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Afghanistan

Afghanistal US Consular Information Sheet March 03, 2009


COUNTRY DESCRIPTION:


Afghanistan has made significant progress since the Taliban were deposed in 2001, but still faces daunting challenges, including de

eating terrorists and insurgents, recovering from over three decades of civil strife, dealing with years of severe drought and rebuilding a shattered physical, economic and political infrastructure. Coalition and NATO forces under ISAF work in partnership with Afghan security forces to combat Taliban and al-Qa’ida elements who seek to terrorize the population and challenge the government. Violence in 2008 reached unprecedented levels, as both ISAF/Afghan forces and the Taliban initiated more battles than ever before. President Hamid Karzai was sworn in as President of the Islamic Republic of Afghanistan on December 7, 2004 and the Afghan Parliament was subsequently convened in late 2005. The government is working to develop a more effective police force, a more robust legal system, and sub-national institutions that work in partnership with traditional and local leaders to meet the needs of the population. The U.S. works closely with the international community to provide coordinated support for these efforts. An Afghanistan-hosted Peace Jirga with Pakistan resulted in a commitment to cooperate in combating terrorism, facilitate the return of Afghan refugees, and support regional economic activity. Read the Department of State Background Notes on Afghanistan for additional information.


ENTRY/EXIT REQUIREMENTS:


 A passport and valid visa are required to enter and exit Afghanistan. Afghan entry visas are not available at Kabul International Airport or any other ports of entry in Afghanistan. American citizens who arrive without a visa are subject to confiscation of their passport and face heavy fines and difficulties in retrieving their passport and obtaining a visa, as well as possible deportation from the country. Americans arriving in the country via military air usually have considerable difficulties if they choose to depart Afghanistan on commercial air, because their passports are not stamped to show that they entered the country legally. Those coming on military air should move quickly after arrival to legalize their status if there is any chance they will depart the country on anything other than military air. Visit the Embassy of Afghanistan web site at http://www.embassyofafghanistan.org for the most current visa information. The Consular office of the Embassy of Afghanistan is located at 2233 Wisconsin Avenue NW, Suite 216, Washington, DC 20007, phone number 202-298-9125. 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:


The latest Travel Warning for Afghanistan emphasizes that the security situation remains critical for American citizens. The Taliban and associated insurgent groups, al-Qaida network terrorist organizations, and narco-traffickers oppose the strengthening of a democratic government. These groups aim to weaken or bring down the Government of Afghanistan and to drive Westerners out of the country. They do not hesitate to use violence, including targeting civilians. Terrorist activities may include, but are not limited to bombings -- including improvised explosive devices and car bombs -- assassinations, carjackings, rocket attacks, assaults and kidnappings. There were over 120 suicide attacks in 2008. There is an ongoing threat to attack and kidnap U.S. citizens and Non-Governmental Organization (NGO) workers throughout the country. In 2008,, more than 30 NGO workers were killed (six foreigners) and at least 78 NGO staff members (seven foreigners) were abducted. Over 25 other foreign civilians, including journalists, were kidnapped. Kabul continues to experience suicide bombings against Afghan government personnel and installations, Afghan and coalition military assets, and international civilians. Riots -- sometimes violent -- have occurred in response to various political or other issues. Crime, including violent crime, remains a significant problem. Official Americans' use of the Kabul-Jalalabad, Kabul-Kandahar highways and other roads throughout the country is often restricted or completely curtailed because of security concerns. Insurgents continue to use roadside and car bombs to conduct attacks and abductions along major highways. Millions of unexploded land mines and other ordinance present a constant danger. The country faces a difficult period in the near term, and American citizens could be targeted or placed at risk by unpredictable local events. Americans should not come to Afghanistan unless they have made arrangements in advance to address security concerns. The absence of records for ownership of property, differing laws from various regimes and the chaos that comes from decades of civil strife have left property issues in great disorder. Afghan-Americans returning to Afghanistan to recover property, or Americans coming to the country to engage in business, have become involved in complicated real estate disputes and have faced threats of retaliatory action, including kidnapping for ransom and death. Large parts of Afghanistan are extremely isolated, with few roads, mostly in poor condition, irregular cell phone signals, and none of the basic physical infrastructure found in Kabul or the larger cities. Americans traveling in these areas who find themselves in trouble may not even have a way to communicate their difficulties to the outside world. For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found. Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays). The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.


CRIME:


 A large portion of the Afghan population is unemployed, and many among the unemployed have moved to urban areas. Basic services are rudimentary or non-existent. These factors may directly contribute to crime and lawlessness. Diplomats and international relief workers have reported incidents of robberies and household burglaries as well as kidnappings and assault. Any American citizen who enters Afghanistan should remain vigilant for possible banditry, including violent attacks.


INFORMATION FOR VICTIMS OF CRIME:


The loss or theft abroad of a U.S. passport should be reported immediately to the local police and to the U.S. Embassy in Kabul. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the U.S. Embassy in Kabul for assistance. The Embassy 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 provide a list of attorneys if needed. The local equivalent to the "911" emergency line in Afghanistan is: 119 Please see our information on Victims of Crime, including possible victim compensation programs in the United States.


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 Afghanistan’s laws, even unknowingly, may be expelled, arrested or imprisoned. During the last several years, there have been incidents involving the arrest and/or detention of U.S. citizens. Arrested Americans have faced periods of detention—sometimes in difficult conditions—while awaiting trial. Penalties for possession or use of, or trafficking in illegal drugs in Afghanistan are severe, and convicted offenders can expect long jail sentences and heavy fines. Another sensitive activity is proselytizing. Although the Afghan Constitution allows the free exercise of religion, proselytizing is often viewed as contrary to the beliefs of Islam and considered harmful to society. Proselytizing may lead to arrest and/or deportation. 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.


SPECIAL CIRCUMSTANCES:


Because of the poor infrastructure in Afghanistan, access to banking facilities is limited and unreliable. Afghanistan's economy operates on a "cash-only" basis for most transactions. Credit card transactions are not available. International bank transfers are limited. Some ATM machines exist at Standard Charter Bank and Afghan International Bank (AIB) in the Wazir Akbar Khan neighborhood of Kabul, but some travelers have complained of difficulties using them. International communications are difficult. Local telephone networks do not operate reliably. Most people rely on satellite or cellular telephone communications even to make local calls. Cellular phone service is available locally in Kabul and some other cities, but can be unreliable. Injured or distressed foreigners could face long delays before being able to communicate their needs to family or colleagues outside of Afghanistan. Internet access through local service providers is limited. In addition to being subject to all Afghan laws, U.S. citizens who are also citizens of Afghanistan may also be subject to other laws that impose special obligations on Afghan citizens. U.S. citizens who are also Afghan nationals do not require visas for entry into Afghanistan. The Embassy of Afghanistan issues a letter confirming your nationality for entry into Afghanistan. However, you may wish to obtain a visa as some Afghan-Americans have experienced difficulties at land border crossings because they do not have a visa in their passport. For additional information on dual nationality in general, see the Consular Affairs home page for our dual nationality flyer. U.S. citizens are encouraged to carry a copy of their U.S. passport with them at all times, so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available. As stated in the Travel Warning, consular assistance for American citizens in Afghanistan is limited. Islam provides the foundation of Afghanistan's customs, laws and practices. Foreign visitors -- men and women -- are expected to remain sensitive to the Islamic culture and not dress in a revealing or provocative manner, including the wearing of sleeveless shirts and blouses, halter-tops and shorts. Women in particular, especially when traveling outside of Kabul, may want to ensure that their tops have long sleeves and cover their collarbone and waistband, and that their pants/skirts cover their ankles. Almost all women in Afghanistan cover their hair in public; American women visitors should carry scarves for this purpose. Afghan customs authorities may enforce strict regulations concerning temporary importation into or export from Afghanistan of items such as firearms, alcoholic beverages, religious materials, antiquities, medications, and printed materials. American travelers have faced fines and/or confiscation of items considered antiquities upon exiting Afghanistan. It is advisable to contact the Embassy of Afghanistan in Washington for specific information regarding customs requirements. Travelers en route to Afghanistan may transit countries that have restrictions on firearms, including antique or display models. If you plan to take firearms or ammunition to another country, you should contact officials at that country's embassy and those that you will be transiting to learn about their regulations and fully comply with those regulations before traveling. Please consult http://www.customs.gov for information on importing firearms into the United States. Please see our Customs Information sheet.


MEDICAL FACILITIES AND HEALTH INFORMATION:


Well-equipped medical facilities are few and far between throughout Afghanistan. European and American medicines are available in limited quantities and may be expensive or difficult to locate. There is a shortage of basic medical supplies. Basic medicines manufactured in Iran, Pakistan, and India are available, but their reliability can be questionable. Several western-style private clinics have opened in Kabul: the DK-German Medical Diagnostic Center (www.medical-kabul.com), Acomet Family Hospital (www.afghancomet.com), and CURE International Hospital (ph. 079-883-830) offer a variety of basic and routine-type care; Americans seeking treatment should request American or Western health practitioners. Afghan public hospitals should be avoided. Individuals without government licenses or even medical degrees often operate private clinics; there is no public agency that monitors their operations. Travelers will not be able to find Western-trained medical personnel in most parts of the country outside of Kabul, although there are some international aid groups temporarily providing basic medical assistance in various cities and villages. For any medical treatment, payment is required in advance. Commercial medical evacuation capability from Afghanistan is limited and could take days to arrange. Even medevac companies that claim to service the world may not agree to come to Afghanistan. Those with medevac insurance should confirm with the insurance provider that it will be able to provide medevac assistance to this country. There have been outbreaks of Avian Influenza in poultry in Afghanistan, to include the areas of Nangahar, Laghman, and Wardak provinces, and in the city of Kabul, however, there have been no reported cases of the H5N1 virus in humans. Updates on the Avian Influenza situation in Afghanistan are published on the Embassy’s web site at http://kabul.usembassy.gov/information_for_travelers.html. For additional information on Avian Influenza, please refer to the Department of State's Avian Influenza Fact Sheet available at http://travel.state.gov/travel/tips/health/health_1181.html Tuberculosis is an increasingly serious health concern in Afghanistan. For further information, please consult the CDC's Travel Notice on TB. http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx| The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Afghanistan. However, if one has questions, please inquire directly with the Embassy of Afghanistan at http://www.embassyofafghanistan.org before you travel. Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site. For information about outbreaks of infectious diseases abroad, consult the World Health Organization’s (WHO) web site. Further health information for travelers is available from the WHO.


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 Afghanistan is provided for general reference only, and may not be totally accurate in a particular location or circumstance. All drivers face the potential danger of encountering improvised-explosive devices and land mines that may have been planted on or near roadways. An estimated 5-7 million landmines and large quantities of unexploded ordinance exist throughout the countryside and alongside roads, posing a danger to travelers. Robbery and kidnappings are also prevalent on highways outside of Kabul. The transportation system in Afghanistan is marginal, although the international community is constructing modern highways and provincial roads. Vehicles are poorly maintained, often overloaded, and traffic laws are not enforced. Vehicular traffic is chaotic and must contend with numerous pedestrians, bicyclists and animals. Many urban streets have large potholes and are not well lit. Rural roads are not paved. Please refer to our Road Safety page for more information.


AVIATION SAFETY OVERSIGHT:


As there is no direct commercial air service to the United States by carriers registered in Afghanistan, the U.S. Federal Aviation Administration (FAA) has not assessed Afghanistan’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. U.S. Government personnel are not authorized to travel on Ariana Afghan Airlines or any other airline falling under the oversight of the Government of Afghanistan’s Civil Aviation Authority, owing to safety concerns; however, U.S. Government personnel are permitted to travel on international flights operated by airlines from countries whose civil aviation authorities meet international aviation safety standards for the oversight of their air carrier operations under the FAA’s International Aviation Safety Assessment (IASA) program.


CHILDREN'S ISSUES:


 For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction. R


EGISTRATION / EMBASSY LOCATION:


Americans living or traveling in Afghanistan are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site and to obtain updated information on travel and security within Afghanistan. Americans without internet access may register directly with the U.S. Embassy. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located in Kabul on Great Massoud (Airport) Road, local phone number 0700-108-001 or 0700-108-002, and for emergencies after hours 0700-201-908. The web site is http://kabul.usembassy.gov/ * * * * * This replaces the Country Specific Information dated June 16, 2008 to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Information for Victims of Crime, Criminal Penalties, Special Circumstances, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Thu, 7 Mar 2019 10:54:44 +0100
By Mushtaq MOJADDIDI

Kabul, March 7, 2019 (AFP) - At least two blasts struck a large ceremony Thursday attended by Afghanistan chief executive Abdullah Abdullah and other leading government officials, killing one person and injuring 17 others.   The Kabul attack represents a major security breach and marks a resumption of violence in the capital after weeks of calm amid ongoing peace talks between the US and Taliban in Doha.   "Stay calm, the area of the blast is far from us," said former lower house speaker Mohammad Younus Qanooni during a live broadcast of the event.   But moments after the announcement, another explosion and gunfire could be heard that sent people running.   A second unidentified voice then addressed the screaming crowd, saying: "I request my countrymen to stay calm. The mortar attack is far from the gathering."

The blasts happened during a ceremony marking the 24th anniversary of the death of Shiite Hazara leader Abdul Ali Mazari that was attended by many of the country's political elite, including Abdullah and former President Hamid Karzai.   "Terrorists were firing Mortars at Abdul Ali Mazari remembrance ceremony, from inside a compound," deputy interior minister Khoshal Sadat said in English on Twitter, adding that police had arrested one person linked to the attack.    "One martyred, 17 wounded -- 3 children and one woman among them," tweeted Wahidullah Mayar, spokesman for the health ministry.    Foreign Minister Salahuddin Rabbani -- who was at the scene -- later added that "terrorists launched rocket attacks on commemoration ceremony", and said he had escaped safely.   It remained unclear whether rockets or mortar fire were being used, with officials using both terms.

- 'Unforgivable attack' -
No group has claimed responsibility for the blasts.   "This was the most horrid and unforgivable attack on civilians by a merciless enemy," tweeted presidential candidate and former national security adviser Mohammad Haneef Atmar.   He added that eight of his security guards were injured in the attack.     The incident comes as US and Taliban negotiations continue to hold peace talks in Qatar aimed at ending the nearly 18-year conflict. 

The last major attack in Kabul occurred in January when the Taliban-claimed responsibility for a car bomb that struck the heavily fortified Green Village foreign compound.    Heavy snowfall across large swathes of Afghanistan has led to a reduction in violence this winter, but warmer weather in the country's south will likely spark an increase in bloodshed with the arrival of the spring fighting season.   Analysts have warned that the Taliban are likely to ramp up attacks in the coming months as they seek to maintain momentum on the battlefield and leverage at the negotiating table.

On Wednesday at least 16 people were killed in a suicide attack on a construction company in eastern Afghanistan's Jalalabad city.    The hours-long attack began early Wednesday when two suicide bombers detonated explosives at the gate of the compound, allowing three others to enter the area where they went on a killing spree.   No group has claimed responsibility for the attack, but both the Islamic State group and the Taliban are active near the city, in Nangarhar province.   Afghanistan has been enmeshed in nearly constant conflict since the Soviet invasion of 1979, which was followed by civil war, the Taliban regime, and the US invasion in late 2001.
Date: Sat, 2 Mar 2019 18:38:14 +0100

Kandahar, Afghanistan, March 2, 2019 (AFP) - At least 20 people were killed by flash floods in southern Afghanistan's Kandahar province, the UN said Saturday, as heavy rains swept away homes and vehicles and potentially damaged thousands of houses.   The United Nations Office for the Coordination of Humanitarian Affairs said widespread flooding indudated Kandahar city and surrounding districts in the province, with 97mm of rain falling in affected areas in the last 30 hours.   "At least 10 people, including children, are still missing," said the UN agency in a statement.

"It is anticipated that up to 2,000 homes may have been damaged", with severe damage to infrastructure also being reported.   Kandahar's deputy governor Abdul Hanan Moneeb said the flooding was the worst in at least seven years, with many nomadic herders camped in the area swept away by the floodwaters along with their livestock.   The official added that 400 families have been rescued by the Afghan army since the flooding began late Friday night.   Rescue operations, however, were largely delayed due to heavy rainfall, Raziq Shirzai, the provincial commander of the Afghan air force, told AFP.

Disasters such as avalanches and flash floods often hit mountainous areas and river valleys of Afghanistan as snow melts in the spring and summer. It is made worse by deforestation.   Heavy snowfall across large swathes of Afghanistan this winter has raised fears of severe flooding as spring approaches, following years of devastating drought in the country.   Nearly 50 people have been killed as of February 12 due to flooding in Afghanistan so far this year, according to the UN.
Date: Mon 18 Feb 2019 3:33:02 PM AFT
Source: MENAFN/Afghan Times, AT News report [edited]

One new polio case is just confirmed in southern Kandahar province, days after nationwide campaign against the crippling disease kicked off on [Mon 18 Feb 2019].  A 60-month-old boy from Ghorak district is infected by the poliovirus. This is the 2nd case reported in 2019, highlighting the ongoing risks of polio and the need for continued immunization, health officials said.  "From today [18 Feb 2019], polio vaccination teams will visit 5.8 million children under 5 years old in 195 high-risk districts of 21 provinces of West, Central, and Southeast regions of Afghanistan," said a statement issued by Ministry of Public Health (MoPH).

The Minister of Public Health Ferozuddin Feroz urged Afghan people to take the situation seriously and called on people to open doors to vaccinators in the upcoming campaign.  "We already have 2 cases reported from Kandahar this year [2019]. While there is polio anywhere in this country, all children are at risk. Polio will continue to fight for survival. Immunization is the only way to put an end to this virus. We urge the people of Kandahar and across the country to step up, open your doors and get your children vaccinated. We don't want to see any more children paralyzed by polio, and we need to work together to stop polio once and for all."

Polio is incurable and can paralyze children for life. The only way to prevent polio virus is to vaccinate all children with 2 drops of polio vaccine every time it is offered. Children are better protected with every additional dose of the vaccination. Repeated vaccination helps to build strong immunity of your child and the whole community.

The vaccination campaign will take place from [18-22 Feb 2019]. Parents should ensure their children are home and available to be vaccinated. All children under 5 should receive the polio vaccine, including children who are asleep, visiting other homes and new-borns, even if they have been immunized in the past. Children who miss the vaccination should visit their local health centre as soon as possible, where the vaccine is available free of charge. The polio vaccine is safe, even for sick and new-born children. It is very important these children get the vaccine, because they have lower immunity which makes them more susceptible to the virus. Polio vaccination has also been strongly endorsed by national and global Islamic scholars, the statement added.

Every country in the world except Pakistan, Nigeria, and Afghanistan has ended polio, highlighting the fact that the strategy and vaccines work Twenty-one Afghan children were infected by polio in 2018.
======================
[Sadly, transmission of the WPV continues in Pakistan and Afghanistan. Since the beginning of 2019 there have now been 6 cases confirmed, 4 in Pakistan and 2 in Afghanistan. The vaccination history of this child isn't included in this media report, but most likely the child was inadequately vaccinated at 60 months (5 years) of age. - ProMED Mod.MPP]

[HealthMap/ProMED map of Afghanistan:
Date: Tue 29 Jan 2019
Source: Afghanistan Times [edited]

Afghanistan's 1st polio case in 2019 was reported in Kandahar province, where a 22-month-old girl from Spin Boldak district was infected by the poliovirus.

According to a statement the Minister of Public Health, Dr Ferozuddin Feroz said, 'this case indicates that the poliovirus is still transmitting in Kandahar and the South region. This child's life is now changed forever. It is really sad that she will never walk properly again, therefore I call upon all of you, our Muslim parents, caregivers, community elders, and health workers to work together to protect our innocent children against this disease and eradicate polio in our country.'

He said that polio is a crippling and potentially fatal infectious disease. There is no cure and the polio vaccine is the only safe and effective way to protect children. All children should be vaccinated against polio during each campaign, until they reach the age of 5. House-to-house vaccination is the only effective way to achieve polio eradication because it means every child has access to vaccination. This strategy has been implemented in all countries and has proven efficacy. However, if parents live in areas where there is no house-to-house campaign available, they should take their children to the local health facility for free polio vaccine.

The polio vaccine is safe, even for sick and new-born children. It is very important these children get the vaccine, because they have low immunity which makes them more susceptible to the virus.

Polio vaccination has also been strongly endorsed by national and global Islamic scholars, he added.

Currently, Afghanistan, Pakistan, and Nigeria are the only 3 remaining polio-endemic countries in the world. There were 21 cases reported in Afghanistan in 2018. Of these, 15 cases were in the Southern region, while 6 cases were in the Eastern region. There is a polio vaccination campaign carried out in the Southern and Eastern regions of Afghanistan, parents should ensure their children are home and available to be vaccinated.
==========================
[The wording of the media report above suggests that the date of onset of paralysis of this case was in 2019, but it is possible onset was in late 2018. Clarification of the date of onset would be greatly appreciated.

Kandahar province is located in the Southwestern region of Afghanistan (see <https://www.researchgate.net/figure/Regions-of-Afghanistan_fig1_284510443> for a map of regions in Afghanistan and <http://www.afghana.com/GetLocal/Afghanistan/Provinces.htm> for a map of provinces in Afghanistan). It shares a border with Balochistan Pakistan.

In last week's global update, there was mention of 7 positive environmental samples in Afghanistan collected on 26 Dec 2018, that identified 3 of the 7 coming from Kandahar province, confirming that the WPV1 was actively circulating in the province (see Poliomyelitis update (08): global (Pakistan, Nigeria), WHO (Mozambique) http://promedmail.org/post/20190125.6277951). - ProMED Mod.MPP]

[HealthMap/ProMED-mail map of Afghanistan:
Date: Thu 24 Jan 2019
Source: Tolo News [edited]

At least 90 British military personnel have been diagnosed with confirmed cases of Q fever after serving in Helmand, Afghanistan. According to a UK military news outlet, Forces Network, a consultant in infectious diseases and tropical medicine told to the Central London Country Court on [Tue 22 Jan 2019], that 90 confirmed cases of Q fever had been recorded among British soldiers who had served in Helmand.

Lieutenant Colonel Mark Bailey's testimony was heard in the case of a private with 2nd Battalion, the Mercian Regiment, who said his life has been ruined after he contracted the disease while in Helmand in 2011/2012. During his tour, his lawyers said [the private] was in contact with goats and sheep and "was often required to take cover and jump through ditches and crawl along the ground -- coming into contact with animal products and excrement." The soldier was medically discharged from the Army in 2014 because of his Q fever and chronic fatigue symptoms.

Humans can catch Q fever by breathing in dust from the secretions of infected farm animals such as sheep, cattle, and goats.

Bailey, who specializes in infectious diseases and tropical medicine, and a national expert in Q fever said he has 90 military and 10 civilian cases in his care after they were referred to him. He confirmed the 90 had served in Helmand and said the number of military cases "built up from 2008", Forces Network reported. Bailey told the court: "We have seen no new cases since 2014 from Afghanistan. Occasionally we get other military cases from other locations. Cyprus most recently."

Bailey said he had seen "one British soldier who very, very nearly died" as a result of Q fever and subsequent complications, but there have been no UK deaths in his group.
====================
[Q fever is due to _Coxiella burnetii_, an obligate intracellular rickettsia-like bacterial pathogen. It is highly resistant to drying and heat, which enables the bacteria to survive for long periods in the environment. Its survival is attributed to a small cell variant of the organism that is part of its biphasic developmental cycle. Q fever is a zoonosis. Domestic ungulates such as sheep, cattle, and goats serve as the reservoir of infection for humans. The organism is shed in urine, feces, milk, and especially birthing products; intermittent high-level shedding occurs at the time of parturition, with millions of bacteria being released per gram of placenta.

Humans usually become infected by inhaling aerosolized organisms. Acute symptoms of a flu-like illness usually develop within 2-3 weeks of exposure, although as many as half of humans infected with _C. burnetii_ do not show symptoms (<http://www.cdc.gov/qfever/symptoms/index.html>). Although most persons with acute Q fever infection recover, others may experience serious illness with complications that may include pneumonia, granulomatous hepatitis, endocarditis (especially in patients with previous cardiac valvulopathy), myocarditis, and central nervous system involvement. Pregnant women who are infected may be at risk for pre-term delivery or miscarriage.

The solider likely suffers from Q fever-associated chronic fatigue. The following related to post-Q fever fatigue syndrome is extracted from Melgar TA, Bauler TJ, Lutwick LI. Q fever in man: A one health paradigm disease. In, The Principles and Practice of Q Fever, Simoes JCC, Anastacio SF, da Silva GJ (eds), Nova Science Publishers, 2017, pp 1-24:

"Up to 20% of patients with acute Q fever report chronic fatigue more than a year later. Most of these cases meet the CDC criteria for chronic fatigue syndrome. Other symptoms include night sweats, nausea, headache, myalgia, enlarged lymph nodes, arthralgia, insomnia, depression, decreased concentration and short term memory impairment. The pathogenesis is not clear although there is evidence that genetic factors may play a role and _C. burnetii_ antigens and DNA can be found in patients' macrophages for up to 12 years and in one case 70 years after acute infection (1,2). Treatment is focused on chronic fatigue including exercise therapy and cognitive behavior therapy. There are no current recommendations for antimicrobial therapy for Q fever-associated chronic fatigue although case reports and one study demonstrated improvement with antimicrobials (3). A large placebo controlled randomized trial in the Netherlands (4,5) reported some non-sustained improvement was found with cognitive-behavioral therapy but not with long term doxycycline.

References
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1. Marmion BP, Sukocheva O, Storm PA, et al. Q fever: persistence of antigenic non-viable cell residues of _Coxiella burnetii_ in the host - implications for post Q fever infection fatigue syndrome and other chronic sequelae. QJM 2009; 102(10): 673-84; abstract available at <https://www.ncbi.nlm.nih.gov/pubmed/19556396>.
2. Sukocheva OA, Marmion BP, Storm PA, et al. Long-term persistence after acute Q fever of non-infectious _Coxiella burnetii_ cell components, including antigens. QJM 2010; 103(11): 847-63; abstract available at <https://www.ncbi.nlm.nih.gov/pubmed/20639288>.
3. Arashima Y, Kato K, Komiya T, et al. Improvement of chronic nonspecific symptoms by long-term minocycline treatment in Japanese patients with _Coxiella burnetii_ infection considered to have post-Q fever fatigue syndrome. Intern Med 2004; 43(1): 49-54; <https://www.jstage.jst.go.jp/article/internalmedicine/43/1/43_1_49/_article>.
4. Keijmel SP, Delsing CE, Bleigenberg G, et al. Effectiveness of long-term doxycycline treatment and cognitive-behavioral therapy on fatigue severity in patients with Q fever fatigue syndrome (Qure study): a randomized controlled trial. Clin Infect Did 2017; 64(8): 998-1005; <https://academic.oup.com/cid/article/64/8/998/3056564>.
5. Raijmakers RPH, Keijmel SP, Breukers EMC, et al. Long-term effect of cognitive behavioural therapy and doxycycline treatment for patients with Q fever fatigue syndrome: one-year follow-up of the Qure study. J Psychosom Res 2019; 116: 62-7; <https://www.sciencedirect.com/science/article/pii/S0022399918308183>.

Helmand is one of the 34 provinces of Afghanistan, in the south of the country. It can be seen on a map at

[HealthMap/ProMED-mail map of Afghanistan:
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Kyrgyzstan

Kyrgyzstan Republic - US Consular Information Sheet
August 29, 2008
COUNTRY DESCRIPTION:
The Kyrgyz Republic, a mountainous country of five million people, is undergoing political and economic change. Tourist facilities are not highly deve
oped, and many of the goods and services taken for granted in other countries are not yet widely available. Read the Department of State Background Notes on the Kyrgyz Republic for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. American citizens can obtain a one-month single-entry, non-extendable tourist visa upon arrival at the “Manas” International Airport outside Bishkek for a $36 fee without invitation or sponsorship. Newly enacted legislation requires that all foreigners present in the Kyrgyz Republic for more than sixty days register with the Kyrgyz Department of Visa and Passport Control. Failure to do so may cause difficulties when exiting the country. Individuals traveling to Kyrgyzstan to perform religious work or work in affiliation with any religious organization in any capacity are required by Kyrgyz law to declare so on their visa applications. Failure to do so may lead to difficulties with local law enforcement as it is considered a violation of Kyrgyz law to engage in activities not matching the purpose of travel indicated on an individual’s visa. In general, travelers should apply for the correct category of visa for their purpose of travel. Travelers cannot obtain a tourist visa at land borders or other airports. American citizens visiting the Kyrgyz Republic are not required to register with the Office of Visas and Registration. The Embassy recommends that Americans traveling in the Kyrgyz Republic also obtain Kazakh visas, as commercial air travel out of the Kyrgyz Republic is limited and Americans may need to travel through Kazakhstan to return to the United States. For further information regarding entry/exit requirements, contact the Embassy of the Kyrgyz Republic at 2630 Massachusetts Avenue, NW, Washington, DC 20008, telephone: (202) 338-5141, fax: (202) 742 6501. Visit the Embassy of the Kyrgyz Republic web site at http://www.kgembassy.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:
The Department of State urges U.S. citizens to avoid all travel to rural areas along the Kyrgyz-Uzbek and Kyrgyz-Tajik borders, and all areas to the south and west of the provincial capital of Osh. Security conditions in these parts of the southern Kyrgyz Republic differ from security conditions in the north, and the threat of violence against foreigners in the southern Kyrgyz Republic continues. Hostage-taking incidents involving foreigners occurred during the summers of 1999 and 2000, including one incident in the summer of 2000 involving American citizens. In 2007, there were reports of attempted “bride-kidnappings” in rural areas. While foreigners are not believed to be intentional targets, an American female was held against her will for several days in one reported incident. In 2006, suspected militants attacked a border post on the Kyrgyz-Tajik border, and ensuing skirmishes took place between the militants and Kyrgyz military forces throughout the southern Batken region. Land mines in Batken Oblast and near the Kyrgyz-Tajik border continue to be a concern. There are currently restrictions for U.S. Government employees traveling to areas of the Kyrgyz Republic south and west of Osh and in rural areas along the Kyrgyz-Uzbek border because of the volatile security situation in these areas.
Supporters of extremist groups such as the Islamic Movement of Uzbekistan (IMU), the Islamic Jihad Union (IJU), al-Qaeda, and the Eastern Turkistan Islamic Movement remain active in Central Asia. These groups have expressed anti-U.S. sentiments and may attempt to target U.S. Government or private interests in the region, including in the Kyrgyz Republic. Terrorist attacks involving the use of suicide bombers have previously taken place in neighboring Uzbekistan. Terrorists do not distinguish between official and civilian targets. Because of increased security at official U.S. facilities, terrorists are seeking softer civilian targets such as residential areas, clubs and restaurants, places of worship, hotels, schools, outdoor recreation events, resorts, beaches, maritime facilities, airports and aircraft.
In 2005-2007, there were several large-scale demonstrations and protests. Demonstrations in Bishkek have occurred in front of the Presidential Administration building (White House) and on Alatoo Square in the city center. The Embassy does not always have advance information regarding new demonstrations. Therefore, all Americans are reminded to remain vigilant and are urged to avoid the vicinity of all protests, because even protests that are intended to be peaceful can turn confrontational and possibly escalate into violence.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphletA Safe Trip Abroad.
CRIME: The U.S. Embassy advises U.S. citizens to exercise caution in urban areas of the Kyrgyz Republic due to the high rate of violent crime against foreigners. Travelers arriving at Manas International Airport should arrange their transportation from the airport in advance. Foreign travelers have been the victims of extortion by airport taxi drivers, who appeared in some cases to be colluding with airport personnel to identify their victims. Travelers should not take public transportation or walk after dark, and should be extremely cautious in or near hotels, bars, parks and all places that attract an expatriate clientele. The Kyrgyz Republic has a high rate of violent crime due to unemployment and a large number of organized gangs. Muggings often occur after dark and can be quite violent, leaving the victim severely injured. Other common crimes include auto theft, mugging, and pick pocketing in crowded places such as markets, Internet cafes and on public transportation. U.S. citizens have been the victims of such crimes as rape, assault, kidnapping and robbery while in urban and rural parts of Kyrgyzstan, and there have been reports of U.S. citizens who were robbed by groups of young men who had followed them back to their residences from hotels and bars. Police officers rarely speak English and no victims’ assistance programs are available. Medical and psychiatric care for victims is limited.
Harassment and extortion by people who purport to be Kyrgyz police officers are common. According to Kyrgyz law, any person claiming to be a police officer must show identifying documents on demand. U.S. citizens should not act upon requests by people, whether in civilian dress or in police uniform, if they have no official identification. Also U.S. citizens should not get into cars with someone they do not know, even if the person claims to be a police officer.

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.

The local equivalent to the “911” emergency lines in Kyrgyzstan are: 101 for fire; 102 for police;
103 for first aid ambulance (state-funded); 151 (from landline), 0 312 684466 (from landline or cellphone); and 161 for rescue service (under the Ministry of emergency situations.)

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical services in the Kyrgyz Republic are extremely limited. Elderly travelers and those with existing health problems may be at risk due to inadequate medical facilities. The U.S. Embassy strongly recommends that travelers to the Kyrgyz Republic carry medical evacuation insurance in case of emergency. The Consular Section of the U.S. Embassy in Bishkek maintains a list of foreign-trained and local physicians who have agreed to give medical assistance to Americans. This list is available on the Embassy web site at http://bishkek.usembassy.gov.
Some HIV/AIDS entry restrictions exist for visitors to and foreign residents of Kyrgyzstan. There is no legal requirement for HIV/AIDS testing during the visa application or registration process. Kyrgyz law does state that if a foreign citizen refuses to submit to HIV/AIDS testing when requested while in Kyrgyzstan, that person could be deported. Please verify this information with the Embassy of Kyrgyzstan at http://www.kgembassy.org before you travel.

Tuberculosis is an increasingly serious health concern in Kyrgyzstan. For further information, please consult the CDC's Travel Notice on TB available at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning the Kyrgyz Republic is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Most of the Kyrgyz Republic’s road infrastructure consists of two-lane roads, which are all in various states of disrepair, and are poorly marked and lit. Many local drivers tend to disobey fundamental traffic laws – such as stopping at red lights. As a result, driving can be very dangerous. Accidents involving severe injury and/or death are not uncommon.
Drivers must exercise particular caution to avoid uneven pavement, potholes and open drains and manholes. Night driving should be avoided, as roads are inadequately lit. In winter, roads are seldom plowed and ice and snow make the poor driving conditions even more hazardous. Pedestrians routinely walk in the road, often wearing dark clothes at night, necessitating even greater caution for drivers. Mountain roads in the Kyrgyz Republic are often narrow and treacherous, and may close without notice due to snow, ice or rockslides. Guardrails and barriers preventing falling rocks are often missing. The Kyrgyz Republic does not have a roadside assistance infrastructure. Towing companies do not exist. Although mechanics are available in cities there is little organized oversight or certification of their practices or abilities. Rest areas are infrequent and very primitive. Service stations are generally available in and near cities, but the fuel they provide may be adulterated or of poor quality.
The road between Almaty, Kazakhstan and Bishkek, Kyrgyz Republic, is especially treacherous at night or during poor weather. Americans and other travelers have been killed in traffic accidents on that road, and travel at night is not recommended.
Generally, speed limits are 60 km per hour in the cities and 90 km per hour in rural areas. Kyrgyz law mandates that all automobile passengers wear seat belts and that motorcycle riders wear helmets. International driving permits are recognized in the Kyrgyz Republic.

Drivers may face harassment by traffic police, who have been known to demand payment for arbitrary "fines" for purported infractions.

The Kyrgyz Republic has a "zero tolerance" policy for driving under the influence of alcohol.
Public transportation in the Kyrgyz Republic is limited to buses, taxis, and very few intercity trains. Travelers should be particularly careful when using public transportation. Buses tend to be very crowded and can be unsafe and unreliable. Taxis too can be dangerous. Due to the danger of theft or assault, travelers should avoid entering a cab that already contains passengers. Taxis are seldom metered, and travelers should negotiate a fare prior to entering a cab and be aware that cab drivers often try to charge foreigners a high fare. Drivers of vehicles that are not taxis are often willing to drive people for fares. However, U.S. citizens should avoid using any of these "private taxis" and unmarked taxis.

Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office and national authority responsible for road safety at insert site here.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in the Kyrgyz Republic, the U.S. Federal Aviation Administration (FAA) has not assessed the Kyrgyz Republic’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES:
Kyrgyz customs authorities may enforce strict regulations concerning temporary importation into or export from the Kyrgyz Republic of items such as antiquities or hunting trophies. It is advisable to contact the Embassy of the Kyrgyz Republic in Washington at 2630 Massachusetts Avenue, NW, Washington, DC 20008, telephone: (202) 338-5141, fax: (202) 742 6501 or at http://www.kgembassy.org/ for specific information regarding customs requirements.
The Kyrgyz Republic is a cash-only economy. The banking system is not well developed. ATMs are available, but the security of these machines remains untested. A hotel or bank may, on occasion, accept traveler’s checks or credit cards, but the fees can be as high as 20 percent for traveler’s checks.
U.S. citizens are encouraged to carry a copy of their U.S. passport with them at all times, so that, if questioned by local officials, proof of identity and citizenship are readily available.

In accordance with the Vienna Convention on Consular Relations and certain bilateral treaties, a consular officer from the U.S. Embassy must be given access to any U.S. citizen arrested in the Kyrgyz Republic. U.S. citizens who are arrested or detained should ask that the U.S. Embassy be contacted immediately. This is generally recognized, though there can be a sizeable delay in notification times depending on the local authorities’ interpretation of the case’s legal status.
The Kyrgyz Republic is an earthquake-prone country. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov.
Hunting and trekking are popular sports for locals and tourists in the Kyrgyz Republic; however, American citizens traveling to the Kyrgyz Republic should know that hunting in the Kyrgyz Republic without proper licenses is illegal. It is illegal to import or own firearms in the Kyrgyz Republic without a permit issued by the Kyrgyz government. Foreign hunters who do not have official permission to hunt or take trophies out of the country may face criminal and civil charges. Both hunting and trekking infrastructures are underdeveloped with limited services, especially in the high mountainous regions popular with trekkers and hunters. Avalanches and landslides are common in these mountainous regions, often cutting off villages for weeks at a time. These villages and hunting areas are in isolated, rugged, mountainous areas inaccessible by the limited rescue services available in the Kyrgyz Republic. Americans traveling to the Kyrgyz Republic to hunt or trek need to be aware of the risks involved. The Embassy recommends that all Americans register with the Embassy in Bishkek for the duration of their stay in the country.
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 the Kyrgyz Republic’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in The Kyrgyz Republic are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.

CHILDREN'S ISSUES: For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in the Kyrgyz Republic are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within the Kyrgyz Republic. Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy in Bishkek is located at 171 Prospect Mira, 720016 Bishkek, Kyrgyz Republic. The phone number is 996-312-551-241, fax: 996-517-777-202, and web site: http://bishkek.usembassy.gov
* * *
This replaces the Country Specific Information for the Kyrgyz Republic Dated January 8, 2008, to update sections on Country Description, Entry/Exit Requirements, Crime, Information for Victims of Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Wed 9 Jan 2019
Source: AKIpress [abridged, edited]

A total of 722 cases of measles have been registered since the beginning of 2018 in Kyrgyzstan compared with one case in January through November 2017, the National Statistics Committee reports.

[Full story is available only by subscription.]
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[HealthMap/ProMED-mail map:
Date: Wed 21 Nov 2018 14:26 KGT
Source: Kazakh Telegraph Agency (KazTAG] [edited]

KyrTAG [Kyrgyzstan Telegraph Agency] reports 2 people have been hospitalized in the Jalal-Abad region with anthrax assumption. "2 inhabitants of Suzak district have been hospitalized with anthrax assumption. The lab tests made in Jalal-Abad have shown a negative result, we sent the analysis to Osh for a repeated research," said Usen Zhorobayev, head of center of state sanitary-epidemiological surveillance of the Suzak district. In his words, the hospitalized men had been butchering a cow. The patients are in satisfactory condition
=============================
[To find Suzak in western Kyrgyzstan, go to:
<http://www.fallingrain.com/world/KG/03/Suzak.html>.

For a description of Jalal-Abad region, go to

Outbreaks in Jalal-Abad are an overflow of infection from the enzootic state of this disease in the adjoining Fergana Valley of Uzbekistan. Jalal-Abad is in western Kyrgyzstan at the head of the Fergana Valley. The Fergana Valley is rife with livestock anthrax. Without a coordinated vaccination-control program between the 2 countries in this region, we will continue to see outbreaks there. In spite of an initial negative test result, not uncommon with human cases, the authorities are assuming a greater probability of cutaneous anthrax based on the exposure history of these 2 farm workers. A pity they did not get their veterinary colleagues to test what was still available from this dead cow. - ProMED Mod.MHJ]

[HealthMap/ProMED-mail map of Kyrgyzstan:
Date: 27 Jun 2018
Source: Interax Kazakhstan [edited]

Nine people have been hospitalized with suspected anthrax infection in the Jalal-Abad region of southern Kyrgyzstan, Mamatzhan Miyanov, the coordinator of the healthcare ministry for the Jalal-Abad region, told Interfax on Wednesday [27 Jun 2018].
Date: Tue 13 Mar 2018
Source: XinHuaNet [edited]

A total of 14 people, including 4 children, were hospitalized after a mass botulism food poisoning outbreak in southern Kyrgyzstan, the Health Ministry said [Tue 13 Mar 2018]. It said 3 of them are in a serious condition. An epidemiological investigation has been conducted and all patients have received the botulinum antitoxin.

The first case of food poisoning in the city of Uzgen in the Osh region was reported on [Sun 11 Mar 2018]. According to preliminary data, the poisoning occurred due to eating homemade canned vegetable salad. A month earlier [February 2018], 17 people in southern Kyrgyzstan were hospitalized for the same reason; 2 of the 7 children affected died in that outbreak.
======================
[It is unclear if these clusters are related. Most clusters of botulism are associated with home prepared food. - ProMed Mod.LL]

[HealthMap/ProMED-mail map:
Date: Tue 5 Sep 2017 16:10
Source: Evening Bishjkek [in Russian, trans. ProMED Mod.NR, edited]

Currently in the at-Bashy district of Naryn region 3 recorded cases of anthrax infection are in the hospital, and 15 under the supervision of experts. Doctors say that the locals butchered the carcass of an animal, and 10 days later the 1st symptoms of this dangerous infection appeared on the skin of the wrist areas and forearms.

People have turned to professionals with complaints of ulcers. Then on [Wed 30 Aug 2017] 3 people were hospitalized in the Infectious Diseases Department. Tests confirmed the preliminary diagnosis. Doctors have checked all sick family members and friends, and currently they are under surveillance.

The incubation period of the infection is 10-14 days.[Actually it can be as short as 3 days and up to 60 days. - ProMED Mod.MHJ] At the end of this period, if there is no suspicion, patients are discharged from the hospital. "This disease is curable, it is treatable by conventional antibiotics. It's just included in the list of especially dangerous infections classifications of the World Health Organization. The main sources of infection are animals", - said the Director of the Republican center of Quarantine and Especially Dangerous Infections the Sabyrzhan of Abdykaimov.

It is likely that the meat of an infected animal got into the markets. According to some reports, some infectious contaminated products were located in the market town of Tokmak. Now multiple site checks are in hand by the Investigative Department. In addition, the market site and the territory around the cattle slaughter site have been quarantined, say doctors. And veterinary control has been initiated, along with the population being educated.

However, the situation is aggravated by the confused information from the sick individuals. They can't exactly tell where the infected meat was sent, said Abdykaimov. "One says that the meat is buried. Another says sold. Now this is in the hands of the investigating authorities and veterinary services. They don't say what happened: just stopped someone in a car; it was loaded, and they left. And where, on what car - they don't specify. The investigating authorities are handling this, but we in Public Health are doing our best to explain what should happen," - said Abdykaimov.  [Byline: Rodion Reshetov]
====================
[Comment by ProMED Mod.NP. In the territory of the Republic there are 1219 natural foci of anthrax. Concreted and enclosed only 1000 of them. Vaccination of cattle is held only periodically, delayed due to problems with funding and vaccine supplies, increasing the risk disease anthrax in both animals and humans. Annually in the territory of the Republic there are nearly 20 cases of anthrax in people. In this case, the situation is compounded by the fact that there is no accurate information on location of infected meat, which can lead to new cases of the disease. - ProMED Mod.NP]

[Public Health as it really is and not as shown on television. People get confused and, fearing legal action, may make up stories. My thanks to my colleague Natalia. It seems that circulation of the news in English is limited and widely available in Kyrgyz. - ProMED Mod.MHJ]

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

World Travel News Headlines

Date: Thu, 21 Mar 2019 16:10:28 +0100

Kinshasa, March 21, 2019 (AFP) - A six-month-old baby in the eastern DR Congo city of Bunia has died of Ebola, becoming the first fatality of the disease in a provincial capital, the heath ministry said Thursday.   Bunia, which has a population of 300,000, is the capital of Ituri province, which along with neighbouring North Kivu province has been battling an epidemic of Ebola since last August.

The baby is among 610 fatalities out of 980 recorded cases, the ministry said in a statement.   "The parents are apparently in good health," it said.   "Extensive investigations are underway and will include, among other things, analysis of the maternal milk to identify the source of contamination."   The ministry added that it had also registered 97 new cases in the previous three weeks.   This increase "was expected" given the impact of an attack on two Ebola treatment centres by armed groups in the troubled region, it said.
Date: Thu, 21 Mar 2019 22:32:17 +0100

Blantyre, Malawi, March 21, 2019 (AFP) - Heavy rains could cause a dam in southern Malawi to give way if there is no let-up, authorities said Thursday, urging local residents to take shelter.   The warning came after cyclone Idai battered neighbouring Mozambique last Friday killing 242 people    Hurricane-force winds and rains have also ravaged hit eastern Zimbabwe where over 100 have died.

In Malawi, the storm has affected nearly a million people with over 80,000 displaced, according to the WHO.   The Chagwa dam "has had one of its major embankments eroded due to heavy rains," the interior security ministry said in a statement. "(It) is likely to burst in the event of heavy and incessant rains."   The statement advised local residents in the southern African country to evacuate "in case of an emergency".
Date: Thu, 21 Mar 2019 12:27:11 +0100
By Abhaya SRIVASTAVA

New Delhi, March 21, 2019 (AFP) - Walls draped in lush vertical gardens and air filtered through purifiers insulate diners at a swanky New Delhi food court from the choking haze outside in one of the most polluted places on earth.   But these eco-eateries, offering cleaner air as well as modern menus to the well heeled are beyond reach for the poor, who have little means of escaping the deadly smog which coats the city for much of the year.   Air pollution kills more than one million Indians every year, according to a study by Lancet Planetary Health, and Delhi is ranked one of the most toxic urban centres to live, regularly exceeding World Health Organisation (WHO) limits.

But for Ramavtar Singh there is no escape: like many of the city's poorest, he eats, sleeps, and works outside.   "I work for six to eight hours every day and my children eat and sleep outside most times of the year," the father of five tells AFP at a roadside food stall, gulping down a 50-cent dish of rice and lentils.   Singh earns a living by cycling passengers and cargo around Delhi on his rickshaw, a strenuous activity that means he's inhaling dangerous concentrations of tiny pollutants deep into his lungs.    At best, he can wrap a rag over his mouth on smoggy days, a low-cost approach taken by labourers and rickshaw drivers that does little to prevent the most dangerous particles entering the bloodstream.   Delhi's smog peaks from October to February, routinely exceeding WHO recommendations for PM2.5 -- tiny and harmful airborne particles -- and some days registers levels more than 20 times safe limits.   Experts warn the long term health consequences of living enveloped in pollution are disastrous, often causing chronic sickness and in some cases early death.

- ' A quick oxygen shot' -
Across town, Abhimanyu Mawatwal is settling down for lunch at a food court in Worldmark Aerocity, a grand commercial centre boasting purified air.   A meal here could cost twice Singh's monthly salary, but it is a price Mawatwal is willing to pay because outside the smog is at hazardous levels.   "I love to come here for my meals. It is like getting a quick oxygen shot," the office worker says, surrounded by creeper vines and a faux stream as he breathed lungfuls of filtered air circulating through expensive filters.   "We need to bring greenery to concrete jungles and create places where everybody can come for a breath of fresh air," insists S. K. Sayal, CEO of Bharti Realty which owns Worldmark Aerocity.   Delhi's affluent, who are often better informed about the dangers of pollution, increasingly expect the same safety measures they have in place at home, to be available when they are out.

High-end eateries, bars and cinemas are tapping into that demand -- installing electronic air purifiers and creating dedicated areas of rich vegetation to help filter airborne toxins.   But for Singh, and the one in five Indians living on less than $2 a day, visiting such places is nothing more than a fantasy.   "What will I do if I spend all the money on one meal? How will I feed my family?" said the rickshaw cyclist, who earns about 1,200 rupees ($17) a month.   He cannot dream of buying the foreign-made air purifiers to protect his family at home -- machines favoured by Delhi's elite, expat communities and office workers -- that easily cost Singh's annual wage.    "The rich and the poor have to breathe the same poisonous air. But the poor are more exposed to pollution," explains Sunil Dahiya, a campaigner for Greenpeace India.    He adds: "Most of the time, they don't even know the effects the toxic air is having on their health. Poor communities are definitely at the losing end."
Date: Thu, 21 Mar 2019 12:17:21 +0100

Geneva, March 21, 2019 (AFP) - The number of people in Zimbabwe affected by a devastating cyclone and flooding has jumped to 200,000, with most of the damage occurring near the Mozambique border, the UN said Thursday.    The initial estimate of those hit in Zimbabwe was 15,000 but World Food Programme (WFP) spokesman Herve Verhoosel told reporters in Geneva that the numbers had surged following an overnight assessment.
Date: Wed, 20 Mar 2019 09:25:29 +0100
By Vishal MANVE

Mumbai, March 20, 2019 (AFP) - India's Jet Airways was fighting multiple crises Wednesday after grounding six planes, leaving it with only a third of its fleet flying, while pilots have threatened to walk out and a major shareholder is reportedly looking to offload its huge stake.   The problems at India's number-two carrier come as other airlines struggle to turn a profit despite the sector rapidly expanding in the country over recent years.   Jet, which employs more than 20,000 people, is gasping under debts of more than $1 billion and has now been forced to ground a total of 78 of its 119 aircraft after failing to pay lenders and aircraft lessors.   In a statement late Tuesday announcing its latest grounding, the firm it said it was "actively engaging" with lenders to secure fresh liquidity and wanted to "minimise disruption".

But with hundreds of customers left stranded, Jet's social media accounts have been flooded with often suddenly stranded passengers demanding information, new flight tickets and refunds.   "@jetairways We book our flights in advance so that we save on travel cost and you are sending cancellation (message) now?", read one irate tweet on Wednesday.   "I have sent a DM (direct message) regarding my ticket details. Please respond!", said Sachin Deshpande, according to his Twitter profile a design engineer.   Another, Ankit Maloo, wrote: "Received an email for all together cancellation of flight days before departure without any prior intimation or communication over phone!"   The firm is also facing pressure from its many pilots who have not been paid on time, with unions threatening they will walk off the job if salaries do not arrive soon.

- Alarm bells -
"Pilots will stop flying jet planes from 1st April 2019 if the company does not disburse due salaries and take concrete decisions," a spokesperson for the National Aviator's Guild, a pilots union, told AFP.   India's aviation regulator on Tuesday warned Jet Airways to ensure that staffers facing stress are not forced to operate flights.   Meanwhile, Bloomberg reported that Etihad Airways of the United Arab Emirates has offered to sell its 24 percent stake in Jet to State Bank of India (SBI).   A collapse would deal a blow to Prime Minister Narendra Modi's pragmatic pro-business reputation ahead of elections starting on April 11.   India's passenger numbers have rocketed six-fold over the past decade with its middle-class taking advantage of better connectivity and cheaper flights.    The country's aviation sector is projected to become the world's third-largest by 2025.

But like other carries, Mumbai-based Jet has been badly hit by fluctuating global crude prices, a weak rupee and fierce competition from budget rivals.   Alarm bells for Jet first rang in August when it failed to report its quarterly earnings or pay its staff, including pilots, on time. It then later reported a loss of $85 million.   In February, it secured a $1.19 billion bailout from lenders including SBI to bridge a funding gap, but the crisis has since deepened.   "Jet Airways is rapidly reaching a point of no return and running out of assets to keep itself afloat," Devesh Agarwal, editor of the Bangalore Aviation website, told AFP.   "The only solution is equity expansion by diluting its stakes but Jet is just trying to cut losses and running out of options," Agarwal said.    Shares in Jet Airways were down more than five percent on Wednesday.
Date: Tue 19 Mar 2019
Source: Pragativadi [edited]

Three members of a family, including 2 minor girls, fell sick after consuming toxic wild mushrooms in Mirigikhoji village under Patana block in Keonjhar district.

According to sources, some members of the family complained of vomiting and nausea after consuming the wild mushroom. They were rushed to the Keonjhar district headquarters hospital where their health condition is stated to be critical.

Although the actual reason behind the illness has not been ascertained, the doctor suspected it to be a case of food poisoning, sources said.
=====================
[In India, mushrooms have been a source of diet and article of commerce for a long time and across many cultures. Poisoning results from unintentional consumption of wild poisonous mushrooms. The cases however remain undiagnosed, underreported and unpublished. A large number of suspected cases are reported in lay press. There have been small epidemics of mushroom poisoning culminating in mortality especially during monsoon. The published literature from India is sparse and mostly in the form of case reports  (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4298634/#bib2>).

There is no way to tell which mushrooms were consumed, and no clinical signs are reported. - ProMED Mod.TG]

[A map showing the location of the Keonjhar can be found at

[HealthMap/ProMED map available at:
Keonjhar, Orissa, India: <http://healthmap.org/promed/p/13795>]
Date: Thu 14 Mar 2019, 12:50 PM
Source: The Indian Awaaz [edited]

Over 100 schools have been closed after the dumping of toxic waste into a river caused hundreds of people to fall ill, including many children, authorities said in Malaysia. Over 500 people, many of them school pupils, have received medical treatment after inhaling the fumes.

A lorry [truck] is believed to have dumped the waste in southern Johor state last week, sending hazardous fumes across a wide area.

Education Minister Maszlee Malik said his Ministry has decided to close all 111 schools in the Pasir Gudang area immediately.
=========================
[It is very difficult to comment on what the toxin might have been. We know it produced fumes which were inhaled and resulted some individuals being treated, possibly for respiratory issues.

It is sad, and since it was dumped in a water way, we may see other individuals, and/or animals affected by the toxin. - ProMED Mod.TG

[HealthMap/ProMED map available at:
Date: Mon 18 Mar 2019
Source: Abidjan.net [in French, trans. ProMED Corr.SB, edited]

Two people, including a 70-year-old woman, died on [Sun 17 Mar 2019] in the village of Yrouzon and 4 other people were admitted to the general hospital of Duekoue (West, region of Guemon), after having consumed a decoction of herbal tea, supposed to cure malaria.

According to information collected from the victims, a decoction of herbal tea was prepared the day before by the wife of the young -30 years old- BN, that passed away instantly. [BN may have been trying to relieve the pain of what he believed to be chronic malaria]. BN, affected with chromatic [chronic?] malaria took a sip of the product with the hope of relieving his pain.

Also, his family members of who came to visit him, each took a sip, which was supposed to mitigate their "palu" [pain]. But unfortunately, the following events were; BN, having consumed the first liquid, lost consciousness and died during his evacuation. The old woman, aged about 70, fell on her way home and died on the spot. The other 4 affected people were fortunate enough to be admitted to the general hospital.  An investigation is opened to determine the causes of the tragedy.
======================
[Herbs can be healing, or dangerous. They become dangerous when the plant is misidentified, or mistaken. When a toxic plant is incorrectly identified as non-toxic beneficial herb, then disastrous consequences can follow. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
Date: Fri 15 Mar 2018
Source: WJHG [edited]

A rabies alert has been expanded to all of Bay County. The Florida Department of Health in Bay County is expanding a rabies alert issued in March [2019]. Health officials say there were 4 confirmed rabies cases in the span of a month.

Health officials say the most recent case involved a rabid raccoon killed by dogs off Oakenshaw Drive between Highway 2301 and Camp Flowers Road in Youngstown. Florida law requires pets 4 months or older to be vaccinated. If an animal is not vaccinated, keep the pet inside. Health officials say cats are the most likely to be infected with rabies.

Rabies is a fatal viral infection of the nervous system transmitted from animal to animal or animal to human by bite, scratch, or mucous membrane exposure. If your pet fights a wild animal, contact the Florida Department of Health in Bay County. The wild animal will need to be tested for rabies. Health official ask you do not shoot the wild animal in the head.  The alert will last 60 days.
==========================
[In the eastern USA, the main terrestrial reservoir of rabies is raccoons (see map of distribution of major rabies virus variants among carnivores at

A strategy that has been developed to control and contain the spread of rabies in raccoons is the use of oral rabies vaccination [ORV], which can be implemented by distributing bait. Florida has not been included in recent ORV actions, but the northwestern part of the state has been established as a zone needing enhanced rabies surveillance (see <https://doi.org/10.3390/tropicalmed2030034>). - ProMED Mod.PMB]

[HealthMap/ProMED-mail map:
Florida, United States: <http://healthmap.org/promed/p/212>]
Date: Wed 20 Mar 2019
From: Lucille Blumberg, John Frean, Evan Shoul <lucilleb@nicd.ac.za>,
<johnf@nicd.ac.za>, <evan.shoul@gmail.com> [edited]

A game hunter working in an area close to the South Luangwa National Park, Zambia has been admitted to a Johannesburg hospital with laboratory confirmed East African trypanosomiasis (EAT) [_Trypanosoma rhodesiense_] following an acute febrile illness.

He has a typical trypanosomal chancre on the dorsum of his hand, and a scanty parasitaemia was noted on a Giemsa- stained blood smear in Lusaka and Johannesburg laboratories.

On admission, he was moderately hypotensive with a tachycardia, had a mild acidosis, but no definite myocarditis, no ARDS, or clinical CNS pathology. He had a profound leucopaenia (WBC: 1.5) and thrombocytopenia (but no bleeding), moderately deranged hepatic transaminases (chronic hepatitis B infection) but normal renal function.

Suramin treatment was commenced promptly after admission. A CSF examination will be carried out later this week once the peripheral parasitaemia has cleared and the thrombocytopaenia has improved.

This is the 3rd case of EAT admitted to the unit in the past 4 months, one person working in game park, Malawi reserve (fatal case) and one person working in a game management area close to the Lower Zambezi National Park, Zambia.
-----------------------------------------------
Prof Lucille Blumberg
John Frean
Centre for Emerging Zoonotic and Parasitic Diseases
GeoSentinal Site
National Institute for Communicable Diseases
Johannesburg, South Africa
<lucilleb@nicd.ac.za>
<johnf@nicd.ac.za>
and
Dr Evan Shoul
Infectious Diseases Specialist
Johannesburg, South Africa
===========================
[ProMED thanks Lucille Blumberg, John Frean, and Evan Shoul for this report.

The South Luangwa National Park is in eastern Zambia, the southernmost of 3 national parks in the valley of the Luangwa River (see map at: <https://en.wikipedia.org/wiki/South_Luangwa_National_Park>).  African trypanosomiasis is a zoonotic disease with a reservoir in wild game animals and is a risk throughout game parks in Africa including Zambia. More information can be found on the FAO (Food and Agricultural Organization of the United Nations) website on African trypanosomiasis: <http://www.fao.org/paat/en/>.
The case story presented here shows that trypanosomiasis is a differential diagnosis to malaria and indeed haemorrhagic fever in endemic areas. Thus, such patients with a negative malaria blood film should be suspected and investigated for trypanosomiasis, also called African sleeping sickness. - ProMED Mod.EP]

[HealthMap/ProMED maps available at: