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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 ...

Niue

No Profile is available at present

Travel News Headlines WORLD NEWS

20th July 2012

- Niue Island. 20 Jul 2012. Two tourists visiting Niue have been taken to hospital with dengue fever. More than 100 people, or about 8 percent of the population, are believed to be suffering from the fever, and visitors are being warned to use insect repellent during early morning and evening. Dengue, which does not often occur on Niue, has been afflicting  the island since February [2012]. It was originally confined to a small area of Niue's main village but has now spread throughout the island. One local man recently died from a serious form of the virus.
==================
[A HealthMap/ProMED-mail interactive map showing the location of Niue Island in the Pacific Ocean can be accessed at <http://healthmap.org/r/1ZWb>. - ProMed Mod.TY]
Monday 30th April 2012
A ProMED-mail post
<http://www.promedmail.org>

- Niue Island. 24 Apr 2012. The Niue Health Department says it believes the dengue outbreak has peaked. The department says there have been 47 recorded cases of dengue fever, but only one case has been picked up in the last 7 days. The Acting Director of Health, Manila Nosa, says it's a relief to see the wane in cases, but it's too early to say that dengue is completely gone. He said that there has been a lot of rain lately, and it's hoped this won't contribute to a further spread.
======================
[A HealthMap/ProMED-mail interactive map of Niue Island can be accessed at <http://healthmap.org/r/1ZWb>. - ProMed Mod.TY]
Monday 16th April 2012
A ProMED-mail post
<http://www.promedmail.org>

- Niue Island. 12 Apr 2012. Health authorities on Niue are confident that they are on top of the latest dengue outbreak that has infected 20 people to date. The chief medical officer, Dr Eddie Akau'ola, says this outbreak began about 3 weeks ago but they believe they have been able to contain it. He says it is peaking now and they expect a decline in a week or 2. Dr Akau'ola says none of the cases have been too serious.
====================
[A HealthMap/ProMED-mail interactive map showing the location of Niue Island in the Pacific can be accessed at <http://healthmap.org/r/2bMz>. - ProMed Mod.TY]
Tuesday 13th March 2012
A ProMED-mail post
<http://www.promedmail.org/>

- Niue Island. 6 Mar 2012. Niue health authorities are hopeful they've contained a rare outbreak of dengue fever on the island where 3 people were reported with dengue last week, with 2 admitted to hospital.
======================
[A HealthMap/ProMED-mail interactive map showing the location of Niue Island in the Pacific can be accessed at <http://healthmap.org/r/1ZWb>. - ProMed Mod.TY]
Date: Sun, 24 Jul 2011 10:42:49 +0200 (METDST)
by Neil Sands

ALOFI, Niue, July 23, 2011 (AFP) - In a once-thriving village on the Pacific island of Niue, homes lie abandoned, their stucco-clad walls mildewed and crumbling as the jungle slowly reclaims them. "These villages used to be bustling with people -- now you go there in the afternoon and there's no one," says the Niue Tourism Authority chairman Hima Douglas. The number of people living on the lush coral atoll, about 2,500 kilometres (1,550 miles) northeast of New Zealand, has been declining for decades as inhabitants seek a better life overseas.

The population, which peaked at more than 5,000 in the mid-1960s, has dwindled to just 1,200, according to a New Zealand parliamentary report, raising doubts about the island nation's economic viability.  Douglas said a major cyclone in 2004, which destroyed much of Niue's infrastructure, accelerated the exodus, and the threat of future natural disasters was discouraging people from returning. "Of course it's concerning but it's not something we can do too much about until we can build an economy that will give them the confidence to come back," Niue's Premier Toke Talagi told reporters this month. "There aren't simple and easy answers to people leaving. We've got to build a strong economy and hope to attract them back." Known locally as "The Rock", Niue was settled by Polynesian seafarers more than 1,000 years ago and the palm-dotted island's name in the local language means "behold, the coconut".

The British explorer captain James Cook tried to land there three times in 1774 but was deterred by fearsome warriors, eventually giving up to set sail for more welcoming shores and naming Niue "savage island" on his charts. But modern day Niueans are desperate for visitors, with Talagi unveiling plans this month to turn it into a boutique tourism destination in a bid to put his nation on a sound economic footing. Using aid from New Zealand, with which Niue has a compact of free association giving its people dual citizenship, Talagi has overseen construction of a new tourism centre and expansion of the island's Matavai Resort.

Paths have also been cut through the jungle to give visitors access to swimming spots on the rugged limestone coastline, and cruise liners are being encouraged to include Niue on their itineraries. "We can become self-sustaining in the long term (and) reduce New Zealand assistance to Niue," Talagi said, estimating that visitor numbers could quadruple to 20,000 a year in the next decade. Addressing a visiting delegation of New Zealand business executives this month, Talagi acknowledged doubts about the nation's ability to meet the challenge. "I know some of you are a bit sceptical about our ability to become self sustaining... (but) tourism is not going to fail and I don't expect it to fail given the numbers that are being generated," he said.

The New Zealand parliamentary report, released last December, estimates that about 50,000 Niueans and their children now live in Australia and New Zealand, creating a shortage of skilled labour in one of the world's smallest states. "Niue is caught in a vicious cycle, with its economic difficulties both exacerbated by, and reflected in, the long-term decline of its population," it said, adding that 40 years of New Zealand aid "has yielded almost no return". The report's authors suggested Niue should concentrate on promoting itself as a retirement destination for elderly New Zealanders, who could help revitalise the economy. "The climate is excellent, existing buildings could be brought into service, and health facilities are satisfactory," it said. "Retirees would bring steady cash flow and contribute to stable employment options."

Asked about the suggestion, Talangi said "we'll look at everything", although one long-time resident, who asked not to be named, was unenthusiastic at the prospect. "How depressing to think that we might be turned into a major geriatric ward," she said. "Not that I have anything against old people, mind." Another resident said that whatever steps Niue took to improve its economy must result in major changes, pointing out people could earn more by moving to New Zealand and claiming unemployment benefits than working on the island. "It's pretty hard when your cuzzies (cousins) call you and say 'we're getting more on the dole in Auckland than you're getting paid'," he said.
More ...

Israel

General Information:
***************************************
The Middle East is a favourite destination for many Irish holiday makers. The combination of a beautiful climate linked with such historical richness is hard to beat. Unfortunately the
security situation throughout the region has led to some significant concerns over the years. Nevertheless, in the vast majority of cases those visiting the region will not encounter any particular concerns in this regard. It is a wise precaution to ensure that your passport is valid for at least a further six months beyond the time of your holiday as otherwise you may be refused entry.
Security Situation:
***************************************
Security throughout the Middle East is generally tight. Carry some means of identification at all times in case you are requested to produce it by police or army personnel. In Jerusalem the city has been divided and it is sensible to remember which quarter you are in at all times.
Health Facilities:
***************************************
Generally the health facilities throughout the region are excellent. However, when visiting certain rural regions you may find it difficult to obtain hospital care similar to that at home. In Israel, travellers can find information in English about emergency medical facilities and after-hours pharmacies in the "Jerusalem Post" and English language "Ha'aretz" newspapers.
Food & Water Facilities:
***************************************
Again, this depends on your location and the facilities which are there at the time of the year you visit. Bottled water is easily available and food hygiene is usually excellent throughout all the main tourist destinations. However, it is generally wiser not to drink hotel tap water and only to use it for brushing your teeth if there is a clear smell of chlorine. When on organised trips tourists are sometimes offered local tea or other drinks. Generally this will be safe as the water is boiled but take care that the cup hygiene is acceptable.
Sun Exposure:
***************************************
The climatic conditions in the Middle East vary considerably throughout the year. Many tourists visit in late autumn or early spring. At these times the climate is much cooler and the evenings can be distinctly chilly. However, during the main tourist season (May to September) the temperatures rise high into the 80’s or 90’s and dehydration can easily occur. Increasing fluid and salt intake is important under these circumstances. It is essential that travellers are aware of the climatic conditions which should be present for their trip and that sensible clothing is used at all times.
Rabies:
***************************************
Tourists should avoid all animals as this viral disease is transmitted through the bite, lick or scratch of any infected warm blooded animal. In Israel the most common animals involved are foxes and jackals and in Jordan, dogs tend to be the main culprits.
Exploring the Region:
***************************************
Leaving the main tourist routes is unwise. There are a number of security risks which have to be considered and there are also significant health concerns which may be encountered. In July 2000 an 18 year old American tourist died of sunstroke when she became separated from her group in the Dead Sea region of Israel. Those exploring caves and parts of the desert areas also run the risk of diseases like Borreliosis and Rabies.
Walking & Trekking:
***************************************
For many going to these countries their trip will involve visiting some of the major ruins and archeological sites. This will involve a good deal of walking and trekking. Good supporting foot wear is essential and it would be wise to carry a crepe bandage in case of a sprained ankle. Having a suitable painkiller or anti-inflammatory medication would also be advantageous. Check your health will be up to the journey.
Swimming:
***************************************
Pools are usually very well maintained and the risk of disease is small. Those swimming in the sea should remember that the Mediterranean is home to many jelly fish. Swim with others and never alone and especially after alcohol or a heavy meal.
Anthrax:
***************************************
This bacterial disease is rare in the Middle east though travellers should be aware that it can be transmitted through unprepared leather goods usually bought in the local market places. Typically the disease may then present with a black ulcerated skin lesion.

Malaria:
***************************************
Fortunately this disease does not occur in Israel or Jordan. However other mosquito and sandfly diseases do occur and so protection against their bites should be used when necessary.
Hepatitis:
***************************************
There are many forms of this disease but the most common is Hepatitis A, often known as Infectious Jaundice. This disease can keep an infected individual off work for many weeks and it is wise to consider vaccination cover before exposure. In Israel approx 65% of the population will have been infected before 18 years of age.
Vaccinations:
***************************************
There are no essential vaccines for entry/exit however most Irish tourists are recommended to receive cover against; Poliomyelitis, Typhoid, Tetanus and Hepatitis A. Those living in these countries or planning an extended trip should also consider cover against Hepatitis B and Rabies.
Summary:
***************************************
Due to the unrest within Israel there are concerns regarding the safety of tourists at this time. If you are travelling to this region it is wise to ensure that your insurance policy is sufficient if your circumstances or travel plans change.

Travel News Headlines WORLD NEWS

Source: Arutz Sheva 7 [edited]
Date: Tue 13 Aug 2019

A stewardess of Israel's El Al airline died Tuesday [13 Aug 2019], following a months-long battle with measles. The 43-year-old stewardess was infected with the measles virus during a flight from New York to Israel 5 months ago.

After she was infected, the stewardess was hospitalized in serious condition at Meir Medical Center in Kfar Saba in central Israel after she was found unconscious and struggling to breathe. During her hospitalization, the stewardess' condition deteriorated, and she was transferred to the quarantine section of the hospital's intensive care wing.

On Tuesday [13 Aug 2019], doctors at Meir hospital declared her death, following the 5-month struggle.  [Byline: Orly Harari]
===========================
[This is a very sad outcome, and our condolences go out to the family of the flight attendant, who worked for El Al, the Israeli national airline. It is not clear whether she contracted the virus in New York, in Israel, or on a flight between the two locations. The flight attendant received only one dose of the measles vaccine when she was a child. It wasn't discovered until later that one dose is only about 93% effective. More recently -- in the USA, starting in 1989 -- children have been given 2 doses, which is about 97% effective, according to the CDC. See Measles update (27) http://promedmail.org/post/20190418.6429834 for an earlier report on the flight attendant. - ProMED Mod.LK]
Date: Wed, 14 Aug 2019 17:55:43 +0200 (METDST)

Jerusalem, Aug 14, 2019 (AFP) - An Israeli flight attendant has died months after contracting measles on a flight from New York to Tel Aviv, Israel's health ministry and local media said Wednesday.   Rotem Amitai, 43 and a mother of three, was hospitalised in March following the flight with Israeli airline El Al, Israeli media reported.

She died on Tuesday at a hospital near the coastal city of Tel Aviv, a hospital spokeswoman said.   The health ministry confirmed her death and said her condition had been complicated by encephalitis, inflammation of the brain.   "The immediate cause of death was not defined as measles," it said in a statement. "However, the disability (caused by) the disease was a secondary cause."

The World Health Organization said Tuesday that measles cases had nearly tripled globally during the first seven months of the year compared to the same period in 2018.   The global body warned against "misinformation about vaccines".   The so-called anti-vax movement -- driven by fraudulent claims linking the MMR vaccine against measles, mumps and rubella to a risk of autism in children -- has gained traction.

So far this year, 364,808 measles cases have been reported around the world, compared to 129,239 cases during the first seven months a year earlier -- the highest registered since 2006.   Amitai's death was the first related to measles in Israel this year, following two last year, according to the ministry.   The highly contagious disease can be entirely prevented through a two-dose vaccine.   Amitai had only received one dose, Israeli media reported.

The Democratic Republic of Congo, Madagascar and Ukraine registered the highest number of cases, WHO said.   The United States has registered 1,164 cases so far this year, up from 372 for the whole of 2018 and the highest number on record in a quarter-century.   Nearly 90,000 cases have been registered in Europe this year -- well above the 84,462 cases registered last year.   The airborne infection, which causes fever, coughing and rashes that can be deadly in rare cases -- had been officially eliminated in many countries with advanced healthcare systems.
Date: Fri, 26 Jul 2019 15:53:07 +0200

Jerusalem, July 26, 2019 (AFP) - A forest fire in northern Israel's Galilee region is threatening a church where Christians believe the transfiguration of Jesus took place, the fire service said Friday.    It said in a statement that the blaze broke out on Thursday and monks were evacuated from the  Basilica of the Transfiguration overnight.

Fanned by strong winds the flames still menaced the church on Friday afternoon, fire service spokesman Dudi Peretz told AFP.   "An additional front of the fire is at the moment advancing  toward the church," he said in Hebrew.   "The fire's centre is far from main roads and the topography of the area and difficulty of access are hindering the work of the firefighting teams."    He said that the church itself had so far not been damaged.   Police said that arson was not suspected.   Israel has been gripped by record high temperatures accompanied by drought and strong winds over the past week, with wildfires reported across the country.

The basilica, built in 1924, by the Roman Catholic Franciscan order, sits atop the wooded Mount Tabor at a site where the Christian gospels say that Jesus -- accompanied by disciples Peter, John and James -- glowed with light and spoke with the prophets Moses and Elijah.   Hundreds of thousands of pilgrims visit the church every year, according to the Franciscan Custody of the Holy Land, which oversees Roman Catholic properties in the area.   In a statement Friday it accused Israeli authorities of neglecting essential infrastructure at the site, failing to provide a proper water supply.   The fire, it said,"is a direct consequence of state negligence".
Date: Wed 17 Apr 2019
Source: Jerusalem Post [abridged, edited]

More than 2 million Israelis [population 8.2 million] are either unvaccinated or only partially vaccinated for the measles, according to a Channel 13 report. An outbreak of the measles has been worrying Israelis for months as it spread throughout the country, as well as in the rest of the world. But Israeli media reports on Tuesday night [16 Apr 2019] exposed the severity of the situation and the difficulty in solving the crisis.

The Health Ministry claims that it has only 115,000 doses of measles, mumps and rubella (MMR) vaccine available and 100,000 additional doses of the MMRV vaccine, which combines the diminished measles, mumps, rubella and varicella vaccine with the addition of chickenpox vaccine, according to Channel 13.

State comptroller Yosef Shapira has considered examining the Health Ministry's handling of the recent measles outbreak, according to a report released in January [2019].

The comptroller's office contacted infectious disease and public health experts and is working on compiling data about past efforts regarding the measles outbreak, examining if they were sufficient. However, no formal decision has been made so far over the next steps to take in combating the outbreak.

The ministry released a statement in the past warning the general public about the dangers of measles, including that one out of every 10 patients requires hospitalization after contracting the virus. Nearly 3% of hospitalized patients also have encountered issues with pneumonia. According to data presented at that time, 3 have contracted meningitis, and 2 measles cases resulted in fatalities.

The ministry has been facing intense criticism for its "ineffective" efforts in containing the outbreak. Critics cite the delayed start of vaccination efforts in the Jerusalem area, the city with the largest amount of unvaccinated people. Moreover, those born between 1957 and 1977 only received one dose of the measles vaccine and are only partially protected.

For years, the ministry has also not taken action against doctors who distributed false information about vaccines and has not worked to exhort the public to vaccinate their children. Finally, critics mentioned the lack of government support for Tipat Halav (early childhood clinics), where most infants receive their 1st vaccinations.

The measles surfaced due to the failure of thousands of parents to vaccinate themselves or their children, particularly among the Haredi (ultra-Orthodox) communities in Jerusalem, according to Health Ministry officials. Community leaders and rabbis in recent months have sent mobile units to entire neighbourhoods to vaccinate citizens living in the affected areas.

Several members of Knesset have reacted to the outbreak in the past.

The Health Ministry has since shown their inability to contain the outbreak within Israel's affected communities, and at the moment, there have been 2000 reported cases of Israelis who have contracted measles during the last few months, according to Israel Hayom.

The Health Ministry has not held any informational seminars to encourage these parents to immunize their children, and even though the Health Ministry offers to pay for these services, the parents still decline them just the same, according to Israel Hayom.  [Byline: Zachary Keyser]
Date: Wed 17 Apr 2019
Source: CNN [edited]

An Israeli flight attendant has slipped into a coma after contracting measles, according to health officials. The 43-year-old woman has encephalitis, or inflammation of the brain, a well-known and potentially deadly complication of the virus. She was otherwise healthy before getting measles.  "She's been in a deep coma for 10 days, and we're now just hoping for the best," said Dr. Itamar Grotto, associate director general of Israel's Ministry of Health.

The flight attendant, who works for El Al, the Israeli national airline, might have contracted the virus in New York, in Israel, or on a flight between the 2, Grotto said. Health authorities do not believe that she spread the virus to anyone on the flights.  She's unable to breathe on her own and is on a respirator in the intensive care unit at Meir Medical Center in Kfar Saba, near Tel Aviv. She developed a fever on 31 Mar [2019] and entered the hospital that same day.

Ongoing measles outbreaks in the USA and Israel started with parents who've chosen not to vaccinate their children, according to health authorities. Authorities believe that the flight attendant was vaccinated as a child, but the vaccine isn't perfect, and in her case, it didn't work.  "I knew this was going to happen sooner or later," said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University and an adviser to the US Centers for Disease Control and Prevention on vaccines. "We have the reintroduction of a serious viral infection with a population that's withholding the vaccine from their children, and now it's spreading beyond that population."

Like many others of her generation around the world, the flight attendant, who has not been identified, received only one dose of the measles vaccine when she was a child.  It wasn't discovered until later that one dose is only about 93% effective. More recently -- in the USA, starting in 1989 -- children have been given 2 doses, which is about 97% effective, according to the CDC. It's not known why most people who get measles recover fully while others have devastating complications.

About one out of every 1000 children who gets measles will develop encephalitis, according to the CDC. This can lead to convulsions and leave a child deaf or with an intellectual disability.  Additionally, one or 2 out of 1000 US children who get measles will die from it. Worldwide, the illness is fatal in one or 2 out of every 100 children. No fatalities have been reported in the USA from measles this year [2019] or last year [2018]. In Israel, a toddler and an elderly woman died last year [2018] of the disease. In the European Union, 35 people died of the disease in 2018, according to the European Centre for Disease Prevention and Control.

There have been 3920 cases of measles in Israel from March 2018 through 11 Apr [2019], said Grotto, who is also a professor of epidemiology and public health at Ben-Gurion University of the Negev.  In the USA, there have been fewer than 1000 cases in about the same time period.
 
In Europe, there were 34 383 cases of measles based on data reported to the World Health Organization from April of last year [2018] to April of this year [2019]. Ukraine had the highest number of cases in the past 12 months, with more than 72 000, followed by Madagascar and India with more than 69 000 and 60 000 cases, respectively. WHO warned that there are delays in reporting and that this data may be incomplete.

Grotto said there was a surge of cases in Israel last fall [2018] when large numbers of ultra-Orthodox Israelis traveled to Ukraine on a religious pilgrimage during the Jewish New Year. Ukraine has had more than 72 000 measles cases this year [2019], more than any other country, according to the World Health Organization.

About 85% to 90% of Israeli measles cases have been among ultra-Orthodox Jews, Grotto said. There's nothing in Judaism that teaches against vaccination; on the contrary, rabbis encourage vaccination in keeping with Jewish teachings on protecting your health and the health of others.

Ultra-Orthodox Jews tend to have large families, and Grotto said those who don't vaccinate tend to have practical, not ideological, reasons. "Sometimes, they vaccinate their 1st or 2nd child, but with so many children, they don't always have time to vaccinate them all," he said. "They're not against vaccines. They have nothing against them ideologically."

To turn the tide in the outbreak, Israeli public health authorities have increased vaccine clinic hours, opened mobile clinics in religious neighborhoods and taken out ads in newspapers in religious communities.  [Byline: Elizabeth Cohen]
=======================
[Additional information: "A 10-year-old boy on the same flight also has suffered permanent brain damage from measles infection. In November [2018], an 18-month-old toddler in Jerusalem died of the disease, the 1st recorded death from measles in Israel in the past 15 years. A month later, an 82-year-old woman became the 2nd fatality." <https://www.jpost.com/Breaking-News/El-Al-stewardess-10-year-old-child-in-coma-after-contracting-measles-587236>.  Communicated by: ProMED-mail Rapporteur Kunihiko Iizuka]

[There is concern that transmission will increase as family and friends gather for Passover. - ProMED Mod.LK]
More ...

Lebanon

Lebanon - US Consular Information Sheet
August 20, 2008
COUNTRY DESCRIPTION:
The Republic of Lebanon is a parliamentary republic. Political power is concentrated in the office of the President, Prime Minister and Speaker of Parliament, eac
representing one of Lebanon's three largest religious sects (Maronite Christians, Sunni and Shi'a Muslims). Since 1973, Lebanon has been in a state of war with Israel. Read the Department of State Background Notes on Lebanon for additional information.

ENTRY/EXIT REQUIREMENTS: Passports and visas are required.
American citizens coming to Lebanon for tourism can purchase a short-term visa at the border.
Travelers holding passports that contain visas or entry/exit stamps for Israel will likely be refused entry into Lebanon.
Travelers whose passports contain Israeli stamps or visas and who also hold an "Arab nationality" may be subject to arrest and imprisonment.
Travelers who have overstayed their entry visa validity in Lebanon have to adjust their status with the Central Department of Surete General (Department of Passport and Immigration) prior to their departure.

Further information on entry/exit requirements can be obtained from the Embassy of Lebanon, 2560 28th Street NW, Washington, DC, 20008, tel. (202) 939-6300.
Travelers may also contact one of the following Consulates General:
1959 E. Jefferson, Suite 4A
Detroit, MI 48207
(313) 567-0233
2400 Augusta, Suite 308
Houston, TX 77057
(713) 268-1640
7060 Hollywood Blvd., Suite 510
Los Angeles, CA 90028
(323) 467-1253
6600 S.W. 57th Avenue, Suite 200
Miami, FL 33143
(305) 665-3004
(Honorary Consul, for Florida residents only)
9 E. 76th Street
New York, NY 10021
(212) 744-7905
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:
A Department of State Travel Warning advises U.S. citizens against travel to Lebanon.
Recent events underscore the need for caution and sound personal security precautions.
U.S. citizens who are in Lebanon despite this Travel Warning should exercise particular caution when traveling in parts of the southern suburbs of Beirut, portions of the Bekaa Valley and areas south of the Litani River in South Lebanon.
Hizballah maintains a strong presence in many of these areas, and there is the potential for action by other extremist groups.
The situation remains tense and a resumption of sporadic violence remains a possibility.
On May 7, 2008, Hizballah militants blocked the road to Rafiq Hariri International Airport.
The action rendered the airport inaccessible and travelers were unable to enter or leave the country via commercial air carriers.
Armed Hizballah and other opposition members proceeded to enter areas of Lebanon not traditionally under their control resulting in heavy fighting and a number of casualties.
While there is now full access to the airport, widespread hostilities have subsided, and the government of Lebanon has successfully elected a president and formed a cabinet, the United States remains concerned about Hizballah's willingness to use violence to achieve political ends with little or no warning.
Since the May hostilities there have been violent outbreaks in Tripoli that left over ten dead and dozens wounded.

Americans have been the targets of numerous terrorist attacks in Lebanon in the past.
The perpetrators of many of these attacks are still present and retain the ability to act.
On January 15, 2008, a U.S. Embassy vehicle was involved in a bomb attack that killed three Lebanese bystanders.
American citizens should thus keep a low profile, varying times and routes for all required travel.
Americans should also pay close attention to their personal security at locations where Westerners are generally known to congregate, and should avoid demonstrations and large gatherings.
Unofficial travel to Lebanon by U.S. Government employees and their family members requires prior approval by the Department of State.
Palestinian groups hostile to both the Lebanese government and the U.S. operate largely autonomously inside refugee camps in different areas of the country.
Intra-communal violence within the camps has resulted in violent incidents such as shootings and explosions.
Travel by U.S. citizens to Palestinian camps should be avoided.
Asbat al-Ansar, a terrorist group with apparent links to Al-Qaida, has targeted Lebanese, U.S. and other foreign government interests.
It has been outlawed by the Lebanese government but continues to maintain a presence in Ain al-Hilweh refugee camp.
Americans traveling to Lebanon should also be aware that personnel from the U.S. Embassy are not able to travel in all areas of Lebanon.
In the case of an emergency involving a U.S. citizen in areas where it is unsafe for Embassy personnel to travel, the Embassy may not be able to render assistance.
In addition, dangers posed by landmines and unexploded ordnance throughout south Lebanon are significant and also exist in other areas where civil war fighting was intense.
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, including the Travel Warning for Lebanon, 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 overseas callers, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State's pamphlet A Safe Trip Abroad.
CRIME: The crime rate in Lebanon is moderate, but both car theft and home break-ins occur.
Violent crime and sexual assault are rare, although petty theft -- such as pick pocketing and purse snatching -- is common in crowded public areas.
Police are responsive but often unable to effect a positive outcome.
There are no special concerns with regard to targeted victimization of Americans or to scams or confidence schemes.
There have, however, been recent kidnappings of Lebanese-American women by their Lebanese relatives in an effort to force these women into marriage.

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, 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.
The local equivalent to the “911” emergency line in Lebanon is 112.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: In Beirut and the surrounding areas, modern medical care and medicines are widely available.
Such facilities are not always available in outlying areas, although no location in the country is more than three hours from the capital.
Doctors and hospitals often expect immediate cash payment for services, and without such payment, may deny service even in emergency cases.
A list of doctors who speak English and a list of hospitals are available from the U.S. Embassy and at the Embassy's web site at http://lebanon.usembassy.gov/
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 or foreign residents of Lebanon.

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 Lebanon is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Drivers in Lebanon often maneuver aggressively and pay little regard to traffic lights and stops signs.
Lanes are generally unmarked and roads outside of the capital may be poorly lit.
Pedestrians, especially, should exercise great caution.
Inter-city directional signs are improving throughout the country, but side roads are often not signposted at all.
Public transportation is generally safe.
Emergency services in Lebanon are adequate.
In case of a road accident, emergency numbers are “140” for the Red Cross and “125” for the emergency civil police.
Please refer to our Road Safety page for more information.
Visit the website of Lebanon's national tourist office at http://www.destinationlebanon.gov.lb.
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Lebanon, the U.S. Federal Aviation Administration (FAA) has not assessed Lebanon’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES: In addition to being subject to all Lebanese laws, U.S. citizens who also possess Lebanese nationality may also be subject to other laws that impose special obligations on them as Lebanese citizens.
Lebanese citizens who are discovered to have associated with or traveled through Israel, are subject to arrest and detention.

Military Service:
Mandatory military service in Lebanon was abolished on February 4, 2007.
However, travelers with questions about prior military service, desertion, or failure to register in the past should contact the Military Office of the Embassy of Lebanon, 2560 28th Street, N.W., Washington, D.C. 20008, or call (202) 265-2335 or fax (202) 667-0063 for details prior to traveling to Lebanon. Information about military service can also be found at the Lebanese government web site at http://www.lebarmy.gov.lb/English/FlagService.asp
Lebanese Customs authorities may enforce strict regulations concerning import and export of such items as firearms or antiquities.
It is advisable to contact the Embassy of Lebanon in Washington, D.C., or one of Lebanon's consulates in the United States for specific information regarding customs requirements. Please see our information on customs regulations.
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 Lebanese laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Lebanon 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.
For more information 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 Lebanon are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website, and to obtain updated information on travel and security within Lebanon.
Americans without Internet access may register directly with the U.S. Embassy in Beirut.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located in Awkar, near Antelias, Beirut, Lebanon.
Public access hours for American citizens are Monday, Tuesday, and Thursday, 8:00 a.m. to 11:00 am for regular consular services.
Consular Report of Births Abroad (birth certificates for newborns) are handled Wednesdays only from 8:00 a.m. to 11:00 a.m.
The telephone numbers are (961-4) 542-600, 543-600, and fax 544-209, and American citizens who require emergency services outside of these hours may contact the Embassy by telephone at any time.
American citizens registering at the embassy can receive updated information and warden messages via e-mail by subscribing to join-wardenmessagebeirut@mh.databack.com.
Information on consular services and registration can be found at http://lebanon.usembassy.gov or by phone at the above telephone numbers between 2:00 p.m. and 4:00 p.m. Monday through Friday local time.
* * * * * *
This replaces the Country Specific Information dated December 27, 2007 to update the sections on Safety and Security, Crime, Information for Victims of Crime, Medical Facilities and Health Information and Aviation Oversight.

Travel News Headlines WORLD NEWS

Date: Mon 26 Nov 2018 (accessed)
Source: Epidemiology and Infection, 1st view, published online 15 Nov 2018 [edited]
<https://doi.org/10.1017/S095026881800300X>

Citation: Kassir MF, El Zarif T, Kassir G, Berry A, Musharrafieh U, Bizri AR (2018).
Human rabies control in Lebanon: a call for action.

Epidemiology and Infection 1-8.
------------------------------------------------------------------------------------------------------------------------------------------------------------
Abstract:   The status of rabies as a neglected disease has made its eradication rather challenging in different parts of the world despite the availability of a successful vaccine. Lebanon, in particular, is a country endemic to the disease with several cases of rabies deaths reported over the past 30 years. The risk of rabies, however, has taken a new turn over the past few years in Lebanon with 2 emerging situations that have made the control of the disease rather challenging: the neighbouring Syrian war and the local garbage crisis.

Both of these milestone events might have contributed to an increase in the number of disease vectors as well as individuals at risk, thus nourishing the cycle of disease transmission. In this observational study, the effects of these 2 events are investigated, with an update on the status of this preventable, yet often neglected, disease in the country. Both events were found to be concomitant with a notable increase in the number of dog bites and thus possible rabies exposure.

Current regulations are explored through interviews with veterinarians, and customs recommendations, ranging from policies to control of dog populations to awareness campaigns in high-risk individuals, are then proposed to help control the disease.
===========================
[According to information included in the paper, between 2005 and 2016, a total of 7369 animal bites were reported to the LMOPH (Lebanese Ministry of Public Health), with an annual average of 614 bites per year. About 91 percent of the bites were caused by dogs, of which 53 percent were by domestic dogs and 47 percent by stray dogs. The remaining 9 percent involved cats, bats and rodents. It may be assumed that some events involved farm animals as well, not mentioned in the paper.

In 2013, a steep increase in numbers was observed and was sustained up to 2016. The yearly average of animal bites post-2013 was, reportedly, 1004 ± 272 bites per year, which is significantly higher than the average of 355 ± 145 bites per year prior to 2013 (span from 1991 to 1996 and 2001 to 2013). The highest number of bites (per 100 000 individuals) was observed in the northern governorate and in the (southern) Nabatieh governorate (Lebanon's administrative map at <https://en.wikipedia.org/wiki/List_of_cities_and_towns_in_Lebanon>).

Counting bites does not necessarily reflect the incidence of rabies in animals; it may serve as suggestive of increased rabies incidence in the vector animals. Unfortunately, no information about clinically suspected and/or lab confirmed rabies in animals is included in the paper. Lebanon has reported a rabies case in a dog to the OIE in March 2018 (http://promedmail.org/post/20180314.5687339); this was the 1st reported animal rabies case from Lebanon since 1995(!).

As suggested by the authors, the Syrian war and the local garbage crisis are plausible explanations for increased rabies incidence in Lebanon. A wide circulation of the virus in Lebanon's canines/fauna, particularly in the Nabatieh governorate bordering northern Israel, was suggested in the past, most recently in http://promedmail.org/post/20180321.5701731 (item 4) and in ref 1.

It could also be deduced from the data presented in Israel's rabies map of 2015 at <http://www.moag.gov.il/vet/Yechidot/Machon/maabada_kalevet/airueim%20kalevet/kalevet_2015/PublishingImages/rabiesmap272016.jpg>.

Reference 1.
D David, N Devers, BA Yakobson, I Davidson. Emergence of dog rabies in the Northern region of Israel. Epidemiol Infect 2009; 137(4): 544-8; DOI:10.1017/S0950268808001180. - ProMED Mod.AS]

[HealthMap/ProMED map available at: Lebanon: <http://healthmap.org/promed/p/85>]
Date: Thu, 5 Apr 2018 14:31:16 +0200

Beirut, April 5, 2018 (AFP) - A funding gap is compromising the response to a measles outbreak in Lebanon, a United Nations statement said Thursday, warning it also risked allowing polio to spread from Syria.   The UN's Children Fund, which has provided free vaccines for children in Lebanon for a quarter of a century, said the first 12 weeks of 2018 had seen a sharp increase in measles cases.   It said it was currently among several partners supporting the Lebanese health ministry's immunisation campaign "not only for measles but also for polio in order to mitigate the risk of polio spreading from Syria."   "If we don't react now, more serious epidemics will hit," Tanya Chapuisat, UNICEF's representative in Lebanon, said.   The agency made a $5 million appeal to donors, arguing it needs to replenish vaccine stocks and reach vulnerable children in isolated areas.
Date: Thu, 9 Nov 2017 22:13:18 +0100

Riyadh, Nov 9, 2017 (AFP) - Saudi Arabia and Kuwait on Thursday urged their citizens to leave Lebanon immediately, days after Lebanese prime minister Saad Hariri announced his resignation while visiting Riyadh.

"Due to the situation in the Republic of Lebanon, the kingdom asks its nationals visiting or living in Lebanon to leave as soon as possible, and advises its citizens not to travel there," said a Saudi foreign ministry source, quoted by state news agency SPA.   Kuwait called on "all its citizens to leave Lebanon immediately" and avoid going there as a precautionary measure, state agency KUNA reported a source at the foreign ministry as saying.

On November 4, Hariri announced in a televised speech from Saudi Arabia that he was stepping down, citing Iran's "grip" on Lebanon and threats to his life.   The shock announcement raised fears that Lebanon -- split into rival camps led by Hariri and the Iranian-backed movement Hezbollah -- could once again descend into violence.   Hariri, who also holds Saudi nationality and whose wife and children live in the kingdom, has since met Saudi King Salman and travelled to the United Arab Emirates, according to official media in the Gulf states.

Lebanese President Michel Aoun has said he will await Hariri's return before taking any decision, while Hezbollah chief Hassan Nasrallah said Hariri's resignation had been "imposed" by Saudi Arabia.   The resignation coincided with the announcement in Saudi Arabia of an anti-corruption purge in which dozens of princes, ministers and businessmen have been rounded up.   Bahrain, a close ally of Saudi Arabia, advised its citizens against travel to Lebanon a day after Hariri's announcement.
Date: Tue, 12 Apr 2016 14:33:35 +0200

Sidon, Lebanon, April 12, 2016 (AFP) - A car bomb exploded on Tuesday in Lebanon's southern port city of Sidon, killing at least one person identified as a Palestinian official, a security source said.   The source said the blast killed Fathi Zeidan, who headed the Fatah movement in the Miye Miye Palestinian refugee camp near Sidon.   "His identification card was found near the car which exploded, which was also his," the source told AFP.

A statement from Lebanon's armed forces said Zeidan had been driving the car when one kilogramme of explosives hidden inside his vehicle detonated.    The army's forensics unit arrived at the scene of the blast and cleared away scorched body parts lying near a car in flames, according to an AFP correspondent at the scene.   More than 450,000 Palestinians are registered in Lebanon with the UN agency for Palestinian refugees, and many live in squalid conditions in 12 official camps.   The camps are administered by Palestinian officials and security forces, rather than the Lebanese authorities.

In recent years, tensions have risen between Palestinian president Mahmud Abbas' Fatah movement and the Jund al-Sham Islamist group, especially in the Ain al-Hilweh camp, which is also near Sidon.   The rival factions in Ain al-Hilweh have clashed several times in the past year, with each side accusing each other of assassination attempts.   Ain al-Hilweh has become the scene of score-settling between several factions, and a breeding ground for extremist groups that have flourished on the back of the poverty afflicting the camp.
Date: Mon, 4 Apr 2016 05:15:50 +0200
By Maya Gebeily

Naameh, Lebanon, April 4, 2016 (AFP) - Imagine living near a trash dump so putrid that you would rather move to war-torn Syria.   That's what Fayyad Ayyash, his wife Riham and their four young daughters plan to do next week, leaving behind their home in Lebanon for neighbouring Syria.

Their modest two-storey house in the town of Naameh, about 20 kilometres (12 miles) south of the Lebanese capital, directly overlooks the infamous and odorous landfill by the same name.    "We're going next week. In Syria, there's a possibility I might die. Here, we'll definitely die," Fayyad tells AFP.    From his grassy backyard, dozens of large trucks carrying tonnes of waste can be seen -- and smelled -- lining up to add their load to the "trash mountain."

The July 2015 closure of the notorious landfill lies at the heart of Lebanon's trash crisis, which has seen rivers of trash spread across the Mediterranean country, triggering protests nationwide.   Then last month, the government made a controversial decision to reopen it -- and this was the last straw for residents like Fayyad.   Pulling out a bright blue inhaler, he says his family has been suffering from respiratory problems for months because of the dump.

His daughters, whose ages range from just under two to 10 years, all have trouble eating and sleeping.   "It's always worse at night than during the day. The whole area is swarming with the same smell and the same sickness," he says.   Fayyad says it's become so bad, he's decided to flee across the border to the town of Libeen in southern Syria, a country where a conflict has been raging since 2011.

- Costly medical bills -
The Naameh landfill opened in 1997 and was meant to be a temporary dump, but an alternative site was never opened.    For 20 years, the waste generated in Beirut and Mount Lebanon -- the country's most populous areas -- was dumped in Naameh.   The verdant valley swelled into a trash mountain of more than 15 million tonnes.    Furious residents forced the closure of the site in July 2015, saying it was leading to high cancer rates, skin diseases and breathing problems.

Uncollected rubbish began piling up around Beirut and its suburbs, emitting a horrible stench that sparked protests in downtown Beirut demanding a long-term solution.   After months of political wrangling, Lebanon's cabinet announced a four-year plan to end the waste crisis -- and its first step was reopening Naameh for two months.    "When the dump reopened, my baby immediately started throwing up again," Fayyad says.

Fayyad and his Syrian wife, Riham, are both Druze, an offshoot of Islam.   Riham estimates that she spends about $1,000 (around 880 euros) per month on doctor's visits, inhalers, and other medication for her children.    Pointing to her bare finger, she says she had to sell her wedding ring to cover the costs.    "I wish my kids would eat food as much as they take medicine," she says.    Riham's family hails from Libeen, in Syria's southern Sweida province. That's where she will travel to next week, in the hope that the open plains there will be good for her children.

- Suitcase 'packed and ready' -
Sweida, the heartland of Syria's Druze minority, has come under attack by jihadists of the Islamic State group but has seen less fighting than other parts of the country.   "No, it isn't safe, but I'm forced to leave... I have a suitcase packed and ready on top of the closet," Riham says.    Farouk Merhebi from the American University of Beirut says the smell has probably made life incredibly uncomfortable for hundreds living within a one-kilometre radius of the dump.

Before the crisis began, trash trucks would dump between 2,800 to 3,000 tonnes of waste per day in Naameh, says Merhebi, who is AUB's director of environmental health, safety and risk management.    "Now it's about 8,000 to 9,000 tonnes. The operations almost tripled because they're playing catch-up with the trash that had accumulated," he says.   "The waste that has accumulated in streets has fermented, so the smell is offensive...

The smell is worse because it's been there for seven to eight months."   But the long-term health effects of the dump on the surrounding area remain untested.   Merhebi is part of a team at AUB hoping for funding to complete research in the area "to test the surface water, ground water, and some samples of the soil as well as samples of ambient air."    But Fayyad and his family say they cannot wait.    "Riham's family said they were thinking of coming to Lebanon," he says.    "But we told them, 'do you want to die here from the smell?'"
More ...

World Travel News Headlines

Date: Mon, 19 Aug 2019 03:45:54 +0200 (METDST)

Lomo del Pino, Spain, Aug 19, 2019 (AFP) - A raging wildfire on the Spanish holiday island of Gran Canaria forced the evacuation of some 5,000 people, authorities said Sunday, warning it could take days for the blaze to be brought under control.   The fire, which has spread to the mountainous Cruz de Tejeda region popular with tourists for its breathtaking views, is "extremely fierce" and "unstable", said Canary Islands president Angel Victor Torres in a statement.   No fatalities have been reported.

More than 600 firefighters and 14 aircraft battled to contain the flames, hampered by strong winds and high temperatures.   With the temperature set to rise Monday, authorities estimate it could take days before the blaze is brought under control.   "The next few hours will be very important because the weather forecast for the night is not good," Torres said.   The fire broke out days after another wildfire in the same region forced the evacuation of hundreds.

Gran Canaria is the second most populous of the Canary Islands in the Atlantic off the northwest coast of Africa.   The Canary Islands received 13.7 million foreign visitors last year, over half of them from Britain and Germany.   Spain is frequently plagued by huge forest fires because of its arid summer climate.
Date: Sun, 18 Aug 2019 23:01:00 +0200 (METDST)

Lisbon, Aug 18, 2019 (AFP) - Portuguese fuel tanker drivers whose strike has caused fuel shortages at the summer holiday season on Sunday ended their industrial action.   Drivers have been staging a strike since Monday to demand further wage increases in 2021 and 2022, prompting the government to declare an energy crisis.   "Since all the conditions are now in place to negotiate, we decided to end the strike," Pedro Pardal Henriques, spokesman for the National Union of Dangerous Goods Carriers (SNMMP), told reporters.

A meeting is scheduled for Tuesday, the union President Francisco Sao Bento said, adding that the union did not "rule out new strikes being called if Antram (the employers association) adopts an uncompromising attitude".   Police had launched an operation to escort fuel tankers with extra supplies and Portugal also mobilised about 500 members of the security forces to replace the strikers and drive the trucks.   Despite the shortages, Energy Minister Joao Pedro Matos Fernandes said about two-thirds of the country's 3,000 or so petrol stations had not run dry.
Date: Sun, 18 Aug 2019 11:47:26 +0200 (METDST)
By By Emal Haidary and Mushtaq Mojaddidi

Kabul, Aug 18, 2019 (AFP) - Joy and celebration turned into horror and carnage when a suicide bomber targeted a packed Afghan wedding hall, killing at least 63 people in the deadliest attack to rock Kabul in months, officials and witnesses said Sunday.   The massive blast, which took place late Saturday in west Kabul, came as Washington and the Taliban finalise a deal to reduce the US military presence in Afghanistan and hopefully build a roadmap to a ceasefire.   The groom recalled greeting smiling guests in the afternoon, before seeing their bodies being carried out hours later.

The attack "changed my happiness to sorrow", the young man, who gave his name as Mirwais, told local TV station Tolo News.   "My family, my bride are in shock, they cannot even speak. My bride keeps fainting," he said.   "I lost my brother, I lost my friends, I lost my relatives. I will never see happiness in my life again."   Interior ministry spokesman Nasrat Rahimi said at least 63 people had been killed and 182 injured.   "Among the wounded are women and children," Rahimi said. Earlier he stated a suicide bomber carried out the attack.

Afghan weddings are epic and vibrant affairs, with hundreds or often thousands of guests celebrating for hours inside industrial-scale wedding halls where the men are usually segregated from the women and children.   "The wedding guests were dancing and celebrating the party when the blast happened," recounted Munir Ahmad, 23, who was seriously injured and whose cousin was among the dead.   "Following the explosion, there was total chaos. Everyone was screaming and crying for their loved ones," he told AFP from his bed in a local hospital, where he is being treated for shrapnel wounds.

Images from inside the hall showed blood-stained bodies on the ground along with pieces of flesh and torn clothes, hats, sandals and bottles of mineral water. The huge blast ripped parts of the ceiling off.   The wedding was believed to be a Shia gathering. Shia Muslims are frequently targeted in Sunni-majority Afghanistan, particularly by the so-called Islamic State group, which is also active in Kabul but did not immediately issue any claim of responsibility.

Wedding guest Hameed Quresh told AFP the young couple were saying their vows when the bomb went off.    "We fainted following the blast, and we don't know who brought us to the hospital," sobbed Quresh, who lost one brother and was himself wounded.   Another guest told Tolo that some 1,200 people had been invited. With low security, weddings are seen as easy targets.   The attack sent a wave of grief through a city grimly accustomed to atrocities. President Ashraf Ghani called it "barbaric", while Afghanistan's chief executive Abdullah Abdullah described it as a "crime against humanity".

- Withdrawal deal expected -
The attack underscores both the inadequacy of Afghanistan's security forces and the scale of the problem they face. While the police and army claim they prevent most bombings from ever happening, the fact remains that insurgents pull off horrific attacks with chilling regularity.   On July 28, at least 20 people were killed when attackers targeted Ghani's running mate Amrullah Saleh as he campaigned in presidential elections.    The incident showed how even amid tight security and known threats, insurgents can conduct brazen attacks.   The issue also goes to the heart of a prospective deal between the US and the Taliban that would see Washington begin to withdraw its approximately 14,000 soldiers from Afghanistan.

The deal relies on the Taliban providing guarantees they will stop jihadist groups such as Al-Qaeda and IS from using Afghanistan as a safe haven. Saturday's attack suggests any such promise would be tough to keep.   The "Taliban cannot absolve themselves of blame, for they provide platform for terrorists," Ghani said.   Few believe such a deal will bring quick peace.

Many Afghans fear the Taliban could return, eroding hard-won rights for women in particular and leading to a spiralling civil war.   Meanwhile, in the northern province of Balkh, 11 members of the same family were killed when their car hit a roadside bomb, officials said. The provincial governor blamed the Taliban for planting the device.
Date: Sun, 18 Aug 2019 05:28:47 +0200 (METDST)
By Amélie BOTTOLLIER-DEPOIS

Paris, Aug 18, 2019 (AFP) - Seafood lovers who prize the mussel for its earthy taste and succulent flesh may be unaware of its growing potential in the fight against water pollution.   The mussel is the hoover of the sea, taking in phytoplankton for nourishment along with microplastics, pesticides and other pollutants -- which makes it an excellent gauge.

One day, it may also be pressed into service to cleanse water.   "It's a super-filter in the marine world, filtering up to 25 litres of water a day," says marine biologist Leila Meistertzheim.   "It's a real model of bioaccumulation of pollutants generally speaking."   As they pump and filter the water through their gills in order to feed and breathe, mussels store almost everything else that passes through -- which is why strict health rules apply for those destined for human consumption.

Like canaries in a coal mine, mussels have long been used as "bio-indicators" of the health of the seas, lakes and rivers they inhabit.   Little-known pollutants can turn up to join the usual suspects, with increasing attention paid to microplastics containing bisphenol A and phthalates, both thought to be endocrine disruptors.

Meistertzheim heads a study for France's Tara Ocean Foundation using mussels to gauge the health of the estuaries of the Thames, Elba and Seine rivers.   The mussels, placed in fish traps, are submerged in the waters for a month before researchers dissect them to determine what chemical substances lurk in their tissues.   The idea of deploying mussels across the oceans to absorb ubiquitous microplastics is just a dream for now, but for other pollutants, the bivalves are already at work.   "In some places, mussels are used, as well as oysters, to cleanse the sea of pesticides, for example," Meistertzheim notes.

- E. coli busters -
Richard Luthy, an environmental engineer from California's Stanford University, says that, in most cases, mussels harvested from contaminated waters should not be eaten.   But if the contaminant is E. coli, mussels can be thanked for the "removal and inactivation" of the faecal material, he says, calling the service a "public health benefit".   The mussels are edible because they "excrete the bacteria as faeces or mucus," he says.   Mussels living in waterways affected by eutrophication -- often marked by abundant algae -- are also fit for human consumption, researchers say.   The phenomenon is often the result of waste dumped into the waterway containing phosphates and nitrites, such as detergents, fertilisers and sewage.   The nutrients in these substances encourage the proliferation of algae, which in turn starves the water of oxygen, upsetting the ecosystem.

Mussels "recycle" these nutrients by feeding on the algae, says Eve Galimany, a researcher of the US National Oceanic and Atmospheric Administration's Milford Laboratory who has experimented with mussels in the Bronx River in New York.   The recycling principle is already at work in a pilot project titled Baltic Blue Growth in Sweden, Denmark and the Baltic countries which grows mussels to be fed to animals such as poultry, fish and pigs.   "Eutrophication... is the biggest problem of the Baltic Sea, the most urgent one," says project head Lena Tasse. Mussels "could be part of a solution".   Why feed them to animals if they are safe for humans? Because Baltic mussels are too small to be of interest to seafood lovers, says Tasse, adding: "Swedes like big mussels."

Meanwhile, the jury is still out on the effects of microplastics on human health.   A recent report by WWF said that humans ingest an average of five grammes of microplastics a week -- about the weight of a credit card.   A 2018 study published in the journal Environmental Pollution, based on samples from British coastlines and supermarkets, estimated that every 100 grammes (3.5 ounces) of mussels contained 70 tiny pieces of plastic.   Should we be worried? Meistertzheim thinks not.   "I eat them," she says. "A dish of mussels is not necessarily worse than organic hamburger meat wrapped in plastic."
Date: Sat, 17 Aug 2019 20:51:48 +0200 (METDST)
By Ricky Ombeni and Marthe Bosuandole

Kinshasa, DR Congo, Aug 17, 2019 (AFP) - Measles has killed 2,758 people in the DR Congo since January, more than the Ebola epidemic in a year, medical NGO Doctors Without Borders said, and called Saturday for a "massive mobilisation of funds."   The disease, preventable with a vaccine, has infected over 145,000 people in the Democratic Republic of Congo between January and early August, it said in a statement.   "Since July, the epidemic has worsened, with a rise in new cases reported in several provinces," said the NGO that goes by its French acronym MSF.   "Only $2.5 million has been raised out of the $8.9 million required for the Health Cluster response plan  -- in stark contrast with the Ebola epidemic in the east of the country, which attracts multiple organisations and hundreds of millions of dollars in funding," it added.

MSF tweeted that without a "massive mobilisation of funds and response organisations, the current measles outbreak in #DRCongo could get even worse."   The NGO said it has vaccinated 474,860 children between the ages of six months and five years since the beginning of the year, and provided care to more than 27,000 measles patients.   In the country's east, Ebola has claimed more than 1,900 lives since erupting last August.

Measles is a highly-contagious diseased caused by a virus that attacks mainly children. The most serious complications include blindness, brain swelling, diarrhoea, and severe respiratory infections.   Last year, cases more than doubled to almost 350,000 from 2017, according to the World Health Organization, amid a rise in "anti-vaxxer" sentiment in some countries that can afford the vaccine, and lagging resources for the preventative measure in poor nations.   The DR Congo declared a measles epidemic in June.
Date: Sat, 17 Aug 2019 12:12:19 +0200 (METDST)

Toulouse, France, Aug 17, 2019 (AFP) - Nine people were injured during a fireworks display in a popular resort in southern France when one rocket misfired close to onlookers on the beach, firefighters said Saturday.   Three of those hurt in the incident in on Friday night in Collioure were taken to hospital after the device "exploded very low" and rained down sparks on some of the 80,000 crowd, firefighters and the local prefecture said.

One person remained in hospital after surgery for a shoulder fracture.   The misfiring rocket was part of a show on a barge just off the port of Collioure, a small picturesque seaside town near the Spanish border whose 3,000 population mushrooms around 30-fold with summer tourists.   Three doctors on site swiftly intervened to treat those injured, the local prefecture said, adding local police have opened an investigation into the incident.
Date: Fri, 16 Aug 2019 21:37:39 +0200 (METDST)
By Ricky Ombeni and Marthe Bosuandole

Bukavu, DR Congo, Aug 16, 2019 (AFP) - A woman has died of Ebola and her infant son was diagnosed with the virus in the first confirmed cases in DR Congo's South Kivu province, reviving fears Friday the highly contagious disease could spread through the region.

The Democratic Republic of Congo's Ebola epidemic has claimed more than 1,900 lives since erupting last August.   "Two cases which tested positive for Ebola were confirmed overnight in South Kivu, in Lwindi district in the Mwenga region," the provincial government said in a statement.   A woman in her twenties died while her seven-month-old child tested positive for the virus and is receiving treatment, the vast central African nation's pointman on Ebola, Jean-Jacques Muyembe, said in a statement.

The woman had been staying with a family in the North Kivu town of Beni, the epicentre of the outbreak, and was identified as a "high-risk contact" of one of the family members infected with Ebola, the statement said.   She then "escaped" movement controls in the area, changing identities four times and travelling from Beni through the North Kivu cities of Butembo and Goma to South Kivu's Bukavu and Mwenga, the statement added.    She died on Wednesday.   "We reassure neighbouring countries that all steps are being taken to strengthen surveillance at points of entry as well as sanitary control," the statement said.    South Kivu shares borders with Rwanda, Burundi and Tanzania.

World Health Organization (WHO) chief Tedros Adhanom Ghebreyesus tweeted that the outbreak in South Kivu "has sparked a rapid response... to provide treatment, identify all contacts, raise community awareness & begin vaccinating".   The International Federation of Red Cross and Red Crescent Societies (IFRC) said it was "rapidly deploying an expert team" to the area.   And South Kivu Governor Theo Ngwabidje told reporters: "Teams from the national anti-Ebola coordination campaign arrived yesterday to provide support."

- Risk of crossing border 'enormous' -
The outbreak of the haemorrhagic virus began in neighbouring North Kivu province on August 1, 2018 and spread to Ituri province.   The WHO declared the epidemic a "public health emergency of international concern" last month after cases were confirmed in the densely-populated North Kivu capital Goma.   The city's proximity to Rwanda and many transport links sparked fears of cross-border spread.    "Beni, Butembo and Goma are still containable," a Congolese professor and epidemiologist said of the three North Kivu cities.   "But with the disease in South Kivu, the risks of it spreading to (the eastern DR Congo town) of Kalemie, Tanzania and Burundi are enormous."

Residents in South Kivu's capital Bukavu said they were worried.   "At this time of year, we rarely have running water -- how are we going to avoid this disease if we have to frequently wash our hands?" asked mother-of-five Martine Mushagalusa.   Anselme Kangeta, 35, said: "Given the crowded way we live, movement is uncontrolled, people go from one place to another without taking precautions. The authorities must get involved otherwise we will all die."   South Kivu experienced an Ebola scare on July 31 when doctors briefly quarantined 15 people in the town of Birava over fears they were infected, but tests came back negative.

- Drug breakthrough -
Ebola is named after a river in northern DR Congo, formerly named Zaire, where the virus was first identified in 1976.   The latest outbreak is the second-deadliest on record after more than 11,000 people were killed in Guinea, Sierra Leone and Liberia between 2014-2016.   The pathogen causes fever, vomiting and severe diarrhoea, often followed by kidney and liver failure, and internal and external bleeding.   The disease is spread by contact with infected bodily fluids and is fought with the time-honoured but laborious techniques of tracing contacts and quarantining them.

The cases in South Kivu come on the heels of researchers announcing a possible breakthrough in the quest for drug to treat Ebola. Two prototype drugs, REGN-EB3 and mA114, slashed mortality rates among Ebola patients in a
trial in eastern DR Congo.   The authorities have also deployed a US-made vaccine called rVSV-ZEBOV, which is unlicensed but has been widely tested for safety.    Muyembe, appointed by President Felix Tshisekedi to coordinate the campaign against Ebola, predicted Thursday that with the new drugs and vaccine "we can manage to completely control the epidemic in three to four months".    Nearly 200,000 people have been vaccinated to date.   Burundi said Wednesday it had begun vaccinating frontline workers at its border with DR Congo.
Date: Fri 16 Aug 2019
Source: CBS Boston [edited]

The Massachusetts Department of Public Health has confirmed a 2nd human case of eastern equine encephalitis [EEE] in the state on Friday [16 Aug 2019]. Officials also raised the risk level for EEE to "critical" in 10 more towns in central and eastern Massachusetts.

The department said the new EEE case is in a man between the ages of 19-30 in Grafton. As a result, Grafton, Hopkinton, Northbridge, Shrewsbury, Southboro, Upton, and Westboro are all at "critical risk" for EEE.  The wife of the Grafton man diagnosed with EEE says he is in his late 20s and lives near a farm. The couple asked not to be identified but told WBZ he was diagnosed after having a seizure.  A goat in Bristol County has also tested positive for EEE, leading officials to put Easton, Norton and Raynham at critical risk as well. A total of 19 communities across the state are at critical risk now, and 18 are at high risk.

The department said it is working with local boards of health and mosquito control experts to work on "appropriate public health response activities."  "The most intense level of EEE activity is still being seen in Bristol and Plymouth Counties," said Public Health Commissioner Monica Bharel in a statement. "However, in active EEE years, the virus may move outside of southeastern Massachusetts. This is evidence of that movement, and residents in the area of increased risk should use mosquito repellent and avoid outdoor activities at night."  Less than a week ago, the department confirmed the 1st human case of EEE in Massachusetts since 2013. The infected man is over 60 and lives in southern Plymouth County.

So far, EEE has been found in 288 mosquito samples.  "[The] history here in Massachusetts [is that] the mosquitos test positive, but the people don't, so this is a little bit unusual," said Dr. Michael Hirsh of the Worcester Division of Public Health.  He said weather may be to blame. "Whenever there is a winter that doesn't have a really hard frost, if it's much more mild, the mosquitoes don't really ever knock off from last year."  Residents should make efforts to avoid mosquito bites, which can spread EEE, including using insect repellent, being aware of peak mosquito hours (dusk to dawn), wearing long sleeve shirts and pants when outside, draining standing water from around your home, replacing window screens, and protecting your animals from mosquitos.

EEE symptoms can range from a stiff neck, headache and lack of energy to dangerous complications like inflammation and swelling of the brain.  The risk of EEE will remain until the 1st killing frost.
========================
[There was a recent human eastern equine encephalitis (EEE) case in Massachusetts, the 1st human case that ProMED-mail has posted this year (2019), and now a 2nd case in that state and the 3rd in the eastern USA.

So far this year (2019), all of the EEE cases other than in humans posted on ProMED-mail have been in horses, indicating that this has been an active EEE virus transmission season. The case above again reminds us that human cases occur as well. As usual, the equine cases have occurred in the eastern states and a midwestern state in the USA. There is a vaccine available for equine animals, and their owners are wise to have them vaccinated. There is no commercially available vaccine for humans, so avoidance of mosquito bites is the best preventive measure.

Additional information on EEE is available on the CDC website at
<https://www.cdc.gov/EasternEquineEncephalitis/>. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Massachusetts, United States: <http://healthmap.org/promed/p/224>]
Date: Sun 18 Aug 2019
Source: Taipei Times [abridged, edited]

The Centers for Disease Control (CDC) yesterday [17 Aug 2019] confirmed 5 new measles cases associated with a cluster outbreak in Taipei, saying that 1981 people who had come into direct contact with the patients would be monitored for symptoms until 6 Sep 2019.

The cases are likely associated with a man in his 30s living in northern Taiwan who was infected with measles in Viet Nam, returned home on 29 Jul 2019, transmitted the disease to his flat-mate, and was confirmed to have measles on Wed 31 Jul 2019, the centres said.

One of the 5 cases confirmed yesterday [17 Aug 2019] is a man in his 30s who was on the same flight with the index case on 29 Jul 2019 and was in Viet Nam from 5 Aug to Wed 14 Aug 2019, so he might have been infected by the index case or by other people in Viet Nam, it added.

The other 4 patients are nurses who work at Cathay General Hospital's emergency room who had come into contact with the index case, the CDC said.

The nurses started experiencing symptoms between Friday last week [9 Aug 2019?] and Thursday this week [15 Aug 2019?], CDC Deputy Director-General Chuang Jen-hsiang said, adding that one of them was vaccinated for measles, mumps and rubella (MMR) in 2013, and 2 were vaccinated last year [2018], but the other has not been vaccinated.

The hospital held an emergency response meeting to discuss prevention measures and asked the medical practitioners who have had direct contact with the index case to have their measles antibody levels measured and receive an MMR vaccine if no antibodies are found, hospital deputy superintendent Lee Chia-long said. The hospital also asked medical practitioners with higher antibody levels to help screen patients with a fever, control the personnel who are allowed to enter the emergency room, take disinfection measures, and put up posters to warn people about clustered measles cases, he said.

One 119 measles cases have been confirmed this year [2019] -- 72 domestic cases, among whom 51 had come into contact with confirmed cases, and 47 imported -- the CDC said.  [Byline: Lee I-chia]
Date: Fri 16 Aug 2019
Source: 1 News Now [abridged, edited]

A spike in measles cases this week is the worst since the outbreak started, Auckland Regional Public Health Service said.

In the past week, there have been 81 new cases.

As of midday [16 Aug 2019], the total number of cases in Auckland this year [2019] was 456.