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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: Wed 29 May 2019 Source: Xinhua [edited] <http://www.xinhuanet.com/english/2019-05/29/c_138100250.htm>
A fresh positive polio case was detected in Afghanistan's eastern province of Kunar, bringing the number of confirmed cases of poliovirus to 8 since January this year [2019], a public health official said on Wednesday [29 May 2019]. "A new polio case has been reported from Watapur district of Kunar province which permanently paralyzed a 3-month-old boy," Wahidullah Mayar, spokesperson for the Ministry of Public Health, tweeted.
The latest case is the 1st case from the eastern Afghan region this year [2019], and the rest of 7 cases have been reported from southern provinces, he added. Poliovirus can be rapidly transferred, and the only way [to prevent the disease] is vaccination, according to the official.
The ongoing insurgency and conflicts have been hindering the efforts to stamp out the infectious disease in the mountainous country, as more than 1 million children from areas inaccessible to vaccination teams missed the latest vaccination drive.  [byline: Xuxin] ========================
[As this media report is based on a governmental announcement, I suspect this case will be in next week's global update, providing information on the date of onset of paralysis. It is noteworthy that this is the 1st case reported in Kunar province this year (2019). This represents the 8th case of WPV1-associated paralysis reported by Afghanistan with date of onset since 1 Jan 2019.
A map of Afghanistan showing provinces and districts can be found at <http://ontheworldmap.com/afghanistan/administrative-map-of-afghanistan-with-provinces-and-districts.jpg>.  Watapur district is located in the north central part of Kunar province. The southern and eastern districts of Kunar province border with Khyber Pakhtunkhwa and the tribal districts of Pakistan. The region is known for civil unrest. - ProMED Mod.MPP]
Date: Mon, 13 May 2019 18:12:22 +0200

Jalalabad, Afghanistan, May 13, 2019 (AFP) - At least three people were killed and another 20 wounded in a series of blasts in the eastern Afghan city of Jalalabad on Monday, an official said.   Nangarhar provincial spokesman Attaullah Khogyani said three blasts rocked the city centre, and had taken place near an armoured police vehicle.   "The nature of explosions is not clear, but it could be IEDs," Khogyani said, using the acronym for improvised explosive devices.   "So far we can confirm three people have been killed and 20 wounded."

No group immediately claimed responsibility for the attack, but the area around Jalalabad is home to fighters from both the Taliban and the Islamic State group's Afghan affiliate.   On March 6, at least 16 people were killed in a suicide attack on a construction company in Jalalabad, which is near the Pakistan border.   Violence in Afghanistan has continued apace even during the holy month of Ramadan, and despite government calls for a ceasefire.
Date: Sat, 11 May 2019 14:59:03 +0200

Ghazni, Afghanistan, May 11, 2019 (AFP) - A landmine explosion killed seven children and wounded two others in southern Afghanistan on Saturday, officials said, as war ordnance again claimed civilian lives.   The blast occurred in Ghazni province, south of the capital Kabul, when the children stepped on a landmine while playing near a main road, provincial spokesman Aref Noori told AFP.   "The mine was planted by the Taliban on a main road to inflict casualties on security forces," he said.   The Taliban did not immediately respond to a request for comment.   The insurgents often use roadside bombs and landmines to target Afghan security forces, but the lethal weapons also inflict casualties on civilians.   Amanullah Kamrani, a member of Ghazni provincial council, said the children were aged between seven and nine and at least four of them belonged to one family. 

Years of conflict have left Afghanistan strewn with landmines, unexploded mortars, rockets and homemade bombs -- and many are picked up by curious children.   Last month, seven children were killed and 10 more wounded in the eastern province of Laghman when a mortar shell exploded while they were playing with it.    According to the United Nations, 3,804 civilians -- including more than 900 children-- were killed in Afghanistan in 2018, with another 7,000 wounded. It was the deadliest year to date for civilians in Afghanistan's conflict.
Date: Tue, 16 Apr 2019 14:52:10 +0200

Kabul, April 16, 2019 (AFP) - Torrential rainstorms have lashed drought-stricken Afghanistan in recent days, bringing widespread flooding that has killed at least five people and washed away homes including in the capital Kabul, officials said Tuesday.   While some welcomed the wet weather after the punishing dry spell of recent years, residents complained about the lack of infrastructure and government assistance to help them clear up from the deluge.

Sixteen of Afghanistan's 34 provinces were hit in the past 24 hours, destroying or damaging hundreds of houses and sweeping away livestock, said Hashmat Bahaduri, a spokesman for Afghanistan's National Disaster Management Authority (ANDMA).   Hardest hit was Herat province in western Afghanistan, where at least five people were killed when their houses collapsed, Jilani Farhad, a spokesman for the local governor said.   Officials were also searching for 17 people whose minivan was swept away by flooding in the province's Obey district late Monday, Farhad added.    "There were women and children in the vehicle, we are searching but haven't found any sign of them yet," he said.

Extraordinary scenes played out in the capital, where the usually parched Kabul River swelled suddenly, bursting its banks in places and swamping surrounding streets and neighbourhoods with about one metre (three feet) of water in places.   Drug addicts who normally spend their time in the riverbed or hiding under bridges could be seen openly smoking opium at street level as water swirled around them.   By Tuesday, authorities were warning locals living along the river to be prepared to evacuate their homes as water levels surged.   Bahaduri said 113 houses had already been partially or completely destroyed in Kabul.

In the capital, a university student named Mujtaba bemoaned a lack of drainage canals, but others welcomed the rain.   "It is a bliss to have all this water and rain, we are thankful to God to have rain and get rid of the drought problems," Kabul resident Mansoor Majab told AFP.   Years of dry weather, combined with a booming population and wasteful consumption, have drained Kabul's water basin, forcing residents to drill ever-deeper wells.   This winter saw heavy snowfall across parts of Afghanistan, which had led to flash floods in the spring melt.   Over one hundred people had been killed as of March 28 due to flooding in Afghanistan so far this year, according to ANDMA.
Date: Mon 1 Apr 2019, 4:39 PM
Source: Xinhua Net [edited]

A 2-year-old child was reported to have been affected by poliovirus despite receiving anti-polio vaccination in Afghanistan's southern province of Uruzgan [Oruzgan], a local official said on [Mon 1 Apr 2019].

The case was found affecting a baby-boy in Charchino district of the restive province, where he received 5 times anti-polio immunization, Khan Agha Miakhil, director of provincial public health department, told Xinhua.

The ongoing insurgency and conflicts have been hindering the efforts to stamp the infectious disease out in the mountainous country, he said.

The latest confirmed polio cases have risen to 2 so far this year [2019] while 20 polio cases were registered in the country last year [2018], according to health officials.
=======================
[With the addition of this case, it will bring the number of confirmed cases of polio reported from Afghanistan this year (2019) to 3; 2 prior cases were reported from Kandahar province. The total number of cases reported by Afghanistan during 2018 was 21, including 2 cases from Uruzgan (Oruzgan) province.

The history of 5 doses of polio vaccine is an unfortunate occurrence, but well observed in many countries due to competing infections for receptor sites. One wonders if this child had received the recommended 1 dose of IPV as part of the vaccinations. Below are a collection of references that can give an overview of the observations and studies done to address the issue of observed OPV "vaccine failure" and possible causes.

Uruzgan province shares it's southern border with Kandahar province where the prior cases of polio were reported this year (2019) (see

The HealthMap/ProMED map of Afghanistan can be found at:

References discussing challenges in vaccine efficacy with OPV.
1. Nasir UN, Bandyopadhyay AS, Montagnani F, et al. Polio elimination in Nigeria: A review. Hum Vaccin Immunother. 2016 Mar 3;12(3):658-63. doi: 10.1080/http://promedmail.org/post/21645515.2015.1088617.
Full article available at:
2. Paul Y and Priya. Polio eradication in India: some observations. Vaccine. 2004 Oct 22;22(31-32):4144-8.
Abstract available at:
3. John TJ and Vashishtha VM. Eradicating poliomyelitis: India's journey from hyperendemic to polio-free status. Indian J Med Res. 2013 May;137(5):881-94.
Full article available at:
4. Taniuchi M, Platts-Mills JA, Begum S, et al. Impact of enterovirus and other enteric pathogens on oral polio and rotavirus vaccine performance in Bangladeshi infants. Vaccine. 2016 Jun 8;34(27):3068-3075. doi: 10.1016/j.vaccine.2016.04.080. Epub 2016 May 3.
Full article available at:
5. Saleem AF, Mach O, Quadri F, et al. Immunogenicity of poliovirus vaccines in chronically malnourished infants: a randomized controlled trial in Pakistan. Vaccine. 2015 Jun 4;33(24):2757-63. doi: 10.1016/j.vaccine.2015.04.055. Epub 2015 Apr 24.
Full article available at:
6. Patriarca PA. Poliomyelitis in selected African and Asian countries. Public Health Rev. 1993-1994;21(1-2):91-8.
Abstract available at:
7. John TJ. Experience with poliovaccines in the control of poliomyelitis in India. Public Health Rev. 1993-1994;21(1-2):83-90.
Abstract available at:
8. Balraj V, John TJ and Thomas M. Efficacy of oral poliovirus vaccine in rural communities of North Arcot District, India. Int J Epidemiol. 1990 Sep;19(3):711-4.
Abstract available at:
9. Sutter RW, Patriarca PA, Brogan S, et al. Outbreak of paralytic poliomyelitis in Oman: evidence for widespread transmission among fully vaccinated children. Lancet. 1991 Sep 21;338(8769):715-20.
Abstract available at:
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Comoros

Comoros US Consular Information Sheet
May 21, 2008
COUNTRY DESCRIPTION:
The Union of the Comoros is a developing nation located in the Indian Ocean off the east coast of Africa.
Comoros consists of three islands, Ngazidja (also known
s Grand Comore), Moheli, and Anjouan, that cover about 900 square miles.
A fourth island, Mayotte, is claimed by Comoros but remains a territory of France.
Ngazidja is home to the capital city, Moroni, and is the most developed of the three islands.
Facilities for tourism are limited and telecommunication links are unreliable.
French, Arabic, Swahili, and Comorian Creole are spoken.
Read the Department of State Background Notes on the Union of Comoros for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and onward/return ticket are required.
Visas are available from the Comoran Mission to the United Nations in New York; American citizens visiting Comoros can obtain a free, 24-hour transit visa upon entry.
The following day, visitors are required to go to the immigration office in Moroni to change their visa status.
A fee is charged, depending on length of stay.
Travelers should obtain the latest details from the Mission of the Union of Comoros, 420 East 50th Street, New York, NY 10022; telephone number (212) 972-8010, fax (212) 983-4712.

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:
Comoros has experienced frequent strikes and civil unrest, resulting in violent clashes between police and demonstrators.
The most recent unrest involved the de facto separation of Anjouan from the Union government.
In March 2008, Union forces re-took Anjouan and are preparing the island for elections.
The former leader of Anjouan, Mohamed Bacar, has applied for asylum with France and is being held on the French Island of Reunion while his asylum claims is adjudicated.
As the government completes the transition to constitutional federalism and as Bacar’s asylum claim is pending, periodic strikes and protests will likely continue to occur.
U.S. citizens should avoid political rallies and street demonstrations as even demonstrations intended to be peaceful can turn confrontational and possibly escalate into violence.
American citizens are therefore urged to avoid the areas of demonstrations if possible, and to exercise caution if within the vicinity of any demonstrations.
Conditions are subject to rapid change on each of the three islands of the Comoros due to weak political institutions and a lack of economic development.
In a rare, apparently religious-based attack, a clinic run by a foreign Christian organization was firebombed on the island of Grande Comore in August 2007.
Religious intolerance and religious-based violence remain very unusual in Comoros.

Although foreign residents and visitors have not been targeted, the potential for further outbreaks of civil disorder remains high, and Americans should exercise caution and good judgment, keep a low profile, and remain vigilant with regard to their personal security.
U.S. citizens are encouraged to register with the U.S. Embassy in Antananarivo, Madagascar, if visiting or residing in Comoros.
Embassy contact information is provided below.
For the latest security information, Americans traveling abroad should regularly monitor the Department’s web site, where the current Travel Warnings and Public Announcements, including the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for 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:
U.S. travelers are advised to be vigilant against pick-pocketing and other forms of petty crime when visiting crowded market areas, parks, and at the beaches.
Violent crime is uncommon.
The most commonly reported crime is breaking into homes.
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, help you 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:
Medical facilities in Comoros are poorly equipped.
Travelers should bring their own supplies of prescription drugs and preventive medicines. Malaria is prevalent in Comoros.
Travelers to Comoros should take malaria prophylaxis.
The serious and sometimes fatal strain of malaria, P. falciparum, is resistant to the anti-malarial drug chloroquine.
Because travelers to Comoros are at high risk for contracting malaria, the Center for Disease Control and Prevention (CDC) advises that travelers should take one of the following antimalarial drugs: mefloquine (Lariam™), doxycycline, or atovaquone/proguanil (Malarone™).
The CDC has determined that a traveler who is on an appropriate antimalarial drug has a greatly reduced chance of contracting the disease.
In addition, other personal protective measures, such as the use of insect repellents, help to reduce malaria risk.
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and tell the physician their travel history and what antimalarials they have been taking.
For additional information on malaria, protection from insect bites, and anitmalarial drugs, please visit the CDC Travelers' Health web pages.
The East African Indian Ocean islands have seen a rise in the cases of chikungunya, a viral dengue-like ailment, and dengue itself.
As with malaria, chikungunya and dengue are transmitted by mosquitoes.
Every effort should be made to use repellants, proper clothing and barriers that discourage/prevent mosquito bites.
The CDC web site contains further information on chikungunya at http://www.cdc.gov/ncidod/dvbid/chikungunya/ and dengue at http://wwwn.cdc.gov/travel/yellowBookCh4-DengueFever.aspx.
There have been occurrences of measles in Comoros, with outbreaks of greater severity on the islands of Anjouan and Moheli.
Travelers are advised to ensure that their measles vaccinations are up to date.
Further, information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith.
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and if 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 Comoros is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
In Comoros, one drives on the right side of the street.
Roads are ill-maintained, congested, very narrow and poorly lit at night.
Travelers should exercise extreme caution when driving after dark.
Most urban roads are paved, but many rural roads are not.
Many roads are full of potholes and dangerous curves.
Most roads have no posted speed limits, but road conditions limit speeds to below 30 miles an hour.
Drivers and front seat passengers are required to wear seat belts.
There are no laws regarding child safety seats.
There are no organizations in Comoros that provide emergency or roadside assistance.
Individuals involved in accidents rely on passersby for assistance.
Taxis or a rental car with driver are preferable to public transportation.
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 Comoros, the U.S. Federal Aviation Administration (FAA) has not assessed Comoros’ 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: While religions other than Islam are permitted in Comoros, evangelization is illegal.
Violators of this law can be fined or imprisoned.
Few establishments accept credit cards in the Comoros and most prefer Comoran Francs or Euros to dollars.
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 laws of Comoros, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use or trafficking in illegal drugs in Comoros are strict, with convicted offenders receiving a mandatory minimum five-year jail sentence and heavy fines.
Engaging in sex 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:
The United States has no Embassy in Comoros.
Americans living or traveling in Comoros are encouraged to register with the U.S. Embassy in Antananarivo, Madagascar through the State Department's travel registration web site, and to obtain updated information on travel and security within Comoros.
Americans without Internet access may register in person at the U.S. Embassy in Antananarivo.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency. The U.S. Embassy is located at 14-16 Rue Rainitovo, Antsahavola, Antananarivo.
The mailing address is B.P. 620, Antsahavola, Antananarivo, Madagascar; telephone [261] (20) 22-212-57; fax [261] (20) 22-345-39.
The Embassy web site is http://www.usmission.mg/.
*

*

*
This replaces the Country Specific Information dated October 26, 2007 to update the section on Safety and Security.

Travel News Headlines WORLD NEWS

Date: Sat 11 May 2019
Source: Revue Francophone des Laboratoires May 2019, no. 512, p. 18 [in French, transl., abridged, edited]

In February 2019, 63 cases of Rift Valley fever were diagnosed by PCR at the Mayotte hospital laboratory. The first 5 cases were detected in November 2018 by the hospital laboratory and confirmed by the Reunion Reference Center. The vector control center and the health emergency unit of the ARS OI [The Indian Ocean Health Agency] were able to analyze the epidemiology of 36 cases: 21 subjects had been in direct contact with animals and 5 others lived nearby; the last 5 declared no direct or indirect contact with animals. In addition, in 15 cases, patients had consumed raw or curdled milk. Finally, it is interesting to note that 21 patients resided in the communes of west-central Mayotte. With regard to the 63 confirmed cases, the average age of the patients was 38 years (range, 10 to 74 years), of which 16% were under 20 years, with a male/female sex ratio of 4. In addition, 29 patients lived in rural or semi-urban dwellings, 9 of whom lived in traditional huts. In terms of symptoms, 24 patients had headache, 19 arthralgia, 17 myalgia, 14 asthenia, 6 retro-orbital pain, and 6 nausea and vomiting. An entomological survey found several mosquito species, especially _Culex_, _Aedes_, _Anopheles_ and _Mansonia_.

At the same time, samples taken from farms in which abortions were reported identified 33 outbreaks of 1 to 6 animals, including 25 cattle and 8 small ruminants [the figures have increased since; see in comments].

Rift Valley fever, which has been present in Mayotte for a long time, had disappeared in the past decade, with 10 patients detected in 2008 following an epidemic in Kenya. Then there was a steady regression of verified seroprevalence on ruminants. But this seroprevalence rose to 3.6% in 2017 and then to 10.1% in 2018, indicating a new circulation of the virus. This is probably due to illegal and continuous importation of contaminated livestock.  [By: Dr. Patrice Bouree]
============================
[Mayotte's health authorities published on Sat 11 May 2019 the following update.

"Epidemiological situation as of May 10, 2019. In total, since the beginning of the epidemic (end of November 2018):
1. Animals.
Samples taken by veterinarians on sick animals or during abortions have identified 119 foci of sick animals (of which 95 are cattle and 24 small ruminants). Animal foci are mainly located in the center and northwest of the island. Additional outbreaks have appeared since the end of March [2019] in the communes of Dembeni, as well as on Petite Terre.
2. Humans.
The CHM laboratory reported 130 human cases of RVF [Rift Valley fever] at the monitoring and health emergencies platform of the ARS OI (CVAGS) of Mayotte.

The number of reported cases has remained stable since the beginning of April [2019] (on average, 4 to 5 reported cases per week). Since the beginning of the health alert, human cases have remained mainly in the center and northwest of the island." (<https://lejournaldemayotte.yt/2019/05/11/fievre-de-la-vallee-du-rift-a-mayotte-stabilite-du-nombre-de-nouveaux-cas/>).

Application of the following measures will contribute to the prevention of future RVF events in animals and humans in Mayotte:
1. Preventing illegal introduction of ruminants;
2. Preventive vaccination of cattle, sheep and goats (preferably, with an inactivated RVF vaccine; see http://promedmail.org/post/20190422.6434655). - ProMED Mod.AS]

[It would be of interest to know what role, if any, mosquito vectors are playing in transmission of RVF virus during the current outbreak. If _Aedes_ mosquitoes are involved, there is a risk of transovarial transmission of the virus that can persist for months in mosquito eggs with resumption of transmission when those eggs hatch and infected adult female mosquitoes emerge. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Region d'outre-mer de Mayotte, France:
Date: Mon, 25 Mar 2019 15:42:31 +0100
By Philippe ALFROY

Bambao, Comoros, March 25, 2019 (AFP) - The Bambao hospital, nestled in a tropical forest on Anjouan island in the Comoros, was meant to bring state-of-the-art medical care to the poor Indian Ocean nation.   Just two years later, the hospital is deep in debt and shunned by potential patients who find it too costly.   "A poisoned chalice", "a colossus with feet of clay", "a sinking ship" are among the cliches that chief paediatrician Ahmed Rakibou used to describe the facility funded and built under a Chinese aid scheme.   "If they had consulted us while building it, this could have been a jewel," the doctor said, regretting that "today it's all going straight to hell".   The hospital is some 30 kilometres (about 20 miles) east of Mutsamudu, the capital of Anjouan, the poorest of the three islands comprising the Union of the Comoros.

The aim was to make the hospital a flagship of Comoran healthcare, with 120 beds in a brand-new building, a team of 167 staff, many recruited locally, and modern equipment including a digital radio scanner.   China's ambassador to the Comoros, Xiao Ming, hailed a "new page in the annals of cooperation" at the opening ceremony, saying "public health has always had a priority place in Sino-Comoran cooperation".   But a project that cost four billion Comoran francs (8.1 million euros, $9.2 billion) today looks more like a ghost ship, with a handful of patients wandering its corridors in stifling heat. For lack of funds, about 100 staff jobs have not been filled.

- 'Not many patients' -
In the emergency ward, a doctor silently examines a child's injured arm. The lethargic mood is broken only by the arrival of an ambulance carrying the victim of a motorcycle accident.   "Our activity is very varied," nurse Ali Mosthadoi says cautiously before going further. "In fact, we don't have many patients."

Deputy director Sidi Chaanbane was more forthcoming. Since the hospital was opened by President Azali Assoumani in 2017, it has faced mounting difficulties, he said.   "At the start, the road from Mutsamudu was in a very bad state and patients had trouble getting here," the administrator said. "It's been repaired since, but our real problem is that we sorely lack equipment and staff."   In addition to staff salaries, the Comoran state provides just five million francs (10,000 euros) a month, but the hospital needs three times as much to pay its bills.   "We can't balance the budget," Chaanbane said.

Day-to-day management is a nightmare. The scanner broke down soon after it was first used. Repairs were not covered by the Chinese cooperation agreement, so the hospital took out a loan to get the machine working again.   The main problem is the cost of treatment, which is not free in the former French colony, independent since 1975.   Much of the funding comes from the French Development Agency (AFD) in its aid budget. France still rules over the fourth major island in the archipelago, Mayotte.   The three islands forming Comoros lack the standard of living on Mayotte and are far from able to make up the remaining health budget.

- 'Expensive' -
Rakibou said the hospital charges 125,000 Comoran francs for a Caesarean birth.   "What Comoran can pay that?" he asks. "No -- this hospital is not made for the population."   Kanissa Adbou, 27, brought her eight-year-old daughter who trod on a nail to the hospital. "The treatment is expensive. If I could afford it, I would go to Mayotte because there, hospital is free."   Those who believed that providing a modern hospital on Anjouan would dissuade Comorans from trying their luck on Mayotte have been disappointed, although the trip is illegal.   "People here prefer to pay 1,000 euros to go to Mayotte by kwassa kwassa (human traffickers' dugouts) than to come to us," a nurse said. "They trust only white doctors."

The failure to put the sophisticated equipment at Bambao to regular good use enrages Ahmed Abdallah, secretary general of the Hombo public hospital in Mutsamudu.   "The money spent there would have been enough to repair our buildings, replace our equipment and build roads so that sick people could come from nearby villages," he said.   "We don't have even a single ambulance, yet the government has I don't know how many four-wheel drives."   Health Minister Fatma Mbaraka declined to respond to requests for comment from AFP.   But Rakibou refuses to throw in the towel. He hopes that the winner of Sunday's presidential election and the international community will come up with increased funding. "It wouldn't take much to change our lives!" he said.
Date: Fri 15 Mar 2019
Source: Le Journal de Mayotte [in French, trans. ProMED B, edited]

The circulation of Rift Valley fever (RVF) continues in Mayotte. An animal disease of viral origin, Rift Valley fever mainly affects domestic ruminants (cattle, sheep, goats), causing abortions and high mortality in young animals. It can be transmitted from the infected animal to humans.

In total, since the beginning of the epidemic (end of November [2018]),
- samples taken by veterinarians from sick animals or during abortions led to the identification of 8 new outbreaks this week [week of Mon 11 Mar 2019], for a total of 60 cases in animals (including 49 cattle). Animal foci are located mainly in the centre and north west of the island;
- a total of 101 human cases of RVF have been reported to the platform/cell watch and health emergencies of the ARS OI (CVAGS) of Mayotte by the CHM laboratory. Of those who could be interviewed, almost 80% report having been in contact with animals;
- since the beginning of the health alert, human cases have been located mainly in the centre and north west of the island, with nearly 60% of cases in Chiconi and Tsingoni.

Since 25 Feb 2019, the weekly number of new human cases has been on the decrease.  [byline: Anne Perzo]
========================
[This Rift Valley fever (RVF) outbreak has been going on since November 2018. The number of human cases of RVF has increased from 82 to 101 in about 2 weeks. However, it is good to learn that the number of new human cases is decreasing. The above report implies that the human infections are the result of contact with infected animals or their products, with fewer from virus transmission by mosquito vectors. The cattle cases certainly are the result of mosquito transmission.

Because RVF virus can be transovarially transmitted in populations of aedes mosquito vectors, and those resulting eggs can persist for a long period of time in nature, cases can occur periodically when the virus-containing eggs hatch, and infected adult females emerge from them. There is a risk that RVF will reappear on the island after the current outbreak has ended.

Recent studies have shown that RVF virus may severely injure human foetuses if contracted by mothers during pregnancy. There is no indication of whether any of the 101 RVF virus-infected people were pregnant. Abortions in infected livestock are common. There is no vaccine available for human use, but there is for livestock. There is no mention of whether the livestock populations in the area have been vaccinated.

The clinical findings related to the above human cases are not mentioned. In an earlier comment, ProMED noted that: "The most common complication associated with RVF is inflammation of the retina. As a result, approximately 1-10% of affected patients may have some permanent vision loss. Approximately 1% of humans that become infected with RVF virus die of the disease." - ProMED

[ealthMap/ProMED-mail map of Region d'outre-mer de Mayotte, France:
Date: Fri 22 Feb 2019
Source: Le Journal de Mayotte [in French, trans. ProMED Corr. SB, edited]

Rift Valley fever (RVF) continues to circulate in Mayotte among the herds of ruminants, and the number of human cases is increasing.

The prefecture of Mayotte, in collaboration with the ARS Indian Ocean and the Directorate of Food, Agriculture and Forestry of Mayotte (DAAF) reminds the population of the importance of implementing recommendations and preventive actions to avoid being ill.

Epidemiological situation as of 22 Feb 2019:
- Samples taken by veterinarians from sick animals or during abortions have identified 33 animal FVR outbreaks.
- Since late November [2018], 63 human cases of RVF have been reported to the monitoring and health emergencies platform of the ARS OI (CVAGS) of Mayotte by the CHM laboratory.

Rift Valley fever (RVF) is a zoonosis (infectious disease that can be transmitted from animals to humans) of viral origin, which mainly affects domestic ruminants (cattle, sheep, goats), causing abortions and high mortality in young animals.

Transmission to humans can occur in different ways:
- By contact with blood, body fluids, or tissues of a sick animal (during slaughter, cutting of meat, calving, care, etc.). The most exposed people are therefore professionals such as breeders, slaughterhouse employees, and veterinarians.
- By mosquito bite, vectors of the disease near infected flocks, often in the rainy seasons.
- When eating unboiled milk or unpasteurized curd from an infected animal.

There is no [direct] person-to-person transmission of RVF [virus].

The disease in humans is usually manifested by an influenza-like illness that clears in a few days and includes symptoms such as high fever (39 deg C [102 deg F]), muscle and / or joint pain, intense headaches, and fatigue. However, in 5% of cases, more serious forms may occur: ocular meningitis / meningoencephalitis, haemorrhagic fever.

Recommendations for protection against the disease-causing virus:

For farmers and people in contact with animals:
- Wash hands with soap after contact with domestic ruminants (cattle, sheep, goats).
- Do not handle unprotected or diseased animals or abortion products without protection.
- Do not handle animal carcasses without protection.
- Wear gloves, goggles, and especially a mask for the slaughter of any animal. Infected animals may have no signs, although they can transmit the virus.

For food consumption:
Transmission by ruminants
- Boil the milk
- Do not consume curd unless it has been boiled and curdled with lactic fermentation.
- Wash hands after cutting meat.
- Do not eat uncooked meat.
- Do not consume the meat of a sick animal.

To protect yourself from mosquito bites:
- Eliminate breeding sites; empty all containers that may contain water.
- Use mosquito nets and repellents.

In case of appearance of symptoms, consult your doctor immediately.

Management measures:
By the Directorate of Food, Agriculture, and Forestry: The monitoring of Rift Valley fever involves the monitoring of abortions. Farmers are asked to report to veterinarians without delay any abortions occurring in their animals in order to take samples for the disease. The prevalence of RVF in the exchange zone with Mayotte being important, the risk of spread of the disease is not negligible in case of uncontrolled import of animals.

By the Indian Ocean Health Agency: Since the1st report, each ill person is interviewed by the ARS Indian Ocean to identify the risk factors for the disease.

A treatment of larval breeding and a mosquito control are done by the service of the Anti-vector Fight [unit] to the homes of the sick persons and around the houses. Information to health professionals was made to strengthen surveillance and identification of human cases.  [Byline: Anne]
======================
[This Rift Valley fever (RVF) outbreak has been going on since November 2018. The numbers of human cases of RVF have increased from 31 to 63 in about 2 weeks. The above report does not indicate whether the human infections are the result of virus transmission by mosquito vectors, but the cattle cases certainly are. Because RVF virus can be transovarially transmitted in populations of _Aedes_ mosquito vectors, and those resulting eggs can persist for a long period of time in nature, cases can occur periodically when the virus-containing eggs hatch and infected adult females emerge from them. Recent studies have shown that RVF virus may severely injure human fetuses if contracted by mothers during pregnancy. There is no indication of whether any of the 63 RVF virus-infected people were pregnant. Abortions in infected livestock are common. There is no vaccine available for human use, but there is for livestock. There is no mention of whether the livestock populations in the area have been vaccinated.

The clinical findings related to the above human cases are not mentioned, but the symptoms associated with RVF infections in general are listed. In an earlier comment, Mod.CP noted that, "The most common complication associated with RVF is inflammation of the retina. As a result, approximately 1-10% of affected patients may have some permanent vision loss. Approximately 1% of humans that become infected with RVF virus die of the disease." - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Region d'outre-mer de Mayotte, France:
Date: Fri 1 Feb 2019
Source: Outbreak News Today [edited]

In the Indian Ocean, between Madagascar and the coast of Mozambique, sits the archipelago of Mayotte, a Department of France.  Health officials have reported an increase in autochthonous Rift Valley fever (RVF) cases in the past 6 weeks. Since the 1st human case was detected on [Tue 11 Dec 2018], health officials have reported 19 human cases. Most of the cases were located in the western part of the island.  Samples made on ruminants present around human cases were analyzed at CIRAD in Reunion for the search for the RVF virus. The results identified several positive animals in different villages located in west and center of the island.

In addition, an IgM-positive cattle has been reported in Mamoudzou. This 2-year-old cattle belongs to a breeding herd of 8 cattle, including 4 adults and 4 2-month-old calves. Biological control and investigations are underway.  ECDC reports that the detection of autochthonous Rift Valley fever cases on Mayotte is not unexpected, but the occurrence of 19 cases within a short time period is of concern, as current weather conditions (rainy season from November to March) are favorable for the vectors.

Rift Valley fever (RVF) is an illness that is primarily spread by direct contact with blood, fluids, or tissues of infected animals such as cattle, buffalo, sheep, goats, and camels. Less commonly, it can also be spread through mosquito bites.  Most people with RVF do not feel sick or have only mild illness. Symptoms of RVF include fever, weakness, back pain, dizziness, and weight loss. However, a small percentage (8-10%) of people may have more serious illness, such as severe bleeding, swelling of the brain, or eye disease. Approximately 1% of people who get RVF die from the disease.  [Byline: Robert Herriman]
*************************************
Date: Sat 2 Feb 2019
Source: ECDC Communicable Diseases Threats Report Week 5, 27 Jan - 2
Feb 2019 [edited]

According to Institut de Veille Sanitaire (InVS), from 11 Dec 2018 - 28 Jan 2019, 19 Rift Valley fever cases were confirmed on Mayotte. All cases were locally acquired. Among these cases, 14 are male and 5 are female, with an age range of 27-64 years.

Most of the cases were located in the western part of the island. Further investigations identified several positive ruminants in the western and central parts of the island.

According to CIRAD, Rift Valley fever seroprevalence among ruminants has decreased from 2008 to 2017, but significantly increased in 2017 and 2018 (3.6%, CI 95% [2.3-5.6%]) and 2018 and 2019 (10.1% CI 95% [6.5-15.3%]). In addition, according to InVS, one case imported from Comoros was reported by authorities on Mayotte in 2011.

The detection of autochthonous Rift Valley fever cases on Mayotte is not unexpected, but the occurrence of 19 cases within a short time period is of concern, as current weather conditions (rainy season from November to March) are favourable for the vectors.

ECDC will continue monitoring this event through epidemic intelligence activities and report again if there is a relevant epidemiological update.

[Map] Distribution of RVF human cases and ruminants, Mayotte, 11 Dec 2018 to 28 Jan 2019

[Graph] Distribution of RVF confirmed human cases, Mayotte, 11 Dec 2018 to 28 Jan 2019

Year-Week / Number of cases
2018-50 / 1
2018-51 / 0
2018-52 / 2
2019-01 / 2
2019-02 / 0
2019-03 / 2
2019-04 / 8
2019-05 / 4
========================
[It is not surprising to have both human and cattle Rift Valley fever (RVF) cases occur simultaneously. The above report does not indicate if the human infections are the result of virus transmission by mosquito vectors, but the cattle cases certainly are. Because RVF virus can be transovarially transmitted in populations of _Aedes_ mosquito vectors, and those resulting eggs can persist for a long period of time in nature, cases can occur periodically when the virus-containing eggs hatch and infected adult females emerge from them. Recent studies have shown that RVF virus may severely injure human fetuses if contracted by mothers during pregnancy. There is no indication if any of the 19 RVF virus-infected people were pregnant. Abortions in infected livestock are common. There is no vaccine available for human use, but there is for livestock.

The clinical findings related to the above human cases are not mentioned. In an earlier comment, ProMED Mod.CP noted that, "The most common complication associated with RVF is inflammation of the retina. As a result, approximately 1-10% of affected patients may have some permanent vision loss. Approximately 1% of humans that become infected with RVF virus die of the disease. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Region d'outre-mer de Mayotte, France:
More ...

Eritrea

Eritrea US Consular Information Sheet
November 26, 2008
COUNTRY DESCRIPTION:
Eritrea is a poor but developing East African country, the capital of which is Asmara. Formerly a province of Ethiopia, Eritrea became an independent country on M
y 24, 1993, following a 30-year struggle that culminated in an overwhelming referendum vote for independence. Tourism facilities are very limited. Read the Department of State Background Notes on Eritrea for additional information.

ENTRY/EXIT REQUIREMENTS:
All travelers should have a passport and valid visa prior to arrival; visas are not available at the airport unless specifically pre-authorized by the Eritrean government.
Travelers visiting Eritrea using a foreign passport do not need an exit visa, provided they leave before their entrance visa expiration date.
Persons staying beyond their entrance visa expiration date may be subject to fines or imprisonment, or be required to remain in Eritrea for an extended period while their case is reviewed in court.
All long-term residents, regardless of citizenship, must obtain an exit visa 30 days prior to departure, unless they hold a difficult-to-obtain multiple entry visa.
Upon entry and exit, visitors must declare all foreign currency, and may be asked to declare electronic equipment such as cameras, computers and video equipment.
Visitors must save all receipts for foreign exchange and present these upon departure to account for all foreign currency spent in Eritrea.
Failure to report foreign currency or meet customs requirements usually results in both a fine and imprisonment.
There is also a $20 airport departure tax.
Information about the airport tax and entry/exit requirements is available from the Embassy of Eritrea, 1708 New Hampshire Avenue NW, Washington, DC 20009; telephone (202) 319-1991; fax (202) 319-1304.
Overseas, inquiries may be made at the nearest Eritrean embassy or consulate.

U.S. citizens born in Eritrea, to Eritrean parents, or who in any other way appear to have Eritrean origins, are required to register with the Immigration and Nationality office in Asmara within seven business days of their entry into the country.
The Eritrean government sometimes subjects U.S. citizens of Eritrean heritage to the same entry/exit requirements as Eritrean citizens.
See the “Special Circumstances” section below for more information about dual nationality.

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:
Eritrea and Ethiopia fought a border war from 1998-2000.
United Nations peacekeepers patrolled the border until March 2008, when Government of Eritrea diesel fuel restrictions resulted in the peacekeepers’ withdrawal.
Both Eritrea and Ethiopia maintain large military presences along the border and currently all border crossings into Ethiopia from Eritrea remain closed.
U.S. citizens are strongly advised to avoid travel near the Eritrean-Ethiopian border and to register their presence in Eritrea with the U.S. Embassy in Asmara.

Since April 2008, large numbers of Eritrean troops have been deployed along the northeastern border of Djibouti.
U.S. citizens are strongly advised to avoid non-essential travel to the Southern Red Sea region of Eritrea, including the port of Assab.

Landmines and unexploded ordnance remain a serious problem throughout the country.
There are reports of accidents and numerous incidents where vehicles and people occasionally detonate mines.
Many detonations occurred on relatively well-traveled roads in and near the Gash Barka region of western Eritrea; subsequent investigations indicated that several mines had been recently laid.
Vast areas of the country still have not been certified free of mines and unexploded ordnance left over from both the 30-year war for independence and the subsequent 1998-2000 conflict with Ethiopia.
Americans should avoid walking alone and hiking in riverbeds or areas that local government officials have not certified as safe.

Although Eritrea and Sudan have diplomatic relations, the procedures for crossing their common border are not clear and subject to change.
Overland travel between the two countries is dangerous and ill advised.
Travelers crossing from Eritrea to Sudan north and west of the Keren-Barentu road risk becoming victims of banditry or Islamic extremist insurgent activity.
Several incidents were reported in 2007, apparently involving insurgents or criminals in this area.
The U.S. Embassy also received reports of sporadic bombings of vehicles and government facilities in the Gash Barka region near Sudan in 2007 and 2008.
If travel near the Eritrean-Sudanese border is essential, travelers should consult both the Eritrean authorities and the U.S. Embassy in advance.
Foreign travelers who wish to visit any area outside of Asmara must apply at least ten days in advance for a travel permit from the Eritrean government.

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

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the 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:
Although still a safe city by many measures, Asmara reported significant increases of street crime, such as theft, robbery, and assault in 2008.
Travelers should exercise vigilance in their personal security and safety precautions regarding what valuables they carry and which areas they visit.

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 Eritrea are extremely limited.
Travelers must carry their own supplies of prescription drugs and preventative medicines because pharmaceuticals are in short supply.
Food and water-borne illnesses are very common among travelers, so drink only bottled or purified water and eat foods that are cooked or peeled.
Malaria is a serious risk to travelers in the lowlands of Eritrea, but Asmara is generally considered free of the disease.

There is no HIV testing requirement for temporary or permanent entry into Eritrea.
Please verify this information with the Embassy of Eritrea 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 website at http://wwwn.cdc.gov/travel/default.aspx.
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/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 Eritrea is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

The roads between major cities (Asmara, Massawa, Mendefera, Dekemhare, Barentu, and Keren) are paved and in relatively good condition.
However, secondary roads and those in remote areas are usually unpaved and in poor condition.
U.S. citizens should avoid traveling on these roads, especially at night.
Bad weather can also make the condition of poor roads worse.
If you must take unpaved roads, check first with local government and village officials as new minefields continue to be discovered.

Landmines and unexploded ordnance litter the countryside in many areas, occasionally causing injuries and deaths.
Although the UN conducted de-mining efforts until late 2007, evidence of new mines has been reported, particularly in areas near the Ethiopian border.
All areas that are not well traveled are potentially dangerous due to live mines, especially north and west of Keren.
There are also minefields near Massawa, Ghinda, Agordat, Barentu, south of Tessenae, Nakfa, Adi Keih, Arezza, Dekemhare, and in a roughly 40-kilometer wide region just west of the Eritrean-Ethiopian border between the Setit and Mereb Rivers.

Many Eritreans use inexpensive public transportation, especially bus service.
Travelers should avoid taking buses due to extreme over-crowding.
Taxis are plentiful and inexpensive in Asmara, but usually carry multiple passengers along pre-defined routes.
If an empty taxi is available, a customer may request a "contract" taxi, which accepts no additional passengers, for a significantly higher fixed price.
Drivers should be aware of heavy and erratic pedestrian and bicycle traffic obstructing vehicle flow.
Occasionally horse-drawn carts, cattle, or goats add to the obstacles.
Other hazards are children and the elderly, who sometimes wander into the path of moving traffic, as well as small, slow, motorized carts.
Elderly or disabled people usually drive these carts and do not always yield to faster moving traffic.
When parallel parking on city streets, watch for pedestrians as you back into the space.
Please refer to our Road Safetypage for more information.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Eritrea, the U.S. Federal Aviation Administration (FAA) has not assessed Eritrea’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:
Due to Eritrean government restrictions impacting Embassy operations, the consular section of the U.S. Embassy in Asmara does not provide routine services to American citizens in Eritrea, including reports of birth, passports, and notaries.
Americans traveling or residing in Eritrea who require such services must travel to a U.S. Embassy or Consulate outside Eritrea, and should plan accordingly.

American citizens should also be aware that U.S. diplomatic personnel are subject to travel restrictions.
The Government of Eritrea requires resident diplomats to apply 10 days in advance for travel outside of Asmara city limits; often travel permission is not given.
This restriction can delay or prevent U.S. Embassy emergency assistance to American citizens outside of Asmara.

The consular section of the U.S. Embassy in Asmara has been closed for visa services since January 2007.
Eritrea has complicated citizenship laws and does not recognize renunciation of Eritrean citizenship.
Dual nationals who enter the country on Eritrean documents are treated as Eritrean citizens, regardless of their other citizenship.
U.S. citizens born in Eritrea, or who otherwise are considered to have acquired Eritrean citizenship, may be subject to certain obligations, including being drafted into national service, regardless of the documents they present at entry.
(National service is approximately six months of military training, followed by an often unspecified number of years in military or other government service.)

U.S.-Eritrean dual nationals who enter the country on an Eritrean passport or national ID card must obtain an exit visa prior to departure.
Exit visa applications can significantly delay travel plans or be denied, even for persons who entered Eritrea legally.
Eritrean dual nationals are also required to pay a 2% income tax on overseas earnings to the Eritrean Government prior to being granted an exit visa.
Additionally, Eritrean authorities sometimes to not allow Eritreans who left the country after 1993 to depart Eritrea after visiting the country, even if they have a U.S. passport and a valid Eritrean visa.

The government of Eritrea does not inform the U.S. Embassy of the detention of American citizens, and does not allow Embassy officials to visit incarcerated Americans.

Visitors are advised to exercise caution when taking photographs in Eritrea.
Foreigners in Asmara have been harassed and detained by local police and plain clothes security officials for taking photographs of street scenes in the city.
No law has been cited, but the arresting officials' justifications have been that (unmarked) government buildings are in the background and/or that the pictures are being taken (illegally) for commercial reasons.

All foreign nationals in Eritrea are required to apply for permits to travel outside of Asmara.
Travel permits must be presented at all checkpoints.
Checkpoints are found on major roads through Eritrea, but locations may change without notice.
Applications for travel permits are available at the Ministry of Tourism located on Harnet Avenue.
There is a high risk of earthquakes in Eritrea.
General information about natural disaster preparedness is available on the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov.
Please see our information on Customs Regulations.

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 Eritrean laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Eritrea 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 Eritrea 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 Eritrea.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at 179 Alaa Street, PO Box 211, Asmara; telephone (291-1) 12-00-04; fax (291-1) 124-255 and (291-1) 127-584; the Embassy’s web site is located at http://eritrea.usembassy.gov/
*

*

*
This replaces the Country Specific Information for Eritrea dated April 28, 2008, to update sections on Entry/Exit Requirements, Safety and Security, Crime,
Medical Facilities and Health Information, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Sat 10 Sep 2016
Source: Asmarino Independent [edited]

Activists have reported a serious cholera outbreak in the Upper Gash-Barka Region of Eritrea, which is proving difficult to control. The outbreak was 1st observed at Barentu Referral Hospital 2 weeks ago when people who had travelled from the upper Gash region were reported to be suffering from an illness that was not diagnosed easily. However, as a result of the extended time taken for accurate diagnosis of cholera due to a severe shortage of expertise and infrastructure, the outbreak spread widely, affecting areas of the Gash-Barka Region.

It has now been a week since the Ministry of Health acknowledged the outbreak as being a potential national epidemic and has briefed health professionals in the region to that effect.

So far, the effort to curb the spread is proving futile, and the impact of the outbreak is being felt across the region. Markets were deserted as a result of the spread, and even cattle markets in small villages outside Barentu have been cordoned off to prevent the spread. An expert at the Ministry of Health's public health section for preventing such epidemics stated: "There is currently no national emergency response team to prevent and control such outbreaks; we are, therefore, prone to such epidemics, as it always takes time to pull such a team together to both control the outbreak and treat victims."

Already, the current epidemic is said to have spread from the Upper Gash Region to the Southern Region and particularly to the area of Mai Dima, where an epidemic control team has been dispatched.

According to health experts in the region, when such an outbreak occurs, even able-bodied adults find it impossible to cope with the acute loss of bodily fluids. Without appropriate medical assistance, it is impossible for patients to recover, and the situation is considerably worse for pregnant women and children.

Given the lack of public health awareness, Arbi Harnet calls on the people to take preventive actions by strictly adhering to personal and public hygiene practices.
======================
[A HealthMap/ProMED-mail map showing Eritrea is available at
Date: Sat, 23 Jan 2016 12:14:06 +0100

Nairobi, Jan 23, 2016 (AFP) - Eritrean President Isaias Afwerki on Saturday dismissed fears the Horn of African nation faces a food crisis, despite sweeping drought across the wider region leaving millions in need of aid.   Floods and failed rains caused by the El Nino weather phenomenon have sparked a dramatic rise in the number of people going hungry in east Africa.

But authoritarian and isolated Eritrea has long rejected UN food aid in favour of a policy of self reliance, and Isaias said he was not worried.    "In view of the harvest shortfall that has affected the whole Horn of Africa region, President Isaias stated that the country will not face any crisis in spite of reduced agricultural output," the information ministry said, after he was interviewed by state-run media.   Isaias praised the government's "judicious policy and approaches of bolstering its strategic food reserves."

In November, the UN warned that Eritrea was among the countries at risk, like all the other nations in the wider region. "The current El Nino pattern, being the strongest ever recorded, has caused severe drought in the Horn of Africa nation, resulting in crop reduction by 50 to 90 percent; even failure in some regions," the United Nations said earlier this month.   In Ethiopia, over 10 million people need food aid, it added.    In Eritrea, few if any major foreign aid agencies are allowed operate, while the UN has limited access across the country, and most assessments are dependent on government reports.

Thousands of Eritreans flee the county each month, saying they are escaping conscription and rampant rights abuses.   Refugees from the repressive Red Sea state make up the third-largest number of people risking the dangerous journey to Europe after Syrians and Afghans, running a gauntlet of ruthless people smugglers to make the treacherous Mediterranean crossing.
Date: Thu 30 Jul 2015
Source: Eurosurveillance edition 2015; 20(30) [edited]

Louse-borne relapsing fever (_Borrelia recurrentis_) in asylum seekers from Eritrea, the Netherlands, July 2015
----------------------------------------------------------------------
[Authors: Wilting KR, Stienstra Y, Sinha B, Braks M, Cornish D, Grundmann H]

Two patients from Eritrea, recently arrived in the Netherlands, presented with fever and were investigated for malaria. Bloodfilms showed spirochetes but no blood parasites. Louse-borne relapsing fever caused by _Borrelia recurrentis_ was diagnosed. Treatment was complicated by severe Jarisch-Herxheimer reactions [inflammatory reaction observed after antimicrobial treatment of several infectious diseases] in both patients. Physicians should be aware of the possibility of _B. recurrentis_ infection in migrant populations who travel under crowded conditions, especially after passing through endemic areas such as Ethiopia and neighbouring countries.

_Borrelia recurrentis_ has for many centuries caused infections of often epidemic proportions known as relapsing fever. Since the infection is exclusively transmitted by body lice and humans are their only host, large scale outbreaks are only expected under circumstances conducive to louse infestation. We here report the 1st introduction of louse-borne relapsing fever into the Netherlands after World War II.

Case descriptions
-----------------
Patient 1
On 4 Jul 2015, a young adult from Eritrea was referred from the National Reception Centre for Asylum Seekers (Asielzoekercentrum, AZC) to a regional hospital in the northern Netherlands with a 5-day history of headache, dizziness, right upper quadrant pain, myalgia, and fever (39.3 deg C [102.7 deg F]). Malaria was suspected. The patient had been in the Netherlands for only 2 days after arriving in Europe 14 days earlier. En route to Europe, they travelled through Ethiopia, Sudan, and Libya. Previously, they had noticed chills while sheltering in an unofficial street camp in Rome where they stayed with a small group of fellow Eritreans before travelling to the Netherlands.

Thick and thin bloodfilms did not show malaria parasites and commercial malaria antigen tests were negative. However, filamentous unidentified structures were reported in the thick film by the laboratory of the peripheral hospital. The patient received empirical treatment with a single dose of ceftriaxone (2000 mg intravenously) for suspected bacterial septicaemia. After administration, their condition deteriorated and the patient was transferred within the next 2 hours to the University Medical Center Groningen (UMCG) where they arrived at the emergency department with headache, peripheral hypothermia (35.3 deg C [95.5 deg F]), hypotension (systolic/diastolic blood pressure 78/52 mmHg, heart rate of 106 beats per minute), abdominal pain but no hepatosplenomegaly, and shortness of breath (respiratory rate 23 breaths/min). Laboratory analysis showed leucocytopenia (leucocytes: 1.6 x 10(9)/L, norm: 4.5-10 x 10(9)/L), anaemia (haemoglobin: 6.5mmol/L, norm: 8.6-11.2 mmol/L) and thrombocytopenia (thrombocytes: 16x10(9)/L, norm: 150-450x10(9)/L). C-reactive protein (CRP) was 254 mg/L (norm: less than 1 mg/L). Kidney function was normal. The patient's liver function tests showed mildly elevated transaminases (alanine transaminase: 58 U/L, norm: 7-56 U/L; aspartate transaminase: 108 U/L, norm: 10-40 U/L; alkaline phosphatase: 124 U/L, norm 20-140 U/L; gamma-glutamyl transferase: 93 U/L, norm 0-51 U/L) and total bilirubin levels of 38 micromole/L (norm: less than 26 micromol/L) and direct bilirubin 35 micromol/L (norm: less than 7 micromol/L). Oxygen saturation was 91 percent (norm: 95-100 percent). Giemsa-stained thick and thin films revealed spirochetes in large numbers (Figure 1 [available at the source URL]) and no malaria parasites.

Given the patient's travel history, louse-borne relapsing fever was suspected. The clinical deterioration was provoked by the ceftriaxone administration leading to a severe Jarisch-Herxheimer reaction [1]. Treatment was switched to doxycyline 200 mg per day intravenously intravenously to reduce the risk of relapse [2]. The patient was transferred to the intensive care unit (ICU) for fluid resuscitation, cardiac support with noradrenalin, and supportive oxygen delivery via high flow nose mask.

_B. recurrentis_ was confirmed by 16S rDNA PCR and sequencing directly from blood 2 days later. The patient stayed at the ICU for 2 days, made a full recovery and was discharged after 6 days. The body louse _Pediculus humanus humanus_ was recovered from [the patient's clothing (Figure 2 [available at the source URL]).

Patient 2
In 9 Jul 2015, a 2nd young adult from Eritrea was directly referred by the responsible physician at the AZC to the UMCG. On arrival, the patient presented with general malaise, headache, fever (38.5 deg C [101.3 deg F]) and cough. Blood tests showed elevated inflammatory parameters (leucocytes: leucocytes: 12.7 x 10(9)/L, CRP: 320 mg/L), normal kidney function and slightly elevated transaminases, but the blood sample was haemolytic. Thick and thin films showed spirochetes and treatment was started with doxycyline 200 mg orally. 2 hours later the patient developed a severe Jarisch-Herxheimer reaction [that] required admission to intensive care where they received fluid resuscitation, inotropic treatment with noradrenalin, and oxygen via a face-mask. _B. recurrentis_ was confirmed by 16S rDNA sequencing.

The patient reported symptoms of chills and fever 2 weeks before presentation at our hospital. Their journey through North Africa followed the same route as that of Patient 1, but Patient 2 had arrived in Europe a week earlier. Patient 2 had camped out in the streets for 5 days in Rome (as had Patient 1). Patient 2 arrived in the Netherlands 2 weeks before presenting at our hospitals after travelling through Austria and Germany. The patient made a full recovery and was discharged after 5 days. Lice could not be recovered from the clothing.

Discussion
----------
_B. recurrentis_ should be suspected in patients presenting with fever and a recent history of migration from or through endemic countries (Ethiopia, Sudan, Eritrea, and Somalia). The infection is transmitted through body lice (_P. humanus humanus_, formally known as _P. humanus corporis_), which typically lives and breeds in the seams of clothes but can occasionally also be found in bed linens. Immigrants may share their clothing and that can pose an additional risk of transmission. The incubation period for relapsing fever is usually 4 to 8 days with a range of 2 to 15 days [3]. It should be noted that head lice (_P. humanus capitis_), which are not uncommon in Northern Europe, are incompetent vectors and cannot transmit _B. recurrentis_. The spirochetes are easily visible under a microscope in a Giemsa-stained thick or thin blood film as used for the diagnosis of _Plasmodium_ spp [4]. In our patients, the diagnosis was confirmed in both cases by 16S rDNA PCR and sequencing from blood.

Published evidence supports a single dose of tetracycline 500 mg intravenously as the conventional treatment, but considering the limited availability of this drug, doxycycline 200 mg can be used as an effective alternative [2,5]. In young children, pregnant women, or patients with a tetracycline allergy, erythromycin 500 mg can be used instead [6].

Both patients had travelled independently along a similar route before arriving in the Netherlands. Given the incubation period, it cannot be ruled out that the infection was acquired within Europe. Crucial information about risk factors such as exact travel history, recollection of louse infestation or bites and onset of symptoms was, however, impossible to obtain from our patients. Apart from being very sick and the fact that communication required an interpreter versed in Tigre our patients appeared to be traumatised and intimidated and not eager to volunteer information for fear of legal consequences.

Both patients developed a severe Jarisch-Herxheimer reaction after starting antibiotic treatment. _B. recurrentis_ evades host immune defences, resulting in very high bacterial loads (10(6)-10(8)/microl), and effective antibiotic therapy is followed by severe reactions characterised by sudden rigors, fever, and hypotension in virtually all treated patients [3]. Clinical symptoms are associated with increased plasma concentrations of tumour necrosis factor alpha (TNF-alpha), interleukin-6 and interleukin-8 [7]. Treating physicians should be aware of this complication and the chances that ICU admission may be warranted. It is advised that patients receive 2 well-placed intravenous lines for rapid fluid resuscitation. Treatment of Jarisch-Herxheimer reaction consists mainly of supportive care. Corticosteroids seem to have limited beneficial effect but studies suggests that TNF-alpha blockers may be useful [8].

An ad hoc survey at the AZC on [16 Jul 2015] found body lice on 2 newly arrived Eritreans. Since then, all asylum seekers arriving from endemic countries to the AZC have been segregated into a different compound, where they turn over all of their personal clothes in exchange for disposable overalls. Personal clothes are then washed and returned on the next day. Used overalls and bed linen are subsequently destroyed. In addition to delousing, all arrivals receive a single dose of ivermectin as pre-emptive treatment against scabies and Eritreans who arrive with clinically manifest scabies (about 80 percent of all new arrivals) receive a 2nd dose a week later. No new cases of _B. recurrentis_ infection have been identified since mandatory delousing was implemented.

Conclusion
----------
Because infections with _B. recurrentis_ pose a significant health risk to other migrants, aid workers, healthcare personnel, and arguably to the general population, screening and delousing should be considered for arriving migrants already at ports of entry into the European Union. Our patients may have acquired body lice before arriving in Europe but transmission of infected lice between migrants after arrival in Europe cannot be ruled out and could pose an additional public health challenge.

[Figures and references are available at the source URL above.]
======================
[Relapsing fever is a bacterial infection caused certain species of the spirochete _Borrelia_. These organisms are able to periodically change their surface protein molecules to evade the host's immune response, thus causing a relapsing illness. Following an incubation period of about 7 days, the illness is characterized by recurring episodes of high fever, headache, muscle and joint pain, nausea and vomiting, each episode lasting several days, followed by a several-day asymptomatic interval. There may be up to 3-4 recurrences. Complications may include involvement of the lungs (ARDS; acute respiratory distress syndrome), central nervous system, spinal cord, eyes, heart, and liver. The bacteremia is intense (more than 10,000 organisms per ml of blood) during febrile episodes, which allows detection of organisms on a Wright-Giemsa stained blood smear. Thick blood smears are more sensitive than thin smears.

There are 2 types of relapsing fever: Tick-borne relapsing fever (TBRF) and louse-borne relapsing fever (LBRF). LBRF is more severe than TBRF, with case-fatality rates without antimicrobial treatment of 30 to 70 percent in outbreaks. TBRF occurs in the Western hemisphere, Africa, Asia, the Mediterranean region and the Middle East. In the western United States, TBRF is usually associated with sleeping in rustic, rodent-infested cabins in mountainous areas. In the United States, 3 species, _Borrelia hermsii_, _B. parkerii_, and _B. turicatae_, transmitted by the bite of soft-bodied ticks (genus _Ornithodoros_) cause TBRF. A recently discovered _Borrelia_ species, _Borrelia miyamotoi_, has been found in hard-bodied ticks (_Ixodes_) in regions where Lyme disease is endemic.

LBRF is caused by a single species, _Borrelia recurrentis_, transmitted through abraded skin when the body louse is crushed during scratching. LBRF is endemic in Ethiopia, Sudan, Eritrea, and Somalia. Outbreaks are found in developing regions affected by war and in refugee camps characterized by overcrowding and poor personal hygiene. While mammals and reptiles may serve as a reservoir for tick-borne _Borrelia_ species, humans are the only host of _B. recurrentis_.

Treatment of relapsing fever consists of either a tetracycline (such as, doxycycline), a macrolide (such as, erythromycin), penicillin, or other beta-lactam antibiotics (such as, ceftriaxone). LBRF can be treated effectively with a single dose of the antibiotic (<http://jid.oxfordjournals.org/content/137/5/573.abstract>), whereas treatment of TBRF requires 7-10 days to prevent relapse. When initiating antibiotic therapy, all patients should be observed for a Jarisch-Herxheimer reaction. The reaction, caused by massive release of tumor necrosis factor alpha (TNF-alpha), interleukin-6, interleukin-8, and other cytokines, is manifest by a worsening of symptoms with rigors, tachycardia, sweating, hypotension, and high ever, occurs in over 50 percent of cases. The Jarisch-Herxheimer reaction can be fatal. Pretreatment with anti TNF-alpha antibody has been found to suppress Jarisch-Herxheimer reactions (<http://www.nejm.org/doi/full/10.1056/NEJM199608013350503>).

Corticosteroids and antipyretic agents have little or no effect (<http://jid.oxfordjournals.org/content/137/5/573.abstract> and <http://www.ncbi.nlm.nih.gov/pubmed/6132178?dopt=Abstract>), whereas meptazinol, an opioid agonist-antagonist, has been reported to reduce the severity of the reaction (<http://www.ncbi.nlm.nih.gov/pubmed/6132178?dopt=Abstract>). Treatment with intravenous fluids and vasopressors to maintain adequate blood pressure may be required. - ProMed Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Fri, 20 Jan 2012 13:40:00 +0100 (MET)

ADDIS ABABA, Jan 20, 2012 (AFP) - Addis Ababa said Friday that two Germans kidnapped during a deadly attack by unidentified gunmen on a group of tourists in northern Ethiopia had been taken to neighbouring Ethiopia. Germany said it was still investigating the pair's whereabouts. "There is news that they are in Eritrea by now," foreign ministry spokesman Dina Mufti told AFP.

The Germans are believed to have been abducted when gunmen attacked a group of tourists in Ethiopia's remote Afar region earlier this week. Five people were killed in the attack: two Germans, two Hungarians and one Austrian. The German foreign ministry said three members of Germany's Federal Crime Agency were dispatched to Ethiopia to assist search efforts.  "The Federal Crime Agency (has) sent staff to Ethiopia in order to support the Embassy," a spokeswoman for Germany's foreign ministry told AFP from Berlin.  "They are trying to investigate where the two missing Germans could be." Six other Germans were among twelve survivors, some of them wounded, who were flown back to Addis Ababa on Wednesday. A Belgian citizen with gunshot wounds remains in hospital in Mekele in northern Ethiopia. The five bodies have been flown to the capital.

The attack took place near the famed Erte Ale volcano in Ethiopia's sparsely populated Danakil desert, close to the tense Ethiopia-Eritrea border.  The area, which boasts spectacular moon-like landscapes and is famed to be the hottest place on earth, is popular among travellers.  No group has claimed responsibility for the killings, but Ethiopia blamed arch-foe Eritrea for carrying out the attack. Eritrea vehemently denied being behind the incident, calling Ethiopia's claim "ludicrous" and a "smear campaign." The two Horn of Africa countries fought a bloody border war from 1998 to 2000 which killed 70,000 people. The border remains contested, with Ethiopian troops occupying land that international courts say belongs to Eritrea.
Date: Tue, 30 Aug 2011 12:41:08 +0200 (METDST)
by Jenny Vaughan

Shire, Ethiopia, Aug 30, 2011 (AFP) - In Ethiopias Endabaguna refugee camp, rows of gaunt Eritreans clad in rubber sandals give vent to their exasperation after days of trekking and dodging soldiers in an attempt to escape failed crops, hunger and an autocratic government. Over 12 million people across the Horn of Africa are struggling from the region's worst drought in decades, but secretive Eritrea is the only country to deny it has been affected by the crisis. "This year I farmed, but there was lack of rain. I dont know whats going to happen, only God knows," said Mehreteab, a refugee. He escaped from the army, risking death or jail if caught crossing the heavily militarized border, leaving his wife and three children behind. "There is no food and no grain in the home," he said. "I dont have any idea whats going to happen to them." Camps in northern Ethiopia receive about 900 refugees every month from Eritrea, one of the regions most isolated countries. A former colony of Italy and then part of Ethiopia, Eritrea fought a 30-year war with Ethiopia and only gained independence in 1991. A subsequent border conflict with Ethiopia from 1998-2000 still simmers.  Former rebel leader Issaias Afewoki, who has been in power since 1991 without elections, has cracked down on all dissidents and severely restricted press and religious freedom.

The majority of those arriving in the Ethiopian camps are young men escaping conscription, which forces men above 16 to serve in the military for decades on minimal pay. The UN recently called for tighter economic sanctions after releasing a report linking Eritrea to a failed bomb plot at the African Union. According to satellite imagery from the weather monitoring group FEWSNET, rainfall in parts of Eritrea this year has been "below average" - less than 10 percent of normal levels in some areas. Aid workers admit it is nearly impossible to know just how gravely the Eritrea is affected because access to information is so limited in the country where the only media is state-run. "Its been a black hole for us, we dont know whats going on there," said Matthew Conway, spokesman for the UN humanitarian coordination office in Nairobi. "But thats not to say its not happening."

The US ambassador to the United Nations has said she is "deeply concerned" that Eritrea is facing extreme hunger, and urged the government to allow humanitarian access. "The people of Eritrea who most likely are suffering the very same food shortages that were seeing throughout the region are being left to starve," Susan Rice told reporters in New York. And much like other countries in the region, such as Ethiopia and Kenya, Eritrea is vulnerable to increased food prices, exacerbating the crisis. According to the UN agriculture agency, global food prices jumped 33 percent in the last year. "High international prices affected every country in the world, so from that you can assume Eritrea is affected," said Shukri Ahmed, an economist at the Food and Agriculture Organization. Fiercely self-reliant Eritrea stopped sending market information to FAO about three years ago, Ahmed said, so it is impossible to know how much food prices have risen in the country. "Unfortunately, we dont have any information on the ground," he told AFP by phone from Rome.

Over half of Eritrea's food is imported, the FAO estimate, leaving it vulnerable to market fluctuations for staples such as sorghum and maize. Eritrean refugee Berhane, 35, said the cost of food has surged in recent years, though wages have remained the same. Intermittent work as a labourer earned him about $5 per day. But the cost of grain is about $3 per kilo and a sheep is about $170, more than he could make in a month, he told AFP. "How is someone with no money or daily work supposed to buy this?" he asked. "It is too expensive." Facing steep food costs, he relied on a small plot of land to feed his family. But the rains were two months late this year and his harvest failed. "The government doesnt do anything. Nothing. There are no rations," he told AFP.

The Eritrean authorities deny the country is facing food scarcity. "This nonsense about a hidden famine in Eritrea is utterly false," the Eritrea's information ministry said in an online statement last week. Instead, Asmara claims last year's harvest was the best in a decade, while state run media heap praise on government-run food security programs. But refugee Gebrielxavier, 25, said this is not true. He left Eritrea last November because his crop failed, he could not find work and his family went hungry. "We couldnt live. We were famished," he said. "And the government? It did nothing." He is now running a café in the refugee camp, where he earns less than $2 a  day and relies on UN food rations, but says he is still better off. "I got my freedom," he said.
More ...

World Travel News Headlines

Date: Sun, 16 Jun 2019 12:02:50 +0200

Patna, India, June 16, 2019 (AFP) - Severe heat has left dozens dead over a 24-hour period in India's Bihar state, as the country enters a third week of searing temperatures, officials said Sunday.   The deaths occurred in three districts of the poor northern state, where temperatures have hovered around 45 degrees Celsius (113 Fahrenheit) in recent days, senior health official Vijay Kumar told AFP.

Forty-nine people died in three districts of the Magadh region that has been hit by drought, he said.   "It was a sudden development on Saturday afternoon. People affected by heatstroke were rushed to different hospitals," Kumar added.   "Most of them died on Saturday night and some on Sunday morning during treatment."   Kumar said about 40 more people were being treated at a government-run hospital in Aurangabad.   "Patients affected by heat stroke are still being brought, the death toll is likely to increase if the heatwave continues."

Most of the victims were aged above 50 and were rushed to hospitals in semi-conscious state with symptoms of high fever, diarrhoea and vomiting.   Twenty-seven people died in Aurangabad district, 15 in Gaya and seven in Nawada district, officials said.    State Chief Minister Nitish Kumar has announced a compensation of 400,000 rupees ($5,700) for the family of each victim.   Harsh Vardhan, India's health minister, said people should not leave their homes until temperatures fall.    "Intense heat affects brain and leads to various health issues," he said.

Large parts of northern India have endured more than two weeks of sweltering heat. Temperatures have risen above 50 degrees Celsius (122 Fahrenheit) in the desert state of Rajasthan.   A heatwave in 2015 left more than 3,500 dead in India and Pakistan.   In 2017, researchers said South Asia, which is home to one fifth of the world's population, could see heat levels rise to unsurvivable levels by the end of the century if no action is taken on global warming.
Date: Sun, 16 Jun 2019 01:30:52 +0200

Wellington, June 15, 2019 (AFP) - A powerful 7.4 magnitude earthquake stuck near the uninhabited Kermadec islands northeast of New Zealand Sunday, the US Geological Survey said as authorities monitored for signs of a tsunami.   New Zealand's civil defence organisation said it was monitoring the situation and if a tsunami was generated it would take at least two hours to reach the country.   The Pacific Tsunami Warning Center said "hazardous tsunami waves from this earthquake are possible within 300 km of the epicentre along the coasts of the Kermadec islands."   The earthquake struck at 10:55am (2255 GMT Saturday) some 928 kilometres (575 miles) north-northeast of the New Zealand city of Tauranga in North Island at a depth of 34 km.
Date: Sun, 16 Jun 2019 00:59:42 +0200

Wellington, June 15, 2019 (AFP) - A magnitude 6.1 earthquake struck Sunday centred 97 kilometres (60 miles) north-east of Ohonua, on the Pacific island of Tonga, the US Geological Survey reported.   The quake hit at 2156 GMT Saturday with an epicentre depth of 10 kilometres, the US global quake monitor said.   The Pacific Tsunami Warning Centre issued no alerts, and there were no immediate reports of damage or casualties.   The reported epicentre lies within the so-called Pacific Ring of Fire, an area of regular seismic activity.   In February 2018, a 7.5 magnitude earthquake in Papua New Guinea killed 150 people and destroyed hundreds of buildings.
Date: Sun, 16 Jun 2019 00:19:43 +0200

Geneva, June 15, 2019 (AFP) - A woman has drowned in Lake Geneva when her sightseeing boat sank as a violent storm battered parts of Switzerland on Saturday, police said.   A man who was in the same boat was able to swim to another vessel from where he fired "two flares", Joanna Matta, police spokeswoman for the canton (region) of Geneva, told AFP.   The man told officers that the woman had been "passing through Geneva" and that the storm had taken them "by surprise", Matta said.   Three police boats and emergency services rushed to the scene. Police divers later retrieved the woman's body from the lake.

The victim, whose nationality remains unknown, was then taken to a hospital in Geneva where she was declared dead.   In a separate incident, the storm also damaged some of the 465 boats taking part in the 81st edition of the Bol d'Or, an annual regatta on Lake Geneva, the event's press service said.   Heavy rain and strong winds lashed the participants on Saturday afternoon, causing boats to capsize although nobody was injured.

However, the storm broke the mast of the ultra-fast "Real Team" catamaran, which had been in the lead and was forced to pull out of the race.   The bad weather struck western Switzerland on Saturday afternoon, bringing hail and winds reaching up to 110 kilometres (70 miles) per hour, according to the national forecaster MeteoSwiss.   In the neighbouring French region of Haute-Savoie the storm also caused damage and left a 51-year-old German tourist dead after a tree came down at a campsite.
Date: Sat, 15 Jun 2019 16:27:09 +0200

Windhoek, June 15, 2019 (AFP) - Drought-hit Namibia has authorised the sale of at least 1,000 wild animals -- including elephants and giraffes -- to limit loss of life and generate $1.1 million for conservation, the authorities confirmed Saturday.   "Given that this year is a drought year, the [environment] ministry would like to sell various type of game species from various protected areas to protect grazing and at the same time to also generate much needed funding for parks and wildlife management," environment ministry spokesman Romeo Muyunda told AFP.

The authorities declared a national disaster last month, and the meteorological services in the southern African nation estimate that some parts of the country faced the deadliest drought in as many as 90 years.    "The grazing condition in most of our parks is extremely poor and if we do not reduce the number of animals, this will lead to loss of an animals due to starvation," Muyunda said.

In April, an agriculture ministry report said 63,700 animals died in 2018 because of deteriorating grazing conditions brought on by dry weather.   Namibia's cabinet announced this week that the government would sell about 1,000 wild animals.   They include 600 disease-free buffalos, 150 springbok, 65 oryx, 60 giraffes, 35 eland, 28 elephants 20 impala and 16 kudus -- all from national parks.   The aim is to raise $1.1 million that will go towards a state-owned Game Products Trust Fund for wildlife conservation and parks management.

The government said there were currently about 960 buffalos in its national parks, 2,000 springbok, 780 oryx and 6,400 elephants.   The auction was advertised in local newspapers from Friday.   Namibia, a country of 2.4 million people, has previously made calls for aid to assist in the drought emergency that has already affected over 500,000 people.   In April the government announced that it will spend about $39,400 (35,200 euros) on drought relief this year to buy food, provide water tankers and provide subsidies to farmers.
Date: Fri, 14 Jun 2019 18:27:56 +0200
By Rosa SULLEIRO

Sao Paulo, June 14, 2019 (AFP) - A nationwide strike called by Brazil's trade unions disrupted public transport and triggered road blocks in parts of the country Friday, ahead of protests against far-right President Jair Bolsonaro's pension reform.   Hours before the opening match of the Copa America in Sao Paulo, some metro lines in the country's biggest city were paralyzed as professors and students also prepared to take to the streets over the government's planned education spending cuts.    It will be the latest mass demonstration against Bolsonaro since he took office in January, but the timing could not be worse for the embattled president as Brazil prepares to play Bolivia in South America's showcase football tournament.

Bolsonaro was expected to attend the opener at Morumbi stadium where police sharpshooters will be deployed as part of increased security for the competition.    One of Brazil's main trade unions estimated 45 million workers had taken part in the strike.   Some 63 cities had been affected by the stoppage, with more than 80 cities recording demonstrations, G1 news site said.   The number of protesters is expected to balloon in the afternoon with demonstrations planned in Brazil's major cities.   Protesters have already blocked some roads in several cities, including Rio de Janeiro and Sao Paulo, where G1 said police had used tear gas to disperse demonstrators and clear the streets.   Brazilians were divided over the partial strike.   "This current government wants to destroy everything that we built decades ago so that's why I'm in favor (of the strike) and I am fighting against social inequality," Vania Santos, 49, told AFP in Rio.    In Sao Paulo, Flavio Moreira opposed the stoppage, however, saying it "hurts the commercial part" of the city.

- Pension savings cut -
Bolsonaro's proposed overhaul of Brazil's pension system -- which he has warned will bankrupt the country if his plan is not approved -- is seen as key to getting a series of economic reforms through Congress.    But the changes, including an increase in the retirement age and workers' contributions, have faced resistance from trade unions and in the lower house of Congress, where Bolsonaro's ultraconservative Social Liberal Party has only around 10 percent of the seats.    A pared-back draft of the reform presented to Congress on Thursday -- which reduces expected savings from 1.2 trillion reais ($300 billion) in 10 years to around 900 billion reais -- did little to appease union leaders, who vowed to go ahead with the shutdown.   Such savings are seen as vital to repairing Brazil's finances and economy, which were devastated by a 2015-2016 crisis.

Economy minister Paulo Guedes, who is spearheading the government's reform agenda, has threatened to resign if the bill is not passed or is watered down significantly.   It caps a tumultuous six months for Bolsonaro, who has seen his popularity nosedive as he struggles to push his signature reform through a hostile Congress and keep Latin America's biggest economy from sliding back into recession.   More than 13 million people are unemployed, the latest data shows, with a record number giving up looking for a job.     Fighting between military and far-right factions of Bolsonaro's government has fueled chaos in his administration where his sons and right-wing writer and polemicist Olavo de Carvalho wield enormous influence.   Bolsonaro sacked his third minister on Thursday -- retired general Carlos Alberto dos Santos Cruz, who had been the government secretary and seen as a moderate voice.   That came on the same day Bolsonaro broke his silence to defend Justice Minister Sergio Moro, who has been accused of wrongdoing while serving as a judge in the sprawling Car Wash anticorruption investigation.
Date: Fri, 14 Jun 2019 06:02:40 +0200
By Clotilde RAVEL

Abidjan, June 14, 2019 (AFP) - "Cover your goods," Diakaria Fofana, a doctor of public health, warns food vendors as a thick cloud of insecticide spray wafts down a street in Abidjan, Ivory Coast's economic capital.   Men in protective clothes, goggles and masks are disgorging plumes of mosquito-killing chemicals in a bid to roll back an outbreak of dengue.   Two people have died and 130 have fallen ill since the fever returned to the West African state last month.

The toll, so far, is tiny compared with other tropical countries, especially in Southeast Asia, where the painful and sometimes deadly disease is an entrenched peril.   But tackling the outbreak is a major challenge for Ivory Coast, a poor country that is having to resort to time-honoured, labour-intensive methods of spraying and neighbourhood awareness campaigns to prevent its spread.   Female mosquitoes carrying the dengue virus transfer the pathogen when they tuck into a blood meal from someone. 

A vaccine does exist, but is not available in Ivory Coast because "it has many secondary effects (and) it's expensive"," explained Joseph Vroh Benie Bi, director of the National Institute for Public Hygiene (INHP).    Developed by French pharmaceutical group Sanofi Pasteur, the vaccine is recommended for use in people aged nine and older, and only for individuals who have already been infected.    Usually accompanied by flu-like symptoms, dengue makes some people very sick indeed, developing into a haemorrhagic fever that can cause difficulty breathing, heavy bleeding or even organ failure. While a first bout of dengue is rarely fatal, subsequent infections are usually worse.

- 'Fighting the mosquito' -
The UN's World Health Organization (WHO) says there are up to 100 million cases of dengue worldwide every year, and almost half the world's population lives in countries where the disease is endemic.   It kills more than 20,000 people each year. Southeast Asia and the Western Pacific are the worst-hit areas.   There is no cure, and the WHO recommends that patients take paracetamol, rest and drinking plenty of fluids.   Five new vaccines are in development, but in the meantime Fofana says: "The only effective means of fighting (dengue) is fighting the mosquito."   In Ivory Coast, most recorded cases have occurred in Abidjan.

Health workers are striving to enlist the public in tackling the mosquito, targeting its life cycle.   "The larvae multiply in stagnant water, for example inside used tyres," said Fofana, deputy director of the vector control unit at the INHP.   "People should never store water in buckets in the open air and they should regularly throw out the water in plates under houseplants."   But he faces an uphill job in a sprawling port city of 4.4 million people in the middle of the rainy season.   What's more, people who are infected, even without knowing it, and can bring the virus to new areas when they are bitten by local mosquitoes.    The WHO has set a goal to halve the number of dengue deaths by 2020, but incidence of the disease has increased 30-fold in the last 50 years.   "Before 1970, only nine countries had experienced severe dengue epidemics. The disease is now endemic in more than 100 countries," it says.

- 'Malaria's big brother' -
In Ivory Coast, where malaria accounts for a third of all medical consultations, many people self-medicate when they experience symptoms such as high fever, vomiting, nausea or aches and pains.   "This is a real problem, because the symptoms of malaria, dengue, typhus and yellow fever are similar. Doing a blood test is absolutely indispensable," said Fofana.   Treatment with the wrong medicines can worsen the situation, he stressed -- aspirin or ibuprofen can increase the risk of bleeding, for example.   In the meantime, the spraying goes on.    "We know the risks," said Bamba Segbe, an Abidjan resident watching the masked men in action. "It's not for nothing that we call dengue malaria's big brother."
Date: Thu, 13 Jun 2019 17:37:51 +0200
By Grace Matsiko

Mpondwe, Uganda, June 13, 2019 (AFP) - At the bustling Mpondwe border post, a woman crossing from the Democratic Republic of Congo into Uganda is whisked away to an isolation unit after a thermal scanner picks up her high temperature.   Health workers keep Mulefu Kyakimwa, a 32-year-old vegetable oil trader, under observation but later discharge her, once Ebola has been ruled out as the cause of her fever.

The border post is on high alert after a family with suspected Ebola escaped isolation on the Congolese side and entered Uganda, where two of them died this week.   The spread of the deadly virus to Uganda comes after months of efforts in a region of porous borders to contain an outbreak in Congo which has killed 1,400 people, according to the latest official data.    "Since the start of the outbreak, the total number of cases is 2,084, of which 1,990 have been confirmed and another 94 are probable," the Congolese health ministry said in its daily bulletin from Wednesday.   "In all, there have been 1,405 deaths -- 1,311 confirmed and 94 probable -- and 579 people have recovered," the bulletin said, adding that 132,679 people had been vaccinated.

- 'We expected it' -
Few people seem to be surprised that Ebola would eventually make its way to Uganda -- which has experienced outbreaks in the past.   "The outbreak is not a surprise. We expected it. People cross the borders all the time and interact a lot," said Dorcus Kambere, a 29-year-old Ugandan bar attendant who feels her job puts her at risk.

At Mpondwe -- where 25,000 people cross daily -- travellers undergo rigorous health checks to detect the lethal virus, which attacks the organs and leads to internal and external bleeding.   Soldiers carrying automatic rifles guide travellers through the screening process, making sure they wash their hands with disinfectant.   The travellers then pass through a shelter with a thermal scanner that feeds people's body temperatures into a computer.   "This is a situation we go through every day since the Ebola outbreak," said Ambrose Nyakitwe, 34, a Ugandan trader returning from the Congo side.   "It is good. I have a family. I have to see that they don't get affected," he added, after passing through the scan.   Outside the busy border post, business carries on as usual, with children swimming and playing in the muddy Lhubiriha river that draws a natural boundary between the two nations.

- 'Not safe' -
A woman serves pancakes with her bare hands from a bucket as pot-bellied money changers lounging next to her carry out their trade.   However, while some carry on seemingly oblivious to the dangers posed by the virus, others are increasingly suspicious.   "It is not safe. If they say people with Ebola crossed into Uganda, how sure are we there are not many who will infect us and are yet to be got?" asked Bernadette Bwiso, 41, a trader.    "Government must do a house-to-house search," she said.   Meanwhile, Nyakitwe is anxious about how the infected patients managed to cross into Uganda despite heightened surveillance.   A Congolese woman -- who is married to a Ugandan -- her mother, three children and their nanny had travelled to DRC to care for her ill father, who later died of Ebola.

The World Health Organization said 12 members of the family who attended the burial in Congo were placed in isolation in the DRC, but six "escaped and crossed over to Uganda" on June 9.   The next day, a five-year-old was checked into hospital in Bwera vomiting blood. Tests confirmed he had Ebola and the family was placed in an isolation ward.   His three-year-old brother was also confirmed to have Ebola, as was their grandmother who died late Wednesday.   Uganda and the RDC are discussing what can be done to intensify collaboration between the two countries to prevent the spread, the Congolese authorities said.

- No surveillance -
Uganda's health ministry said that the surviving travellers and the Ugandan father -- five people in total -- had agreed to be repatriated to DRC on Thursday for treatment and "family support and comfort" from relatives on the other side of the border.   However, three unrelated patients are still in a Ugandan hospital awaiting the result of Ebola tests.

Uganda's Health Minister Jane Ruth Aceng said challenges remained at "unofficial entry points" between Congo and Uganda, which share a porous 875-kilometre (545-mile) border.   These unauthorised border crossings, known as "panyas" in the local Lukonzo language, are often merely planks laid down across a point in the river, or through forests and mountains where there is no surveillance.   In a bid to contain the spread of the disease the Ugandan government has suspended market days and urged people to stop shaking hands and hugging.
Date: Thu, 13 Jun 2019 16:33:58 +0200

Madrid, June 13, 2019 (AFP) - Spain will launch a campaign to urge young people to "always carry a condom on them" as the number of sexually transmitted infections (STI) surges, the government said Thursday.   The news comes a week after the World Health Organization expressed alarm at the lack of progress on curbing STI or diseases (STD), with one expert warning of complacency as dating apps spur sexual activity.   In Spain, videos and ads will be posted from Monday on social networks, music platforms and media that 14- to 29-year-olds most follow, the health ministry said.   "It's normal that you want to do it in your parents' bed. What isn't normal is that you want to complicate your life," reads one ad, going on to show the number of new cases of HIV and other infections.

In a statement, the health ministry urged "everyone -- and particularly the young -- to always have a condom on them and use it."   "The use of condoms has dropped among the 15- to 18-year-olds over the last few years," Health Minister Maria Luisa Carcedo told reporters.   She said there was complacency over STI, including infection by the HIV virus that causes AIDS.   The campaign is a "first shock measure" to challenge the rise of STI among young people, the statement said.   The number of cases of gonorrhoea, for instance, has risen an average of more than 26 percent annually between 2013 and 2017, according to the ministry.

Syphilis "has risen less but in 2017, it reached its highest peak since the start of statistics in Spain: 10.61 infections per 100,000 residents compared to 2.57 in 1995."   The highest rates of chlamydia, meanwhile, are among 20- to 24-year-olds and particularly women, the ministry said.   In 2017, Spain registered close to 24,000 cases of infection by gonorrhoea, syphilis, chlamydia and LGV, a sexually-transmitted disease, according to the statement.
Date: Thu, 13 Jun 2019 15:12:32 +0200

Vilnius, June 13, 2019 (AFP) - Lithuanian temperatures have hit record June highs, meteorologists said Thursday, as a heatwave forced school closures and threatened to reduce harvests in the draught-hit Baltic region.   Kaisiadorys in central Lithuania was the hottest place at 35.7 degrees Celsius (96.2 degrees Fahrenheit) on Wednesday, the highest-ever temperature recorded for June in the country, weather forecaster Paulius Starkus told AFP.   Six people drowned in the Baltic EU state on Wednesday, the deadliest day of the year to date, while some schools put classes on hold or cut lessons short due to the heatwave.

Scientists say the extreme weather is in part a result of climate change.   "Lithuania used to have heatwaves but now they occur more often and are more intense due to climate change," Vilnius University climatologist Donatas Valiukas told AFP.   Starkus said a downpour with thunder and hail could follow in some areas on Thursday afternoon.   Agriculture Minister Giedrius Surplys told lawmakers that some areas were experiencing "a real climatic draught" threatening harvests, while hydrologists warned that river water levels posed a threat to fish.   Demand for air-conditioning has also soared in recent weeks.   Lithuania's hot weather is expected to last through the week, then temperatures may ease below 30 degrees Celsius starting Monday.   Fellow Baltic state Latvia is also experiencing unusual heat for June, with temperatures over 32 degrees Celsius.

In recent days, Latvia's western region of Kurzeme saw thunderstorms with hail damaging buildings, smashing greenhouses and tearing power lines.   Two people have been hospitalised in the northern Latvian town of Cesis after a tree fell on their camper van while they were inside.    Fellow Baltic state Estonia had a heatwave last week and is now experiencing rainy and windy weather.   Poland has also been experiencing high temperatures this month, which has resulted in increased air-conditioner use. The power transmission system operator PSE said that on Wednesday there was record electricity demand for a summer morning at nearly 24.10 gigawatts (GW).   Forty-two people have already drowned in Poland this month, according to the government security centre RCB.