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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:
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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.
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[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.
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[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.
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[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.
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[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.
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Travel News Headlines WORLD NEWS

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Singapore

Singapore - US Consular Information Sheet
May 12, 2008
COUNTRY DESCRIPTION:Singapore is a small, stable, highly developed country with an elected parliamentary system of government. Tourist facilities are modern and widely available. Singapore'
resident population of over 4.6 million inhabitants (including permanent residents and foreign workers) comprises 75% Chinese, 14% Malay, 9% Indian and 2% others. English is widely spoken. Criminal penalties are strict and law enforcement rigorous; see sections on “Entry/Exit Requirements,” “Special Circumstances,” and “Criminal Penalties,” below, for further details. Read the Department of State Background Notes on Singapore for additional information.

ENTRY/EXIT REQUIREMENTS: A valid passport is required. U.S. citizens do not need a visa if their visit is for business or social purposes and their stay is for 90 days or less. Travelers to the region should note that Singapore and some neighboring countries do not allow Americans to enter under any circumstances with fewer than six months of validity remaining on their passport. Female U.S. citizens who are pregnant when they apply to enter Singapore for a social visit are no longer required to make prior application through the nearest Singapore overseas mission or to provide documentation from a U.S. embassy concerning the nationality the child will acquire at birth.
Specific information about entry requirements for Singapore may be obtained from the Embassy of the Republic of Singapore at 3501 International Place NW, Washington, DC 20008, tel. (202) 537-3100. Visit the Embassy of Singapore’s web site at http://www.mfa.gov.sg/washington/ for the most current visa information.
Find more information about dual nationality and the prevention of international child abduction on our web site. For further information about customs regulations, please read our Customs Information.

SAFETY AND SECURITY: In 2001, Jemaah Islamiyah (JI), a terrorist organization with links to Al Qaeda, planned attacks in Singapore against government and private targets associated with the United States, Singapore and other countries. These plans were disrupted and the JI organization in Singapore was dismantled. On February 27, 2008 suspected JI leader Mas Selamat Kastari escaped from detention in Singapore. His current whereabouts are unknown. Singapore remains a target of interest for terrorist groups. The Department of State remains concerned because extremist groups in Southeast Asia continue to demonstrate the desire and capability to carry out attacks against locations where Westerners congregate. Terrorist groups do not distinguish between official and civilian targets. Americans residing in or traveling to Singapore and neighboring countries should therefore exercise caution, especially in locations where Americans and other Westerners live, work, congregate, shop or visit. U.S. citizens should remain vigilant about their personal security and surroundings.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s web site at http://travel.state.gov, where the current Worldwide Caution, Travel Warnings and Travel Alerts 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., or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. eastern time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.

CRIME: Major crimes against tourists in Singapore are uncommon. Petty crimes such as pick-pocketing and purse or briefcase snatching occur in tourist areas, hotels and at the airport. Travelers should exercise the same caution that they would in any large city.. Visitors should be aware that credit card fraud is on the rise and should practice standard precautions to avoid falling victim of credit card fraud: do not carry multiple credit cards on your person; do not allow credit cards to be removed from your sight; avoid giving credit card information over the phone and use only secure internet connections for financial transactions.

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

MEDICAL FACILITIES AND HEALTH INFORMATION: Good medical care is widely available in Singapore. Doctors and hospitals expect immediate payment for health services by credit card or cash and generally do not accept U.S. health insurance. Recipients of health care should be aware that Ministry of Health auditors in certain circumstances may be granted access to patient medical records without the consent of the patient, and, in certain circumstances, physicians may be required to provide information relating to the diagnosis or treatment without the patient's consent.

Despite vigorous mosquito eradication efforts in Singapore, from time to time Singapore experiences a spike in the number of dengue fever cases. Outbreaks tend to be clustered in residential areas, but there have been no reports of clusters in primary tourist areas, such as the Night Safari, the Singapore zoo, or Orchard Road.

In January 2008, a new strain of the viral disease Chikungunya was detected in Singapore. A dozen cases of the disease, which like Dengue Fever is transmitted by the Aedes aegypti mosquito, were documented. There were no deaths. Unlike prior cases in Singapore, these cases were contracted locally and the outbreak centered around guest worker housing on Clive Street.

Information on dengue fever, 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 Singapore is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Singapore has a highly developed and well-maintained road and highway network. Driving is done on the left-hand side of the road. Motorists should be particularly aware of motorcyclists, who often ignore lane markings. Lanes are frequently closed without warning due to construction throughout the city. Public transportation and taxis are abundant, inexpensive, and reliable. Visitors should consider using this form of transportation. The Automobile Association of Singapore provides roadside assistance, and the Land Transport Authority has rescue vehicles on the road at all hours. In addition, closed circuit cameras monitor all major roads. As with all laws in Singapore, those involving traffic rules, vehicle registration, and liability in case of accident are strictly enforced, and failure to follow them may result in criminal penalties. Please refer to our Road Safety page for more information.

Singapore has one of the worst road-fatality records among developed countries. In 2007, 2.6 deaths were logged for every 10,000 vehicles in Singapore, compared to 0.8 in Japan, 1.2 in Australia and 1.8 in the United States. For specific information concerning Singaporean driver's permits, vehicle inspection, road tax and mandatory insurance, please contact the Singaporean National Tourist Board located at 590 Fifth Ave., Twelfth Floor, New York, NY 10036, tel. 1-212-302-4861 or fax: 1-212-302-4801.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Singapore's Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Singapore’s 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: Singapore customs authorities enforce strict regulations concerning temporary import and export of items such as weapons, illegal drugs, certain religious materials, pornographic material, videotapes, CDs, DVDs, and software. Singapore customs authorities’ definition of "weapon" is very broad, and, in addition to firearms, includes many items which are not necessarily seen as weapons in the United States, such as dive knives, kitchen knives, handcuffs, and expended shell casings. Carrying any of these items without permission may result in your immediate arrest. All baggage is x-rayed at every port of entry, so checked baggage will also be inspected for regulated items.

It is advisable to contact the Embassy of Singapore in Washington, DC at 3501 International Place NW, Washington, DC 20008, tel. (202) 537-3100, http://www.mfa.gov.sg/washington/ for specific information regarding customs requirements. You may also visit Singapore Customs’ web site, http://www.customs.gov.sg/. Singapore customs officials encourage the use of an ATA (Admission Temporaire/Temporary Admission) carnet for the temporary admission of professional equipment, commercial samples, and/or goods for exhibitions and fair purposes. ATA carnet headquarters located at the U.S. Council for International Business, 1212 Avenue of the Americas, New York, N.Y. 10036, issues and guarantees the ATA carnet in the United States. For additional information, please call 1-212- 354-4480, or send an e-mail to atacarnet@uscib.org or visit http://www.uscib.org/ for details.

In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products are illegal and bringing them back to the United States may result in forfeitures and/or fines. A current list of those countries with serious problems in this regard can be found at http://www.ustr.gov/Document_Library/Reports_Publications/2004/2004_Special_301/Section_Index.html.
Please see our Customs Information.
Automated teller machines (ATMs) are plentiful in Singapore, and they are the best method of obtaining cash. Bank transfers generally take weeks, and surcharges are steep. Transfers from commercial services such as American Express and Western Union are generally efficient.

Americans may be asked by police, employers or hotels to surrender their passports in lieu of surety (guaranteed) bonds. Americans should carefully consider whether they wish to surrender their passport rather than seek some other type of surety, particularly if the passport is requested by someone who is not a government official (e.g., an employer, or hotel employees).
Note that Singapore does not recognize dual nationality beyond the age of 21, and it strictly enforces universal national service (NS) for all male citizens and permanent residents. Male U.S. citizens who automatically acquired Singaporean citizenship and continue to reside in Singapore are liable for Singapore national service once they reach the age of 18. Travel abroad of Singaporean males may require Singapore Government approval as they approach national service age and may be restricted when they reach sixteen-and-a-half years of age. Under Singaporean law, an individual who acquires Singaporean citizenship at birth retains that status even after acquiring the citizenship of another country, including U.S. citizenship.

Males may renounce Singaporean citizenship only after having completed at least two years of national service. U.S. citizens are subject to this law. Dual nationals, Singapore Permanent Residents, and their parents should contact the Ministry of Defense in Singapore to determine if there will be a national service obligation. For additional information, please see the Bureau of Consular Affairs’ web site for our dual nationality flyer, and contact the Ministry of Defense Central Manpower Base (tel. 65-6373-3127), or visit http://www.ns.sg/nsPortal/appmanager/nsp/default?_nfpb=true&_pageLabel=nsPortal_NSREG_ABT&nsp_community=ENLIST.
National-service-liable males who migrated from Singapore before age 11 and have not enjoyed significant socio-economic benefits of citizenship (e.g., applied for a Singapore identity card or studied in Singapore beyond the age of 11) are allowed to renounce their Singapore citizenship, but not before they turn 21. Until then, they are required to register for national service with Central Manpower Base and apply for a deferment. After turning 21, they are then eligible to renounce their Singapore citizenship and, if successful will not be required to serve NS and may continue to make short social visits to Singapore.

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 in Singapore than for similar offenses in the United States, and persons violating Singapore laws, even unknowingly, may be expelled, arrested or imprisoned.
There are strict penalties for possession and use of drugs as well as for trafficking in illegal drugs. Trafficking charges may be brought based on the quantity of illegal drugs in a subject’s possession, regardless of whether there is any proven or demonstrated intent to distribute the drugs. Convicted offenders can expect long jail sentences and heavy fines. Singapore has a mandatory death penalty for many narcotics offenses. Singapore police have the authority to compel both residents and non-residents to submit to random drug analysis, and do not distinguish between drugs consumed before or after entering Singapore in applying local laws.

Visitors should be aware of Singapore's strict laws and penalties for a variety of actions that might not be illegal or might be considered minor offenses in the United States. These include jaywalking, littering, and spitting. Singapore has a mandatory caning sentence for vandalism offenses, and caning may also be imposed for immigration violations and other offenses. Commercial disputes that may be handled as civil suits in the United States can escalate to criminal cases in Singapore, and result in heavy fines and prison sentences.
There are no jury trials in Singapore. Judges hear cases and decide sentencing. The Government of Singapore does not provide legal assistance except in capital cases; legal assistance may be available in some other cases through the Law Society.

There are strict penalties for those who possess or carry arms, or who commit crimes with arms. Singaporean authorities define “arm” as any firearm, air-gun, air-pistol, automatic gun, automatic pistol and any other kind of gun or pistol from which any shot, bullet or other projectiles can be discharged or from which noxious liquid, flame or fumes can be emitted, and any component part thereof. This definition also includes any bomb or grenade and any component part thereof. The unlawful possession of any arm or ammunition could result in imprisonment and caning. Any person convicted of committing a crime with an arm could receive punishment which could result in the maximum penalty of imprisonment for life and caning.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. In Singapore, local law prohibits causing or encouraging prostitution of, or engaging in sexual relations with, a female below the age of 18. An indecent assault against anyone, male or female, regardless of age, is also prohibited. Those convicted of facilitating or abetting the prostitution of any woman or girl could be sentenced to imprisonment of up to 5 years and a fine of $7,100 or both. If the crime involves a female below the age of 16, the offender faces an additional charge carrying a possible sentence of imprisonment of up to 3 years and a fine of $2,000 or both.
Singapore enforces strict laws pertaining to the propriety of behavior between people, and the modesty of individuals. The Singaporean law “Outrage of Modesty” is defined as an assault or use of criminal force on any person, intended to, or knowing it to be likely to, outrage the modesty of that person. Penalties may include imprisonment for up to 2 years, a fine, caning, or a combination thereof. Men are sometimes accused of inappropriately touching other people, often women, resulting in their prosecution and punishment under this Singaporean law.
CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children’s Issues web site.

REGISTRATION / EMBASSY LOCATION: Americans living or traveling in Singapore are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site and obtain updated information on travel and security within Singapore. 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 27 Napier Road, Singapore 258508, tel. [65] 6476-9100, fax [65] 6476-9340; web site http://singapore.usembassy.gov/. In case of emergencies after working hours, the duty officer at the Embassy may be contacted by calling tel. [65] 6476-9100.
* * *
This replaces the Country Specific Information dated September 11, 2007, to update sections on Country Description, Safety and Security, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: 27 Jul 2019
Source: Outbreak News Today [abridged, edited]

The Singapore Ministry of Health has noted an increase in the number of measles cases in Singapore in recent weeks. In the past week, there were 17 confirmed cases of measles infection at a residential home for persons with intellectual disability, and a foreign worker dormitory.

Officials say there is no evidence of community spread from these cases.

As of 22 Jul 2019, 116 measles cases have been notified to MOH in 2019. 88 of these cases were local, and 28 were imported from Bangladesh, Dubai, Malaysia, New Zealand, Philippines, Thailand and Viet Nam. No deaths were reported in 2019 arising from the notified cases of measles.

Peak dengue season in Singapore: 8000 cases, 5 times last year's [2019] number.

Measles vaccination is compulsory by law for all children residing in Singapore, as children are at high risk of developing complications.
Date: Sat 27 Jul 2019
Source: Today Online [abridged, edited]

It was supposed to be a fun school camp. Instead, the outdoor adventure turned into a harrowing ordeal for a 14-year-old student in Singapore when he contracted an unusual infection, likely from camp activities.

Weeks following his contact with murky water, the boy showed up at KK Women's and Children's Hospital (KKH) with fever, stomach pain, nausea and jaundice. Tests also showed a swollen liver and spleen. On the 2nd day, his condition worsened and he was transferred to the intensive care unit. The infection causing his misery? Leptospirosis, a disease more commonly seen in rodents, livestock, dogs and cats but can also spread to humans.

As families spend time bonding on holidays overseas and adrenaline-seekers head outdoors and go on off-the-beaten tracks, health experts raised the possibility that they could expose themselves to less commonly seen infections such as leptospirosis.

In the last 2 years, 96 human cases of leptospirosis were notified in Singapore, based on data published by the Ministry of Health. It was added to the list of notifiable infectious diseases in September 2016.

The _Leptospira_ bacteria, which is commonly found in tropical countries, can enter the body [through] cuts on the skin, the eye, or mucous membranes that line body parts such as the mouth, nose and windpipe. Associate Professor Chong Chia Yin, senior consultant at KKH's infectious disease service, said that besides exposure to urine or bodily fluids from infected animals, people may also get the disease if they are exposed to contaminated water during recreational activities such as swimming, water sports and rafting in contaminated lakes and rivers.

Dr. Chan Si Min, head and consultant at the division of paediatric infectious diseases at National University Hospital, said that leptospirosis can range in severity, from mild or asymptomatic (no symptoms) to severe and life-threatening, resulting in jaundice, kidney failure and bleeding in the lungs. It can also affect other organs such as the liver and heart. Assoc. Prof. Chong said that about 5% to 15% of cases will have life-threatening consequences. Death rate is the highest among people above 60 years old.

Certain measures may help reduce the risk of contracting leptospirosis when travelling and engaging in outdoor recreational activities. Assoc. Prof. Chong advised researching travel destinations before getting there, to check if there are any floods, previous outbreaks of leptospirosis in the lakes, rivers, and so forth.

Dr. Chan advised those who are wading, swimming or boating in freshwater -- which may be contaminated by animals shedding the infection in urine -- should avoid being submerged in the water or swallowing it.

Wear protective footwear and clothing when taking part in outdoor activities, as leptospirosis can be transmitted via abrasions or cuts on the skin that come into contact with contaminated soil, mud or water. For instance, it is advisable to wear covered splash-proof shoes or boots instead of going barefoot or wearing slippers, and long pants instead of shorts when trekking, and to be aware of touching certain surfaces that could potentially lead to accidental cuts and abrasion, Dr. Leong Hoe Nam [an infectious diseases specialist] said.

Assoc. Prof. Chong advised: "Avoid participating in outdoor water activities if you have any cuts on your skin."

Some studies suggest that taking the antibiotic doxycycline shortly after exposure to leptospirosis can potentially reduce illness caused by the disease.

It is not standard procedure to prescribe doxycycline before travel to prevent leptospirosis. However, Dr. Leong said that he might consider giving the medication to certain groups of adult travellers heading to high-risk areas as a preventive measure.

Besides potentially reducing the risk of illness by leptospirosis, it also protects against malaria, which is another type of zoonotic disease (that can be passed from animals to humans) more commonly seen among travellers, he added.  [Byline: Eveline Gan]
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[Leptospirosis is a zoonotic spirochetal infection that is distributed widely throughout the world in warm climates. The microorganism can be found in fresh (not salty) water, wet soil, or vegetation that has been contaminated by urine from chronically infected animals.

Leptospirosis affects humans and a variety of animals that include dogs, cattle, pigs, and rodents. Different leptospiral serovars are prevalent in particular geographical regions. Leptospires enter the body through open sores or wounds in the skin, or through mucous membranes following exposure to contaminated water. Outbreaks frequently follow large rainfalls, flooding with fresh water, and increasing rodent numbers.

Leptospirosis is a risk during recreational activities, such as camping, fresh water swimming, canoeing, kayaking, rafting, golfing, and trail biking, that involve exposure to water in lakes, rivers, or ponds contaminated by urine from leptospire-infected animals (<https://www.cdc.gov/leptospirosis/exposure/index.html>).

Leptospirosis is also an occupational hazard for people who work outdoors or with animals; for example, workers in wet agricultural settings (such as rice field workers), ranchers, slaughterhouse workers, trappers, loggers, sewer workers, veterinarians, fishery workers, dairy farmers, or military personnel.

Because of the relatively nonspecific nature of the clinical presentation of leptospirosis, its diagnosis cannot be made confidently without laboratory confirmation. The _Leptospira_ Dip-S-Tick (DST) IgM dot-ELISA test kits (PanBio Integrated Diagnostics) can provide in-the-field testing of suspected patients (<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC149700/>). Confirmatory testing uses the microscopic agglutination test (MAT). Molecular assays such as DNA PCR can also be used, if available. - ProMED Mod.ML]

[HealthMap/ProMED-mail map:
Date: Fri, 10 May 2019 10:52:12 +0200

Singapore, May 10, 2019 (AFP) - Singapore has reported its first ever case of monkeypox, brought in by a Nigerian man thought to have contracted the rare virus by eating bushmeat at a wedding.   Symptoms in humans of monkeypox -- which is endemic in parts of Central and Western Africa -- include lesions, fever, muscle ache and chills.

Transmission is usually via close contact with infected animals such as rodents and monkeys and is limited between people. It has only been fatal in rare cases.   The man who brought in the virus arrived in Singapore on April 28, the city-state's health ministry (MOH) said in a statement late Thursday.   The 38-year-old developed symptoms two days later and is currently isolated at an infectious disease centre in a stable condition, the ministry said.

At least 23 individuals who had been in close contact with the man had been traced, and those who are in Singapore will be quarantined and monitored for 21 days as a precaution, MOH said.   One had already left Singapore on May 5 before the Nigerian was diagnosed at hospital but has since made contact with the city's health authorities and has reported he is well.   "The risk of community spread of monkeypox in Singapore is low," said Leo Yee Sin, executive director of Singapore's National Centre for Infectious Diseases.   He said that on average "each infected person transmits the infection to less than one other person", which makes the virus less infectious than the common flu.

Outside Africa, human monkeypox infections had only been previously reported in the United States, Britain and Israel, according to the US Centers For Disease Control and Prevention.   Singapore, a tiny but affluent city-state dependent on external trade and tourism, has toughened measures against infectious diseases after it was hit hard by the 2003 SARS virus outbreak.   The disease killed 33 people in Singapore, inflicted major losses on the economy and hit the number of international visitors.
Date: Thu 9 May 2019
Source: Straits Times [edited]

The Ministry of Health (MOH) has confirmed one imported case of monkeypox infection in Singapore, involving a Nigerian national who arrived last month [April 2019] for a workshop. The 38-year-old man tested positive for the rare viral disease, which is primarily transmitted to humans from animals, on Wednesday (8 May [2019]), said the MOH on Thursday [9 May 2019]. It is the 1st case of monkeypox reported here.

He is currently in an isolation ward at the National Centre for Infectious Diseases (NCID), and is in stable condition.

Meanwhile, 22 of 23 individuals who have been identified as close contacts of the patient are also under quarantine as a precautionary measure. One of the close contacts, a workshop participant, had left Singapore on 5 May [2019] before the patient was diagnosed. He has reported to the MOH that he remains well with no symptoms.  "Nonetheless, as a precaution, MOH has informed the public health authority in his home country," said the ministry. The MOH added that while it is possible for the disease to be transmitted between humans, the risk of spread is low.

The MOH offers the following precautions to take when travelling to areas affected by monkeypox in central and western Africa: - Maintain a high standard of personal hygiene, including frequent hand washing after going to the toilet, or when hands are soiled. - Avoid direct contact with skin lesions of infected living or dead persons or animals, as well as objects that may have become contaminated with infectious fluids, such as soiled clothing or linens (e.g., bedding or towels) used by an infected person. - Avoid contact with wild animals, and consumption of bush meat. - Returning travellers from areas affected by monkeypox should seek immediate medical attention if they develop any disease symptoms (e.g., sudden onset of high fever, swollen lymph nodes and rash) within 3 weeks of their return. They should inform their doctor of their recent travel history.

Before coming to Singapore, the man attended a wedding in Nigeria, where he may have consumed bush meat -- a possible source of transmission of the monkeypox virus. Bush meat, the meat of wild animals hunted and sold for food, is a popular source of protein in some parts of Africa where meat from domesticated animals is scarce or expensive.

Upon his arrival on 28 Apr [2019], he stayed at Hotel 81 Orchid in Geylang. In the following 2 days, he attended a workshop at the Samsung Hub in Church Street, in the Central Business District. On 30 Apr [2019], he developed fever, muscle ache, chills and skin rash. Between 1 and 7 May [2019], the man reported that he stayed in his hotel room most of the time. On 7 May [2019], he was taken to Tan Tock Seng Hospital by ambulance and referred to NCID.

Subsequently, the MOH identified the people who had come into close contact with the man, including 18 participants and trainers who attended the same workshop; one worker at the workshop venue; and 4 hotel staff. They have since been assessed by NCID and offered vaccination to prevent the disease or reduce the severity of symptoms, said the ministry.  "As a precautionary measure, they will be quarantined and monitored for 21 days from their date of exposure to the patient," said MOH. Those who develop symptoms will be treated at NCID, and all others who came into contact with the man and have a low risk of being infected are being put under active surveillance, and will be contacted twice daily to monitor their health status, the ministry added. MOH's investigation and contact tracing operations are ongoing.

Common symptoms of the disease are fever, headache, muscle ache, backache, swollen lymph nodes and skin rash. In its statement, the MOH said monkeypox is usually self-limiting, with most patients recovering within 2 to 3 weeks.  "In some cases, however, the virus can cause serious complications such as pneumonia, sepsis, encephalitis (brain inflammation) and eye infection with ensuing loss of vision," added the statement. "There have been reported mortality rates of 1% to 10% during outbreaks, with most deaths occurring in younger age-groups."

Transmission of monkeypox mainly occurs when a person comes into close contact with infected animals, usually rodents, through the hunting and consumption of bush meat. It added that transmission of the disease between humans is possible but limited, as a person is infectious only when he has symptoms, particularly skin rash.  "Transmission typically occurs from close contact with the respiratory tract secretions or skin lesions of an infected person, or objects recently contaminated by an infected person's fluids or lesion materials," it added.
=======================
[This is not the 1st time that a human monkeypox (MPX) virus infection has been imported into another country from Nigeria. In 2018, 2 cases of MPX virus infection were imported into the UK with an additional case ensuing from local transmission from the 2nd patient. The 1st monkeypox case involved a male Nigerian naval officer who was attending a training course at a naval base in Cornwall in southwestern England. The 2nd patient was a UK man who returned to the country from a 22-day vacation in Nigeria on 4 Sep 2018. A 3rd imported case was an Israeli who lived and worked in the Port Harcourt area of Rivers state in southern Nigeria (an endemic MPX region). The man got sick about a week after his return to Israel from Nigeria.

MPX virus is endemic in Nigeria and has been actively transmitted this year (2019). Since the beginning of the outbreak in September 2017, 311 suspected cases and 7 deaths have been reported in 26 states in Nigeria. MPX virus transmission is currently occurring over a broad geographic area in Nigeria. This outbreak has been unusual. Rather than sporadic or rare cases, there have been over 100 cases scattered over a large geographic area since 2017 and again this year (2019). The reasons for this relatively sudden appearance are not clear. Perhaps there has been an epizootic of MPX virus infections among its rodent hosts, with spillover to people.

Monkeypox is an orthopoxvirus infection and is related to smallpox. The disease can also be confused with chickenpox, which is caused by an unrelated virus.

Non-human primates are not monkeypox virus reservoirs. The main reservoirs of monkeypox virus are suspected to be rodents, including rope squirrels (_Funisciurus_ spp., an arboreal rodent) and terrestrial rodents (genera _Cricetomys_ and _Graphiurus_).

Map of Nigeria:

[HealthMap/ProMED-mail maps:
Singapore - National. 3 Apr 2019

3rd reported death. 2099 cases as of 23 Mar compared with 575 over same period 2018.
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.