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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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Chad

Chad - US Consular Information Sheet
March 29, 2007
COUNTRY DESCRIPTION: Chad is a developing country in north central Africa with one of the lowest per capita incomes in the world. Chad faces challenges in the areas of political stability and
conomic development. Years of war, drought, and lack of economic growth have severely damaged the country's institutions and its infrastructure. Facilities for tourism are limited. The capital is N'Djamena. French and Arabic are the primary languages. Read the Department of State Background Notes on Chad for additional information.
ENTRY/EXIT REQUIREMENTS: A valid passport and visa are required. Visitors must check in with the National Police and obtain a registration stamp within 72 hours of arrival. Further entry information may be obtained from the Embassy of the Republic of Chad, 2002 R St. N.W., Washington D.C. 20009, telephone (202) 462-4009. Overseas, inquiries should be made at the nearest Chadian embassy or consulate. Some travelers originating in countries with no Chadian embassy or consulate can arrange for airport entry visas. This process is generally limited to business or official travelers, and arrangements must be made by the traveler’s local contact in Chad several days in advance of arrival. The U.S. Embassy is not in a position to assist private U.S. citizens with their visa application for travel to Chad.

See our Foreign Entry Requirements brochure for more information on Chad and other countries.

See Entry and Exit Requirements for more information pertaining to dual nationality and the prevention of international child abduction. Please refer to our Customs Information to learn more about customs regulations.

SAFETY AND SECURITY: See the Department of State’s Travel Warning for Chad.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s website where the current Travel Warnings and Travel Alerts, including the Worldwide Caution, can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., 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: Americans and Europeans are perceived to be wealthy and certain precautions should be taken. Travelers are advised not to leave cash or valuables unsecured in their hotel room and not to wear expensive jewelry or show large amounts of cash. Travelers are also advised to dress modestly, not to walk outside after dark, and to lock their car doors. Petty crimes such as purse snatching, pick-pocketing and theft from vehicles do occur, particularly in areas frequented by expatriates. Violent crime is somewhat rare, but does occur. Burglary and vehicle thefts increase during times of political instability. Expatriate residences have been targeted for armed robbery, and some foreigners have been assaulted in the process. Travelers to northern Cameroon should contact the U.S. Embassy’s Regional Security Officer in N'Djamena prior to crossing the Chad/Cameroon border because of a high incidence of road attacks there.

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: Medical facilities in Chad are extremely limited. Medicines are in short supply or unavailable, including many over-the-counter preparations sold in the United States. Travelers should carry any needed, properly labeled, medicines with them. In the event of major injury or illness, visitors generally will require medical evacuation.

There are two medical clinics in the capital of N’Djamena, International SOS and the Centre Medico-social de l’Ambassade de France. Advance membership is required to access these two clinics.

Malaria is a serious and sometimes fatal disease.
Plasmodium falciparum malaria, the type that predominates in Chad, is resistant to the antimalarial drug chloroquine.
Because travelers to Chad are at high risk for contracting malaria, the Centers for Disease Control and Prevention (CDC) advises that travelers should take one of the following antimalarial drugs: mefloquine (Lariam - TM), doxycycline, or atovaquone/proguanil (Malarone -TM).
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and tell the physician their travel history and what antimalarials they have been taking.
For additional information on malaria, including protective measures, visit the CDC Travelers’ Health web site at http://www.cdc.gov/travel/malinfo.htm.

Other widespread diseases in Chad include diarrhea and upper respiratory infections. AIDS is becoming an increasingly serious problem as infection rates have risen to alarming levels (up to 25 percent in high-risk groups). Meningitis outbreaks usually occur annually and several other diseases (cholera, diphtheria, chicken pox, typhoid) periodically appear.

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 internet site at http://www.cdc.gov/travel. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) website 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 Chad is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Roads are in poor condition and dangerous. In the capital city of N'Djamena, only the main roads are paved; the rest of the roads are either hard-packed dirt or looser dirt and sand. During the summer rainy season (mid-June to mid-September) many roads become impassable or are restricted by rain barriers, while during the drier season, clouds of dust rising from the roads reduce visibility.

Visitors should take great care while driving. Both paved and unpaved roads are poorly maintained, and often have large ruts and potholes. All drivers should adjust their speed accordingly. At night, streets are not lit; it is imperative to watch for pedestrians, bicyclists, motorcyclists, and livestock, as they may not become visible until they are in very close proximity.

Driving in Chad tends to be erratic both in cities and in rural areas. In cities, particularly N'Djamena, motorists share the roads with bicycles, motor scooters, pedestrians, and non-motorized wheelchairs. Lanes are not marked, and it is not uncommon for a normally two-lane thoroughfare to become a four-lane road during rush hours (generally 7:00 a.m.-9:00 a.m. and 3:00 p.m.-6:00 p.m. Monday-Thursday; 7:00 a.m.-9:00 a.m. and 11:00 a.m.-12:30 p.m. on Friday). Drivers are urged to be particularly observant at these times because motorists often attempt to overtake slower traffic by moving into oncoming lanes, usually at high speeds.There are only a few traffic lights in N'Djamena, and these are often out of service. Drivers yield to traffic on their right, particularly when entering the many traffic circles.

In rural areas, drivers should watch for livestock crossing the roads, and for large hawks that rest on the roads. These birds can be fearless, and cause damage by smashing into drivers' windshields; drivers may avoid this by slowing down when approaching the hawks, and allowing them sufficient time to fly away. Finally, drivers should be alert to older transport trucks traveling between cities, which do not always have functioning headlights.

No emergency services exist, so drivers should exercise extreme caution. Travelers should always wear seat belts. When traveling by car, be sure to carry a spare tire. Roadside service is limited to good Samaritans and children who will help push cars to the side or out of holes. When traveling outside the capital, it is imperative to carry sufficient quantities of drinking water. Drivers should ensure that their gas tanks are at least half-full at all times, as gas stations are not widely available. Gas may be purchased in an emergency in bottles from roadside stands, but it is generally of poor quality.

Travelers on roads in all areas of the country are subject to attack by armed bandits.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service between the United States and Chad, the U.S. Federal Aviation Administration (FAA) has not assessed Chad’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s internet website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES: All photography requires a government permit. Taking photos of military sites, official buildings, and airports is strictly prohibited, even with a permit. Such sites are not always clearly marked. Film and cameras may be confiscated, often by undercover police.

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 Chadian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Chad 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 onCriminal Penalties.

CHILDREN'S ISSUES: Embassy N’Djamena does not issue immigrant visas. Therefore, American citizens who adopt children in Chad are required to travel to the U.S. Embassy in Yaounde, Cameroon, or another Embassy for visa processing before return to the United States.

For information on international adoption of children and international parental child abduction, see the Office of Children’s Issues website.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Chad are encouraged to register with the U.S. Embassy in Chad through the State Department’s travel registration website , Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy to contact them in case of emergency. The U.S. Embassy in Chad is located in N'Djamena on Avenue Felix Eboue; mailing address is B.P. 413; telephone (235) 51-62-11, 51-70-09, 51-77-59, 51-90-52, 51-92-18 and 51-92-33, fax (235) 51-56-54.
* * *
This replaces the Country Specific Information dated July 10, 2006 with no updates.

Travel News Headlines WORLD NEWS

Date: Thu, 11 Apr 2019 05:29:58 +0200
By Amaury HAUCHARD

Adré, Chad, April 11, 2019 (AFP) - Dinar Tchere is fighting time and the sun, and he fears he may be losing.   This morning, the health worker is expected in a remote village of eastern Chad, where he will administer the measles, mumps and rubella vaccine to poor children.   But he's behind schedule -- and there is limited time before his enemy, the blistering Sahelian heat, will destroy his precious drugs.  Tchere takes his gear and the ice-packed cooler that shields the vaccines, puts them in an NGO pickup and heads out from his clinic in Hilouta, in Ouaddai province, on the dusty untarmacked road.

Twenty minutes later he is in Agang, a village of 400 people, and there, another private dread has turned to reality. No-one is there to be vaccinated.   "It's just what I feared -- most of the mums have gone off to the market to do their shopping," groans Tchere, a stocky, shaven-headed man in his fifties.    There is nothing to do but hope that the mothers and their children will return. He stretches out a mat on the soil, under a mango tree.   His luck starts to turn. One by one, mothers with their children make their way to the spot, and soon there is no room on his mat for youngsters waiting for their jab.

- Cold chain -
Always worried by the heat -- the thermometer now reads 40 degrees Celsius (104 degrees Fahrenheit) -- Tchere dips his finger into the cooler to check that the ice has not melted, and starts the vaccination.   "Our biggest headache is ensuring that the vaccines are always kept cold," says Tchere, who heads one of 21 health centres in the region.   "Since the troubles of 2007, we no longer have a solar panel or fridge."   The "troubles" refer to years-long violence by armed groups on the tense border between Sudan and Chad.   Hilouta, which lies less than two kilometres (one mile) from the border, became a combat zone.   With no power, how does Tchere keep his vaccines cool?   "I stock them in Sudan, in a clinic on the other side of the border. They've got a fridge," he explains.

But there's a problem: because of security concerns, Sudan refuses to let people cross the border by motorbike -- Tchere's only form of transport when he cannot use the pickup.   So on the eve of every immunisation session, Tchere walks into Sudan, carrying his cooler, fills it up with vaccines, and walks back into Chad.   His clinic administers to about 60 villages. He says e does four vaccination sessions per month -- two in the clinic, and two in the villages.   Most often, he does the outside trips on his motorbike, always taking care never to take the same route back home, in order to avoid holdups.

The state no longer pays the running costs of his health centre -- a French NGO, Premiere Urgence Internationale (PUI), has stepped in, using financial help provided by the European Union.   In Arkoum, about 50 kilometres (30 miles) from Hilouta, Felix Djembonoudji, a nurse who runs the health centre, says that the stockpile of vaccines -- held in the district's main town of Adre, several hours away by road -- has run out.   "The people (in Adre) sometimes don't receive any -- we've been without MMR (vaccine) for five days," he says.

- Measles threat -
Measles is often dismissed by so-called anti-vaxxers who oppose immunisation as a disease of the past or non-threatening.   Experts say that it is neither -- measles is on the comeback trail.    And out of every 20 children who catch measles, as many as one will suffer from pneumonia, according to the US Centers of Disease Control (CDC). Blindness, encephalitis and severe diarrhoea are also serious complications.   Only one child in five in Chad is fully vaccinated against measles, according to a 2017 survey.   "Measles can also cause malnutrition in non-vaccinated children, which in itself is a cause of premature death," said PUI's mission chief in Chad, Fabienne Mially.

According to UN figures, more than one child in 10 in Chad will die before their fifth birthday.   In Agang, the measles vaccination session comes to an end, and Tchere is packing up his gear when a horse appears on the horizon, its hooves kicking up dust, bearing a man and his six-month-old baby.   The infant needs his second MMR vaccine. "It's important!" pleads the father. The child will get his jab.   Tchere returns to his clinic in Hilouta. There is no water or electricity. Two local people are awaiting him in the gloom, desperate for a medical consultation.    "The working day is long," he sighs, as he welcomes them in.
Date: Tue, 9 Apr 2019 04:47:15 +0200
By Amaury HAUCHARD

Hadjer Hadid, Chad, April 9, 2019 (AFP) - "I've already earmarked a customer for this drum -- I need to get a move on!"   Ali Ahmat,12, flicks his whip to persuade a hard-driven horse to press on with his cart, laden with 200 litres (44 imperial gallons) of freshly-fetched water.   The young entrepreneur is one of the informal but indispensable links in a chain to supply people in Ouaddai, eastern Chad, with water, the stuff of life.

Scorching temperatures, an open sky, a shortage of deep wells and lack of water purification system make this a thirsty part of the world indeed.   "After the rainy season, water becomes scarce," says Mahamat Adoum Doutoum, chief of the Guerri region, where only two deep wells exist for 86,000 inhabitants. "So people go to look for water in the wadi."   Wadis -- "riverbeds" in Arabic -- are watercourses that run strong and fast during the rains and are often dangerous to cross, but largely dry up for the rest of the year. When there is no more rain, people dig wells in the wadis and install pumps to extract groundwater.

Ali and dozens of other water carriers flock to the pumps to collect supplies they plan to sell to people who have no access to the source, often in dusty settlements.   Each refill of his 200-litre drum costs Ali 100 CFA francs (0.15 euros / $0.17), but he can sell the water for five times as much in town. "We do between seven or eight return trips each day, roughly," he says.     Towards the end of a hot Sunday, the blazing sun has set and Ali's cart is heading towards Hadjer Hadid.

The town harbours a refugee camp for people who fled conflict and mass killings in the Darfur region of western Sudan, the far side of the border.   Pascal, a Sudanese refugee and father of five in his 50s, is also used to the return trips between the town, the bed of the wadi and the muddy wells.    He first came to Chad about 15 years ago and says that he "suffered" to be able to buy his own donkey.   The beast of burden was an investment that has paid off, however, enabling Pascal to deliver water to the townsfolk over the past two years and bring a small sum home to his family.

- Add bleach -
But he remains concerned about the quality of the water.   "To drink the water, you also have to add bleach," Pascal says.   While water has become as rare as it is valuable, the kind to be found around wadis is unsafe. Traditional wells dug into the earth at the wadis provide water that is often the same colour as the soil.   "The water can be contaminated at various points, either at the source, which may be unprotected, or during transport, using receptacles which are inappropriate, dirty or uncovered, and during storage and distribution," says Fabienne Mially, mission chief in Chad for the French aid group Premiere Urgence Internationale (PUI).

The NGO supports 11 health centres in the Ouaddai region, where awareness sessions on the importance of proper drinking water are regularly organised.   In Borota, a village several hours' drive from Hadjer Hadid, the head of the local health centre has no illusions. Of the six standpipes in the village, none is working any more.   "They were installed by NGOs," says the official, Koditog Bokassa, who says that wadi water is the only available source of water locally.   He hands out sachets of bleach to dilute in untreated water.   But Bokassa lacks the means to satisfy everybody and PUI has become the sole supplier of bleach in central parts.    The state used to deliver some, but has not done so for more than a year, he says. It is quite common to see young people at the wadis drink directly from their cans.

- 'Barely enough' -
The town has holding basins and water towers designed to retain water during the rainy season.   "But the holding basins are insufficient and the two water towers broke down several years ago," says local resident Hassan.   One trader has bought two barrels of 200 litres apiece, which he leaves in the courtyard of his house. "It's barely enough for the children, but it's better than nothing."   The water deliverer Pascal does not have the money to buy a drum of such munificence. For the seven members of his household, there are seven 20-litre cans on the stoop.    "I haul water every day, but I have the same problem as everyone else," he said.
Date: Sun, 7 Apr 2019 06:19:43 +0200
By Amaury HAUCHARD

Abeche, Chad, April 7, 2019 (AFP) - The chief medical officer at Adre hospital takes a routine phone call: a patient has been admitted with gunshot wounds and needs emergency surgery.   A dusty town in eastern Chad, once part of the proud Ouaddai empire, Adre is caught up in a mounting conflict between local farmers and nomadic camel herders from the north of the sprawling country.   Last year, the hospital treated more than 100 patients with bullet wounds.

In a territory where almost everyone seems to have a gun -- a legacy of rebellions launched from eastern Chad and of the brutal conflict in Sudan's Darfur -- squabbles over grazing land and trampled crops swiftly lead to violence.   Such disputes are tragically familiar in many parts of Africa.    But in arid eastern Chad, near the border with Sudan, the bloodshed is particularly acute, rooted in a bitter drought and population pressure sharpening rivalry over access to land.   The vicious circle of attack and retribution is running full tilt.

- Seasonal -
Admissions in Adre rise sharply during "times of tension", a source at the local hospital said.   Those times mirror the seasons. At the end of the rainy season, in December and January, herders drive their beasts northwards into the Sahel. When water sources start running low, they return south, from about the end of June.   Local chief Abderahim Dahab, who supervises 136 villages in his traditional leadership role, said the modern-day bloodshed contrasted with long-established cohabitation.   "Movement of livestock has always happened peacefully, for decades," he said.   Migratory herders benefit from pasture on which to feed their animals, and farmers benefit from the animals, whose droppings fertilise the soil. And farmers and herders mutually benefit from trading with each other for food.

Historian Mahamat Saleh Yacoub said two factors explained the breakdown between the two communities.   The first is a drought that has gripped the Sahel since the 1970s and seems to be worsening. Everyone who spoke to AFP agreed that the key issue is a lack of water.   "The herders are now coming earlier in the year and going back later. The established ways have broken down," said another district chief.   Saleh Yacoub, who is head of the ENS college of higher education in Abeche, near Adre, said the second cause was a population increase -- "as much among people as among livestock".   Herds are getting larger, straining the fragile ecological resources of the Ouaddai.

- Ethnic friction -
The rivalry has "become intertwined with ethnic problems", added Yacoub.   "The herds all belong to the same people: colonels, generals, people in politics," explained a village elder sitting on his mat with a glass of tea.   "We have had meetings, we write letters to the deputy prefect (district administrator), the prefect himself, but get nothing back," he protested. "The population has no power against them."

Many cattlemen are members of the Zaghawa ethnic group, who come from the northeast of the giant country.    The Zaghawa include President Idriss Deby Itno, who came to power in 1990.    Members of their ethnicity have entered every rank of the Chadian state, although Ouaddai's governor, Ramadan Erdebou, dismisses any suggestion that tribalism is to blame for the region's problems.   "This ethnic question is a false debate. There are Chadian women and Chadian men and one single unity, Chad," said Erdebou, who was formerly the chief of the regime's powerful intelligence services.

- Disarmament -
Erdebou's predecessor was sacked after an explosion of communal violence last October claimed eight lives.   One of his first moves in office was to announce a massive disarmament campaign among the population.   He also warned that a mission would be coming from the capital N'Djamena to chase away "those farmers who have cultivated crops along the corridors (set aside) for livestock movement."

These designated corridors were established by law in 1959, to give nomads and their herds passage of up to one kilometre (more than half a mile) wide for their seasonal migrations.   "But Zaghawa herders feel they can do what they like and don't respect them," said a farmer, who maintains he lost his entire peanut crop in 2016 when hundreds of dromedaries trampled his field.   "How do you expect Ouaddians to agree to be disarmed when you see that the herdsmen have more and more weapons?" asked a local official.

In 2015, the National Assembly in the distant western capital passed a Pastoral Code that led to an outcry from people who found it heavily biased in favour of the cattle breeders. Deby overturned the law.   "It's hard to want national unity when those in power only favour their own," said the local official, who asked not to be named, saying he feared reprisals.   But, Saleh Yacoub observed, when quarrels turn violent, "the Zaghawa become the target for all the grievances, regardless of whether they are legitimate or not."   In a visit to Abeche in February, Deby named no names but acknowledged there was a "serious problem."   He vowed to "take matters in hand".   "The hour for vendettas is past," he declared.
Date: Mon 18 Jun 2018
Source: The New York Times [edited]

In this arid central African country [Chad], the long global struggle to eliminate a horrifying human parasite has encountered a serious setback: dogs. They are being infected with Guinea worms [dracunculiasis], and no one knows how.

Scientists are desperate to solve the puzzle. If the answer isn't found soon, or if the worms begin to spread widely into other species -- a handful already have been found in cats and even baboons -- then 32 years of work to end the scourge may crumble, said Mark L Eberhard, a parasitologist at the Centers for Disease Control and Prevention.

In 1986, when the Carter Center -- the global health philanthropy in Atlanta founded by President Jimmy Carter -- launched the eradication drive, an estimated 3.5 million people in 21 countries had worms.

Last year [2017], only 30 human cases were found: half in Chad and half in Ethiopia.

But 6 years ago, here on the hot, dusty banks of the Chari River, the worms mysteriously began emerging from dogs. Last year [2017], over 800 Chadian dogs had them.

Dogs cannot infect people directly, but they may carry the worms into ponds from which people drink, which is how humans are normally infected.

"They haven't caused a big human outbreak yet, knock wood, but that's my nightmare," said Ernesto Ruiz-Tiben, who directs the Carter Center's campaign.

To prevent that, Chad is paying villagers to tether dogs until all their worms wriggle out. The reward is $20 cash, plus a stout chain with 2 locks. (Dogs chew through ropes or are freed by children who take pity on them.)

The reward is $100 to humans with worms. To generate publicity, the cash is handed out at ceremonies held in the weekly roadside markets where villagers gather to barter meager fish hauls for goods like plastic buckets or quart bottles of gasoline.

At one such ceremony in Dangabol, in southeast Chad, Dr Hubert Zirimwabagabo, who heads the Carter Center's work in the country, played a quiz game with the audience, handing out bars of soap as prizes. Asked what caused worms, one winner shouted, to general laughter: "Drinking bad water -- and speaking ill of others."

Then Dr Zirimwabagabo asked local officials to present $100 to each of 3 women who had worms, reported them, and kept them away from drinking water. The officials obliged with grand ceremony, to loud ululations. People here may not see that much cash in a year.  [Byline: Donald G McNeil Jr]
=======================
[HealthMap/ProMED-mail map of Chad:

The reservoir in dogs in Chad was discussed by the WHO in the 2014: "Dracunculiasis eradication: global surveillance summary, 2014" (Weekly Epid Rec. 2015; no. 19, (May 2015, pp. 201-15. <http://apps.who.int/iris/bitstream/handle/10665/242354/WER9019_201-215.PDF>), which wrote "the unusually high number of dogs with confirmed Guinea-worm infections in Chad, which poses epidemiologic and biologic questions."

The situation was also described in a 2014 paper, Eberhard ML et al. The peculiar epidemiology of dracunculiasis in Chad. Am J Trop Med Hyg. 2014; 90(1): 61-70. doi: 10.4269/ajtmh.13-0554; available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886430/>).

The contribution by the canine reservoir to maintaining infections in humans and whether they actually transmit the infection to humans by contaminating the water reservoirs is not known. A zoonotic reservoir is a potential complication to the attempts to eradicate dracunculiasis. - ProMED Mod.EP]

[In the majority of cases, under unhygienic conditions, both people and animals are affected by dracunculiasis.

Exceptionally, Guinea worm may occur as a purely animal infection. This was demonstrated during the last century, when 11 percent of stray dogs were found infected in Kizylorda (Kazakhstan), where no human infection was known.

In Uzbekistan and Turkmenistan, _Dracunculus medinensis_ has been identified in golden jackals (_Canis aureus_), which potentially can infect water sources.

According to WHO 2017 data, 817 dogs in Chad, 11 dogs in Ethiopia, and 9 dogs in Mali were reported to be infected with Guinea-worm (see at <http://apps.who.int/iris/bitstream/handle/10665/272648/WER9321-305-320.pdf>).

_D. medinensis_ infection in dogs remains a challenge to global eradication, particularly in Chad and to a lesser extent in Ethiopia and Mali. - ProMED Mod.AS]
Date: Tue, 29 May 2018 04:39:34 +0200

N'Djamena, May 29, 2018 (AFP) - Hospitals and schools were shut in Chad Monday as civil servants went on strike over pay cuts imposed by the cash-strapped government which is under pressure to cut public funding to meet the demands of international donors.   Public sector workers are demanding payment of their "full salary" after bonuses and allowances were slashed by 50 percent in January as part of a package of austerity measures to improve state finances. They had already seen a similar 50 percent cut in 2016.   President Idriss Deby, who has been in power since 1990, had asked them to wait until the end of the year to regularise their salaries.   The unions on Saturday refused his request and called for an indefinite strike.   Primary and secondary schools in the capital and the University of N'Djamena were closed on Monday while the main ministries were functioning at a slow pace, with many offices shut.   "This strike is jeopardising thefuture of our children who are in exam class," said parent Joseph Issa.   Schools in other major cities were also closed.

At the general hospital in N'Djamena, staff nurse Ali Soumaine said they were providing "a minimal service for surgery, resuscitation and other sensitive services".   The government was "surprised" at the strike call, spokeswoman Madeleine Alinque said in a statement.   "We question the headlong rush of unions that do not honour our country or workers," she said.   "The government is inviting all workers to go about their daily business normally, and efforts are under way for a sustainable recovery of the social situation," she added.   Magistrates on Monday also began a three-day strike in protest at a police attack on lawyers in Doba last week.   According to trade union leader Michel Barka, the situation of civil servants "is more and more unacceptable, and it gives the workers no pleasure every time they have to close the schools, the hospitals, the public administration".   Barka accused the government of not "making an effort" to deal with the situation.

Chad, a poverty-stricken landlocked country of nearly 15 million people, has about 92,000 civil servants.   The austerity measures imposed in January led to a seven-week strike by civil servants. The government and trade unions in March reached an agreement to end the paralysis of the public sector.   The government proposed ending the cuts to bonuses and allowances at the end of May.   N'Djamena obtained a three-year $312 million (254 million euro) credit line from the International Monetary Fund last June. It has received two tranches of $99.8 million but has to make progress on improving state finances to access further funds.   The economy of Chad, where 40 percent of the population live in poverty, has been badly hit by a downturn in the price of oil exports since 2015.
More ...

World Travel News Headlines

Date: Wed, 22 May 2019 16:52:39 +0200
By Nazeer al-Khatib with Hashem Osseiran in Beirut

Maaret al-Numan, Syria, May 22, 2019 (AFP) - Syrian government air strikes killed 18 civilians, including a dozen people at a busy market, as fierce fighting raged for the jihadist-held northwest, a war monitor said on Wednesday.   Regime forces battled to repel a jihadist counteroffensive around the town of Kafr Nabuda that has left 70 combatants dead in 24 hours, the Syrian Observatory for Human Rights said.   The Hayat Tahrir al-Sham alliance, led by Syria's former Al-Qaeda affiliate, controls a large part of Idlib province as well as adjacent slivers of Aleppo, Hama and Latakia provinces.   The jihadist-dominated region is nominally protected by a buffer zone deal, but the government and its ally Russia have escalated their bombardment in recent weeks, seizing several towns on its southern flank.   At least 12 people were killed and another 18 wounded when regime warplanes hit the jihadist-held Idlib province town of Maarat al-Numan around midnight (2100 GMT) on Tuesday, the Observatory said.

The market was crowded with people out and about after breaking the daytime fast observed by Muslims during the holy month of Ramadan.   The bombardment blew in the facades of surrounding buildings, and ripped through the flimsy frames and canvas of stalls in the market square, an AFP photographer reported.    The bodies of market-goers were torn apart.   "Residents are still scared," stallholder Khaled Ahmad told AFP.   Three more civilians were killed on Wednesday by air strikes in the nearby town of Saraqib, the Observatory said.    Two others were killed in strikes on the town of Maaret Hermeh, it added.    Another civilian was killed in air raids on the town of Jisr al-Shughur, the monitor said.   The Britain-based Observatory relies on a network of sources inside Syria and says it determines whose planes carried out strikes according to type, location, flight patterns and munitions.

- 'Worst fears'-
The strikes came as heavy clashes raged in neighbouring Hama province after the jihadists launched a counterattack on Tuesday.   Fresh fighting on Wednesday took the death toll to 70 -- 36 regime forces and militia and 34 jihadists, the Observatory said.   It said the jihadists had recaptured most of Kafr Nabuda from government forces, who had taken control of the town on May 8.   State news agency SANA on Wednesday however said the army repelled a jihadist attack in the area, killing dozens of insurgents.

Russia and rebel ally Turkey inked the buffer zone deal in September to avert a government offensive on the region and protect its three million residents.   But President Bashar al-Assad's government upped its bombardment of the region after HTS took control in January.   Russia too has stepped up its air strikes in recent weeks.   The Observatory says nearly 200 civilians have been killed in the flare-up since April 30.   The United Nations said Wednesday that Idlib's civilian population once again faced the threat of an all-out offensive.   "A full military incursion threatens to trigger a humanitarian catastrophe for over 3 million civilians caught in the crossfire, as well as overwhelm our ability to respond," said David Swanson, a spokesman for the UN humanitarian office.   Swanson said more than 200,000 people have been displaced by the upsurge of violence since April 28.   A total of 20 health facilities have been hit by the escalation -- 19 of which remain out of service, Swanson said.   Collectively they served at least 200,000 people, he added.

- 'Break the status quo' -
The September deal was never fully implemented as jihadists refused to withdraw from a planned buffer zone around the Idlib region.   But it ushered in a relative drop in violence until earlier this year, with Turkish troops deploying to observation points around the region.   The Syrian government has accused Turkey of failing to secure implementation of the truce deal by the jihadists.   But Turkish Defence Minister Hulusi Akar accused the Syrian regime late Tuesday of threatening the ceasefire deal.   "The regime is doing all that it can to break the status quo including using barrel bombs, land and air offensives," Akar told reporters.   "Turkish armed forces will not take a step back from wherever they may be", he however added.   Earlier, the US State Department said it was assessing indications that the government had used chemical weapons on Sunday during its offensive in Idlib.   HTS accused government forces of launching a chlorine gas attack on its fighters in the northern mountains of Latakia.   But the Observatory said Wednesday it had "no proof at all of the attack".
Date: Wed, 22 May 2019 02:06:35 +0200
By Amelie BARON

Port-au-Prince, May 22, 2019 (AFP) - With no oxygen in intensive care or gloves in the emergency room, residents at Haiti's largest hospital have gone on strike to protest the filthy environment and demand six months of back pay.   "We have almost nothing when we talk about emergency services," said Emmanuel Desrosiers, 24, one of the doctors-in-training at the State University of Haiti Hospital (HUEH) that began the work stoppage Monday.    "When a patient arrives, when we should immediately take charge, we start by listing the things they or their family need to go buy."   The HUEH, known as the "general hospital," is where the most disadvantaged families in this impoverished Caribbean country crowd. Buying the medical supplies themselves is a financial headache, but private clinics are far too expensive.   In crumbling buildings in the center of Port-au-Prince, male and female patients are crowded together in tiny rooms, while trash cans overflow.   "We feel ridiculous when we give hygienic advice to patients," one resident said of the situation.

The residents' selflessness as they work in an unsanitary environment is compounded by the fact that they have not been paid since the start of their residency, nearly six months ago.   After five years of medical studies, the state is required to pay them 9,000 Haitian gourdes (HTG) per month -- only about $100, due to the devaluation of the national currency.   Nothing is being done about the hospital's disrepair, with those in charge waiting for a new building to be completed, according to resident Yveline Michel.   The new HUEH will have two floors and more than 530 beds once it's finished -- but it's unclear when that will be.   The project began after the January 2010 earthquake, which destroyed more than half the hospital. The United States, France and Haiti invested $83 million in a new hospital, which should have been completed by 2016.   Instead, there is little visible activity on the construction site, which can be seen through the windows of the current building.

Due to the heat, the windows are always open, letting in noise and dust from the street. There are only a few fans in the hospital rooms, which do little to combat the humidity or the flies.   "At any moment we could lose patients, but the state isn't doing anything to save their lives," said Michel, 25.   "We're striking for the population, since it should make these demands."   But some locals question the residents' position because the strike prevents the already struggling hospital from functioning.   Since the strike began, the poorest families in the area no longer know where to go for medical emergencies, as the residents are in charge of admitting patients.   "Due to the lack of resources and the unsanitary environment, there are always people dying in the hospital, so it's not the strike causing that," said Michel in response.
Date: Tue 21 May 2019
Source: Le Dauphin [in French, trans., edited]

Lovers of sushi, maki, sashimi, and other raw fish, beware of your stomach! 7 cases of fish tapeworm, better known as tapeworm [ProMED presumes it is Diphyllobothrium latum], have been reported in 2 years by the Rennes hospital in Ille-et-Vilaine [Brittany].

An exceptional number of cases was counted between July 2016 and September 2018, especially since no case had been detected for at least 20 years.

The infection is acquired by "eating raw or marinated fish which contains larvae of this parasite. The larvae will undergo several moults and develop in our digestive tract," explained Professor Florence Robert-Gangneux to our colleagues in France Bleu Armorique.

The parasite can measure up to 20 meters [66 ft] long and live 10 years in the body. The fish tapeworm can cause digestive disorders, deficiencies, although some patients do not notice.

The only solution to eliminate these parasites of the fish is freezing. This is what a 2004 European regulation imposes on restaurant owners serving raw fish. Freezing should be from -20 deg C [-4 deg F] during 24 hours or -35 deg C [-31 deg F] during 15 hours. And to get rid of the worm once ingested, it is necessary to undergo an unpleasant antiparasitic treatment, often on several occasions.
=====================
[We presume it is the fish tapeworm _Diphyllobothrium latum_, which is a tapeworm found in freshwater fish (<https://www.cdc.gov/parasites/diphyllobothrium/index.html>). In saltwater fish the most common parasite is _Anisakis_, but this is not a tapeworm. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of France:
Date: Mon 20 May 2019
Source: El Pais [in Spanish, trans. Mod.TY, edited]

Tarija Departmental Health Services (SEDES) reported a new case of hantavirus [infection] in Padcaya municipality. The number of patients with this illness is within what is expected, because this season is when more people acquire the disease. Epidemiological surveillance is continuing in Arce province. The person who acquired this illness is male and is under medical care until his recuperation.

The head of the Epidemiological Unit of SEDES, Claudia Montenegro, stated that the patient is hospitalized in the San Juan de Dios Regional Hospital in Tarija awaiting his recuperation. The physician said that in Bermejo and Padcaya municipalities, the harvest of citrus fruit and sugar cane for production of sugar has begun, so there is a trend for the cases of this illness to increase. This is due to the large number of families that move to the countryside where the rodent (long tail) is present that transmits this disease [virus].

"In contrast to previous seasons, this year [2019], there were positives for this disease in Gran Chaco province, including fatalities," Montenegro commented. "Epidemiological surveillance there is being implemented, as well as in areas such as Padcaya and Bermejo."

The official explained that in these localities, the rodent that transmits the disease [virus] to families is present, and with agricultural activities, [people] move into places where this animal lives, and so new cases of patients with hantavirus [infections] are registered every year.

In order to prevent this illness, it is recommended that rodent control campaigns be done to reduce their populations, openings in houses be sealed, and that residents reduce the possibility for rodents to make nests within a radius of 30 meters [100 ft] around the house, and eliminate items that could attract these animals near the house (food, grain, garbage). Workers should employ protective measures during agricultural tasks and cleaning work.

Initial symptoms include fatigue, fever and muscle pain, especially in the thighs, hips and back. Also, patients may present with headache, dizziness, chills, nausea, vomiting, diarrhea and abdominal pain. [These symptoms may progress rapidly to respiratory difficulty requiring mechanical ventilation (hantavirus cardio pulmonary syndrome). Death can occur. - ProMED Mod.TY]
=====================
[The hantavirus involved in the above cases is not mentioned. Cases of hantavirus infections in Tarija department are not new. Tarija department is endemic for hantaviruses, and cases occur there sporadically. Last year (2018), there were 11 cases. The previouslyreported 2015 cases of hantavirus pulmonary syndrome (HPS) that occurred in Tarija department were confirmed. As noted in the previous comments, earlier cases of hantavirus pulmonary syndrome have been reported from tropical, lowland areas of Bolivia, including 7 cases in Tarija during 2014. The specific hantaviruses involved in these or previous cases in Bolivia were not given.

In the lowland Amazon Basin of Bolivia, the rodent hosts of the hantavirus that might be involved in these hantavirus pulmonary syndrome (HPS) cases, with their images, include the following: - Laguna Negra virus (_Calomys laucha_ <http://www.faunaparaguay.com/images/Calomys%20laucha%20enciso%2031aug2011.jpg> and _C. callosus_ <https://eee.uci.edu/clients/bjbecker/PlaguesandPeople/Calomyscallosusb.jpg>); - Bermejo (Chaco rice rat _Oligoryzomys chacoensis_ <http://www.faunaparaguay.com/oligorizomyschacoensis.html>); and - Oran (_O. longicaudatus_ <http://calphotos.berkeley.edu/imgs/512x768/0000_0000/0711/1203.jpeg>).

Since previous cases in Tarija department have occurred in Bermejo, perhaps Bermejo hantavirus was involved.

Dr. Jan Clement commented that there is a need to be able to differentiate Seoul (SEOV) as a causative agent, but that is hampered by the fact that most current commercial ELISA or WB formats do not contain (anymore) a SEOV antigen, so that a preliminary presumption of a hantavirus infection can even be missed in non-research laboratories (ibidem, and: Reynes J-M, Carli D, Bour J-B, Boudjeltia S, Dewilde A, Gerbier G, et al. Seoul virus infection in humans, France, 2014-2016. Emerg Infect Dis. 2017;23:973-7;  <https://wwwnc.cdc.gov/eid/article/23/6/16-0927_article>.

SEOV is widely distributed around the world in the brown rat and is likely found in Tarija department. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Tarija, Tarija, Bolivia: <http://healthmap.org/promed/p/12643>]
Date: Tue 21 May 2019
Source: ZBC (Zimbabwe Broadcasting Corporation) [edited]

The Zambezi Parks & Wildlife Management Authority (Zimparks) says it has managed to contain the anthrax outbreak in the Zambezi Valley which claimed 6 elephants, 3 buffalo, a lion and an impala. Zimparks, which has been working together with other stakeholders following the outbreak of anthrax in Zambezi Valley, confirmed that the infectious disease has now been brought under control.

Zimparks Public Relations Manager, Mr. Tinashe Farawo said the authority is pleased to have contained the disease, adding that measures are being put in place to strengthen surveillance mechanisms. "We can confirm that we have managed to contain the anthrax diseases in the Zambezi Valley thanks to efforts by our officers and support from private stakeholders," said Mr. Tinashe Farawo.

The disease killed a number of hippos in Binga last year [2018]. Anthrax is usually transmitted by feed and water contaminated with spores, which can lie dormant in the soil for many years. The primary sign of anthrax in grazing animals is sudden death, often with bloody discharges.
=======================
[So far so good, but I must point out that nature is illiterate and does not read the announcements of senior bureaucrats. She does what she does. Hopefully Mr. Farawo is correct but we should wait a couple of weeks at full alert.

Maps of Zimbabwe can be seen at

For a description of Hwange national park, go to
<https://en.wikipedia.org/wiki/Hwange_National_Park>.

Hwange is in the western part of the country bordering Botswana and Zambia
(<https://en.wikipedia.org/wiki/Hwange>). - ProMED Mod.MHJ]

[HealthMap/ProMED map available at:
Matabeleland North Province, Zimbabwe:
Date: Mon 20 May 2019, 2:49 PM
Source: KDKA [edited]

Pennsylvania's Secretary of Health, Dr. Rachel Levine has announced that the state has declared a hepatitis A outbreak with 171 cases in 36 counties. According to the map provided by the Department of Health, Allegheny and Philadelphia counties are hit the hardest with anywhere between 31-50 cases.

The counties hit hardest by this outbreak are Philadelphia and Allegheny, but we have seen an increase of cases throughout much of the state," Dr. Levine said. "We are taking this action now to be proactive in our response to treating Pennsylvanians suffering from this illnesses and prevent it from spreading. The best way to prevent hepatitis A is through vaccination."
=======================
[Pennsylvania is the latest (now almost half of the states in the USA) to declare a hepatitis A outbreak. As the numbers of cases continue to rise in a number of states, and news of smaller (so far) outbreaks occur in others, the question at the end of ProMED post http://promedmail.org/post/20190104.6241686 by a Kentucky official, "This is a disease of developing countries.

One has to ask: Why are we seeing it in the USA?" is more and more relevant. We are seeing these outbreaks because of the inability to deal with marginalized populations among their midst. The dramatic cutbacks in public health infrastructure in some of these states clearly feed the fire of these outbreaks. They must be addressed by bolstering public health resources and education and directly addressing the needs of these marginalized populations. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Pennsylvania, United States: <http://healthmap.org/promed/p/240>]
Date: Thu 16 May 2019
Source: AllAfrica, The Guardian report edited

A serving medical doctor has been infected with Lassa fever while 2 persons were confirmed dead in Kebbi state. Another medical doctor disclosed this yesterday [15 May 2019] when The Guardian visited the Federal Medical Centre (FMC), Birnin Kebbi. He said that 2 children died last week [week of 6 May 2019] as a result of the Lassa fever while a medical doctor, who was doing his primary assignment treating the patients, was also infected.

"You see, the management of the FMC has opened a special unit called isolated unit for the Lassa fever patients. We still have some patients inside. Also, a medical doctor, who was managing some patients last month [April 2019], has also been infected and he is presently on admission," he said.

Meanwhile, the state's Commissioner for Health, Alhaji Umar Kambaza, who confirmed the incident, said they were aware of the cases in the state but the government is working towards them.  [Byline: Michael Egbejule, Ahmadu Baba Idris]
========================
[The dates of occurrence of these cases is not given. Presumably, they were hospitalized after 12 May 2019 when the Nigeria CDC update was issued. It is indeed unfortunate that an attending physician became infected in the hospital. Nosocomial infections are not unusual when personal protective equipment and barrier nursing measures are not employed. - ProMED Mod.TY]
Date: Sun 19 May 2019
Source: Vax Before Travel [abridged, edited]

The eastern African country of Ethiopia has been reporting measles outbreaks for many years, however, in 2019, new information indicates children are the ones most vulnerable for this infectious disease.

According to reporting by the European Commission, approximately 54% of the 4000 measles cases in Ethiopia reported during 2019 affected children under 5 years of age.

Moreover, over 60% of the children had never received their 1st measles vaccine dose.

This new data estimates that by the end of 2019, about 3.5 million children will be susceptible to the measles virus, mainly because of the failure to achieve the 'herd-immunity' necessary to interrupt transmission.

Moreover, these Ethiopian children are not the only under-vaccinated population.

An estimated 169 million children missed out on the 1st dose of the measles vaccine between 2010 and 2017, or 21.1 million children a year on average, said UNICEF on 25 Apr 2019.

And, the measles virus is one of the leading causes of death among children, particularly in developing countries. An estimated 100,000 measles deaths occurred globally in 2017.

Ethiopia announced it would aggressively confront this under-vaccination issue by integrating the measles vaccine 2nd dose (MCV2) vaccination into the routine immunization program in the 2nd year of life.

The Ethiopian Ministry of Health said about 3 348 363 children will receive measles vaccine 2nd doses.

Dr Chatora Rufaro, World Health Organization (WHO) Ethiopia representative said in a press release, "The introduction of the 2nd dose of measles vaccination in Ethiopia will significantly contribute to a reduction of measles morbidity and mortality as well as the overall child mortality by preventing measles outbreaks."

To notify visitors about Ethiopia's ongoing measles risks, the CDC issued an initial Level 1 Travel Alert in 2015. Since then, the CDC advises all visitors to Ethiopia to ensure they are immunized against the measles virus.  [Byline: Don Ward Hackett]
======================
[HealthMap/ProMED-mail map of Ethiopia:
Date: Mon 20 May 2019 08:47 IST
Source: The Hindu [abridged, edited]

The current global resurgence in measles is having its resonance in Kerala too, which has been witnessing a serious surge in the disease since January [2019].

Across the globe, huge local outbreaks have been caused by travel as well as the increase in unvaccinated populations.

In Kerala, however, the majority of the cases are reported from Thiruvananthapuram, which has good vaccination coverage and amongst people who are well-nourished and have received at least one dose of vaccine in their lifetime.

Kerala reports around 600 plus cases of measles every year. This year [2019], as many cases have been reported in the first 4 months itself, with over 50% cases in the 19-40 year age group. There are also cases in the less than 9 months age group, but fewer cases than before in the 1-5 years group.

Immunisation
------------
"When universal routine immunisation in childhood improves and the virus is still in circulation, the disease will naturally move to the older age group who may be unimmunised or whose vaccine-derived immunity has begun to wane. At a time when the state is moving towards measles elimination, adult measles is a major concern," a senior health official said.

Historically, measles has been a childhood disease. The epidemiological shift to older population presents new public health challenges because of the increased severity of the disease, especially in vulnerable populations like pregnant women and immunocompromised patients (HIV, organ transplant recipients on immunosuppressants, cancer patients), who cannot be vaccinated with the live attenuated measles vaccine.

"Earlier, nearly 90% of measles cases could be managed on out-patient basis. This year [2019], most cases are in the 19-35 age group and over 60% of the cases had to be admitted as in-patients, with a good percentage requiring ICU management," said R Aravind, head of infectious diseases at Thiruvananthapuram Medical College.

The changing epidemiology of measles has not just brought forth the several unknowns but also raised important questions on whether adult immunisation should be a policy, on vaccine potency and the adequacy of vaccine immune response.

Though measles vaccine is highly immunogenic, as part of the national measles elimination strategy, a mandatory 2nd dose at 15-18 months was introduced in 2010, so that there is better immune protection. It is fairly certain that those currently in the 18-40 years age group have not had the protection of the 2nd dose and may be one reason for the increase in cases in this age group.

The 1st vaccination age for measles has been fixed at 9 months because till then, the maternal antibodies transferred in utero are supposed to afford protection to the child. If vaccinated earlier, the maternal antibodies might interfere with the immune response to vaccine.

Susceptible
-----------
However, at Rajiv Gandhi Centre for Biotechnology, the director, M Radhakrishna Pillai and team, who are currently studying the efficacy of measles vaccination in South India, have reported that children under the recommended vaccination age of 9 months are highly susceptible to measles.

SAT Hospital too has recently reported the death of an infant younger than 9 months due to measles.

"If the young mothers of the day do not have sufficient antibody protection, how do we protect infants younger than 9 months against measles? Given measles' age shift to older age group, should we move the vaccination age to 12 months for better vaccine response?

"Is a 3rd dose of MMR (mumps-measles-rubella) necessary? And should we recommend that all adults be given a dose of MMR as the virus is still in circulation? These questions need to be looked at from a research perspective by the State/National Technical Advisory Group on Immunisation," a public health expert said.  [Byline: C Maya]
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[HealthMap/ProMED-mail map of Kerala State, India:
Date: Fri 17 May 2019
Source: The Government of Hong Kong Special Administrative Region, press release [abridged, edited]

The Centre for Health Protection (CHP) of the Department of Health (DH) said today (17 May 20-19) that no additional case of measles infection had been recorded as at 4pm today and announced that the outbreak of measles infection at Hong Kong International Airport earlier has concluded.

A spokesman for the CHP said, "A total of 73 cases of measles infection were recorded so far this year [2019], among them 29 cases were associated with the outbreak among airport workers.

Regarding measles control measures implemented at the airport, a total of 23 persons had received measles vaccination at the airport vaccination station as at 6pm today [17 May 2019], bringing the cumulative number of vaccinations given to 8501 since 22 Mar 2019. The airport vaccination station will cease operation from [18 May 2019].

As for the blood test service, the DH earlier provided the measles serology test service to airport staff. A cumulative total of 777 blood samples have been collected. For the pilot service to provide measles serology testing for Filipino foreign domestic helpers working in Hong Kong, a total of 146 blood samples have been collected to date. Participants are notified individually of the serology results.
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[HealthMap/ProMED-mail map of Hong Kong: