang, where two giant stone women form an arch over a road, a secondary school teacher from Shanghai called Peng said: "We are both socialist countries. I feel there are more Chinese coming to visit."
Date: Tue, 18 Jun 2019 06:14:38 +0200

Mae Sai, Thailand, June 18, 2019 (AFP) - Tourists snap selfies by a bronze statue of the diver who died trying to save the 'Wild Boars' football team from a flooded cave, while momentos from their rescue fly off the shelves -- scooped up by the 1.3 million people who have descended on a once serene mountainside in northern Thailand.   "It's amazing what happened here. I followed everything from Australia," tourist John McGowan told AFP after taking photos at the visitor centre around 100 metres from the Tham Luang cave entrance.   "I wanted to see it with my own eyes," the 60-year-old said, adding he was a little disappointed the cave is still off limits to visitors.

For a few dollars tourists can get framed photos at the site, pick up posters of the footballers and take home a souvenir t-shirt  -- some printed with the face of Saman Gunan the Thai diver who died in the bid to save the group.   There has been extraordinary global interest in the picturesque rural backwater of Mae Sai since 12 youngsters -- aged between 11 and 16 -- and their coach entered the Tham Luang cave on June 23, 2018.   They quickly became trapped by rising water levels and the daring, unprecedented mission to extract them through twisting flooded passageways captivated the world for 18 nail-biting days.   When they emerged -- after being heavily sedated and manoeuvered out by expert divers -- they did so into the centre of a global media frenzy.

The cave, which previously received around 5,000 visitors a year, has since been inundated by visitors both Thai and foreign.   "A miracle has happened here with these children," Singaporean tourist Cheong, giving one name, said but adding Tham Luang "must still have a spiritual side" despite the mass popularity.   - Tragedy and luck -   Mae Sai district, where the cave is located, was considered off the beaten track for foreign visitors.    But between October 2018 and April this year alone "1.3 million people visited," site manager Kawee Prasomphol told AFP.

The government now has big plans for the area around the storied cave, Kawee added, allocating a total of 50 million baht ($1.6 million) including a shopping complex, restaurants, hotels and several campsites outside the national park.   Vans disgorge streams of tourists who explore a visitor hub where the centrepiece is a mural entitled "The Heroes".   It depicts the young footballers, stars of the rescue, and junta chief Prayut Chan-O-Cha -- a reminder of the governmental fingerprints in aiding their cause.   At the heart of the mural is the beaming face of Saman Gunan, the Thai Navy SEAL diver who ran out off oxygen attempting to establish an air line to the children and their coach -- the only fatality across the near three-week rescue mission.

Laying white flowers at the foot of his bronze statue, Thai nurse Sumalee, who travelled four hours to the site, described him as "the hero of the whole country" in a sobering reminder of the risks involved in the rescue amid the blizzard of marketing opportunities now attached to the cave story.    Nearby lottery ticket vendors are capitalising on the perceived good fortune linked to the boys' survival and the folkloric appeal of a nearby shrine. The number of stalls has mushroomed from a few dozen to around 250.    Kraingkrai Kamsuwan, 60, who moved his stall to the site weeks after the rescue, sells 4,000 tickets a month ($2.5) but reckons more will visitors will arrive once the cave reopens.    He told AFP: "People want to gamble after wishing for luck from the shrine."
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.