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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]
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Paraguay

Paraguay - US Consular Information Sheet
September 15, 2008
COUNTRY DESCRIPTION:
Paraguay is a constitutional democracy with a developing economy.
Tourist facilities are adequate in the capital city of Asuncion, but they vary greatly
n quality and prices.
Travelers outside Asuncion should consider seeking travel agency assistance, as satisfactory or adequate tourist facilities are very limited in other major cities and almost nonexistent in remote areas.
Read the Department of State Background Notes on Paraguay for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and visa are required.
U.S. citizens traveling to Paraguay must submit completed visa applications in person or by secure messenger to the Paraguayan Embassy or one of the consulates and pay a fee.
Paraguay issues visas for one-entry or multiple entries up to the validity of the U.S. passport.
Applicants under 18 years of age traveling alone must appear with both of their parents or a legal guardian.
In case of a guardian, an original and one copy of proof of legal guardianship are required.
A document of authorization from parents/guardian will be accepted only if it is notarized and certified by the county clerk.
Travelers entering or departing Paraguay with regular U.S. passports will be fingerprinted.
Some airlines include the Paraguayan airport departure tax in the price of the airline ticket.
It is recommended that you check with the airline in order to determine whether or not the departure tax has been included.
If the tax is not included in the airline ticket then payment would be required upon departure in either U.S. or local currency (no credit cards or checks accepted). Visit the Embassy of Paraguay web site at http://www.embaparusa.gov.py 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:
As stated in the Department of State's latest Worldwide Caution, U.S. citizens overseas may be targeted by extremist groups and should maintain a high level of vigilance.
The U.S. Embassy is not aware of any specific terrorist threat to Americans in Paraguay.
Individuals and organizations providing financial support to extremist groups operate in Ciudad del Este and along the tri-border area between Paraguay, Brazil and Argentina.
Small armed groups have also been reported to be operating in the San Pedro and Concepcion Departments.
Drug trafficking remains a serious concern in the Department of Amambay.
Because of concerns about the lack of security in border areas, the U.S. Embassy in Asuncion requires U.S. Government personnel and their family members to provide advance notice and a travel itinerary when traveling to Ciudad del Este or Pedro Juan Caballero.
As a general precaution, the Embassy also counsels its employees traveling outside the capital to provide an itinerary including dates, contact names, and telephone numbers where the employee may be reached.

Since January 2007, there have been numerous kidnapping incidents mainly in the Alto Parana department.
Targets have been members of the Paraguayan business community or their family members.
It is believed that the individuals responsible for the kidnappings are financially motivated and have pre-selected their targets based on the victims’ wealth.

U.S. citizens should avoid large gatherings or any other event where crowds have congregated to demonstrate or protest.
Such activities have resulted in intermittent road closures including major routes traveled by tourists and residents.
While generally nonviolent, demonstrations and/or roadblocks have turned violent in the past.
Areas where such closures and barricades exist should be avoided.
U.S. citizens who encounter demonstrations and/or roadblocks should not attempt to continue the planned travel or to confront those at the roadblock.
Instead, they should avoid areas where individuals are demonstrating and in case of roadblock, wait for the road to reopen or return to the origin of their trip.
Uniformed police often conduct roving checks of vehicles and passengers.

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

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the United States and Canada, or for callers outside the United States and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.

CRIME:
Crime has increased in recent years with criminals often targeting those thought to be wealthy.
Although most crime is nonviolent, there has been an increase in the use of weapons and there have been incidents where extreme violence has been used.
U.S. citizens have on occasion been the victims of assaults, kidnappings, robberies, and rapes.
Local authorities frequently lack the training and resources to solve these cases.
Under these circumstances, U.S. citizens traveling to or residing in Paraguay should be aware of their surroundings and security at all times.
They should take common sense precautions including refraining from displaying expensive-looking cameras and jewelry, large amounts of money, or other valuable items.
Resistance to armed assailants has often aggravated the situation and therefore is not advised.

Armed robbery, carjackings, car theft, and home invasions are a problem in both urban and rural areas.
Street crime, including pick pocketing and mugging, is prevalent in cities.
The number of pick pocketing incidents and armed assaults is also increasing on public buses and in the downtown area of Asunción.
As many incidents on public buses involve individuals snatching valuables, passengers should not wear expensive-looking jewelry or display other flashy items.
There have been incidents of pilferage from checked baggage at both airports and bus terminals.
Travelers have found it prudent to hide valuables on their person or in carry-on luggage.
Unauthorized ticket vendors also reportedly operate at the Asuncion bus terminal, badgering travelers into buying tickets for substandard or non-existent services.

In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime are solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

Below are the local equivalent phone numbers to the “911” emergency line in Paraguay.
In Asuncion, the following phone numbers exist for roadside/ambulance assistance:
Emergency Services, including police and ambulances:
911.
Fire Department, including rescue of accident victims: 131, 132.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Adequate medical facilities, prescription and over-the-counter medicine, supplies, and services are available only in Asuncion.
Elsewhere, these are limited and may not exist.

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.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to Paraguay or foreign residents of the country.

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

U.S. citizens have been injured and killed in traffic accidents.
Only minimal standards must be met to obtain a Paraguayan driver's license, and driver education prior to licensing is not common.
Drivers throughout Paraguay routinely ignore traffic regulations.
No vehicle insurance is required, and many Paraguayans drive without any insurance coverage.
Persons who drive in Paraguay should be prepared to drive defensively and with their own insurance in both urban and rural areas.

Public transportation is readily available for urban and inter-city travel.
Buses vary in maintenance conditions and may not meet U.S. safety standards.
Armed robberies and pick pocketing occur on buses in cities and rural areas, sometimes with the apparent collusion of the bus driver.
Taxis are available and may be called using telephone numbers listed in the newspapers.
No passenger train service exists.
Bicycle travel may not be safe due to traffic and other road hazards.
Most urban streets consist of cobblestones over dirt.
Some roads in Asuncion and other large cities are paved.
However, these roads frequently develop potholes that often remain unrepaired.
Nearly all rural roads are unpaved, and during rainy periods and the rainy season (November-March/April), they may be impassable.
Road signs indicating hazards, such as sharp curves or major intersections, are lacking in many areas.

Driving or traveling at night is not advisable outside Asuncion because pedestrians, animals, or vehicles without proper lights are often on the roads.
In addition, assaults and other crimes against motorists traveling at night have occurred.
Extra precautions should be exercised along infrequently traveled portions of the rural roads.

Intercity highway maintenance is not equal to U.S. standards.
The privately maintained toll road between Caaguazu and Ciudad del Este and the routes between Asuncion and Encarnacion and Asuncion and Pedro Juan Caballero are in good condition.
Most other intercity routes are in good to fair condition, with brief stretches in poor condition.
The Trans-Chaco route is in fair condition except for the portion between Mariscal Estigarribia and the Bolivian border, which is unpaved and at times impassable.

The Touring and Automobile Club provides some roadside assistance to its members.
The Club may be contacted in Asuncion by visiting its offices at 25 de Mayo near Brazil, First Floor, or telephoning 210-550, 210-551, 210-552, 210-553, Monday through Friday from 8:00 a.m. to 5:00 p.m., or Saturday from 8:00 a.m. to noon, except for Paraguayan holidays.
The Touring Club also has offices in Ciudad del Este (tel. 061-512-340), Coronel Oviedo (tel. 0521-203-350), Encarnación (tel. 071-202-203), San Ignacio Misiones (tel. 082-232-080), Caaguazu Campo 9 ( tel. 0528-222-211), Santani (tel. 043-20-314), Pozo Colorado (cell phone. 0981-939-611, Villa Florida (tel. 083-240-205) and Ybyyau (tel. 039-210-206).
Towing services are scarce outside urban areas.
Twenty-four-hour tow truck services from Asuncion may be contacted by telephoning (021) 224-366, (021) 208-400, (cellular service provider) Tigo by dialing *822 or 0971-951-930.
For an extra fee, these companies may provide service outside Asuncion, but they typically demand immediate payment and may not accept credit cards.

Please refer to our Road Safety page for more information.
Visit the website of Paraguay’s national tourist office and national authority responsible for road safety at http://www.senatur.gov.py and http://www.mopc.gov.py/
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Paraguay’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Paraguay’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs%5Finitiatives/oversight/iasa/
SPECIAL CIRCUMSTANCES: Paraguay’s customs authority may enforce strict regulations concerning temporary importation into or export from Paraguay of items such as firearms, medications, toys resembling weapons, or protected species.
It is advisable to contact the Paraguayan Embassy in Washington, D.C., or one of Paraguay's consulates in the United States for specific information regarding customs requirements.

Paraguay does not recognize dual Paraguayan nationality for American citizens.
Under Article 150 of the Paraguayan Constitution, naturalized Paraguayans lose their nationality by virtue of a court ruling based on unjustified absence from the Republic for more than three years, or by voluntary adoption of another nationality.
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 Paraguay’s laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Paraguay 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 residing or traveling in Paraguay 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 Paraguay.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at 1776 Mariscal Lopez Avenue, Asuncion; telephone (011-595-21) 213-715, fax (011-595-21) 213-728; Internet: http://paraguay.usembassy.gov, email: paraguayconsular@state.gov.
The Consular Section is open for U.S. citizen services, including registration, Monday through Thursday from 1:00 p.m. to 4:30 p.m. and Fridays from 7:30 a.m. to 10:30 a.m., except for U.S. and Paraguayan holidays; telephone (011-595-21) 213-715, fax (011-595-21) 228-603.

Travel News Headlines WORLD NEWS

Date: Tue, 28 May 2019 03:40:13 +0200
By Hugo OLAZAR

Nanawa, Paraguay, May 28, 2019 (AFP) - Like 70,000 people living close to the broken banks of the Paraguay River, where the water level has risen seven meters (23 feet) in some places, Graciela Acosta has had to pack up her belongings and evacuate.   Piled up on a canoe are the 39-year-old housewife's bed, wardrobe, bedside table and her dog Pirulin.

Acosta is getting ready to cross the border into Argentina with her daughter to seek refuge in a reception center in the neighboring town of Clorinda.   "I've had enough! It's the third time that I've had to move everything because of the floods," said Acosta.   "I pray to God that it ends. Every time. it costs a lot of money."   However, there's no chance of Acosta leaving her home in Nanawa, a town of just 6,000 people that borders Argentina to the west and faces the capital Asuncion to the east across the Paraguay River, for good.   "As soon as the water level drops, I'll go home," she said.

- 'Greater impact' -
In Nanawa, only around 500 people were able to avoid evacuation, due to living in homes with upper floors above the flood levels.   They're used to this as the Paraguay River, one of the largest in the Americas, breaks its banks and causes havoc in the poorest Nanawa neighborhoods built on the flood plain.   The river's brown waters rise almost to the height of street signs: in some areas, there is up to one or two meters of water covering roads.

Paraguayans have seen worse, though, back in 1983, according to the assistant director of the country's meteorology and hydrology service, Nelson Perez.   "It's not the Paraguay River's worst flood, but the impact is greater because more people live close to the river," said Perez.   "These are the worst floods I've seen," said Ruben Acosta, 55, who peddles his moving services by canoe.   It's a far cry from January and February, when the river's level was so low that navigating it became difficult.   "It rained a lot in March, three times more than usual, and it also rained a lot in April and May," said Perez, who pointed to deforestation as an added problem.

- 'It's like being in Venice' -
Wading through water up to his chest, Rigoberto Nunez leaves a cemetery carrying a chandelier, a vase, some crucifixes and family portraits, all plucked from the family vault.   "I prefer to take them away to be safe," says the 47-year-old traveling salesman.    The town is without electricity or police and inhabitants are afraid of looters.   Nunez is heading to a reception center provided by Argentine authorities in a Clorinda slum where he's already stashed his furniture.   Enrique Cardozo's workshop has already been ravaged by the floods.   "I've lost my sofa, the cupboard, I had nowhere to put them," said the 51-year-old father of four.

The family has moved into the first floor of their house, which is just 15 meters from the river.   "It rained non-stop for a week. One day, the water rose one meter. It was impressive, we couldn't save everything," said Cardozo.   "There's nowhere you can put your feet on the ground. It's like being in Venice, we move about by Gondola!"

On the other side of the river, Asuncion has not been spared as several areas have also had to be evacuated.   In the Sajonia residential zone, inhabitants and shopkeepers have seen their sidewalks lined with sandbags, to keep back the floodwaters.   According to Perez, though, the problems -- and waters -- will soon subside.   The water level rose only slightly on Monday, and will continue to do so for a few more days before it drains away during the first half of June, he said.
Date: Mon, 27 May 2019 12:07:58 +0200

Asuncion, May 27, 2019 (AFP) - Heavy flooding in Paraguay has displaced 70,000 families and is threatening to further inundate the capital Asuncion in the coming weeks, the country's weather bureau said.   Water levels on the Paraguay River are rising at a rate of 4-5 centimetres (1.5-2 inches) every day and is only 46 cm (18 in) below a "disaster" level, according to official data from the Department of Meteorology and Hydrology (DMH).

Crossing that threshold would "have a very strong impact" because of the number of Asuncion residents who have moved into the city's floodplain, said DMH deputy director Nelson Perez on Sunday.   The city's water service infrastructure was clogged with garbage which was exacerbating the floods, Perez added. 

Unusually heavy downpours over May, including two days which together exceeded Asuncion's average monthly rainfall, have exacerbated the flooding, said DMH meteorologist Eduardo Mingo.    Some 40,000 people in Asuncion have already been affected by the floods, official data reported.   A further 10,000 people have been displaced in the southern town of Pilar on the Argentinian border.   The government has mobilized armed forces to help displaced residents relocate to shelters, but hundreds of families have opted to stay behind in their inundated homes.
Date: Thu, 4 Apr 2019 03:06:45 +0200

Asuncion, April 4, 2019 (AFP) - More than 20,000 families across Paraguay have been affected by severe flooding from two weeks of heavy rain that caused the country's main river to burst its banks, a senior official said Wednesday as an emergency was declared in the capital.   National Emergency Minister Joaquin Roa made the announcement as forecasters said the precipitation would continue for the rest of the week.   The Paraguay River, which runs some 1,000 kilometres north to south and splits the country in two, is expected to continue overflowing.

A 90-day emergency was declared in Asuncion on Wednesday due to the flooding. Hardest-hit are some 5,000 families living in the Banado Sur working-class neighbourhood on the city outskirts.   The people affected by flooding "need sheet metal roofing, wood, and all types of help," a municipal official told AFP.   The Paraguay River flows past Asuncion and eventually merges into the Parana River in Argentina.   "We did not expect it to swell so quickly," said Pablo Ramirez, a resident of Banado Sur, a neighbourhood in the capital, dismayed after returning to his home after he left it one month ago due to flooding.

Ramirez, who relies on crutches to get around following a car accident, said that he will not leave home this time. The flooding "will go by quickly," he said optimistically.   Pedro Velasco, the leading neighbourhood Catholic priest, said that one week ago they warned emergency officials that the river was about to overflow and asked for trucks to deliver aid and help evacuate people.   "They didn't move until Monday, but by then it was already too late and they couldn't come in" because of the flooding, Velasco said.   Roa said that his office will deliver 400,000 of food in the next days in coordination with the Paraguayan military.
Date: Thu 28 Feb 2019
Source: Hoy [in Spanish trans. Mod.TY, edited]

Patients who present with febrile symptoms and who reside in the area where the 1st positive case was reported positive request tests for hantavirus [infection]. Until now there are 5 cases, 3 were positive in initial laboratory tests and 2 are suspect cases that will be tested outside [the country] because the Central Laboratory does not do confirmatory tests.

The febrile cases of residents in Capiata [Central department], the area where the 1st cases of hantavirus occurred, are adding up and now Health Surveillance has reported 2 more suspected cases, all children between 2 and 7 years old living in the same city; community intervention continues in search of possible cases.

The 1st cases confirmed in a private laboratory remain hospitalized in intensive care and the others who have improved are now receiving ambulatory treatment, stated Dr Sandra Irala of Health Surveillance.

"The clinical picture of hantavirus [infection] is that of a patient with a temperature above 38 deg C [100.4 deg F] and respiratory difficulty is another characteristic in the endemic area such as that of Chaco. In the non-endemic area [hantavirus infection] is suspected if the patient presents with fever and other possible causes are eliminated," the doctor indicated in a press conference.

The rodents that transmit the hantavirus do not inhabit urban areas and the way in which the disease [virus] is acquired is through contact with excreta and other secretions such as saliva and urine of these [infected] rodents.

Irala pointed out that the cases that are initially positive should have a cross-section of studies for final confirmation, so the samples were sent to Argentina, where there is a reference laboratory for the detection of this type of virus.

The person acquires the virus by inhaling air contaminated with the virus that is transported through dust particles, which is why it is recommended before cleaning, especially of storage buildings, to open doors and windows to ventilate the environment and moisten the soil to before proceeding with the sweeping.

The possibility of acquiring a hantavirus [infection] is if you have a history of having visited the Chaco area or if you were in a country that registers outbreaks of hantavirus, such as southern Argentina.

The disease has a 30% mortality rate and in Paraguay every year about 20 cases are registered, all in the Chaco region.

Alerting symptoms
-----------------
The symptoms of hantavirus [infection] are similar to other infectious diseases and include fever, headache, and gastrointestinal problems and, according to the development and the seriousness of the case, the patient may present with respiratory manifestations.

Before the appearance of any of these or other symptoms [the Ministry of Health] urges the public to go to the nearest health service to make the appropriate diagnosis and appropriate treatment. Under no circumstances should self-medication be used as this could aggravate the picture and obstruct the actual diagnosis of the disease.
=====================
[The active surveillance efforts in the neighborhood of the initial case has detected more patients now with a total 3 confirmed and 2 suspected. The tests used in the private laboratory to determine that 3 cases as confirmed are not indicated, nor if samples of these 3 cases were sent to the reference laboratory in Argentina for confirmation.

Most of the previous cases of hantavirus infection in Paraguay have been diagnosed in Boqueron department in the north western part of the country. This is the 1st report of hantavirus infections in the Central department of Paraguay. The possible hantavirus involved in this suspected case is not stated. A 2011 report indicated that Leguna Negra hantavirus was responsible for hantavirus pulmonary syndrome (HPS) cases in Presidente Hayes department. In addition to Laguna Negra virus (rodent host _Calomys laucha_), other hantaviruses that can cause HPS and are found in Paraguay (and their rodent hosts) include Juquitiba (_Akodon cursor_), Ape Aime-Itapua (_Akodon montensis_), Araucaria (_A. montensis_, _Oligoryzomys nigripes_), Jabora and Jabora-like (_A. montensis_), Alto Paraguay (_Holochilus chararius_), and Lechiguanas (_Oligoryzomys nigripes_). - ProMED Mod.TY]

[Maps of Paraguay:
Date: Tue 12 Jun 2018
Source: WHO, Malaria [edited]

- What were the key elements to Paraguay's malaria elimination success that helped the country reach zero indigenous cases of the disease?
Paraguay is the 1st country in the Americas since Cuba in 1973 to be certified malaria-free, representing a significant public health achievement not only for Paraguay but for the Americas as a whole. Achieving elimination in Paraguay required substantial levels of political commitment and leadership, as well as sustained investments in its national malaria programme over a period spanning more than 50 years. Notable aspects of its approach include:

Rapid and targeted response
---------------------------
With free universal health services in Paraguay and a strong malaria surveillance system, malaria cases were detected early, investigated promptly, and classified correctly.

Dedicated elimination strategy
------------------------------
After reporting its last case of malaria in 2011, Paraguay launched a 5-year plan to consolidate the gains, prevent re-establishment of transmission, and prepare for elimination certification. Activities centred on strengthening epidemiological surveillance, robust case management, and a public information campaign on the diagnosis, treatment, and prevention of malaria to promote behaviour change among populations in at-risk areas.

Integration
-----------
During 2015 and 2016, as part of a broader health reform, malaria surveillance, diagnosis, and treatment activities were integrated within Paraguay's general health services, with the aim of expanding health coverage to at-risk populations and preventing re-establishment.

Strengthening surveillance skills
---------------------------------
A 3-year initiative to hone the skills of front-line health workers in the country's 18 health regions was launched in 2016 to keep the malaria surveillance system sustainable over the long term. Supported by The Global Fund to Fight AIDS, Tuberculosis and Malaria, the project addresses disease prevention, identification of suspected cases, accurate diagnosis and prompt treatment to respond to the on-going threat of malaria importation from endemic countries in the region and Africa.

- How has Paraguay managed to stay malaria-free since 2012? What are the systems in place that made this possible and how long will the country keep those systems operational?
As part of the WHO elimination certification process, countries must demonstrate that they have the capacity to prevent the re-establishment of malaria transmission. The availability of free universal health services in Paraguay and a strong malaria surveillance system ensure imported cases of malaria are detected and responded to in a timely manner to prevent local transmission.

The inclusion of the national malaria programme within the National Malaria Eradication Service (SENEPA, in the Spanish acronym), the institution within the ministry of health responsible for the control of vector-borne diseases, helps guarantee the programme's future existence.

Further, congressional legislation provides predictable and long-term financing for the national malaria programme: by law, 1.5 percent of annual income from Paraguay's social security programme is allocated to SENEPA. Together, these elements ensure that efforts to prevent the re-establishment of malaria transmission can be sustained in the decades to come.

- What are the benefits of malaria elimination for Paraguay?
Eliminating malaria in Paraguay means that no one will fall ill or die from local transmission of the disease, bringing about tangible health benefits at the individual and community levels, as well as broader socio-economic outcomes.

- What role did national leadership, political will, civil society and international partners play in Paraguay's success?
Eliminating malaria is a collective effort, requiring the sustained engagement of many partners at the national, regional and global levels. However, achieving elimination is a country-driven process. For elimination efforts to succeed, government stewardship is essential, together with the engagement and participation of affected communities.

- Does Paraguay coordinate cross-border surveillance activities to prevent importation of malaria cases and do they provide antimalarial treatment to visitors and migrants?
Paraguay provides free treatment to all citizens, visitors, and migrants, regardless of their nationality or residency status. The national malaria programme has identified 3 populations at greatest risk: the military, Brazilian students attending universities in Paraguay, and Paraguayans travelling to Africa. Targeted interventions include strengthening passive detection systems, promotion of health education, and providing prophylaxis to travellers heading to and returning from malaria-endemic regions in Africa.

To step up cross-border collaboration, the Pan American Health Organization (PAHO) funded a project focused on strengthening entomological surveillance and control of vector-borne diseases in the 'triple border' area of Argentina, Brazil, and Paraguay. A key outcome of the project, which ran from 2010 to 2012, was the development of an _Anopheles_ mosquito range map, a tool that shows the geographic distribution of malaria-carrying mosquitoes.

- What are the lessons learned from Paraguay's experience that can be applied in other countries looking to eliminate malaria?
Paraguay provides universal free health services to all, one of the critical elements that helps drive a country towards malaria elimination. Sustained political commitment and robust financial support are further keys to success. Continued surveillance of suspected cases, targeted community engagement and education, as well as strengthening skills of front-line health workers, are recommended strategies that WHO encourages countries to adopt as part of their national malaria elimination programmes.
 
- Is Paraguay replicating its elimination strategy with other infectious and mosquito-borne diseases?
Paraguay has an integrated approach to entomological surveillance activities, taking into account several vector-borne diseases including dengue, leishmaniasis, and Zika virus. Integration of malaria surveillance into the general health system had been a challenging task in Paraguay, but the lessons and experiences learned from other vector-borne diseases have contributed to the smooth integration and transition of the malaria programme. At the same time, the approach used to eliminate malaria is now being applied to eliminate Chagas disease and schistosomiasis.
======================
[ProMED congratulates Paraguay for this important public health achievement. It is important to demonstrate that malaria eradication is possible, and the achievement could be an inspiration for the countries in southeast Asia experiencing a decline in artemisinin susceptibility. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Paraguay:
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
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World Travel News Headlines

Date: Wed, 26 Jun 2019 15:37:17 +0200
By Julie Pacorel

Marseille, June 26, 2019 (AFP) - France's second city and key tourist hub Marseille has enforced temporary swimming bans on several beaches amid pollution concerns, disappointing locals and tourists hoping to take a dip as temperatures soar.   Seven of the city's 21 beaches have raised a purple flag -- which means no bathing -- since the start of the month, on days when hygiene inspections revealed high levels of faecal matter.   Marseille is a tourist hotspot, attracting five million visitors per year thanks to its Mediterranean coastline and sun-kissed climate.

But the city, France's largest port, struggles with pollution from industry and shipping.   "It's mostly caused by sanitation problems, but there are also increasing numbers of boats spewing out their grey and black waste before they enter the port," said Sarah Hatimi, head of the water quality programme at Surfrider Foundation Europe environmental group.   Swimming bans are nothing new in Marseille. Last year, authorities enforced 153 bans amid fears of a pollution spike after heavy rainfall.   "This year, we can't say it's because of the rain," Monique Daubet, local councillor responsible for public health, said, adding that spillages from swimming pools and "lots of animal faeces" are part of the problem.   But the city is "proactive", she said, going "even further" than weekly water inspections imposed by a European law to "pay for our own analysis to protect swimmers".

Every morning, inspectors take water samples from each of the city's beaches to test for E. coli and enterococci bacteria, which indicate human or animal defecation.   A laboratory can reveal test results the same morning, whereas the previous weekly tests "arrived far too late, two or three days later," Daubet said.   Despite efforts, Marseille authorities aren't hopeful they can secure a "blue flag" stamp of approval for beach hygiene.   "Our water quality doesn't meet the criteria, which includes, for example, keeping bins at least 100 metres away from the beach".   "Nobody is forcing us to do this," she said. "Rather than complaining, people should be grateful we're closing the beaches!"
Date: Wed, 26 Jun 2019 10:37:11 +0200
By Elizabeth Vuvu

Kokopo, Papua New Guinea, June 26, 2019 (AFP) - Papua New Guinea's volatile Ulawun volcano -- designated one of the world's most hazardous -- erupted Wednesday, spewing lava high in the air and sending residents fleeing.   A pilot for Niugini Helicopters flying near the crater witnessed a column of lava spurting vertically into the equatorial sky, along with ash that has been belching since early morning.   Ulawun, on the remote Bismarck Archipelago chain, is listed as one of 16 "Decade Volcanoes" targeted for research because they pose a significant risk of large, violent eruptions.   Witnesses said lava had cut off the main highway in north of the island.   "The volcanic activity at Mt Ulawun began at 7:00 am this morning after slight rumbling and light emission," Leo Porikura, an official with the West New Britain Disaster Office, told AFP earlier.   "The Rabaul Volcano Observatory has declared a stage one alert warning of a possible eruption."

Witnesses had reported ash spewing out of the 2,334 metre (7,657 foot) summit, sending trails spanning high overhead.    "The sky has turned black," said Kingsly Quou, manager of the nearby Mavo Estates palm plantation.   Quou said that villagers living at the base of the volcano had already been evacuated and he and his colleagues were gathering their belongings.   Japanese satellite imagery and sources on the ground had shown sulphur dioxide and now volcanic ash drifting from the crater.   Australia's Bureau of Meteorology said the ash reached more than 13 kilometres (44,000 feet) into the air.   The bureau's Darwin Volcanic Ash Advisory Centre issued a "red" warning to airlines, indicating the eruption was imminent, although there is not believed to be an immediate threat for flight routes.   Thousands of people live in the shadow of Ulawun, despite it being one of the most active volcanoes in the country.

Porikura said people living in the vicinity of the volcano had been instructed to move away to safer areas and a disaster team had been dispatched.   "The disaster team will liaise with the local community, local businesses and local level government authorities to prepare for a possible eruption," he said.   "Three crucial priority areas being addressed include transport plan, care centre preparations and getting the communities in the high-risk areas to prepare for an evacuation," Porikura said.   The nearby Rabaul Volcano Observatory said emissions from the volcano were getting darker, indicating a higher ash content -- which can cause breathing problems, eye irritation and skin irritation because of the high acid content.   A team of experts had visited earlier this month and reported the volcano was "quiet" adding "there is no indication of any change in its state of unrest."   The ash emissions had been proceeded by an increase in seismic activity, Porikura said.
Date: Wed, 26 Jun 2019 10:01:43 +0200

San José, June 26, 2019 (AFP) - A 6.2 magnitude earthquake hit the Panama-Costa Rica border around midnight on Tuesday, the US Geological Survey said, revising earlier warnings of "significant damage", as the tremor cut power supplies near the epicentre.   The quake struck at a depth of 26 kilometres (16 miles), about two kilometres from the nearest town of Progreso in Panama, USGS said, updating a previous alert that estimated the depth at 10 kilometres.

There were no immediate reports of casualties, and USGS said "the impact should be relatively localized", reversing an earlier advisory that "past events with this alert level have required a regional or national level response."   "Estimated economic losses are less than 1 percent of GDP of Panama," the website said.   According to the National Seismological Network (RSN) in Costa Rica, the quake struck at 0523 GMT Wednesday (11.23 pm Tuesday) with its epicentre located 11 kilometres east of the Panamanian border town of Puerto Armuelles.

The tremor was felt in Costa Rica's capital San Jose and in many parts of the Central American country, according to initial reports, but the national tsunami warning system said there was no risk of a tsunami.   Villagers in the south of Costa Rica fled their homes, fearing aftershocks. Two houses in the region were damaged by the quake, said Alexander Solis, president of the country's National Emergency Commission.

Costa Rica's President Carlos Alvarado said there were power cuts in several communities in the southwest of the country, near the epicentre.   In November 2017 a 6.5-magnitude quake on the Pacific coast of Costa Rica caused buildings to sway in San Jose and contributed to the deaths of two people who had heart attacks.   Further north, two months earlier a 7.1-magnitude earthquake killed more than 300 people in Mexico.
Date: Wed, 26 Jun 2019 03:43:29 +0200
By Béatrice DEBUT

eMalahleni, South Africa, June 26, 2019 (AFP) - Tumelo has again lost several days at school because of sickness.   "My eyes are burning. Sometimes I can't breathe," she coughs.   "The doc said there is nothing we can do," says her mother Nono Ledwaba. "We need to take her out of eMalahleni. When she goes to her grandma in Mafikeng, the symptoms disappear."

The 14-year-old lives in house number 3094 of eMpumelelweni township in eMalahleni, part of the Highveld region turned over to mines and power plants that, according to activists, are killing local people.   Her neighbour in 3095, Lifa Pelican, has similar symptoms, which badly set back his schooling. At 25, he never moves without his inhaler, even inside his chilly home with rough-hewn walls.   "If I don't have it with me, sometimes I can't breathe. Sometimes I feel I am going to die," he says.   "These mines get a lot of money and we suffer. There's solar power. We don't need to use these coal plants."   Green energy such as solar and wind power account for less than two percent of electricity production in South Africa, while coal still provides 86 percent.

Lifa's breathing troubles began after he moved to eMalahleni, at the mercy of gritty coal dust and thick whitish smoke of electricity power stations burning fuel day and night.   Relief comes when he visits his father in Nelspruit, about 200 kilometres (125 miles) away, trips that feel like a new lease on life. "I don't use the inhaler."   Tumelo's own troubles began when the family moved to eMalahleni in 2007, when she was a toddler.   The trips to Mafikeng are literally a breath of fresh air -- her grandmother's home is 400 kms from the mines.   "The only solution is to close down the plants, but will this happen?" Ledwaba asks.   eMalahleni, which means "the place of coal", is among the worst places in the world for pollution by nitrogen dioxide and sulphur dioxide, according to Greenpeace.

- 'Deadly pollution levels' -
South Africa, like many developing countries, has placed a heavy bet on coal for its development -- a fuel that is plentiful, cheap and locally-sourced.   But campaign groups say health and climate costs are high.   Two environmental non-governmental organisations, groundWork and Vukani, say they have identified the top culprits.   They include 12 coal-burning power stations run by state-owned Eskom along with a plant for liquefying coal and an oil refinery.   Pollution from these sites was responsible for between 305 and 650 premature deaths in 2016, say the two NGOs.   They have initiated a suit against the government for "violation of the constitutional right to clean air" -- a legal first in South Africa, the leading industrial power on the continent.

The NGOs contend that the government has failed to reduce deadly pollution levels in the area, just an hour and a half's drive from Johannesburg.   "It has evolved into a public health crisis," says Tim Lloyd, lawyer for groundWork and Vukani.   "The cost of the air pollution to our economy each year is around 35 billion rand (1.8 billion euros, $2 billion)."   In response to the accusations, an environment ministry spokesman told AFP that SO2 (sulphur dioxide) emissions have "shown improvements across all the five monitoring stations" in the worst-affected region of the Highveld.   Criticism by environmental groups "fails to recognise these improvements', the ministry stated, declining to give further details about the data.   "The reality is that the desired improvements will not happen over a short period of time," it said.   Eskom admitted the area's pollution problem "requires urgent attention", adding that domestic coal burning, traffic and mining dust were also to blame.

- 'The life of my kids' -
"When people from other provinces come, they start getting sick with respiratory issues," says Alexis Mashifane, a doctor with a busy practice in Middelberg, 30 kms from eMalahleni.   "When they leave this area, some of them get better."   But many have no choice, saying they are stuck in the toxic region for economic reasons.   "I wish to move away because this place is not right," says Mbali Mathebula, a single mother who is raising a small daughter and a baby girl, both suffering from asthma. "I don't have money to buy a house".

In Mathebula's home at the foot of the Schonland coal mine, five-year-old Princess plays with the useless mask given to her mother at hospital.   Mathebula, a supermarket employee, could not afford a 70-euro ($80) oxygen machine to attach to the mask.   If a child has an asthma attack in the night, Mathebula says she has to wait until the morning and then go to hospital. "Sometimes I don't have money to go there. I must borrow."   Her neighbour Cebile Faith Mkhwanazi has to cope with her three-year-old daughter's asthma attacks.   "I'm thinking of taking them to my mother," she adds, broken-hearted. "So that they stay there forever for their health."
Date: Tue, 25 Jun 2019 17:57:30 +0200
By Clare BYRNE

Paris, June 25, 2019 (AFP) - As Europe sizzled Tuesday at the start of a heatwave tipped to break records, drivers on Germany's famously speedy motorways were ordered to slow down and fans at the women's World Cup were showered in health warnings.

Meteorologists blamed a blast of torrid air from the Sahara for the unusually early summer heatwave, which could send thermometers above 40 degrees Celsius (104 Fahrenheit) in some places on Thursday and Friday.   Experts say such heatwaves early in the summer are likely to be more frequent as the planet heats up -- a phenomenon that scientists have shown to be driven by human use of fossil fuels.

In Germany, where forecasters have warned a June record of 38.5 degrees could be smashed, speed restrictions were placed on some stretches of "autobahns" as the unusually warm weather raised the risks of "blow-ups" -- the hot tarmac breaking up and shredding tyres.   A forest fire was raging north of Cottbus, the second-largest city in Brandenburg state, in an area that was just recovering from a fire in 2018.   It was deemed especially dangerous due to the risk of unexploded ammunition left in the area, which is home to a military training facility.

- 'Hell is coming' -
In Spain, TV weather presenter Silvia Laplana riffed on the doom-filled catchphrase "Winter is coming" from the blockbuster series Game of Thrones to describe what lay in store for the country.   "El infierno (hell) is coming," she tweeted alongside a weather map which showed most of the country coloured scarlet later in the week.   "Of course it's hot in summer but when you have a heatwave that is so extensive and intense, during which records are forecast to be beaten, it's NOT normal," she tweeted.   Temperatures are expected to be particularly sweltering in the northeast of Spain, with a stifling 45 degrees expected Friday in the city of Girona, and 44 degrees in Zaragoza at the weekend.   Five northern provinces were placed on an orange high alert for a heatwave on Wednesday, with another five to be added by the weekend.

- 'Overdoing' the warnings? -
Authorities were also taking no chances in France, where a heatwave in August 2003 was blamed for 15,000 deaths, many of them elderly people who were left to fend for themselves.   In a highly unusual move, Education Minister Jean-Michel Blanquer on Monday postponed national school exams to next week. Paris authorities have banned older models of diesel and petrol cars from Paris on Wednesday, fearing a build-up of pollution.   Health Minister Agnes Buzyn denied the government was being excessively vigilant.   "For all those who know (the risks), obviously it's too much, but if I can avoid unnecessary deaths, I will continue to communicate about prevention," Buzyn told LCI television, referring to the warnings on radio, TV and public transport.

The Red Cross meanwhile urged people to check on vulnerable neighbours, relatives and friends, saying the "coming days will be challenging for a lot of people, but especially older people, young children, and people with underlying illnesses or limited mobility."   Players and spectators at the women's football World Cup taking place in cities around France were also being inundated with messages about keeping hydrated.   In a rare gesture by FIFA on Monday evening, fans were allowed to bring their own bottles of water into the Paris stadium where Sweden took on Canada.   Phil Neville, the England coach, was sanguine about the impact of the weather on the tournament, however.   "There's no excuse, the players are ready for it."

Meanwhile, French beekeepers and farming groups said they were bracing for a "catastrophic" honey harvest this year after frost damage in winter, an unusually rainy spring, and, now, unusually high temperatures.   "In the hives, there is nothing to eat, beekeepers are having to feed them with syrup because they risk dying from hunger," added the union, which represents many small farms in honey-producing regions.   In the Baltic region of northeast Europe, crowds have flocked to lakes and rivers to cool down, leading to a spike in drownings.    Twenty-seven people were reporte to have drowned so far in Lithuania where the temperature soared to an unusual high of 35.7 degrees Celsius.
Date: Tue, 25 Jun 2019 15:49:33 +0200

The Hague, June 25, 2019 (AFP) - Dutch health authorities said Tuesday they are dealing with a measles outbreak in a devout Protestant fishing village where vaccination rates are among the lowest in the country.   Nine children and one adult have been diagnosed with the disease in the village of Urk, part of the so-called "Bible Belt" in the northern Netherlands, the Flevoland province health service said.

The health service said it was "actively monitoring the situation" and examining whether it was necessary to vaccinate or administer antibodies to people who have been in contact with the infected patients.   "In 2013 and previously, the disease occurred more often on Urk. Many people on Urk have experienced this disease and that means that a natural defence has built up," it said.   Only 61.1 percent of people are vaccinated against measles in Urk, one of the lowest rates in the Netherlands, where the national average is 92.9 percent, according to the National Public Health and Environment Institute.

Urk is regarded as one of the most devout of the villages in the "Bible Belt" of conservative Protestant communities running from Zeeland in the south of the Netherlands across the country to the north west.   Ninety-four percent of people in Urk regularly go to church, according to the Dutch Central Bureau of Statistics, compared to one in six of all Dutch people.

Dutch newspaper De Telegraaf said that in this devout community of Urk people believe that life and death are in God's hands, and so vaccinations are not permitted.   Urk is considered a "closed' community because of its fisheries culture and Protestant orthodox religion," a European Commission report from 2010 said.

The UN warned in April of a global resurgence of measles -- a highly contagious viral infection that can prove fatal -- amid a growing "anti-vax" movement worldwide.   The WHO says cases of the once all-but-eradicated disease surged 300 percent in 2018 across the globe.   The anti-vax phenomenon has adherents across Western countries but especially in the United States, where it has been fuelled by the spread on social media of claims that the jab could cause autism, which medical officials have found are baseless.
Date: Thu 13 Jun 2019
Source: I Am Expat [edited]
<https://www.iamexpat.de/expat-info/german-expat-news/giant-tropical-ticks-overwinter-germany-first-time>

Normally, the tropical tick species _Hyalomma [marginatum_] only arrives in Germany with the 1st wave of migratory birds. However, experts believe that this year [2019] the disease-carrying giant ticks have spent the winter here for the 1st time ever. The tropical tick species _Hyalomma_ is not native to Germany and was detected in the federal republic for the 1st time in 2017. The ticks only began to appear in large numbers last year [2018], when a total of 19 specimens were found in 8 of Germany's federal states.

This year [2019], however, discoveries of the ticks were reported unusually early, leading researchers at the University of Hohenheim in Stuttgart and the Munich Institute for Microbiology to conclude that the newly-arrived tropical tick species overwintered in Germany for the 1st time this year [2019]. Over the past few days, 6 of the spidery ticks have been discovered in Germany: 5 on a horse farm in the Lower Rhine and one on a horse in Lower Saxony. "After the 1st evidence of this year [2019], we must assume that these animals can winter in Germany," said Ute Mackenstedt, a parasitologist at the University of Hohenheim.

Accordingly, the ticks are "a significant step further towards establishing themselves here." The _Hyalomma_ tick is native to the dry and semi-arid areas of Africa, Asia, and southern Europe. It is distinctive for its long, spidery, striped legs and large body, and can grow up to 2 centimetres [about 0.8 in] in length, 2-3 times larger than their closest European relatives. Usually, the adult _Hyalomma_ ticks stick to sucking the blood of large animals, but they have been known to transfer themselves to human hosts too.

The major factor that distinguishes them from Germany's native tick population is the fact that they are able to actively sense, track, and hunt their warm-blooded hosts over dozens of meters. _Hyalomma_ ticks are also considered a major carrier of a dangerous virus that can cause Crimean-Congo haemorrhagic fever -- the most widespread viral disease carried by ticks. Currently, there is no vaccine for this, and 10 to 40 percent of cases are fatal.

However, at the moment there is no cause for alarm: none of the tick specimens that were discovered last year [2018] were found to be carrying infectious agents. The size of the ticks means that they are also easier for humans to detect and remove. Moreover, the early appearance of the ticks does not necessarily mean that they have already become native to [established in] Germany. For a significant population to develop, males and females would have to find each other. That can be a tall order when the population is still relatively small. Even if they did find each other, the unhatched larvae would have to rely on an animal host, such as a bird or hare, to develop. [Byline: Aby Carter]
========================
[Although there may not be immediate concern about _Hyalomma marginatum_ ticks posing a human or animal health danger in Germany, if they have truly become established there and their numbers increase, there is a risk of transmission of pathogens such as Crimean-Congo hemorrhagic fever, as occurred in Spain, or spotted fever rickettsia such as _Rickettsia aeschlimannii_ that has been found in these ticks in Germany.

The only documented _Hyalomma_ spp. tick in Germany was found on a human in the southern part of the country (Lake Constance area) in May 2006, but the possibility of tick transportation from Spain was not ruled out (1,2). The authors state that it is reasonable to suggest that the _Hyalomma_ spp. ticks that were examined had been transported by the birds from Africa.

The fact that a randomly caught bird was infested with _R. aeschlimannii_­-infected ticks is suggestive of the intensive stream of new pathogens transported through Europe by migrating birds

References
----------
1. Rumer L, Graser E, Hillebrand T, et al. _Rickettsia aeschlimannii_ in _Hyalomma marginatum_ ticks, Germany [letter]. Emerg Infect Dis. 2011; 17(2): 325-6; <https://dx.doi.org/10.3201/eid1702.100308>.
2. Kampen H, Poltz W, Hartelt K, et al. Detection of a questing _Hyalomma marginatum marginatum_ adult female (Acari, Ixodidae) in southern Germany. Exp Appl Acarol. 2007; 43(3): 227-31 <https://dx.doi.org/10.1007/s10493-007-9113-y>.

A map of the known distribution of _Hyalomma marginatum_ as of 2018 can be accessed at
<https://ecdc.europa.eu/en/publications-data/hyalomma-marginatum-current-known-distribution-january-2018>.

An image of _Hyalomma marginatum_ can be accessed at the source URL above. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Germany:
<http://healthmap.org/promed/p/101>]
Date: Mon 24 Jun 2019
Source: ABC News [edited]

India's Supreme Court on Mon 24 Jun 2019 directed state and national authorities to file reports to the court on an encephalitis outbreak in the eastern state of Bihar this month [June 2019] in which 152 children have died.

A senior health department official in Bihar, Sanjay Kumar, said the epidemic is showing signs of slowing with no new deaths on Monday [24 Jun 2019]. The fatalities have occurred in 20 of the state's 38 districts.

The outbreak has been exacerbated by a heatwave, with temperatures in Patna, Bihar's capital, reaching a high of 45.8 C (114.5 F).

"We're hoping with the onset of the monsoon, the epidemic will ease further," Kumar said.

More than 700 cases of encephalitis have been registered since the outbreak began on 1 Jun [2019], officials said. Young children are particularly vulnerable to the illness, which can cause swelling of the brain, fever, and vomiting.

The Supreme Court was responding to a petition filed by a lawyer. "The deaths of children are a direct result of negligence and inaction" on part of authorities, said Manohar Pratap, the petitioner.

The court expressed concern over the deaths and asked the governments to respond within 7 days with details on medical facilities, nutrition, sanitation and hygiene conditions in the state.

Thousands of Indians suffer from encephalitis, malaria, typhoid and other mosquito-borne diseases each year during the summer monsoon season.

India's central government has sent medical experts to Bihar to help doctors treat the patients.

The Bihar authorities have been sharply criticized because patients were sharing beds in crowded hospital wards with too few doctors. The families who could afford it transferred their children to private hospitals in Patna and other larger cities.

The Press Trust of India news agency on Mon 24 Jun 2019 reported that about 6000 deaths from encephalitis occurred in India between 2008 and 2014.
======================
[The number of cases has increased rapidly from 142 on 22 Jun 2019, to 152 in 2 days in the report above. However, the number of fatal cases reported last week varied widely, from 142 to 1349 (see Japanese encephalitis & other - India (07): (BR) http://promedmail.org/post/20190623.6534477).

One hopes that the assessment of the situation as slowing is accurate. There is no indication in the above report of the etiological agent(s) involved in these cases. Japanese encephalitis is one possibility. The majority of cases have been classified as acute encephalitis syndrome (AES). AES has continued to be attributed to a variety of etiologies, including Reye syndrome-like disease, possible enterovirus infection from polluted water, heatstroke, lychee fruit consumption (especially in recent reports), and scrub typhus (_Orientia tsutsugamushi_). A recent publication states that dengue virus is one of the 3 most common agents identified in AES, but existing surveillance for AES does not include routine testing for dengue. Until the etiology (or etiologies) of these AES cases is determined, effective and efficient prevention of these cases will not be possible. - ProMED Mod.TY]

[Maps of India:
Wed 26/06/2019 15:03
http://www.emro.who.int/som/somalia-news/who-and-unicef-somalia-and-partners-call-on-all-somalis-to-vaccinate-children-against-polio.html
https://www.who.int/en/news-room/fact-sheets/detail/poliomyelitis

Mogadishu, 25 June 2019 - Health authorities rolled out a polio campaign yesterday in Puntland and Somaliland to vaccinate more than 940 000 children under 5 years of age to stop an ongoing outbreak of a strain of poliovirus.

The campaign runs from 24 to 27 June 2019, with support from the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). It targets all children in 12 districts in Somaliland and 9 districts in Puntland.

By the numbers:
  • 945,480 children to be vaccinated
  • 3160 vaccinators knocking on doors
  • 677 team supervisors taking part
  • 1558 social mobilizers sharing messages on vaccination and children’s health
  • 15 children have been infected with the polioviruses so far, since outbreaks began
Somaliland, Puntland and other states in Somalia are currently experiencing outbreaks of 2 strains of poliovirus. Each strain requires a different vaccine. Children need several doses of each vaccine to boost immunity. Even though these viruses are not wild poliovirus, both these circulating strains can infect and paralyse children with low immunity. The last case of wild poliovirus in Somalia was in August 2014.

“It’s vital that parents ensure their children receive this vaccine because it builds immunity against a specific strain of poliovirus circulating in the country. I call upon all caregivers in the areas being covered in this campaign to please ensure children are at home and accept the oral polio vaccine when it is offered. Oral polio vaccines are stored and administered safely, and can save children from paralysis and permanent disability,” said Dr Mamunur Rahman Malik, WHO Representative for Somalia.

“The only way to protect children from all polioviruses is to ensure they receive multiple doses of polio vaccine, through campaigns and health facilities where possible,” said Werner Schultink, UNICEF Somalia Representative. “Caregivers need to ensure children receive this vaccine when it is available.”

Somalia’s polio programme has conducted 14 immunization campaigns, including 5 nationwide campaigns, since December 2017 to stop further spread of the outbreaks. Despite these efforts, not all Somalia’s children are being vaccinated, which has resulted in the polioviruses spreading across the country and spilling over to Ethiopia. To address this, polio teams from Somalia and Ethiopia conducted a joint planning workshop in Hargeisa last week, and are coordinating immunization activities along their shared border and in high-risk areas in each country during this round in order to prevent cross-border transmission and spill over.

Concurrent to the polio campaign, polio health workers have also been working to vaccinate more than 650 000 people aged one year and above against cholera in high-risk districts of Somalia.
Date: Mon, 24 Jun 2019 16:11:10 +0200

Kinshasa, June 24, 2019 (AFP) - More than 1,500 people have died in a nearly 10-month-old outbreak of Ebola in the Democratic Republic of Congo, the health ministry said Monday.   As of Sunday, 1,506 people have died out of 2,239 recorded cases, it said.   Earlier this month, the virus claimed two lives in neighbouring Uganda among a family who had travelled to the DRC.   Nearly 141,000 people have been vaccinated in the affected eastern DRC provinces of Ituri and North Kivu, the epicentre of the outbreak.

Ebola spreads among humans through close contact with the blood, body fluids, secretions or organs of an infected person, or objects contaminated by such fluids.   The current outbreak in the DRC is the worst on record after an epidemic that struck mainly in Liberia, Guinea and Sierra Leone between 2014-2016, killing more than 11,300 people.   Chronic violence and militia activity in Ituri and North Kivu as well as hostility to medical teams among locals have hampered the response.

On Monday, a crowd of people opposed to the burial of two Ebola victims in the Beni area burnt the vehicle of a health team, local police chief Colonel Safari Kazingufu told AFP.   He said a member of the medical team had been injured in the attack and taken to hospital.    The United Nations in May nominated an emergency coordinator to deal with the crisis. However, the World Health Organization (WHO) said this month the outbreak currently did not represent a global threat.