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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 11 Dec 2019
Source: MENA FN [edited]

Officials in the Ministry of Public Health has said that 2 fresh positive cases of polio have been registered in southern Uruzgan [Oruzgan] and northern Baghlan provinces.

According to health officials, the families of the polio-affected children live in Dand-e-Ghori [Dahana-i-Ghori] and Khas Uruzgan districts, [respectively], and the areas were out of the government's control and deprived of medical facilities.

Dr. Abdul Qayum Khplwak, head of the medical institute for the southern part of Afghanistan, said that one of the 2 children has been deprived of polio vaccination in Khas Uruzgan district of the province. He said that despite tremendous efforts towards fighting polio, there are great obstacles against the implementation of the process.

"Until every child receives polio vaccination, our efforts would not reach a complete goal," he said, adding that "the fresh case in Uruzgan shows that southern provinces are facing serious polio threats."

Meanwhile, a local medical in charge for polio affairs in Baghlan, Marjan Rasikh, has put the age of the polio-affected child at 4 years old, saying that the case has marked the initial positive polio in the province.

Over 24 positive polio cases have been recorded from the beginning of 2019: more than 8 cases in Uruzgan, 5 in Helmand, 4 in Kandahar, 2 in Paktia, and 3 other cases in Badghis, Nangarhar, and Kunar provinces.

To prevent the positive cases of polio, the health officials said that anti-polio vaccination should be implemented across the country.
===================
[The addition of these 2 newly confirmed cases will increase the total number of cases reported from Afghanistan with dates of onset during 2019 to 24. There was a newly confirmed case from Kandahar reported in last week's GPEI (Global Polio Eradication Initiative) report with date of onset 10 Nov 2019.

Again, the common denominator in the occurrence of WPV1 (wild poliovirus type 1)-associated AFP (acute flaccid paralysis) cases (presumed to be WPV cases) and in cVDPV (circulating vaccine-derived poliovirus)-associated cases is the presence of a significant susceptible population, or, in other words, areas with suboptimal vaccination coverages.

A map of Afghanistan showing provinces can be found at
The HealthMap/ProMED-mail map of Afghanistan can be found at
Date: Mon 2 Dec 2019
Source: China.org.cn, Xinhua News Agency report [edited]

One fresh polio case had been detected in Afghanistan's southern Kandahar province, a local newspaper reported on [Mon 2 Dec 2019].

"With this new case, the total number of polio cases in 2019 reaches 22 in the country. The latest polio case has been reported from Kandahar city, capital of Kandahar province which permanently paralyzed an 18-month-old child," Daily Afghanistan-e-Ma reported.

The paper added that polio is a crippling and potentially fatal infectious disease.

"Most of the Afghan children affected by poliovirus this year [2019] are living in areas where kids do not have access to health facilities and regular anti-polio vaccination campaign. However, this time a child has been affected in a large city where anti-polio vaccination had been conducted repeatedly this year," the report said.

There is no cure for polio and the polio vaccine is the only safe and effective way to protect children.

The ongoing conflicts have been hindering the efforts to stamp out the infectious disease in the mountainous country.
===================
[The addition of 3 newly confirmed cases of polio (all 3 due to WPV1, as per End Polio Pakistan <https://www.endpolio.com.pk/polioin-pakistan/polio-cases-in-provinces>) in Pakistan and one newly confirmed case of polio in Afghanistan brings the total number of WPV1 associated cases with date of onset in 2019 to 116 (94 in Pakistan and 22 in Afghanistan). The key question here is whether Afghanistan and Pakistan, with all the challenges in vaccinating the susceptible populations due to a variety of anti-vaccination impediments, will be able to interrupt transmission of the WPV1 in both countries simultaneously.

Maps of Afghanistan:
and <http://healthmap.org/promed/p/137>. - ProMED Mod.MPP]
Date: Sun 1 Sep 2019
Source: MENAFN - Afghanistan Times [edited]

Two new polio cases have surfaced separately in capital city of Tirinkot and Chora district of southern Uruzgan [Oruzgan] province, a statement from the relevant ministry said [Sun 1 Sep 2019].

A 30-month-old child and another 6-month-old infant were permanently paralyzed as a result of the polio virus.

According to a statement issued by the Ministry of Public Health (MoPH), the total number of polio cases in 2019 reached 15 with the 2 new cases, saying all of these cases had been reported from inaccessible areas.

"Of the 15 polio cases this year [2019], 14 have been reported from the southern region of Afghanistan,' the statement said, adding "7 positive cases came from [Oruzgan], 5 from Helmand, and 2 other from Kandahar."

Only 1 out of 12 polio cases was reported from eastern Kunar province while the rest happened in the southern zone.

"Access to health services is the right of every citizen of the country," said Dr Ferozuddin Feroz, the Minister of Public Health. "We are deeply concerned about the increasing polio cases and the number of children who still don't have consistent and proper access to vaccination," he added.

He said the virus could spread further in the country and more children would be affected and paralyzed by polio virus.

He called upon people to 'work together and protect innocent children against polio and facilitate a safe and secure environment for our frontline workers in order to enable them administer vaccine drops to children in every nook and cranny of the country."

Polio is a crippling and potentially fatal infectious disease. There is no cure and the vaccine is the only safe and effective way to protect children.

The polio vaccine is safe and harmless for new-born children whether they are sick or not. It is very important that new-borns and sick children get the vaccine because they may have lower immunity which makes them more susceptible to the virus.

Polio vaccination has also been strongly endorsed by national and global Islamic scholars.
========================
[As I mentioned in the moderator comment of the last post (Poliomyelitis update (71): global (Pakistan, Congo DR) http://promedmail.org/post/20190901.6651501), "While there have been no newly confirmed cases reported from Afghanistan this week nor have there been positive environmental samples reported from either Pakistan or Afghanistan, it doesn't mean the virus is not still circulating, just that there aren't new confirmations." Unfortunately there were cases under investigation.

As correctly stated in the media report above, the addition of these 2 newly confirmed cases brings the number of confirmed WPV1 cases reported by Afghanistan during 2019 to date to 15.

Oruzgan is located in the central part of Afghanistan, sharing southern and southwestern borders with Kandahar and Helmand provinces where other polio cases have been reported this year (2019) as well (<http://www.lib.utexas.edu/maps/middle_east_and_asia/afghanistan_admin-2009.jpg>).

HealthMap/ProMED-mail map of Afghanistan:
Date: Mon, 19 Aug 2019 13:26:06 +0200 (METDST)

Jalalabad, Afghanistan, Aug 19, 2019 (AFP) - Scores of people including children were wounded Monday after a series of explosions shook the eastern Afghan city of Jalalabad, as the country's independence day was marred by bloodshed.

As many as 10 blasts were reported in and around the city in Nangarhar province, authorities said, and casualty numbers rose as the day wore on.   "The explosions were caused by IEDs in different parts of the city and as groups of people were celebrating independence day," the Nangarhar governor's spokesman Attaullah Khogyani said, referring to improvised explosive devices.   Jalalabad is the scene of frequent bomb attacks, and the surrounding terrain is home to both Taliban fighters and the Islamic State group's local affiliate.

At least 52 people were wounded, Khogyani said. Zaher Adel, a spokesman for a local hospital, said 66 wounded people had been brought in. An AFP correspondent saw children among the victims.   This year's August 19 celebrations mark 100 years of Afghan independence from British influence.   The day was supposed to be one of national pride and unity, but was overshadowed by an IS suicide attack Saturday on a crowded Kabul wedding hall that killed at least 63 people.

In Kabul, locals took to the streets to wave the black-red-and-green Afghan flag, but several public events to commemorate the date were scrapped as Kabul mourns and due to fears of a fresh attack.    "We postponed the celebrations to honour the victims, but we will definitely take revenge for our people," Afghan President Ahraf Ghani said.   "We will avenge the blood of our people, every drop of it."

Mayhem from Afghanistan's war continues to wreak havoc on Afghans every day, even though the US and the Taliban are in final negotiations for a deal that would see US troops begin to quit Afghanistan and could potentially lead to a reduction in violence.
Date: Sun, 18 Aug 2019 11:47:26 +0200 (METDST)
By By Emal Haidary and Mushtaq Mojaddidi

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

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

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

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

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

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

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

Many Afghans fear the Taliban could return, eroding hard-won rights for women in particular and leading to a spiralling civil war.   Meanwhile, in the northern province of Balkh, 11 members of the same family were killed when their car hit a roadside bomb, officials said. The provincial governor blamed the Taliban for planting the device.
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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 ...

Macedonia

Macedonia US Consular Information Sheet
August 15, 2008
COUNTRY DESCRIPTION:
Macedonia is a parliamentary democracy that is steadily transforming its economy. Tourist facilities are available in the capital, Skopje, and other major towns.
In tourist centers, such as Skopje and Ohrid, European-standard hotels and other travel amenities are available, while the standard of facilities throughout the rest of the country varies considerably. Read the Department of State Background Notes on Macedonia for additional information.

ENTRY/EXIT REQUIREMENTS:
Short trip for business or tourism:
A valid passport is required for travel to Macedonia.
A visa is not required for U.S. passport holders for tourist and business trips up to 90 days during a six-month period.
Entry stamps are issued at airports or land border crossing points, which grant permission to remain 90 days.
All foreign citizens must register with local police within 24 hours of arrival.
Those staying in private accommodation or renting an apartment should register in person at the police station nearest his/her place of residence, and should be accompanied to the station by the owner or landlord of the apartment.
Hotels are responsible for the registration of foreign guests.
If the foreigner changes address in Macedonia, he or she should notify the police station where s/he initially registered and reregister with the police station closest to the new place of residence.

An unaccompanied minor U.S. citizen who enters Macedonia should be in possession of a parental or guardian statement of consent to enter and stay in the country.
The statement of consent must be certified by a competent authority of the country from which s/he arrives or by a diplomatic or consular mission of the Republic of Macedonia abroad.

NOTE:
A U.S. citizen who possesses more than one passport is required to leave the country with the travel document used for entry into the country.

Temporary residence:
Individuals intending to work, study or remain longer then 90 (ninety) days in Macedonia, must obtain an entry visa prior to their arrival in Macedonia.
The practice of switching from tourist status to long-term status when already in Macedonia is no longer allowed.
Those wanting to do so must leave Macedonia and apply for a long-term visa at a Macedonian Embassy of Consulate.
Macedonian visas, as opposed to entry stamps, can only be issued at a Macedonian Embassy or Consulate in a foreign country.

American citizens resident in the United States may apply at:
Macedonian Embassy in Washington D.C.2129 Wyoming Avenue, NW, Washington, D.C. 20008, Tel: (202) 667-0501; Fax: (202) 667-2131;
E-mail: washington@mfa.gov.mk; usoffice@macedonianembassy.org, Website: http://www.macedonianembassy.org.

The passport should be valid for at least three months longer than the validity of the visa.
For additional information about the conditions and procedures for visa issuance, the applicant should contact the Embassy or Consulate of the Republic of Macedonia.
Using the list of diplomatic and consular missions of the Republic of Macedonia abroad (which can be found at the Ministry of Foreign Affairs’ website at www.mfa.gov.mk), a visa applicant can choose the most convenient Embassy/Consulate to the submit the visa application.

Travelers should be aware that all
border areas apart from designated border crossings are restricted zones. Presence in these zones is forbidden without prior official permission.

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 security situation in Macedonia is stable, although occasional criminal violence does occur. Americans should avoid areas with demonstrations, strikes, or roadblocks where large crowds are gathered, particularly those involving political causes or striking workers.

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

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME: Crime in Macedonia is low by U.S. standards, and violent crime against Americans is rare. Pickpocketing, theft, and other petty street crimes do occur, however, particularly in areas where tourists and foreigners congregate. American travelers are advised to take the same precautions against becoming crime victims as they would in any U.S. city. Valuables, including cell phones and electronic items, should not be left in plain view in unattended vehicles. Windows and doors should be securely locked when residences are not occupied. Organized crime is present in Macedonia; organized criminal activity occasionally results in violent confrontations between members of rival organizations. ATM use is safe, as long as standard safety precautions are taken.
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 a victim of a crime while overseas, in addition to reporting to the local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends, and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and find an attorney if needed.

The local equivalent to the “911” emergency line in Macedonia is:
police 192 and ambulance 194
If you are outside the city of Skopje you need to dial 02 first.

For additional assistance see our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Although many Macedonian physicians are trained to a high standard, and a number of well-equipped private clinics are available especially in Skopje, most public hospitals and clinics are not equipped and maintained at U.S. or Western European standards. Basic medical supplies are usually available, but specialized treatment may not be obtainable. Travelers with previously diagnosed medical conditions may wish to consult their physician before travel.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of [country]. Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en/
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Macedonia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Driving safely in Macedonia requires excellent defensive driving skills. Many drivers routinely ignore speed limits and other traffic regulations, such as stopping for red lights and stop signs. Drivers may make illegal left turns from the far right lane, or drive into oncoming lanes of traffic. The combination of speeding, unsafe driving practices, poor vehicle maintenance, the mixture of new and old vehicles on the roads, and poor lighting contributes to unsafe driving conditions. Pedestrians should exercise extreme caution when crossing the street, even when using crosswalks, as local drivers rarely slow down or stop for pedestrians.

A valid U.S. driver’s license in conjunction with an International Driving Permit is required for Americans driving in Macedonia. Driving is on the right side of the road. Speed limits are generally posted. Most major highways are in good repair, but many secondary urban and rural roads are poorly maintained and lit. Horse-drawn carts, livestock, dead animals, rocks, or other objects are sometimes found in the roadway. Some vehicles are old and lack standard front or rear lights. Secondary mountain roads can be narrow and poorly marked, lack guardrails, and quickly become dangerous in inclement weather. Overall, public transportation in Macedonia is dilapidated. Roadside emergency services are limited.
In case of emergency, drivers may contact the police at telephone 192, the Ambulance Service at telephone 194, and Roadside Assistance at telephone 196.

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 Macedonia, the U.S. Federal Aviation Administration (FAA) has not assessed Macedonia’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES: Macedonian customs authorities may enforce strict regulations concerning temporary importation to or exportation from Macedonia of certain items, including items deemed to be of historical value or significance. Taking photographs of anything that could be perceived as being of military or security interest may result in problems with authorities. Visitors should always observe “no photographing” signs. If in doubt, please ask permission before taking photographs.

The local currency is the denar. While credit cards are accepted in larger stores and restaurants, cash in local currency is advised for purchases in small establishments.

Upon entry into Macedonia, every foreigner must declare all cash amounts of foreign currency greater than EUR 2,000 at the Customs Control Office. Failure to report funds in excess of this amount may result in the confiscation of the entire amount by the customs service. After going through the court system, an individual is normally required to pay a fine and the National Bank will also keep a certain percentage of the undeclared amount before it is released.
Please also 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 Macedonian laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Macedonia 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. Prostitution is illegal in Macedonia. 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 Macedonia 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 Macedonia. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy in Skopje is located at Ilindenska bb, 1000 Skopje, tel. (389) (2) 311-6180, fax (389) (2) 321-3767, email: consularskopje@state.gov; web site: http://macedonia.usembassy.gov
* * *
This replaces the Country Specific Information for Macedonia dated March 05, 2008 to update the section on Entry/Exit Requirements.

Travel News Headlines WORLD NEWS

Date: Mon 29 Jul 2019
Source: Institute of Public Health of Republic of North Macedonia [abridged, edited]

Information on the situation of measles in the Republic of North Macedonia in 2018-2019, 25 Jul 2019
--------------------------------------------------------------------------------
In the period from 20 Jul-25 Jul 2019, a total of 5 cases of measles were reported. From the total number of newly reported cases, 4 cases are from Skopje, while one is from Kumanovo.

In total, since the onset of the epidemic in December 2018 as of 25 Jul 2019, 1870 cases of measles have been registered in the Republic of North Macedonia with a disease rate of 90.4 per 100,000 inhabitants.

Due to the epidemiological criteria, a measles epidemic is ongoing in the entire territory of the Republic of North Macedonia.

According to the place of permanent living, measles cases are registered in 24 towns, of which 979 cases are from Skopje, Kumanovo 231, Tetovo 194, Struga 112, Kicevo 59, Veles 53, Gostivar 69, Ohrid 35, Gevgelija 19, Debar 22, Prilep 11, Stip 40, and in other cities less than 10 cases were registered (Chart 1). The highest incidence is registered in Skopje (158.5/100 000, Struga (165.1/100 000, Kumanovo 161.9/100 000)

According to the vaccine status, 1501 or 80.3% of diseased people are unvaccinated, incompletely vaccinated or with unknown vaccine status. >From the non-vaccinated persons, 320 (21.3%) are under the age of 12 months and are not subject to vaccination, according to the Immunization Calendar.

According to the results obtained from the samples sent to Luxembourg's reference measles laboratory, the B3 Dublin genotype circulates in the country, which is circulating also in the neighbouring countries.
 
The total number of immunized people aged 14 years with MRP [morbilli, rubella, and parotitis epidemica/MMR measles, mumps, rubella] vaccine since the start of the epidemic in the republic is 33,729.  From the beginning of the epidemic to present date, in the Centers for Public Health, a total of 6032 people have been vaccinated, of which more than 60% are health workers, students, and pupils in secondary medical schools, the rest are persons over 14 years of age.

[Available at the source URL:]
Chart 1. Geographic distribution of measles in N. Macedonia, December 2018-July 2019
----------------------------------------------
Communicated by:
Aleksandar Jovicic
==========================
[HealthMap/ProMED-mail map of Republic of North Macedonia:
Date: Fri 29 Mar 2019
Source: Institute of Public Health of Republic of Macedonia [abridged, edited]

Information on the situation of measles in the Republic of North Macedonia in 2018-2019, 29 Mar 2019
-------------------

In the period 23 Mar-29 Mar 2019, a total of 109 cases of measles (laboratory confirmed or related to the epidemiological link) were reported.

Out of the total number of newly reported cases, 49 cases are from Skopje, with 89.8% of them incomplete vaccinated, unvaccinated, or with unknown vaccine status. The remaining 60 patients are from 11 other cities in North Macedonia:

- From Kumanovo and Struga, 30 cases (15 cases in each) were reported, of which 90% were unvaccinated, incomplete vaccinated, or with unknown vaccine status;
- From Tetovo and Debar: in 7 cases from Tetovo, 6 were unvaccinated, incomplete vaccinated, or with unknown vaccine status; from Debar, one case was unvaccinated and one with unknown vaccine status;
- From Gostivar, there are 6 cases, of which 5 are unvaccinated, incomplete vaccinated, or with unknown vaccine status;
- 4 cases were reported from Kicevo, with 2 of them unvaccinated and incomplete vaccinated;
- From Veles, 2 cases, with 1 unvaccinated and 1 incomplete vaccinated;
- 1 new case each was reported from Stip (unknown vaccine status), Ohrid (incomplete vaccinated), Radovis (not vaccinated), and Prilep (completely vaccinated).

In total, since the onset of the epidemic in Skopje in December 2018, as of 29 Mar 2019, 767 measles cases were registered in the Republic of North Macedonia, of which 575 were epidemiologically related and reported in the epidemic in Skopje.

According to the place of permanent living, measles cases were registered in 20 towns in Macedonia, of which 521 were from Skopje, 63 from Tetovo, 61 from Kumanovo, 27 from Struga, 18 cases from Gevgelija and Debar, 15 from Gostivar, 12 from Veles, 11 from Kicevo, 4 from Kocani and Shtip, and in sporadic cases in the other 9 cities. The highest incidence per 100 000 inhabitants is registered in Struga (97.3), Skopje (84.4), Debar (64.9), Kumanovo (42.8), and Gevgelija (41.8).

The largest number of cases are from the age group over 30 years, with 305 or 39.8% of the total. A high percentage of patients is also registered in the age group of 0-4 years, with 37.9% of the total number of cases (n = 291).

Out of 150 children aged 1-4 years, 137 or 91.3% were unvaccinated or with unknown vaccine status; from 412 patients in persons over 20 years of age, 69.2% (n = 285) were unvaccinated, incomplete vaccinated, or with unknown vaccine status.

Out of the total number of 767 registered cases of measles, the highest number and percentage, 369 or 48.1%, are laboratory confirmed, 193 or 25.2% are epidemiologically linked, while 205 cases (26.7%) are measles with clinical features.

>From the beginning of the epidemic in Skopje, the total number of vaccinated people under 14 years of age who are subject to 1st or 2nd vaccination is 11 475 children. In the rest of the republic, from the beginning of the epidemic, the total number of vaccinated people up to 14 years of age with a 1st or 2nd dose is 6776 children.

The total number of immunized people aged 14 years with the MRI vaccine since the beginning of the epidemic is 18,251.  Submitted by: Aleksandar Jovicic.
=========================
[HealthMap/ProMED map of North Macedonia
http://healthmap.org/promed/p/55666. - ProMED Mod.MPP]
Date: Fri 8 Mar 2019
Source: IPH (Institute of Public Health of Republic of Macedonia) [abridged, edited]

This week [week of Mon 4 Mar 2019], a total of 81 cases of measles have been reported (laboratory confirmed or with an epidemiological link). A total of 45 cases of measles have been reported from Skopje (of whom 73.3% were incompletely vaccinated, unvaccinated, or with unknown vaccine status) while the other 36 are from 9 other cities in Macedonia.

From Gevgelija, 7 cases were reported, 6 of them unvaccinated. From Kumanovo, 8 cases were reported, 7 unvaccinated. From Tetovo, 7 new cases were reported, 6 of which were not vaccinated, with incomplete vaccine status. From Struga, 5 cases were reported, of which 3 were incompletely vaccinated with unknown vaccine status. Three new cases have been reported from [each of] Debar and Veles; [of these,] 5 persons have been incomplete vaccinated or with unknown vaccine status. Also, one new case from [each of] Kriva Palanka (not vaccinated), Kicevo (unknown vaccine status), and Kocani (completely vaccinated) [were reported].

A total of 493 cases of measles have been registered in Macedonia since the beginning of the epidemic in Skopje since December 2018, of which 410 have been linked to the epidemic in Skopje.

According to the place of permanent living, measles cases were registered in 17 towns in Macedonia, of which 366 cases were from Skopje, 39 from Tetovo, 25 from Kumanovo, 16 from Gevgelija, 9 from Debar, 7 from Struga, 6 from Gostivar, 6 from Veles, 5 from Kichevo, and 4 from Kocani, and the other 7 cities are sporadic cases.

The largest number of cases are from the age group 0-4 years: 220, or 44.6% of the total. A high percentage of patients is also registered in elderly groups. Persons older than 30 years account for 36.9% (n = 182) and persons from 20-29 years for 10.3% (n = 51).

Out of a total of 122 cases of children aged 1-4 years, 105 (86%) were unvaccinated, and out of 233 cases in people over 20 years of age, 70.8% (n = 165) were unvaccinated, incompletely vaccinated, or had unknown vaccine status.

From the total number of registered 493 cases of measles, the highest number and percentage -- 278 (56.4%) -- are laboratory confirmed; 117 (23.7%) are epidemiologically related, while 98 cases (19.9%) are measles [presumably this means clinically diagnosed but not laboratory confirmed. - ProMED Mod.SH].

Since the onset of the epidemic, in Skopje, total of 9958 children under 14 years of age have been vaccinated as part of the response to the outbreak with a 1st or 2nd dose. In the rest of the republic, since the epidemic began, a total of 5193 children up to 14 years have been vaccinated with a 1st or 2nd dose. The total number of those aged 14 years [and under] who have received MRP vaccine since the start of the epidemic in the Republic of Macedonia is 15 151.
Date: Sat 9 Feb 2019
Source: China.org.cn, a Xinhua report [edited]

The Macedonian Health Minister Venko Filipce confirmed on [Fri 8 Feb 2019] the death of a 6-month-old baby related to measles. According to Filipce, the baby was under treatment for lung complications and was not vaccinated.

The minister said vaccination in Macedonia should continue in order to strengthen the immunity of the population after the significant drop on vaccination coverage in 2014.  Filipce also confirmed that 2 children are treated for lung complications but are not in life-threatening conditions. The minister made the remarks after his visit at the Neurology Clinic in Skopje. On [2 Jan 2019], the Health Ministry in Macedonia declared the outbreak of measles in the capital of Skopje.
Date: Wed 2 Jan 2019
Source: Outbreak News Today [abridged, edited]

Health officials in Macedonia are reporting a measles outbreak in the capital city of Skopje. Minister of Health Assoc. Dr. Venko Filipce announced the outbreak declaration today [2 Jan 2019].

In addition to the 7 cases that appeared in the Skopje settlement Radishani 10 days ago, there are now 12 new cases from almost all municipalities in Skopje, of which 6 are officially laboratory confirmed and 6 have a clear clinical picture and are awaiting official laboratory confirmation. The outbreak has affected both children and adults, all of whom were unvaccinated.

"Of the 15 000 unvaccinated children with vaccine calls, only 310 were vaccinated, which is a small figure. It is a good circumstance that schools [were closed] because of the holidays.

"But, of course, we have the situation under control. This is an extremely serious disease that, unfortunately, is sometimes fatal to the lives of children. Any disregard for the recommendations is an additional risk for the health of the whole population," said Minister Filipche (computer translated).  [Byline: Robert Herriman]
=========================
[A total of 310 children vaccinated of 15 000 is only 2% of the children immunized. This is an unacceptably high risk for the children. - ProMED Mod.LK]

[HealthMap/ProMED-mail map:
Skopje, Macedonia (FYROM): <http://healthmap.org/promed/p/1999>]
More ...

Cote d'Ivoire

Cote d'Ivoire - US Consular Information Sheet
May 21, 2007
COUNTRY DESCRIPTION: Cote d'Ivoire (Ivory Coast) is a developing country on the western coast of Africa.
The official capital is Yamoussoukro, but Abidjan is the largest city, the
ain commercial center, and where the Ivorian government and the U.S. Embassy are located.
Cote d'Ivoire is a republic whose constitution provides for separate branches of government under a strong president.

The country has been divided since a 2002 coup attempt developed into a civil war.
Despite several peace agreements and the establishment of a transitional government, key issues remain unresolved, elections have been delayed, and tensions persist throughout the country.

Tourist facilities in and near Abidjan, the commercial capital, are good; accommodations in many other locations are limited in quality and availability.
Read the Department of State Background Notes on Cote d’Ivoire for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport is required, but U.S. citizens traveling to Cote d'Ivoire for business or tourism do not require visas for stays of 90 days or less.
To stay longer than 90 days, the visitor may still enter without a visa, but then must apply for a "carte de sejour" within 90 days of arrival.
(Note: "Cartes de sejour" are not issued to children under the age of 16, who are documented on their parents' visas).
An international health certificate showing current yellow fever immunization is required for entry into Cote d'Ivoire.
Without it, the traveler may be required to submit to vaccination at the airport health office before clearing immigration, at a cost of 5,000 CFA (a little less than $10).

Travelers may obtain the latest information and details on entry requirements from the Embassy of the Republic of Cote d'Ivoire, 3421 Massachusetts Avenue, NW, Washington, D.C. 20007, telephone (202) 797-0300.
There are honorary consulates for Cote d'Ivoire in San Francisco, Stamford, Orlando, Houston and Detroit.
Overseas, travelers should inquire at the nearest Ivorian embassy or consulate.
See our Foreign Entry Requirements brochure for more information on Cote d’Ivoire and other countries.
Visit the Embassy of Cote d'Ivoire web site at http://www.cotedivoireembassy.com/ for the most current visa information.

Foreign travelers are sometimes approached at ports of entry by individuals with offers to expedite passport control and customs, and are then asked to pay an exorbitant fee, both for the service and for the passport and customs officers.
Travelers to Cote d'Ivoire are advised that there is no need to pay a police officer or customs officer at the airport for any service rendered during an arrival or departure, and they should not surrender their passports or other important documents to anyone except easily identifiable government officials in uniform.

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

SAFETY AND SECURITY:Cote d'Ivoire has been unstable since the coup in 1999, and territorially divided since 2002.
The New Forces control the northern and some western parts of the country.
There are many road checkpoints manned by security forces and militia in both the government-controlled and New Forces-controlled portions of the country.
Soldiers and militia members check documents and frequently demand cash for permission to pass.
Cote d'Ivoire's border with Liberia is open, but border controls are extensive.

Political instability has contributed to economic stagnation and high unemployment, exacerbating social tensions and creating the potential for labor unrest and civil disorder.
There have been recurring episodes of violence, some of them severe.
In November 2004, there was a brief resumption of hostilities between the two sides followed by widespread attacks against people and property in Abidjan and elsewhere.
Many of these attacks were directed against French and other expatriates, and thousands fled the country.
Americans should avoid crowds and demonstrations, be aware of their surroundings, and use common sense to avoid situations and locations that could be dangerous.
While diplomatic efforts to end the crisis are ongoing, further civil unrest, coup attempts or the resumption of hostilities are possible.

Swimming in coastal waters is dangerous and strongly discouraged, even for excellent swimmers.
The ocean currents along the coast are powerful and treacherous, and numerous people drown each year.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s Internet web site where the current Travel Warnings and Public Announcements, including the Worldwide Caution Public Announcement, can be found.

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

The Department of State urges U.S. citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Crime continues to be a major security threat for Americans living in Cote d'Ivoire.
Grab-and-run street crime and pick pocketing in crowded areas are widespread.
Armed carjacking, robberies of businesses and restaurants, and home invasions are common, and they often target expatriate residents who are perceived as wealthy.
Armed criminals use force when faced with resistance.
Travelers displaying jewelry and carrying cameras are especially at risk.
Travelers are advised to carry limited amounts of cash and only photocopies of key documents.
While there have been relatively few reported cases of sexual assault, given the general climate of criminality, the actual rate of assault may be much higher than that which is reported.
There were allegations of sexual assaults during the November 2004 civil strife.
Given the strong anti-French sentiment, people of non-African appearance may be specifically targeted for violence.
Avoid large gatherings and political demonstrations, as they can turn violent quickly.

Travel outside of Abidjan or at night is strongly discouraged, and it is particularly dangerous to visit Abidjan's Treichville, Adjame, Abobo, and Plateau districts after dark.
The DeGaulle and Houphouet-Boigny bridges in Abidjan are dangerous areas for pedestrians.
Inadequate resources and training limit the ability of the police to combat crime.
Many hotels, restaurants, nightclubs and supermarkets provide security guards to protect clients and vehicles.

Travelers should take the same common sense precautions in Abidjan that they would in any metropolitan area in the United States.
Travelers should stay in well-lit areas and walk confidently at a steady pace on the side of the street facing traffic close to the curb.
Travelers should avoid crowds, mass transit, doorways, bushes, alleys and sparsely populated areas.
Travelers who need transportation at night should take an Orange metered taxi.
Travelers should be discreet about your transactions, especially in sight on the street.
Normal spending habits of Westerners appear extravagant.

Credit card use in Cote d'Ivoire is limited, particularly outside Abidjan, but credit card fraud is an increasing problem.
Travelers should not use credit cards in paper transactions unless the credit card transaction is electronically performed in view of the individual.

Business fraud is rampant and the perpetrators often target foreigners, including Americans.
Schemes previously associated with Nigeria are now prevalent throughout West Africa, including Cote d'Ivoire, and pose a danger of grave financial loss.
Typically these scams begin with unsolicited communication (usually e-mails) from strangers who promise quick financial gain, often by transferring large sums of money or valuables out of the country, but then require a series of "advance fees" to be paid, such as fees for legal documents or taxes.
Of course, the final payoff does not exist; the purpose of the scam is simply to collect the advance fees.
A common variation is the scammer’s claim to be a refugee or émigré of a prominent West African family, or a relative of a present or former political leader who needs assistance in transferring large sums of cash.
Still other variations appear to be legitimate business deals that require advance payments on contracts.
Sometimes victims are convinced to provide bank account and credit card information and financial authorization that drains their accounts, incurs large debts against their credit, and takes their life savings.

The best way to avoid becoming a victim of advance-fee fraud is common sense — if a proposition looks too good to be true, it probably is a scam, particularly if one has never met the correspondent.
Travelers should carefully check and research any unsolicited business proposal before committing any funds, providing any goods or services, and undertaking any travel.
A good clue to a scam is the phone number given to the victim; legitimate businesses and offices provide fixed line numbers, while scams typically use only cell phones.
In Cote d'Ivoire, all cell phone numbers start with zero.

It is virtually impossible to recover money lost through these scams.
For additional information please consult the Department of State's brochure Advance Fee Business Scams.

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:
Abidjan has privately-run medical and dental facilities that are adequate but do not fully meet U.S. standards.
Good physician specialists can be found, though few speak English.
While pharmacies are well stocked with medications produced in Europe, newer drugs may not be available.
Medical care in Cote d'Ivoire outside of Abidjan is extremely limited.
Malaria is a serious health problem in Cote d’Ivoire.
For more information on malaria, including protective measures, see the Centers for Disease Control Travelers’ Health web site at http://www.cdc.gov/malaria/.

The avian influenza or “Bird Flu” virus (H5N1) has been confirmed in animals in Cote d’Ivoire as of June 2006.
For more information regarding Avian Influenza, please visit the CDC’s internet site at http://www.cdc.gov/travel/other/avian_flu/ and the State Department’s Avian Influenza Fact Sheet.

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

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Cote d’Ivoire is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Serious traffic accidents, one of the greatest threats to U.S. citizens in Cote d’Ivoire, occur regularly in Abidjan.
Unsafe road conditions, unskilled drivers, and poorly maintained and overloaded vehicles create very poor driving conditions.
Speed limits, signals, and yielding for pedestrians and cyclists are not respected.
Travelers should drive defensively, watch out for public transportation vehicles that stop and start without warning, and be especially cautious at intersections because traffic lights often malfunction.
Travelers who must travel at night should beware of vehicles without headlights and/or taillights, and pedestrians and bicycles along the roadside.
In case of an accident, travelers are advised not to move their vehicle until a police officer authorizes.
Travelers should go to the nearest hospital or police station if there is no other vehicle to take the injured to a hospital, or if there is reason to believe that their life is in danger from others at the site of the accident.

Abidjan has a poor public transportation system; if traveling by bus, use only the “Express” line.
In Abidjan, taxis are readily available, inexpensive (metered), but poorly maintained and notorious for not respecting the rules of the road.
Communal taxis (“woro-woros”), used only within the limits of each commune, are not metered and are dangerous.
Local vans ("Gbaka") should not be used because they are frequently involved in accidents.

Criminals usually steal vehicles when the driver is in or near the vehicle, so car doors and windows should be kept locked.
While stopped in traffic, travelers should remember to allow enough room between your car and the one in front to maneuver out if needed.
Travelers should look around to see if there is anyone paying unusual attention or if someone appears to be watching, before entering their vehicles. Travelers should not attempt to enter their vehicles, and should go get assistance.
Travelers should enter and exit their vehicles as quickly as possible, to limit their vulnerability to carjacking.

Victims of carjacking should not resist.
Victims should try to remain calm and give the carjackers what they want, which is usually the vehicle and any valuables.
Experience shows that criminals usually don’t use violence unless they are confronted with resistance.
Furthermore, it is not uncommon to take an occupant, usually a woman or child, as hostage to ensure their safe escape; the hostage is usually released unharmed.
This is a very difficult situation; victims should use their best judgment in deciding a course of action.

A newer phenomenon is the staged accidental "bumping" accident.
If your vehicle is "bumped" from the rear or the side, stay locked inside because this ruse is used to get the driver out and leave the vehicle free for carjacking.
Travelers with cell phones should call for assistance.
Victims should report the accident at the nearest police station as soon as possible if they feel their safety is in jeopardy and try to get the license number for any other vehicle involved.

Emergency services such as ambulance service (SAMU) exist in Abidjan and larger towns.
Call 185 or 22-44-55-53.
In smaller towns there is usually no ambulance service available, but ambulances will be dispatched from larger towns

Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Cote d'Ivoire’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Cote d'Ivoire's air carrier operations.
For more information, travelers may visit the FAA’s internet web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Ivorian customs authorities encourage the use of an ATA (Admission Temporaire/Temporary Admission) Carnet for the temporary admission of professional equipment, commercial samples, and/or goods for exhibitions and fair purposes.
ATA Carnet Headquarters, at the U.S. Council for International Business, 1212 Avenue of the Americas, New York, NY 10036, issues and guarantees the ATA Carnet in the United States.
For additional information, call (212) 354-4480, e-mail atacarnet@uscib.org, or visit http://www.uscib.org.

If traveling to another West African Economic and Monetary Union (WAEMU) country, expatriate residents leaving Cote d’Ivoire must declare the amount of currency being taken out of the country; if going to any other country, tourists are prohibited from taking more than 500,000 CFA francs (approximately $1,000), and business operators two million CFA francs (approximately $4,000), without government approval.
Even with authorization, there is a cash limit of $4,000 for tourists and $5,500 for business people, with any surplus in travelers or bank checks.

Travelers should carry a photocopy of your U.S. passport, visa, and entry stamps.
Travelers should also, carry their international driver's licenses if planning to drive.

Government corruption remains a serious problem in Cote d'Ivoire, and has an impact on judicial proceedings, contract awards, customs, and tax issues.
Security forces (police, military, gendarmes) routinely stop vehicles for traffic violations and security checks. Travelers should politely present identification if stopped.
Travelers who are stopped at one of these check points for any reason and asked to pay a "fine" to these uniformed officials, should politely refuse and present a photocopy of their U.S. passport, visa, and entry stamp.

Taking pictures is prohibited near sensitive installations, including military sites, government buildings such as the radio and television stations, the Presidency building, the airport, and the DeGaulle and Houphouet-Boigny bridges in Abidjan.

Cote d’Ivoire recognizes dual nationality if acquired at birth.
Americans who also are Ivorian nationals may be subject, while in Côte d'Ivoire, to certain aspects of Ivorian law that impose special obligations on citizens of that country.
Please see our information on Customs Regulations.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Cote d'Ivoire's laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Cote d'Ivoire 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 Criminal Penalties.

CHILDREN'S ISSUES:
For information on international adoption of children and international parental child abduction, see the Office of Children’s Issues web site.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Cote d'Ivoire are urged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website and to obtain updated information on travel and security within Cote d’Ivoire.
Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located in the Riviera Golf neighborhood of the Cocody section of Abidjan, east of the downtown area.
The Embassy's postal address is 01 B.P. 1712 Abidjan 01, and the main telephone number is 22-49-40-00.
The Consular Section fax number is 22-49-42-02, and more information is on the Consular pages of the Embassy's web site at http://Abidjan.usembassy.gov/
*

*

*
This replaces the Consular Information Sheet dated November 21, 2006, with no major changes.

Travel News Headlines WORLD NEWS

Date: Thu, 24 Oct 2019 11:46:08 +0200 (METDST)
By David ESNAULT

Bouake, Ivory Coast, Oct 24, 2019 (AFP) - Once the bane of sub-Saharan Africa, sleeping sickness is agonisingly close to being wiped out, but only if countries -- and donors -- keep up their guard, say scientists.   The disease, transmitted to humans by the tsetse fly, was once a curse in 30 countries.   But a coordinated global fight to eradicate it has borne fruit, leading to a 95-percent fall in cases over the past 15 years, according to the World Health Organization (WHO).

Last year, the agency recorded only 977 cases, compared to a peak of some 300,000 in the 1990s. Its hope is that sleeping sickness will enter the history books by 2030.   Sleeping sickness -- human African trypanosomiasis -- is caused by the trypanosoma parasite, which is transmitted to humans by the tsetse when it takes a blood meal.   The disease is fatal unless diagnosed and treated rapidly. Early symptoms are severe headaches and muscle aches and fever.

Sufferers feel lethargic and sleepy by day then awake and exhausted at night. Neuropsychiatric and sensory disorders follow, then a coma before death ensues within months or sometimes even years later.   "Sleeping sickness is scary -- when someone has it, it makes them mad," said Emile Gouribitiali, 56, a villager in central Ivory Coast whose mother and younger brother both fell ill.   But scientists say this dreaded disease is on the ropes.   "After a century of fighting it, sleeping sickness is on the verge of being eradicated," said Dr Dramane Kaba, an entomologist and director of the Pierre Richet Institute (IPR) at Bouake in central Ivory Coast.   "Sleeping sickness has almost stopped being a public health problem in Africa," he said. "But we have to maintain our efforts."   The institute, founded in 1970, specialises in insect-transmitted diseases including malaria, dengue, zika and chikungunya.

- Meticulous task -
Despite the progress, "pockets of resistance" remain, says Kaba.   They include the Democratic Republic of Congo -- home to 80 percent of cases -- and Guinea, where health programmes have been ravaged by the Ebola crisis.   It is also difficult to gain an accurate assessment in areas of armed conflict.   If the overall outlook is relatively favourable, there must be no let-up towards eradication, Kaba insists.

He points to the fact that, after a campaign against the illness from the 1920s through to the 1960s "vigilance then dropped off and the illness returned".   Combatting the spread of the disease requires meticulous work to break the chain of transmission and kill the parasite, said Vincent Jamonneau at France's Research Institute for Development (IRD).   Teams on the ground, working with lab-based researchers, comb rural areas to uncover possible cases of the disease and beef up control of the tsetse fly, which favours a hot, humid habitat.

- Fly traps -
They log symptoms that point to a possible infection and then carry out a quick diagnostic blood test, obtaining results confirmed in a lab.   Patients identified in this way can be cured through hospitalisation of seven to 10 days, which the WHO provides free of charge across Africa. A revolutionary treatment, which involves taking a one-off pill, is being tested.

Ironically, as the disease is rolled back, it becomes more and more difficult to encourage villagers to come forward and get tested, said Jammoneau.   "People no longer feel that the disease is a threat," he said.   The researchers also test cattle, another tsetse target who suffer a different strain of the virus -- animal trypanosomiasis. They lose weight, their milk production slumps, then they die.   IPR teams set tsetse traps in villages where they operate. The traps comprise blue screens impregnated with insecticide -- the flies find the colour attractive. 

Another trap variant permits capture to assess their number and then dissection to determine if they are infected.   The IPR hosts research at its lab as the scientific community hones its battle to eradicate sleeping sickness.    The lab can draw on some state-of-the-art equipment as well as some 100 employees, including 16 researchers, but needs renovating, said Kaba.    For Jamonneau, "the means to eradicate trypanosomiasis are there.   "But this disease raises scant interest among fundraisers. So we still need their support as the challenge is to track down and treat the last cases in order to finish off the illness."
Date: Tue, 22 Oct 2019 16:24:07 +0200 (METDST)

Abidjan, Oct 22, 2019 (AFP) - Ivory Coast announced Tuesday that Arab investors had pledged $5 billion to support its programme to attract foreign tourists to the West African nation.   The tourism ministry said "a round table of investors in Dubai" on Sunday and Monday expressed interest In Ivory Coast and in total, the minister for tourism and leisure, Siandou Fofana, "enlisted from them pledges worth just over $5 billion" (4.49 billion euros).   Ivory Coast's charm offensive in the United Arab Emirates included a delegation with recently retired star footballer Didier Drogba and A'Salfo, lead singer with the pop group Magic System, who gave two concerts.

The initiative, dubbed "Sublime Cote d'Ivoire" (Magnificent Ivory Coast), was launched in May.   "Our goal is to become the fifth biggest destination for tourism in Africa by 2025," Fofana said in the ministry's statement.   If objectives are reached, tourism would account for 12 percent of GDP compared with 5.5 percent today, and jobs in the tourism sector would grow from 270,000, as of 2016, to 365,000.   The economy today is hugely dependent on rural earnings, especially cacao and coffee. The plan is to attract tourists to the remote west of the country, a region of unspoiled mountains and beaches.
Date: Tue, 27 Aug 2019 15:33:42 +0200 (METDST)

Bouake, Ivory Coast, Aug 27, 2019 (AFP) - The main market in Bouake, Ivory Coast's second biggest city, was largely destroyed Tuesday in an overnight blaze, although there were no known casualties, an AFP correspondent reported.   The fire broke out around 2:00 am (0200 GMT) and spread fast, market watchmen said.   It took around seven hours to bring under control, mobilising several hundred firefighters, police and troops, partly to put out the blaze but also to secure the area.   "This tragedy has most fortunately caused no loss of life," Bouake mayor Nicolas Djibo said, adding though that he was "dumbstruck by the scale of the damage".

Djibo said the fire had begun in the butchers' area of the market, which hosts hundreds of stalls and is a hub of social activity in Bouake, a city of one million people in the centre of Ivory Coast.   Some traders had been able to remove their wares in time but others wept at the sight of their loss.   Koffi Rachelle, who sold children's toys and various gadgets, told AFP she had lost everything. "I can"t even get into my shop, the fire has destroyed everything over there," she said in tears.

An inquiry into the fire has been opened, according to a police source who asked not to be named.   The market, which had an area of between eight and nine hectares (about 22 to 22 acres), had been razed by a fire in 1998.   Experts had been studying a proposal to house the stalls in a large modern building before the latest blaze.
Date: Tue, 30 Jul 2019 21:28:27 +0200

Abidjan, July 30, 2019 (AFP) - Eighty-nine people have contracted yellow fever and one person has died in recent weeks during an outbreak in Ivory Coast, the health ministry said Tuesday.   Most of the confirmed cases were in the West African country's economic capital Abidjan, the ministry said in a statement.

It recommended that any unvaccinated people be vaccinated against yellow fever.   "The outbreak occurs in the context of a dengue outbreak," the ministry said, adding that dengue and yellow fever are viral diseases transmitted by the same mosquito.    "The vector control measures that have been implemented to deal with dengue also work for the yellow fever outbreak."   In early June, 130 cases of dengue were reported including two deaths, with the authorities launching a major mosquito-control campaign.   Abidjan is going through the end of its rainy season, which spurs mosquito breeding.

Symptoms of yellow fever -- including high fever, vomiting and muscle aches -- usually manifest themselves three to six days after a person is bitten by an infected mosquito.   The infection caused by yellow fever is usually mild, but in some cases can be life-threatening and result in kidney and liver failure.   Yellow fever is found only in parts of South America and Africa.
Date: Tue 30 Jul 2019
Source: Medical Xpress [edited]

In recent weeks, 89 people have contracted yellow fever, and one person has died during an outbreak in Ivory Coast, the health ministry said Tuesday [30 Jul 2019].

Most of the confirmed cases were in the West African country's economic capital Abidjan, the ministry said in a statement. It recommended that any unvaccinated people be vaccinated against yellow fever.  "The outbreak occurs in the context of a dengue outbreak," the ministry said, adding that dengue and yellow fever are viral diseases transmitted by the same mosquito.

"The vector control measures that have been implemented to deal with dengue also work for the yellow fever outbreak."  In early June [2019], 130 cases of dengue were reported, including 2 deaths, with the authorities launching a major mosquito-control campaign.  Abidjan is going through the end of its rainy season, which spurs mosquito breeding.

Symptoms of yellow fever -- including high fever, vomiting and muscle aches -- usually manifest themselves 3-6 days after a person is bitten by an infected mosquito.  The infection caused by yellow fever is usually mild, but in some cases can be life-threatening and result in kidney and liver failure.  Yellow fever is found only in parts of South America and Africa.
=====================
[Yellow fever (YF) is a serious disease and has a case fatality rate of about 30%. It is surprising that there has been only one death so far among the 89 infected individuals. It is not stated that all 89 individuals were laboratory confirmed YF cases. The above report does not indicate the proportion of the population that has been vaccinated against YF.

YF virus can spread rapidly in a largely unvaccinated population, as it did in Angola in 2016. _Aedes aegypti_ vector control is of limited effectiveness in the face of a YF outbreak. Vaccination is the best preventive measure.

There have been YF cases in Cote d'Ivoire in the past, the most recent in 2011. At that time, more than 700 000 people were vaccinated against yellow fever [YF] in an emergency campaign in the country. There were YF cases in Abidjan in 2008, when the estimated vaccination coverage of the population was around 60 percent after a vaccination campaign. Now, time is of the essence to quickly halt the spread of YF, as it rapidly did in Angola and the DR Congo in that large outbreak. - ProMED Mod.TY]

[Maps of Cote d'Ivoire can be accessed at <http://bit.ly/2uHz53s>
and <http://healthmap.org/promed/p/52>.]
More ...

Nigeria

Nigeria US Consular Information Sheet
June 02, 2008
COUNTRY DESCRIPTION:
Nigeria is a developing country in western Africa that has experienced periods of political instability. It has the largest population on the continent, estimated at
44 million people, and its infrastructure is not fully functional or well maintained. Read the Department of State’s Background Notes on Nigeria for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. The visa must be obtained in advance from a Nigerian Embassy or Consulate. Visas cannot be obtained on arrival at the airport. Promises of entry into Nigeria without a visa are credible indicators of fraudulent commercial schemes in which the perpetrators seek to exploit the foreign traveler's illegal presence in Nigeria through threats of extortion or bodily harm. U.S. citizens cannot legally depart Nigeria unless they can prove, by presenting their entry visas, that they entered Nigeria legally. Entry information may be obtained at the Embassy of the Federal Republic of Nigeria, 3519 International Court NW, Washington, DC 20008, telephone (202) 822-1500, or at the Nigerian Consulate General in New York, telephone (212) 808-0301. Overseas, inquiries may be made at the nearest Nigerian embassy or consulate.

Visit the Embassy of Nigeria web site at http://www.nigeriaembassyusa.org/ for the most current visa information.

Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
The Department of State continues to caution U.S. citizens about the possible dangers of travel to some parts of Nigeria. [Please also see the Crime Section below.] In light of the risk of kidnapping, crime, militant activity, or armed attacks, the U.S. Mission restricts the travel of U.S. government personnel to the following states to official travel only: Delta, Bayelsa, Rivers and Akwa Ibom in the Niger Delta, and Edo and Imo in the south. Only essential travel by non-official Americans is recommended to these areas. In addition, the military's Joint Task Force patrols the creeks in the Niger Delta because of ongoing militant and piracy incidents, especially against oil-related facilities or infrastructure, so individuals may be questioned, detained or arrested when traveling in these sensitive areas without evidence of permission from the Nigerian government or for carrying electronic equipment such as cameras, recorders, etc. Periodically, travel by U.S. mission personnel is restricted in certain parts of Nigeria based on changing security conditions, often due to crime, general strikes, or student/political demonstrations or disturbances. See the Department of State’s Travel Warning for Nigeria for more information.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where current Travel Warnings, Travel Alerts, and 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: Violent crime committed by individual criminals and gangs, as well as by some persons wearing police and military uniforms, is a problem, especially in Lagos, Abuja and other large cities, although it can occur anywhere. Some visitors and resident Americans have experienced armed muggings, assaults, burglary, carjacking, kidnappings and extortion, often involving violence. Home invasions are on the rise in Lagos, with armed robbers accessing even guarded compounds by following, or tailgating, residents or visitors arriving by car into the compound, subduing guards and gaining entry into homes or apartments. Armed robbers in Lagos also access waterfront compounds by boat. U.S. citizens, as well as Nigerians and other expatriates, have been victims of armed robbery on roads to airports during both daylight and evening hours. Law enforcement authorities usually respond to crimes slowly or not at all, and provide little or no investigative support to victims. U.S. citizens and other expatriates have experienced harassment and shakedowns at checkpoints and during encounters with Nigerian officials.

Nigerian-operated fraud scams, known as 419s, are noted for their cleverness and ingenuity. These scams target foreigners worldwide, posing risks of both financial loss and personal danger to their victims. Scams are often initiated through internet postings or from internet cafes, by unsolicited emails, faxes, and letters, or can involve credit card use. As anywhere else, no one should provide personal or financial information to unknown parties or via Nigerian telephone lines. The expansion of bilateral law enforcement cooperation, which has resulted in numerous raids on commercial fraud premises, has reduced the overall level of overt fraud activity, but new types of sophisticated scams are introduced daily.

American citizens are very frequently the victims of Nigerian confidence artists offering companionship through internet dating websites. These confidence artists almost always pose as American citizens visiting or living in Nigeria who unexpectedly experience a medical, legal, financial or other type of “emergency” that requires the immediate financial assistance of the American citizen in the United States. In these cases, we strongly urge the American citizen in the United States to be very cautious about sending money to any unknown person purportedly acting on their behalf, or traveling to Nigeria to meet someone with whom their sole communications have been via the internet. Other common scams involve a promise of an inheritance windfall, work contracts in Nigeria, or an overpayment for goods purchased on-line. For additional information on these types of scams, see the Department of State's publication, International Financial Scams.

Commercial scams or stings that targets foreigners, including many U.S. citizens, continue to be a problem. One needs to be alert to scams that may involve U.S. citizens in illegal activity, resulting in arrest, extortion or bodily harm. These scams generally involve phony offers of either outright money transfers or lucrative sales or contracts with promises of large commissions or up-front payments, or improperly invoke the authority of one or more ministries or offices of the Nigerian government and may cite, by name, the involvement of a Nigerian government official. In some scams, government stationery and seals are also improperly used to advance the scam. The ability of U.S. consular officers to extricate U.S. citizens from unlawful business deals or scams and their subsequent consequences is extremely limited. U.S. citizens have been arrested by police officials and held for varying periods on charges of involvement in illegal business activity or scams. Nigerian police or other law enforcement officials do not always inform the U.S. Embassy or Consulate immediately of the arrest or detention of a U.S. citizen. The U.S. Department of Commerce has advisories to the U.S. business community on a variety of issues that should be seriously reviewed with respect to doing business in Nigeria. To check on a business’s legitimacy while in the United States, contact the Nigeria Desk Officer at the International Trade Administration, Room 3317, Dept. of Commerce, Washington, D.C. 20230, telephone 1-800-USA-TRADE or (202) 482-5149, fax (202) 482-5198. If you are abroad, contact the nearest U.S. Embassy or Consulate.

The Department of State encourages all travelers abroad to register their travel. The most convenient way to do so would be through the online travel registration page. Travelers may also register in person at the U.S. Embassy in Abuja or the U.S. Consulate General in Lagos. See the section on Registration / Embassy Location below.

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, for example, can provide you with a list for appropriate medical care, or contact family members or friends and explain how funds could be transferred to you to cover unexpected costs. 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 the Department of State’s information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: While Nigeria has many well-trained doctors, medical facilities in Nigeria are in poor condition, with inadequately trained nursing staff. Diagnostic and treatment equipment is most often poorly maintained, and many medicines are unavailable. Caution should be taken as counterfeit pharmaceuticals are a common problem and may be difficult to distinguish from genuine medications. This is particularly true of generics purchased at local pharmacies or street markets. Hospitals often expect immediate cash payment for health services.

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 health insurance policy applies overseas and whether it will cover emergency expenses such as a medical evacuation from a foreign country to the United States or another location. Please see the our brochure 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 Nigeria is provided for general reference only and may not be totally accurate in a particular location or circumstance.

Roads in many areas are generally in poor condition, causing damage to vehicles and contributing to hazardous traffic conditions. There are few working traffic lights or stop signs. The rainy season from May to October is especially dangerous because of flooded roads and water-concealed potholes.

Excessive speed, unpredictable driving habits, and the lack of basic maintenance and safety equipment on many vehicles are additional hazards. Motorists seldom yield the right-of-way and give little consideration to pedestrians and cyclists. Gridlock is common in urban areas. Chronic fuel shortages have led to long lines at service stations, which disrupt or block traffic for extended periods.

Public transportation vehicles are unsafe due to poor maintenance, high speeds and overcrowding. Motorbikes, known in Nigeria as "okadas," are a common form of public transportation in many cities and pose particular danger to motorists, their own passengers and pedestrians. Motorbike drivers frequently weave in and out of traffic at high speeds and observe no traffic rules. Motorbikes are banned within Abuja's city limits. Passengers in local taxis have been driven to secluded locations where they were attacked and robbed. Several of the victims required hospitalization. The U.S. Mission advises that public transportation throughout Nigeria be avoided.

It is recommended that short-term visitors not drive in Nigeria. A Nigerian driver's license can take months to obtain, and to date an international driving permit is not recognized. Major hotels offer reliable car-hire services complete with drivers. Reliable car-hire services can also be obtained at the customer service centers at the airports in Lagos, Abuja, and Kano. Inter-city travelers must also consider that roadside assistance is extremely scarce, and as noted above medical facilities and emergency care are poor, meaning that being involved in a traffic incident might result in a lack of available medical facilities to treat either minor or life-threatening injuries.

All drivers and passengers are reminded to wear seat belts, lock doors, and raise windows. It is important to secure appropriate automobile insurance. It is also important to be aware that drivers and passengers of vehicles involved in accidents resulting in injury or death have experienced extra-judicial actions, i.e., mob attacks, official consequences such as fines and incarceration or involvement with the victim's family. Night driving should be done with extreme caution, but it is recommended to avoid driving between 6:00 p.m. and 6:00 a.m. as bandits and police roadblocks are more numerous at night. Streets are very poorly lit, and many vehicles are missing one or both headlights, tail lights, and reflectors.

The Government of Nigeria charges the Federal Road Safety Commission with providing maps and public information on specific road conditions. The Federal Road Safety Commission may be contacted by mail at: Ojodu-Isherri Road, PMB 21510, Ikeja, Lagos; telephone [243] (1) 802-850-5961 or [234] (1) 805-684-6911.
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 Nigeria, the U.S. Federal Aviation Administration (FAA) has not assessed Nigeria’sCivil 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.

The Port Harcourt International Airport, which was closed in mid-2006 for rehabilitation, resumed operations in December 2007 for domestic daylight flights. Installations and improvements needed for international flights and night operations are expected to be completed in 2008.

For additional information on aviation safety concerns, see the Department of State’s Travel Warning for Nigeria.
SPECIAL CIRCUMSTANCES:
Permission is required to take photographs or videotape any government buildings, airports, bridges, and in areas where the military is operating throughout the country. These sites include, but are not limited to, Federal buildings in the Three Arms Zone (Presidential palace area, National Assembly, Supreme Court/Judiciary) of the capital of Abuja, other government buildings around the country and foreign Embassies and Consulates. Many restricted sites are not clearly marked, and application of these restrictions is subject to interpretation by the Nigerian security services and can result in detention. Permission may be obtained from Nigeria's State Security Services, but even permission may not prevent the imposition of penalties or detention. Penalties for unauthorized photography or videography may include confiscation of the still or video camera, exposure of the film or deletion of film footage, a demand for payment of a fine or bribe, and/or detention, arrest, or physical assault. For these reasons, visitors to Nigeria should avoid taking still photos or videotaping in and around areas that are potentially restricted sites, including any government sites.

The Nigerian currency, the naira, is non-convertible. U.S. dollars are widely accepted. Nigeria is a cash economy, and it is usually necessary to carry sufficient currency to cover the expenses of a planned visit, which makes travelers an attractive target for criminals. Credit cards are rarely accepted beyond a few upscale hotels. Due to credit card fraud in Nigeria and by cohorts in the United States, credit card use should be considered carefully. While Citibank cashes some traveler’s checks, most other banks do not. American Express does not have offices in Nigeria; however, Thomas Cook does. Inter-bank transfers are often difficult to accomplish, though money transfer services such as Western Union are available. For further information, visitors may contact the U.S. Embassy or Consulate.

Please see the Department of State’s information on 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 Nigerian laws, even unknowingly, may be expelled, detained, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Nigeria 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 the Department of State’s information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Nigeria are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Nigeria and other general information.Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

The U.S. Embassy is located at 1075 Diplomatic Drive, Central Area, Abuja. American citizens can call [234] (9) 461-4176 during office hours (Monday through Thursday, 7:30 a.m. to 4:30 p.m.; Friday, 7:30 a.m. to 1:30 p.m.). For after-hours emergencies, call [234] (9) 461-4000. The email address for the Consular Section in Abuja is ConsularAbuja@state.gov.

The U.S. Consulate General is located at 2 Walter Carrington Crescent, Victoria Island, Lagos. American citizens can call [234] (1) 261-1215 during office hours (7:30 a.m. to 4:00 p.m.). For after-hours emergencies, call [234] (1) 261-1414, 261-0050, 261-0078, 261-0139, or 261-6477. The e-mail address for the Consular Section in Lagos is Lagoscons2@state.gov.

The Embassy and Consulate website is http://nigeria.usembassy.gov/.
* * *
This replaces the Consular Information Sheet dated April 16, 2007, to update sections on Country Description, Safety and Security, Crime, Traffic Safety and Road Conditions, Aviation Safety Oversight, Special Circumstances and Registration / Embassy Location.

Travel News Headlines WORLD NEWS

Date: Mon, 6 Jan 2020 21:10:44 +0100 (MET)

Kano, Nigeria, Jan 6, 2020 (AFP) - A bomb ripped through a crowded market on a bridge along Nigeria's border with Cameroon on Monday, killing nine people and injuring several others, security sources said.    The bomb exploded around 1520 GMT on the Nigerian side of the El Beid bridge, which separates the town of Gamboru in Nigeria from Fotokol in Cameroon.    "Preliminary findings revealed that nine people were killed... and all are Nigerians," an army officer said, speaking on condition of anonymity.

Twenty-six people were injured, including 21 Nigerians and five Cameroonians, the officer said.   Many on the bridge jumped into the river, witnesses said.    The leader of a local civilian militia told AFP that the victims included young children selling groceries on the bridge.   The Boko Haram jihadist group operates on both sides of the border and has frequently carried out deadly suicide attacks.   Gamboru, a trading hub, has been rocked by violence since August 2014 when Boko Haram jihadists seized the town along with nearby Ngala.

Nigerian troops retook both towns in September 2015 with the help of Chadian forces after months of fierce battles.   But jihadist fighters continue to launch sporadic attacks, ambushing troops and vehicles, farmers and attacking refugee camps.   Boko Haram and its rival Islamic State West Africa Province (ISWAP), which split from it in 2016, are known to operate in areas around Gamboru and Ngala.   Boko Haram's decade-long conflict has killed 36,000 people and displaced around two million from their homes in northeast Nigeria.   The violence had spread to neighbouring Niger, Chad and Cameroon, prompting a regional military coalition to fight the militants.
Date: Sun 29 Dec 2019
Source: The Guardian [edited]

The World Health Organisation (WHO) has confirmed 13 cases of yellow fever, which has resulted in 3 deaths in 4 local government areas of Plateau State.

WHO State Coordinator, Wonk Vingey Bassey, confirmed the incident while presenting a report on a survey conducted on affected councils during an emergency stakeholders' meeting in Jos. The meeting followed the outbreak of the disease in Jos North, Bassa, Riyom and Wase local government areas of the state.

Bassey, who gave the breakdown according to councils, said the deaths were recorded in Wase local government [area]. The coordinator, represented by the consultant Elizabeth Ahinchi, advocated early inspection and reporting of cases of the outbreak, in addition to intensified routine campaigns in communities.

State Commissioner for Health, Dr. Ninkwom Ndam, said the state government is working in collaboration with federal authority and other partners to strengthen healthcare services to citizens. Also, Executive Secretary, Plateau State Healthcare Board, Dr. Livinus Niamkwap, noted that the recent outbreak in the 4 councils calls for proactive measures to avert escalation to other areas.

Participants at the meeting discussed extensively on the way forward, laying emphasis on the need for the provision of mosquito nets, surveillance, awareness campaigns in media stations and worship centres, as well as financial support, among others.  [Byline: Isa Abdulsalami Ahovi]
====================
[A 17 Dec 2019 report indicated that from 1 Jan through 10 Dec 2019, a total of 4189 suspected yellow fever (YF) cases were reported from 604 of 774 local government area (LGAs) across all the 36 states and the federal capital territory in Nigeria (see Yellow fever - Africa (27): Nigeria, WHO http://promedmail.org/post/20191217.6845662). Although that report indicated that there have been YF cases in all 36 states, previous reports do not specifically mention Plateau State. Although the need for the provision of mosquito nets, surveillance, and awareness campaigns in media stations and worship centres is real, it is curious that no mention is made of a vaccination campaign or of the proportion of the populations in the affected areas that have been vaccinated previously. Vaccination is the best YF preventive measure. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Date: Sat 28 Dec 2019
Source: Punch [edited]
<https://punchng.com/lassa-fever-claims-one-in-ebonyi/>

Lassa fever has reportedly killed one man in Igbeagu community in the Izzi Local Government Area of Ebonyi State. He died on Friday [27 Dec 2019].

O and his sibling, UO, had been admitted to St Vincent Hospital in the area. The 2 of them were suspected to have been infected by the disease.

A source, who spoke on condition of anonymity, said, "We are in a big trouble again. This killer disease has come again. The last time we experienced it, it wasn't funny. It killed over 4 persons. Now it is here again. It is important that stakeholders know about its presence and the implication. They should intervene and save us from it."

Meanwhile, the Ebonyi State Government has directed the evacuation of the victim's sibling and other patients to the South-East Virology Centre, Abakaliki, for further treatment.

Ebonyi State Governor David Umahi, who spoke through his Special Assistant on Media, Mr Francis Nwaze, had equally directed the closure of the hospital with immediate effect.

The governor's aide said, "The governor directed that all the family members and close relatives of the above be quarantined at the South East Virology Centre, Abakaliki for comprehensive medical examination. Also, Governor Umahi has directed that the Ministry of Health under the watch of the Commissioner for Health in conjunction with the members of Staff of Federal Teaching Hospital, Abakaliki to immediately address all issues relating to the Lassa fever outbreak including comprehensive examination of all suspects and clean-up of St. Vincent Hospital. Place precautionary announcements in all media houses in the state on preventive measures of Lassa fever."  [Byline: Edward Nnachi]
======================
[Lassa fever [LF] cases have not been unusual in Ebonyi state this year (2019) beginning with a Lassa fever outbreak in Ebonyi state in February 2019, when the Ebonyi state government successfully treated and discharged 14 Lassa fever patients brought to the centre. To date this year (2019), 7% of all Lassa fever cases have been in the state.

There is no mention of the circumstances under which the individuals contracted Lassa fever virus infections. Transmission of LF virus occurs when individuals are in contact with rodent reservoir host excreta or are within healthcare facilities. It would be interesting to know whether the prevalence of Lassa fever virus has been increasing in populations of rodent hosts in areas where human cases are occurring.

Images of the rodent reservoirs of Lassa fever virus:
_Mastomys natalensis_:
_Mastomys erythroleucus_ and _Hylomyscus pamfi_:

There is no specific mention in the plans above of public education for avoidance of contact with these rodents and their excreta. - ProMED Mod.TY]

[Maps of Nigeria:

HealthMap/ProMED map available at:
Ebonyi State, Nigeria: <http://healthmap.org/promed/p/1306>]
Date: Tue 17 Dec 20
Source: WHO Emergencies preparedness, response, Disease Outbreak News (DONs) [edited]

Nigeria is responding to successive yellow fever outbreaks, with nearly a 3-fold increase in number of confirmed cases in 2019 compared to 2018, suggesting intensification of yellow fever virus transmission. Additionally, there have been cases reported in parts of the country that have confirmed cases for the 1st time since the outbreak started in September 2017. From [1 Jan through 10 Dec 2019], a total of 4189 suspected yellow fever cases were reported from 604 of 774 Local Government Area (LGAs) across all the 36 states and the Federal Capital Territory in Nigeria.

Of the total 3547 samples taken, 207 tested positive for yellow fever by Immunoglobulin M (IgM) in Nigerian network laboratories. In addition, 197 samples from 19 states were confirmed positive using reverse transcriptase polymerase chain reaction (RT-PCR). The case fatality rate for all cases (including suspected, probable and confirmed) is 5.1%, and 12.2% for confirmed cases.

Of the total (197 cases) confirmed cases, 68% (134 cases) were reported from 4 states, including Bauchi, Katsina, Edo and Ebonyi. Cases in Edo state have declined after a reactive vaccination campaign in late 2018. From [1 Jan through 10 Dec 2019], a total of 115 confirmed cases and 23 deaths were reported from Bauchi (62 cases), Katsina (38 cases) and Benue (15 cases). These cases tested positive by RT-PCR at national laboratories and/or RT-PCR and serologic tests at a regional reference laboratory, Institute Pasteur Dakar (IPD). Further epidemiological investigations are underway.

Public health response
----------------------
The outbreak response activities are being coordinated by a multi-agency yellow fever Incident Management System (IMS). On [5 Nov 2019], an Emergency Operations Centre (EOC) was activated for the 3rd time, in response to the upsurge of confirmed yellow fever cases reported in a wide-geographic distribution including Bauchi, Benue and Katsina. A national rapid response team has been deployed to Bauchi and other affected states to support the outbreak response activities including surveillance, case management support and risk communications.

In addition to the existing laboratories in the country, new and operational laboratories have been added to the national laboratory network in Abuja, Edo and Enugu states.

A targeted response has been implemented in Alkaleri Local Government area (LGA) in Bauchi state. However, reports of ongoing transmission indicate that more vaccination and a wider geographical scope are needed. Katsina state has recently completed a state-wide preventive mass vaccination campaign; however, challenges linked to vaccine accountability and access to security-compromised areas may result in pockets of populations with immunity gaps. Risk of spread through population movements exist in neighbouring Kano and Kaduna states where population immunity is low.

Nigeria is considered a high-risk country by the Eliminate Yellow Fever Epidemics (EYE) strategy. By 2024, it is anticipated that all the states in Nigeria will have undergone campaign activities to protect at-risk populations against yellow fever. This plan may be further updated or accelerated based on risk, vaccine and implementation feasibility. The country is in the process of completing a planned phase-3 vaccination campaign in 2019 and evaluating the recently concluded mass vaccination campaign.

WHO risk assessment
-------------------
The yellow fever outbreak transmissions reported in Bauchi, Benue and Katsina states since August 2019, with spread to multiple other states, represents an intensification of yellow fever transmission and an elevated risk for yellow fever outbreak to spread and amplify. This is particularly a high risk if yellow fever is introduced into densely populated urban areas where preventive mass vaccination campaigns have not been conducted so far. Areas at risk include those without prior reported cases since 2017 and areas with a large number of under-immunized populations including urban areas such as Kano and Lagos. The preventive mass vaccination campaigns for yellow fever and the ongoing effort to strengthen routine immunization are important activities to reduce the risk of disease spread and amplification.

WHO continues to monitor the epidemiological situation and review the risk assessment based on the latest available information. Based on available information, WHO currently assesses the overall risk as high at the national level, moderate at the regional level, and low at the global level.

Nigeria is facing several concurrent public health emergencies, including circulating vaccine-derived polio virus (cVDPV), measles, monkeypox, Lassa fever, cholera outbreaks, and a humanitarian crisis in the north-east of the country.

WHO advice
----------
Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes and has the potential to spread rapidly, with serious public health impacts. There is no specific treatment, although the disease is preventable using a single dose of yellow fever vaccine, which provides lifetime immunity. Supportive care is required to treat dehydration, respiratory failure and fever; antibiotics are recommended to treat associated bacterial infections.

The early detection and investigation of yellow fever cases through strong surveillance is key to controlling the risk of yellow fever outbreaks. Prevention of mosquito bites (e.g. repellents, wearing long clothes) is an additional measure that limits the risk of yellow fever transmission. In urban centres, targeted vector control measures are also helpful to interrupt transmission.

WHO recommends vaccination against yellow fever for all international travelers more than 9 months of age going to Nigeria, as there is evidence of persistent or periodic yellow fever virus transmission. Nigeria also requires a yellow fever vaccination certificate for travelers older than one year of age arriving from countries with risk of yellow fever transmission.

Yellow fever vaccines approved by WHO are safe, highly effective and provide life-long protection against infection. In the context of international travel, the amendment to Annex 7 of the International Health Regulations (IHR 2005) changes the period of validity of the related international certificate of vaccination against yellow fever, and the protection provided by vaccination against yellow fever infection from ten (10) years to the life of the person (traveler) vaccinated. Accordingly, as of [11 July 2016], for both existing or new certificates, revaccination or a booster dose of yellow fever vaccine cannot be required of international travelers as a condition of entry into a State Party, regardless of the date their international certificate of vaccination was initially issued.

On [1 July 2019], WHO updated the areas at-risk of yellow fever transmission and the corresponding recommendations for vaccination of international travelers. The list of countries at-risk, and revised recommendations for vaccination against yellow fever are available on the WHO website: International travel and health (ITH).

WHO encourages its Member States to take all actions necessary to keep travelers well informed of risks and of preventive measures, including vaccination. Travelers should also be made aware of yellow fever signs and symptoms and instructed to seek rapid medical advice should they develop signs of illness. Travellers returning to Nigeria who may be infected with possible high levels of the virus in the blood may pose a risk for the establishment of local cycles of yellow fever transmission in areas where the competent vector is present.

WHO does not recommend any restrictions on travel or trade to Nigeria on the basis of the information available on this outbreak.
====================
[The above report provides a comprehensive summary of the yellow fever (YF) situation in Nigeria for this year (2019). Increased surveillance, targeted responses by the national response team, the addition of diagnostic laboratories in several localities and vaccination campaigns are all positive responses to the YF situation. Fortunately, no mention is made of cases in the densely populated cities nor of a shortage of YF vaccine, so campaigns could be able to proceed without delay. As noted in earlier posts, because of the geographic wide-spread distribution of yellow fever (YF) in Nigeria, achieving vaccination coverage of the population to the 80-90% coverage necessary to prevent cases is a serious challenge.

Nigerians traveling to countries abroad where YF virus is transmitted present  a risk of introducing the virus to other areas of Nigeria with abundant vectors that could initiate a new outbreak. Also of serious concern is the possibility of an unvaccinated person becoming infected in Nigeria, at the popular game park for example, going to an area historically free of YF but with abundant vector populations, such as southeast Asia, and initiating an outbreak where few local individuals have been vaccinated. - ProMed Mod.TY]

[Maps of Nigeria:
Date: Wed 4 Dec 2019
Source: UK Government, Public Health England [edited]

Public Health England (PHE) confirms an individual has been diagnosed with monkeypox [MPX] in England.

Monkeypox is a rare viral infection that does not spread easily between people, and the risk to the general public in England is very low. It is usually a self-limiting illness, and most people recover within a few weeks. However, severe illness can occur in some individuals.  The patient is believed to have contracted the infection while visiting Nigeria.

The patient was staying in southwest England prior to transfer to the specialist high-consequence infectious disease centre at Guy's and St Thomas' NHS Foundation Trust, London, where [the patient is] receiving appropriate care.

As a precautionary measure, PHE experts are working closely with NHS colleagues to implement rapid infection-control procedures, including contacting people who might have been in close contact with the individual to provide information and health advice. This includes contacting passengers who travelled in close proximity to the patient on the same flight to the UK. If passengers are not contacted, then there is no action they should take.

Dr Meera Chand, consultant microbiologist at Public Health England, said: "Monkeypox does not spread easily between people, and the overall risk to the general public is very low. We are following up with those who have had close contact with the patient to offer advice and to monitor them as necessary."

PHE and the NHS have well-established and robust infection-control procedures for dealing with cases of imported infectious disease, and these will be strictly followed to minimise the risk of transmission.

This is not the 1st time that the virus has been detected in the UK. PHE reported the 1st UK cases of monkeypox in September 2018.

Background
Monkeypox is a rare disease caused by monkeypox virus and has been reported mainly in central and west African countries. In most cases, monkeypox is a mild condition that will resolve on its own and has no long-term effects on a person's health. Most people recover within a few weeks [see comment below].

Initial symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills, and exhaustion. A rash can develop, often beginning on the face, then spreading to other parts of the body. The rash changes and goes through different stages before finally forming a scab, which later falls off.
====================
[Sporadic cases of monkeypox (MPX) continue to occur in Nigeria this year (2019), so it is not surprising if the individual became infected there and travelled to England during the incubation period. The USA CDC states that the incubation period (time from infection to symptoms) for monkeypox is usually 7-14 days but can range from 5-21 days, allowing adequate time for travel prior to the appearance of symptoms (see <https://www.cdc.gov/poxvirus/monkeypox/symptoms.html>).

There is no mention in the above report if the individual acquired the MPX infection from wildlife hosts or from contact with infected people. There is no mention above of the current condition of the patient. The health authorities in England are prudent to track individuals who had been in contact with the patient. Consideration of vaccination of contact individuals with the new MPX/smallpox vaccine, especially those providing care of this patient, in this type of situation may be a useful approach to prevent person-to-person transmission.

Prevention of MPX virus infections in the endemic countries in West and Central Africa will not be possible without knowing the source of infection and locality where they occurred. The question remains about the source of recent infections. Monkeys are not the reservoirs of the virus, despite the name that the virus has received. Studies of prevalence of MPX virus in populations of rodent hosts are not mentioned in this or in previous reports. The main reservoirs of MPX virus are suspected to be rodents, including rope squirrels (_Funisciurus_ spp., an arboreal rodent) and terrestrial rodents in the genera _Cricetomys_ and _Graphiurus_. Halting the bushmeat trade and consumption of wild animals to halt MPX virus exposure will be culturally and economically difficult, so continued occurrence of cases can be expected.

The MPX virus clade involved in these and previous cases is not mentioned. As noted in previous ProMED-mail posts, the monkeypox virus clade in the Congo Basin causes more severe disease in humans -- with a case fatality rate of 11-17% -- than the clade in Ghana, which causes few fatalities. The reported case fatality rate in Nigeria is low.

Similar reports of this case can be found at <https://www.theguardian.com/science/2019/dec/04/person-diagnosed-with-monkeypox-in-england-after-visiting-nigeria>, provided by ProMED Mod.MHJ, and in <https://www.bbc.com/news/uk-england-50659118>, which also shows typical MPX lesions, communicated by Mary Marshall (<mjm2020@googlemail.com>). - ProMED Mod.TY]

[HealthMap/ProMED-mail maps:
More ...

Germany

Germany US Consular Information Sheet
December 08, 2008
COUNTRY DESCRIPTION:
Germany is a modern and stable democracy. Tourist facilities are highly developed. In larger towns, many people can communicate in English.
Read the Departme
t of State Background Notes on Germany for additional information.

ENTRY/EXIT REQUIREMENTS: Germany is a party to the Schengen Agreement. As such, U.S. citizens may enter Germany for up to 90 days for tourist or business purposes without a visa. The passport should be valid for at least three months beyond the period of stay. For further details about travel into and within Schengen countries, please see our fact sheet. Further information on entry, visa and passport requirements may be obtained from the German Embassy at 4645 Reservoir Road N.W., Washington, D.C. 20007, telephone (202) 298-4000, web site: http://www.germany.info/Vertretung/usa/en/Startseite.html, or the German Consulates in Atlanta, Boston, Chicago, Houston, Los Angeles, Miami, New York, or San Francisco. Passengers transiting Germany en route to other countries should ensure that they are aware of and in compliance with the entry requirements for their final destinations as individuals not presenting appropriate documentation for their destination may be denied boarding on connecting flights.

Information about dual nationality or the prevention of international child abduction can be found on our website.
For further information about customs regulations, please read our Customs Information Sheet.

SAFETY AND SECURITY:
German authorities remain vigilant in combating the threat posed by foreign and resident extremists. Specific threats have been uncovered and persecutions undertaken, though Germany itself has been largely free of terror incidents. However, like other countries in the Schengen area, Germany’s open borders with its European neighbors allow the possibility of dangerous individuals entering/exiting the country with anonymity. Germany regularly experiences demonstrations on a variety of political and economic themes. Prior police approval is required for public demonstrations, and police oversight is routinely provided for participants and passersby. Nonetheless, these demonstrations can attract counter-demonstrators and have the potential to turn violent. In addition, hooligans, most often young intoxicated “skinheads” have been known to harass or even attack people whom they believe to be foreigners or members of rival groups. On occasion, American have reported that they were assaulted for racial reasons or because they appeared “foreign.” All Americans are cautioned to avoid the area around protests and demonstrations and to check local media for updates on the situation.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s web site at http://travel.state.gov, where the current Travel Alerts, including the Worldwide Caution, can be found.

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s A Safe Trip Abroad.

CRIME:
Violent crime is rare in Germany- but can occur, especially in larger cities or high-risk areas such as train stations. Most incidents of street crime consist of theft of unattended items and pick-pocketing. There have been a few reports of aggravated assault against U.S. citizens in higher-risk urban areas. American travelers are advised to take the same precautions against becoming crime victims as they would in any American city.

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 or Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. For more information on possible U.S. sources of assistance, see our information on Victims of Crime.

The local equivalent to the 911 emergency line in Germany is 112.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Good medical care is widely available. Doctors and hospitals may expect immediate payment in cash for health services from tourists and persons with no permanent address in Germany. Most doctors, hospitals and pharmacies do not accept credit .

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en
Further health information for travelers is available at http://www.who.int/ith/en
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. U.S. military facilities in Germany will not provide treatment to private American citizens who are not affiliated with the Department of Defense.

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 Germany is provided for general reference only, and may not be totally accurate in a particular location or circumstance. Individuals holding U.S. driver’s licenses may drive in Germany for up to six months without acquiring a German driver’s license.

Road conditions in general are excellent, although caution should be exercised while traveling on older roads in eastern Germany. The high speed permitted on the German autobahn, weather, and unfamiliar road markings can pose significant hazards, and driver error is a leading cause of accidents involving American motorists in Germany. Rules on right-of-way differ significantly from the U.S.
Notice should be taken that it is generally illegal in Germany to pass vehicles from the right and that the threshold for determining whether a person has been driving under the influence of alcohol is lower than in some U.S. states.

Many German streets and sidewalks have dedicated bike lanes for use by bicyclists. Pedestrians should be aware that bicycles have priority use of these lanes and should be careful to observe whether any bicyclist is approaching before crossing or stepping into the bike lane. Bicyclists also have priority over cars turning onto side streets, and motorists should always confirm whether a bicyclist is approaching from either direction before attempting to enter side streets, even when the light is in their favor. Motorists turning into a side street who hit a bicyclist who is using a marked bike lane will be held responsible for any injury or damage caused.
The use of cell phones while driving is prohibited in Germany. For specific information on travel within Germany contact the German National Tourist Board Office in New York at (212) 661-7200, fax (212) 661-7174 or via the Internet at http://www.germany-tourism.de/
Travelers should also note that railroad crossings are marked differently in Germany than in the U.S. There have been several accidents involving Americans in recent years at railroad crossings. In addition to the standard crossbuck (X-shaped) sign, railroad crossings are often marked by signal lights. Signal lights at a railroad crossing means that a train is approaching and that all vehicles should stop.

Please refer to our Road Safety page for information. Visit the website of the country’s national tourist office and national authority responsible for road safety at http://www.germany-tourism.de/
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Germany’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Germany’s air carrier operations. For more information, travelers may visit the FAA’s web site at www.faa.gov/safety/programs_initiatives/oversight/iasa
SPECIAL CIRCUMSTANCES:
Germany’s customs authorities may enforce strict regulations concerning temporary importation into or export from Germany of certain items such as firearms, military artifacts (particularly those pertaining to the Second World War), antiques, medications/pharmaceuticals and business equipment. Under German law it is also illegal to bring into or take out of Germany literature, music CDs, or other paraphernalia that glorifies fascism, the Nazi past of the former “Third Reich.” It is advisable to contact the German Embassy in Washington or one of the German consulates in the United States for specific information regarding customs requirements.

Automatic Teller Machines (ATMs) are widely available throughout Germany. They utilize many of the same account networks that are found in the U.S., so it is possible in most cases to get euros directly from your U.S. bank while you are in Germany without paying any inordinate fees for currency exchange. Credit cards are not accepted as widely as in the United States. 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 German laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Germany are strict and convicted offenders can expect 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:
American citizen parents have at times encountered difficulties having visitation orders enforced in Germany. For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION/EMBASSY AND CONSULATE LOCATIONS:
Americans living or traveling in Germany are encouraged to register with the nearest U.S. Embassy of Consulate through the State Department’s travel registration web site, https://travelregistration.state.gov/, and to obtain updated information on travel and security within Germany.
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.

U.S. Consular Sections are located at:
Berlin: Clayallee 170;
Tel: (49) (30)832-9233; Fax: (49) (30) 8305-1215
American Citizen Services Email: ACSBerlin@state.gov
Frankfurt: Giessner Str. 30,
Tel. (49) (69) 75350; Fax: (49) (69) 7535-2304.
American Citizen Services Email:GermanyACS@state.gov
Passport Inquiries Email: FrankfurtPassports@state.gov
Leipzig: Wilhelm-Seyfferth-Strasse 4,
Tel. (49) (341) 213-8418; Fax: (49) (341) 2138417 (emergency service only).

Munich: Koenigstrasse 5,
Tel. (49) (89) 2888-0; Fax: (49) (89) 280-9998.
American Citizen Services Email: ConsMunich@state.gov
There is also a U.S. consular agency in Bremen at Bremen World Trade Center,
Birkenstrasse 15,
Tel: (49) (421) 301-5860; Fax: (49) (421) 301-5861.

When calling another city from within Germany, dial a zero before the city code (for example, when calling Berlin from Munich, the city code for Berlin is 030).
*
*
*
*
This replaces the Consular Information Sheet dated April 23, 2008 to update information on Entry Requirements, Safety and Security and Medical Insurance.

Travel News Headlines WORLD NEWS

Date: Mon, 30 Dec 2019 10:48:29 +0100 (MET)

Frankfurt am Main, Dec 30, 2019 (AFP) - Cabin crew at Lufthansa subsidiary Germanwings began a planned three-day strike Monday with their union warning the industrial dispute could last longer.   Daniel Flohr, deputy head of air stewards' union UFO, told public broadcaster ZDF "we could prolong it at short notice", failing concessions from bosses, although "we don't want that".

A live list on the carrier's website showed 182 flights between major German cities like Berlin, Cologne, Hamburg and Munich were slashed as UFO called members off the job.   Some connections to neighbouring Austria and Switzerland, including Zurich and Vienna, were also cut.   Set to be folded into Eurowings over the long term, Germanwings operates flights on behalf of the larger Lufthansa subsidiary.   Around 15 percent of Eurowings flights over the three-day period were affected by the walkout, a company spokesman told AFP.

The situation at major airports was "calm" with "no queues," he said, as many passengers had been able to book on trains or other Lufthansa group airlines.   "People were well informed" about the strike, the spokesman added. "We hope things stay this stable."   Frankfurt airport -- Germany's largest -- also said on its website Monday was a "normal day" with "occasional short waits at security checks".

Germanwings bosses judge the strike over rules governing part-time work unjustified.   The dispute has already seen a brief "warning strike" at four Lufthansa subsidiaries, while the group's flagship airline suffered a two-day walkout affecting 1,500 flights and 200,000 passengers in November.
Date: Fri, 27 Dec 2019 20:21:08 +0100 (MET)

Frankfurt am Main, Dec 27, 2019 (AFP) - A German cabin crew union on Friday called a three-day strike at Lufthansa subsidiary Germanwings, plunging passengers into turmoil over the busy end-of-year holiday as it ramps up a bitter row over pay and conditions.   The UFO union said Germanwings employees would strike from 2300 GMT on Sunday until 2300 GMT on Wednesday as talks with bosses remain deadlocked.   The strike period covers New Year's Eve and the January 1 public holiday.   "We are deliberately announcing the strike early so Germanwings passengers have a chance to book flights with other airlines or make alternative travel plans," said UFO vice-chairman Daniel Flohr in a video message.

The union stopped short of announcing a fresh stoppage at flagship carrier Lufthansa itself, but warned that more strike calls could follow from January 2.   Flohr said UFO took stoppages at this time of year -- when many people are travelling to meet friends and family -- "very seriously".   But Germanwings management had "given its employees no clear options for the future," he argued.   A Lufthansa spokesman had earlier condemned the union's latest strike threats, saying "this is no way to resolve the conflict".   Board member Detlef Kayser said in a statement that "UFO has refused for weeks to put concrete demands in writing."

- Increasingly bitter -
Lufthansa and UFO have for months been locked in an increasingly bitter dispute that has triggered repeated walkouts.   A 48-hour stoppage at the main Lufthansa brand led to 1,500 cancellations at German airports in November, affecting 200,000 passengers.   A one-day warning strike in October prompted several dozen flight cancellations at Lufthansa subsidiaries Eurowings, Germanwings, SunExpress and Lufthansa CityLine.   As well as demanding higher wages, especially for entry-level jobs, the UFO union is seeking better benefits and easier routes into long-term contracts.    Lufthansa for a long time refused to discuss the demands, claiming the union no longer had the right to represent its 22,000 cabin crew employees owing to an internal leadership struggle.   The company even challenged UFO's legal status in court.

But the group changed its stance during November's massive strike, agreeing to arbitration with UFO leaders and two mediators.   The UFO union on Sunday said those talks "had failed".   Both sides have agreed to keep details of the talks confidential but German media reported they could not even agree on which topics should be covered by the arbitration.   Aside from pushing its demands for better pay, UFO is reportedly also seeking assurances that certain staff members will not face disciplinary action over the strikes.   Lufthansa said it was putting its hopes in a fresh round of talks proposed by the mediators for January, but UFO denied a new date had been agreed.
Date: Sun, 22 Dec 2019 19:14:14 +0100 (MET)

Frankfurt am Main, Dec 22, 2019 (AFP) - A German cabin crew union on Sunday threatened Lufthansa with fresh walkouts after Christmas as discussions to resolve a bitter dispute over pay and conditions failed to make progress.   Speaking after the latest round of arbitration talks, the UFO union said efforts to come up with a "credible and legally secure" resolution with the help of independent mediators had failed.

While there would be no walkouts on Christmas Eve, Christmas Day or Boxing Day, "we could now announce a strike at any time," vice-chairman Daniel Flohr told reporters at Frankfurt airport.   Lufthansa flight attendants staged a massive 48-hour strike last month that led to 1,500 flight cancellations at German airports, affecting some 200,000 passengers.   As well as demanding higher wages, especially for entry-level jobs, the union is seeking better benefits and easier routes into long-term contracts.

Lufthansa for a long time refused to discuss the demands, claiming the union no longer rightfully represented staff after an internal leadership struggle. It even challenged UFO's legal status in court.   But Germany's flagship carrier changed its stance during November's stoppage, agreeing to arbitration with UFO leaders and two independent mediators.   Lufthansa on Sunday said it continued to expect that through arbitration "good solutions can be found" for its 22,000 cabin crew employees.   The mediators have proposed fresh talks in early January, according to DPA news agency.

Neither side gave details about the discussions, but German media have reported that UFO is seeking guarantees that flight attendants won't face disciplinary action over the strikes.   Four of the Lufthansa group's smaller, subsidiary airlines have also walked out in the long-running battle for better wages.   A one-day warning strike in October led to several dozen flight cancellations at Eurowings, Germanwings, SunExpress and Lufthansa CityLine.
Date: Thu, 7 Nov 2019 15:13:02 +0100 (MET)
By Michelle FITZPATRICK

Frankfurt am Main, Nov 7, 2019 (AFP) - Tens of thousands of Lufthansa passengers faced disruptions Thursday as cabin crew in Germany staged a "massive" 48-hour walkout in the biggest escalation yet of a bitter row over pay and conditions.   The strike called by Germany's UFO flight attendants' union started at 2300 GMT on Wednesday and was to last until 2300 GMT on Friday.

Lufthansa said it had scrapped 700 flights on Thursday and some 600 the following day, warning that "around 180,000 passengers will be affected" across Germany.   The UFO union argued that the stoppage was necessary because negotiations with Lufthansa bosses were deadlocked.   But it accepted a surprise olive branch offered by Lufthansa CEO Carsten Spohr on Thursday, and agreed to preliminary talks over the weekend.    The current strike would carry on as planned "but would not for now be expanded", UFO said on its website.   Lufthansa said it regretted the inconvenience to passengers and stressed that it was working "to minimise the impact of this massive strike on our customers".

The carrier was running an alternative flight schedule where possible, and said passengers could rebook their journeys for free or swap their flights for train tickets.  Knut Kress, a passenger at a quieter than usual Munich airport, voiced support for the flight attendants.   "It's good that there are still unions defending something," he told AFP. But 48 hours "is a long time", he added.   Fellow traveller Birgit Kellner complained about the lack of notice for passengers.   "They should inform passengers a little earlier, not just two days before."   The walkout is UFO's biggest call to action since a week-long strike in 2015 hit Lufthansa with mass cancellations.   It is also seen as a test of strength for the union, weakened by months of infighting that have left Lufthansa questioning its right to speak for cabin crew.

- Internal disputes -
Lufthansa's finance chief Ulrik Svensson declined to put a price tag on the strike but said such stoppages typically cost "between 10 and 20 million" euros per day.   The union already staged a day-long warning strike last month at four Lufthansa subsidiary airlines, causing several dozen flights to be axed at Eurowings, Germanwings, SunExpress and Lufthansa CityLine.

But the flagship Lufthansa brand was spared the upheaval after management offered an unexpected two-percent pay rise to avert the strike.   Since then, however, UFO vice-president Daniel Flohr said no progress had been made in talks.   As well as higher pay for cabin crew across the Lufthansa group, UFO is demanding more benefits and easier routes into long-term contracts for temporary workers.

Lufthansa, however, has long argued that UFO no longer has the right to represent its staff following an internal leadership tussle, and has challenged the union's legal status in court.   But CEO Spohr hinted at a shift in position when he told reporters Thursday Lufthansa wanted to try to resolve the existing legal issues with UFO in the weekend meeting, hoping to then start formal arbitration talks.

UFO's internal disputes have cost it support among the Lufthansa group's 21,000 flight attendants, with some members switching to rival unions.   Separately on Thursday, Lufthansa reported a jump in third-quarter net profits but said it was slashing over 700 jobs at its Austrian Airlines subsidiary as the group seeks to trim costs in the face of fierce competition.
Date: Fri 25 Oct 2019
Source: Berlin Spectator [edited]

Hundreds of people might be infected with the West Nile virus in Germany, experts believe. As many as 3 Germans have already developed the dangerous illness [caused] by this infection.  A month ago, one West Nile Virus case in Germany was reported. A man had developed the disease in the region around Leipzig. He was suffering from meningitis. When doctors looked for the cause, they discovered he was infected. Since he had not travelled, experts believe he [was] infected by a mosquito.

Now there are 2 more cases. According to German-language media, the Bernhard Nocht Institute for Tropical Medicine there are suspected cases in the same region, close to Leipzig. Also there are 2 more confirmed cases of infected patients in Wittenberg, located in the Saxony-Anhalt province, and in Berlin.

The infected person in Berlin is a middle-aged woman. In September [2019], she suffered flu-like symptoms and a rash on her skin, and doctors found out she was infected. Because she had been in Berlin all along, they believe it likely was a mosquito in her case as well.

Before the 3 cases were discovered, the only person who had ever [become] infected with the West Nile virus in Germany was a veterinarian in Bavaria. When his case was investigated, doctors concluded that he was infected while examining a bird.

Because of those 3 patients in Saxony, Saxony-Anhalt and Berlin who developed the serious and sometimes fatal disease, experts believe the number of infected persons in Germany might be in the hundreds. According to the Centers for Disease Control and Prevention in Atlanta (USSA), one in 5 people infected develops fever and other symptoms, while only one in 150 are affected by the far more serious illness the virus can cause.

Animals, especially birds and horses in Germany, have been infected before. The authorities are convinced midges are to blame for spreading the West Nile virus, which originated in regions within Africa. Migrating birds and insects seem to have carried it all the way to Germany.

Researchers believe this situation is only the beginning. They say it is likely that West Nile virus will establish itself in Germany in years to come, especially during summers with excessive heat, the kind of season Germany experienced this year [2019], when both the hottest June day and the hottest day ever were recorded.

The only way to decrease the probability of infection is to avoid mosquito bites as effectively as possible -- for example, by using mosquito repellents. Their bites or direct contact to infected animals seem to be the main ways the virus spreads.  [byline: Imanuel Marcus]
More ...

World Travel News Headlines

Date: Thu, 16 Jan 2020 02:59:31 +0100 (MET)
By Nicolas DELAUNAY

Cousin Island, Seychelles, Jan 16, 2020 (AFP) - Giant tortoises amble across Cousin Island as rare birds flit above.   The scene attests to a stunning success for BirdLife International, a conservation group that bought the tiny Seychelles isle in 1968 to save a songbird from extinction.   Thick vegetation smothers ruins that are the only reminder of the coconut and cinnamon plantations that covered the island when the group stepped in to protect the Seychelles Warbler.

Now teeming with flora and fauna and boasting white beaches, Cousin Island is firmly on the tourist map, with managers scrambling to contain visitor numbers and soften their negative environmental impact.    More than 16,000 people visited the island in 2018, compared with 12,000 a decade earlier.   "Tourism is important for Cousin. That's what allows us to finance the conservation projects we run here.    "But 16,000 tourists... that was too much," said Nirmal Shah, director of Nature Seychelles, which is charged with running the special reserve.

Before the island was in private hands, the population of Seychelles Warblers was thought to have shrunk to just 26, barely hanging on in a mangrove swamp after much of their native habitat had been destroyed.    Now, they number more than 3,000 and the greenish-brown bird has been reintroduced to four other islands in the archipelago.   The former plantations have transformed into native forests, teeming with lizards, hermit crabs and seabirds, and the island is the most important nesting site for hawksbill turtles in the western Indian Ocean.   The International Union for Conservation of Nature (IUCN) waxes lyrical about the "unique biodiversity and conservation achievements" of Cousin, "the first island purchased for species conservation", a model since replicated around the world.

- Nature first -
Tourists have been allowed onto the island since 1972, but the message is clear: nature comes first.   In a well-oiled routine, every morning a handful of luxury sailboats and small motorboats anchor off the island, where their occupants wait for Nature Seychelles to skipper them ashore on their boats.   "Tourist boats cannot land directly on the island, the biohazard risk is too big," Shah said.   "Non-indigenous animals who may accidently be on board could come to the island and threaten its (ecological) balance."   Too many tourists can also upset this balance.

Nature Seychelles in July increased the price of visits from 33 to 40 euros ($36 to $44) and removed a free pass for children under 15, resulting in a welcome 10-percent reduction in visitor numbers.   "Something had to be done, there was too much pressure on the environment," said Dailus Laurence, the chief warden of the island.   "When there are too many tourists it can bother nesting birds and turtles who want to come and lay their eggs on the island."

One guide said that some tourists, bothered by the island's ubiquitous mosquitos, would "leave the paths, move away from the group and walk where they are not supposed to", putting fragile habitats at risk.   Shah said that if they wanted to increase the number of tourists, it would require hiring more wardens and guides who live on the island, which would also have a negative impact on nature.   "Our absolute priority is nature, and it comes before tourists. If we have to take more steps to protect it and reduce the number of tourists, we will," he said.
Date: Thu, 16 Jan 2020 02:45:27 +0100 (MET)
By Ivelisse RIVERA, con Leila MACOR en Miami

Yauco, Puerto Rico, Jan 16, 2020 (AFP) - Living out in the open, their nerves on edge after a series of earthquakes that have shaken Puerto Rico, some 5,000 people are hoping that their president, Donald Trump, will heed the island's plea to be designated a disaster zone and free up much-needed aid.   Since December 28, more than 1,000 tremors have rattled the US island territory in the Caribbean, which just two years ago was devastated by two powerful hurricanes in quick succession.

In Yauco, one of the areas worst hit by the earthquakes, dozens of people were sitting on cot beds Wednesday in the parking lot of a municipal stadium, sheltered from the sun by white tents and blue tarps handed out by the federal disaster management agency, known as FEMA.  "The most difficult thing is the psychological aspect," said Wilfredo Rodriguez, 31. His house had been fractured by the seismic movement and he has spent a week living with his kids, aged six and 10, under an awning.    "We are living in constant fear of another powerful tremor," he said.

He only returns to his house to wash, then hurries back to the shelter. "We worry that there'll be a more powerful tremor while we are inside the house," he said.   Throughout the day, volunteers arrive to hand out food and toys for the children who fill the shelters: schools have been suspended because the buildings are not sturdy enough to withstand another quake.    The island's earthquake detection system has registered 1,104 tremors in the past two weeks alone, of which 186 could be felt by the population. By comparison, during the whole of 2019 there were 6,442 tremors, of which just 62 could be felt by people on the island.

Further south, in Guanico, Juan Santiago decided to move into a shelter on Saturday after a tremor of 5.9 on the Richter scale hit the island. "The mountain shook and rocks and earth started to come down," said the 30-year-old.  "My house has a crack in it and is about to fall down," he added. His home had weathered the Category Five winds of Hurricane Maria in September 2017 and of Hurricane Irma which followed it just two weeks later.   "It's different to a hurricane. What is happening now is much nastier," he said.

As he was talking the earth shook again, a tremor of 5.2 magnitude. Vehicles rocked like hammocks in the wind, but the quake-hardened victims barely reacted.   The houses in this part of the island are mostly rudimentary constructions built by the people who live in them with scant resources available in the mountains, where no regulations stipulate that buildings should be earthquake resistant.    The government of Puerto Rico said that as of Monday, there were 4,924 people living in 28 shelters in 14 municipalities. There were no figures on how many buildings had been damaged or destroyed.

- Seeking disaster designation -
Puerto Rico's governor Wanda Vazquez Garced called on Trump to declare the earthquake a disaster and clear the way for desperately needed aid. Trump had declared an emergency days before, but the governor wanted more.   The declaration of an emergency frees up to $5 million dollars in aid for the island, although Congress can bump that figure up. But if the situation is designated a disaster, there is no ceiling on funding, a FEMA spokesman said.   On Wednesday, the government said it would release $8.2 billion in delayed hurricane relief that had been stalled after the president threatened to divert Puerto Rico's emergency funds to help pay for his wall on the US-Mexico border.

In the past few days there have been growing calls among Democratic lawmakers for Trump to declare the situation in Puerto Rico a disaster.   It is a delicate subject, as Trump has accused the government of Puerto Rico of incompetence and of siphoning off hurricane relief money, triggering a public spat between the president and the mayor of San Juan, Carmen Yulin Cruz, as well as the former governor Ricardo Rossello, who was forced to step down last summer amid massive protests.   The Puerto Rican leaders accused Trump of treating the population of the island like second class citizens.
Date: Wed, 15 Jan 2020 23:16:11 +0100 (MET)

Malabo, Equatorial Guinea, Jan 15, 2020 (AFP) - Firefighters battled to bring a blaze at Malabo's cathedral under control on Wednesday, as flames engulfed parts of the historic building, considered the most important Christian church in Equatorial Guinea.     Dozens of people gathered in silence near the cathedral in the early evening as the fire service sprayed water jets onto the century-old structure.

It was not immediately known whether anyone was hurt in the fire, in which huge flames consumed part of the facade of the building.       "We have just extinguished the fire, it's finished. The roof is gone, it is a catastrophe," firefighter Alfredo Abeso told AFP.   Another firefighter at the scene said: "The whole roof is gone, the interior is burned."   The cause of the fire is not known but the cathedral has been closed to the public since January 7 for restoration work.    Built in a neo-gothic style between 1897 and 1916, the cathedral is one of the central African country's main tourist attractions.

The blaze brought comparisons to the devastating fire that ravaged the 13th century Notre-Dame cathedral in Paris in April 2019.     The French Embassy in Malabo said the fire was a "cruel reminder" of the fire at Notre Dame.    "We share the emotion of our friends in Malabo and Equatorial Guinea and hope that the fire can be brought under control quickly," it said on Twitter.      Paris engineers are still working to stabilise the 13th century cathedral in the French capital after fire tore through its roof and dramatically toppled its spire last year.
Date: Wed, 15 Jan 2020 21:55:41 +0100 (MET)

Rio de Janeiro, Jan 15, 2020 (AFP) - Widespread complaints over foul-smelling drinking water in Rio de Janeiro have triggered a run on supermarket bottled water, though the public utility denied any health risk Wednesday.   Rio governor Wilson Witzel set alarm bells ringing in a Twitter post on Tuesday, saying the situation -- fuelled by social media rumours -- was "unacceptable" and calling for a "rigorous investigation."

Moving to calm growing fears, public water utility Cedae attributed the problems to the presence of geosmin, a harmless organic compound, insisting the resulting earthy-tasting tap water was safe to drink.   "The results of the analyses show the presence of geosmin, at a rate sufficient to change the taste. But there is no risk to health," Sergio Marques, the official in charge of water quality, told a press conference.   Cedae later said it had fired the head of the Guandu treatment plant, which supplies nearly 80 percent of Rio's drinking water.   It said the supply from Guandu would be treated with carbon in the coming days to get rid of the geosmin.

According to O Globo newspaper, nearly 70 districts of the capital have been affected.   It reported that more than 1,300 cases of gastroenteritis were recorded over the last 15 days in Santa Cruz in the west of Rio, where water quality complaints were rife.   Cedae's president Helio Cabral apologized "to the whole population for the problems in the water supply," which began earlier this month.

The problem has been exacerbated by false rumours circulating on social media that the water was toxic.   Despite assurances, many Rio citizens were taking no chances. In supermarkets, mineral water stocks have been selling out and long queues are formed as soon as they are replenished.   Geosmin is also responsible for the earthy taste in some vegetables.
Date: Wed, 15 Jan 2020 21:25:04 +0100 (MET)

Lima, Jan 15, 2020 (AFP) - Five tourists arrested for damaging Peru's iconic Machu Picchu site will be deported to Bolivia later on Wednesday, police said.   A sixth was released from custody and ordered to remain in Machu Picchu pending trial after paying bail of $910.   The six tourists -- four men and two women -- were arrested for damaging Peru's "cultural heritage" after being found in a restricted area of the Temple of the Sun on Sunday.   They were also suspected of defecating inside the 600-year-old temple, an important edifice in the Inca sanctuary.   "We've got the order. Today the five foreign tourists will be expelled," Cusco police official Edward Delgado told AFP.   "We're going to take them by road to the city of Desaguadero, on the border with Bolivia."   The border town, a nine-hour drive away, is the nearest frontier point to the southern Cusco region where Machu Picchu is located.

The sixth tourist, 28-year-old Nahuel Gomez, must sign at a local court every 10 days while awaiting trial.   He admitted to removing a stone slab from a temple wall that was chipped when it fell to the ground, causing a crack in the floor.   He could face four years in prison if found guilty of damaging Peru's cultural heritage.   Several parts of the semicircular Temple of the Sun are off limits to tourists for preservation reasons.   Worshipers at the temple would make offerings to the sun, which was considered the most important deity in the Inca empire as well as other pre-Inca civilizations in the Andean region.   The group -- made up of a Chilean, two Argentines, two Brazilians, including one of the women, and a French woman -- allegedly entered the Inca sanctuary on Saturday and hid on site so they could spend the night there -- which is prohibited.

A source with the public prosecutor's office told AFP that Nahuel admitted to the damage but said "it wasn't intentional, he only leant against the wall."   The Machu Picchu complex -- which includes three distinct areas for agriculture, housing and religious ceremonies -- is the most iconic site from the Inca empire, which ruled over a large swath of western South America for 100 years before the Spanish conquest in the 16th century.   Machu Picchu, which means "old mountain" in the Quechua language indigenous to the area, is at the top of a lush mountain and was built during the reign of the Inca emperor Pachacuti (1438-1471).
Date: Wed, 15 Jan 2020 20:53:05 +0100 (MET)

Alicante, Spain, Jan 15, 2020 (AFP) - A fire broke out Wednesday on the roof of the airport in Alicante, a city on the eastern Mediterranean coast which is a tourism hotspot, forcing its closure to air traffic.   "The fire is under control but it has not been extinguished. Firefighters are continuing to work," a spokesman for Spanish airport operator Aena told AFP, adding the airport will remain closed to air traffic until noon on Thursday.

Ten flights which were due to land at Alicante were cancelled, as were 12 which were supposed to depart from the airport, he said.    Another four flights which were due to land at Alicante were diverted to other Spanish airports.   The flames were visible from inside the terminal, according to an AFP photographer at the scene.   Passengers and workers stood outside as dense smoke rose from the terminal building.   No one was injured and the authorities are still not sure what caused the fire.

The airport serves the eastern region of Valencia, which is home to several popular resorts such as Benidorm. It handled just under 14 million passengers last year, making it Spain's fifth busiest airport.   Aena recommended in a tweet that passengers contact their airline before heading to Alicante airport to see what the status of their flight was.   "We are coordinating with airlines. Consult your company to know if your flight is cancelled or will operate from an alternative airport," it said.
Date: Wed, 15 Jan 2020 11:12:40 +0100 (MET)

Beijing, Jan 15, 2020 (AFP) - A new virus from the same family as the deadly SARS pathogen could have been spread between family members in the Chinese city of Wuhan, local authorities said Wednesday.   The outbreak, which has killed one person, has caused alarm because of the link with SARS (Sudden Acute Respiratory Syndrome), which killed 349 people in mainland China and another 299 in Hong Kong in 2002-2003.   One of the 41 patients reported in the city could have been infected by her husband, Wuhan's health commission said in a statement on Wednesday.   The announcement follows news that a Chinese woman had been diagnosed with the novel coronavirus in Thailand after travelling there from Wuhan.

No human-to-human transmission of the virus behind the Wuhan outbreak has been confirmed so far, but the health commission said the possibility "cannot be excluded".   The commission said that one man who had been diagnosed worked at Huanan Seafood Wholesale Market, which has been identified as the centre of the outbreak, but his wife had been diagnosed with the illness despite reporting "no history of exposure" at the market.   At a press conference on Wednesday following a fact-finding trip to Wuhan, Hong Kong health officials also said that the possibility of human-to-human transmission could not be ruled out despite no "definitive evidence".

Dr Chuang Shuk-kwan, from Hong Kong's Centre for Health Protection, said there were two family group cases among the recorded cases in Wuhan, including the husband and wife and a separate case of a father, son and nephew living together.   However, he said mainland doctors believed the three men were most likely to have been exposed to the same virus in the market.   The market has been closed since January 1.   The woman diagnosed in Thailand, who is currently in a stable condition, had not reported visiting the seafood market, the World Health Organization (WHO) said on Tuesday.

WHO doctor Maria Van Kerkhove said Tuesday that they "wouldn't be surprised if there was some limited human-to-human transmission, especially among families who have close contact with one another".   The US Centers for Disease Control and Prevention issued a Level 1 "Watch" alert for travellers to Wuhan after the patient was diagnosed in Thailand, saying they should practice normal precautions and avoid contact with animals and sick people.

Wuhan's health commission said on Wednesday that most of the patients diagnosed with the virus were male, and many were middle-aged or elderly.   In Hong Kong, hospitals have raised their alert level to "serious" and stepped up detection measures including temperature checkpoints for inbound travellers.   Hong Kong authorities said on Tuesday that the number of people hospitalised with fever or respiratory symptoms in recent days after travelling to Wuhan had grown to 71, including seven new cases since Friday.   Sixty of that total, however, have already been discharged. None have yet been diagnosed with the new coronavirus.
Date: Wed, 15 Jan 2020 03:48:17 +0100 (MET)
By Emile Kouton with Celia Lebur in Lagos

Lome, Jan 15, 2020 (AFP) - After he was struck down by malaria and typhoid, Togolese tailor Ayawo Hievi thought he was set to recover when he started taking drugs prescribed by his doctor.   But far from curing him, the medication he was given at the neighbourhood clinic made him far worse -- eventually costing him one of his kidneys.    The drugs were fake.   "After four days of care, there was no improvement, but I started to feel pain in my belly," Hievi, 52, told AFP.

After two weeks of suffering he became unable to walk and was rushed into the university hospital in the West African nation's capital Lome.    "The doctors told me that my kidneys had been damaged... the quinine and the antibiotics used to treat me in the medical office were fake drugs."   Now, over four years later, he remains crippled by chronic kidney failure and has to go to hospital for dialysis regularly.    Hievi's horror story is far from unique in a continent awash with counterfeit medicines.    The World Health Organization (WHO) estimates that every year some 100,000 people across Africa die from taking "falsified or substandard" medication.

The American Society of Tropical Medicine and Hygiene estimated in 2015 that 122,000 children under five died due to taking poor quality anti-malaria drugs in sub-Saharan Africa.   Weak legislation, poor healthcare systems and widespread poverty have encouraged the growth of this parallel -- and deadly -- market. Since 2013, Africa has made up 42 percent of the fake medicine seized worldwide.    The two drugs most likely to be out-of-date or poor, ineffective copies are antibiotics and anti-malarials, say experts.    And bogus drugs not only pose a risk to the patient -- they also play a worrying part in building resistance to vital frontline medications.

- 'Difficult to trace' -
In a bid to tackle the scourge, presidents from seven countries -- the Republic of Congo, Gambia, Ghana, Niger, Senegal, Togo and Uganda -- meet Friday in Lome to sign an agreement for criminalising trafficking in fake drugs.    The goal is to bolster cooperation between governments and encourage other African nations to join the initiative.   But even if leaders put pen to paper, the task of stamping out the flows of counterfeit medication is huge.    Medicines spread out on plastic sheets or offered at ramshackle stalls are for sale at markets across West Africa.

Those hawked on the streets are often a fraction of the price of what's available in more reputable pharmacies where controls are stricter and supplies often have to come through official channels.    "It is very difficult to trace where the fake medicines come from," said Dr Innocent Kounde Kpeto, the president of Togo's pharmacist association.    "The countries which are mentioned on the boxes are often not the countries of origin or manufacture of these drugs. The manufacturers cover their tracks so as not to be identified".

It is estimated that between 30 and 60 percent of medicine sold in Africa is fake and Kpeto said most of it comes from China or India.    Efforts to staunch the deadly torrents of counterfeits have made some headway.    Some trafficking hubs have been dismantled, such as Adjegounle market in Cotonou that served as a key gateway for fakes heading to giant neighbour Nigeria.   In mid-November, the police in Ivory Coast made a record seizure of 200 tonnes in Abidjan and arrested four suspects including a Chinese national.

Togo is one of the pioneer countries trying to stop the flow.    It changed the law in 2015 and now traffickers can face 20 years in jail and a fine of some $85,000 (75,000 euros).   In a show of force in July the authorities burnt over 67 tonnes of counterfeit pharmaceuticals discovered between     But even given these recent successes, those in the industry like Dr Kpeto insist that the threat is still grave and involves "highly organised criminal networks".    "The phenomenon remains major," he said.    Traffickers can turn an investment of just $1,000 (900 euros) into a profit of $500,000, he claimed.   The fake medicines are smuggled in the same way as guns or narcotics and often bring higher returns.

- 'Die for nothing' -
Nigeria, Africa's most populous country with a market of 200 million people, is the number one destination on the continent for fake drugs and a showcase of difficulties being faced.    In September 2016 the World Customs Organization seized tens of millions of fake pills and medicines at 16 ports around Africa: 35 percent were intended for Nigeria.    Across the vast nation there are tens of thousands of vendors selling the counterfeits.   Competition between traffickers is fierce and the official agency meant to combat the problem is overwhelmed.

In a bid to improve the situation, Vivian Nwakah founded in 2017 start-up Medsaf and raised $1.4 million to help Nigerians track their medication from producer to user.    "The country doesn't have a reliable and centralised distribution network," she said.    "A hospital sometimes has to deal with 30 or 40 distributors for all the medications it needs. How can you have quality control with so many suppliers?"   As a result, fake or faulty medicine has not just flooded markets but also pharmacies and hospitals -- both state and private.    Sometimes, without hospital administrators even being aware, that means the drugs that reach the patients can be expired, poorly stored or the wrong doses. 

Medsaf works to ensure the quality control of thousands of products at over 130 hospitals and pharmacies in Nigeria. It looks forward to expanding deeper into Nigeria as well as Ivory Coast and Senegal.   The company uses technology, database management and analytics to monitor the movement of medications and verifies their official registration number, the expiry dates and storage conditions.   "Technology we use can help to solve most of the issues related to fake drugs," Nwakah said. "People die for nothing. We can change that."
Date: Mon 13 Jan 2020, 00.45 IST
Source: The Hindu [edited]

A 58-year-old woman from Seegemakki village in Tumari Gram Panchayat limits in Sagar taluk died due to Kyasanur Forest Disease (KFD), also known as monkey fever, at a private hospital in Manipal in Udupi district on [Sat 11 Jan 2020].

The deceased, H, who had complained of high fever and aches in joints was admitted to government sub-divisional hospital in Sagar city for treatment on [Tue 7 Jan 2020]. Her blood tested positive for KFD.

Rajesh Suragihalli, District Health Officer, told The Hindu that as her health condition had worsened, she was shifted to a private hospital in Manipal on [Thu 9 Jan 2020] for advanced treatment. She failed to respond to the treatment and breathed her last on [Sat 11 Jan 2020], he said.

Following the death, the Department of Health and Family Welfare has sounded an alert in Sagar and Tirthahalli taluks from where 7 positive cases have been reported since [1 Jan 2020]. The vaccination drive has been stepped up in the villages from where positive cases are reported. Three advanced life support ambulances have been stationed in government sub-divisional hospital in Sagar to shift KFD patients with health complications to private hospitals in Shivamogga city or Manipal for additional treatment, he said.
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[Kyasanur Forest disease (KFD) is an acute febrile illness caused by Kyasanur Forest disease virus (KFDV), a member of the family _Flaviviridae_, characterized by severe muscle pain, gastrointestinal symptoms, and bleeding manifestations. The virus was 1st identified in 1957 after it was isolated from a sick monkey from the Kyasanur Forest in Karnataka state of India. The disease is transmitted to humans following a tick bite or contact with an infected animal, especially a sick or recently dead monkey. There is no evidence of person-to-person transmission (<https://www.cdc.gov/vhf/kyasanur/index.html>).

The case fatality of Kyasanur Forest disease (KFD) is 2-10% and mortality is higher in the elderly and in individuals with comorbid conditions. There is no specific treatment for KFD. Prompt symptomatic and supportive treatment can reduce morbidity and mortality. Surveillance (human, monkey, and tick), personal protection against tick bites, and vaccination are the key measures for prevention and control of KFD (<https://idsp.nic.in/WriteReadData/l892s/60398414361527247979.pdf>).

As per the media report above, 7 confirmed KFD cases have been reported from Sagar and Tirthahalli taluks in Karnataka state so far in 2020. KFD typically occurs during the dry season from November through May, which correlates with the increased activity of the nymphs of ticks. Exposure to adult ticks and nymphs in rural or outdoor settings increases the risk of infection; herders, forest workers, farmers, and hunters are particularly at increased risk of contracting the disease. Vaccination and personal protective measures against tick bites are keys to prevent KFD.

The recommended preventive measures include using tick repellents, walking along clear trails, avoiding contact with weeds, and wearing full sleeved clothes and long pants to reduce exposed skin to reduce contact with ticks and subsequent tick bites. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
Karnataka State, India: <http://healthmap.org/promed/p/307>]
Date: Mon 13 Jan 2020
Source: Food Safety News [edited]

An emergency committee to control the sale of food has been created in a city in northwest Argentina after a spike in _Salmonella_ cases in early 2020. There have been 51 confirmed cases of salmonellosis in Salta so far in 2020. At least 5 people have been hospitalized but recovered after treatment.

The committee will be responsible for controlling food sold on public roads at street stalls and at commercial premises. It includes experts from the National University of Salta (UNSA) and Catholic University of Salta (Ucasal). Officials hope by increasing controls they can bring the rise in infections under control and minimize the risk to the public. The group, created by the Mayor of Salta Bettina Romero and Undersecretary of Health and Human Environment Monica Torfe, held a meeting with Juan Jose Esteban, manager of the Hospital Senor del Milagro, and teams from the department of epidemiology of the province on preventive measures to tackle the salmonellosis rise this past week.

Norma Sponton, head of the microbiology sector; Teresita Cruz, of the epidemiological surveillance program of the province; Paula Herrera, from the Ministry of Health, and Jose Herrera, from the hospital also participated. Experts from the 2 universities are involved in training the inspectors who will be in charge of carrying out the control tasks.

Food contaminated with _Salmonella_ bacteria does not usually look, smell, or taste spoiled. Symptoms of salmonellosis infection can include diarrhoea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for 4 to 7 days. In some cases, however, diarrhoea may be so severe that patients require hospitalization.
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[The serotype of _S. enterica_ is not stated and it is not clear what the food reservoir for this ongoing outbreak is. A food diary of affected persons may be helpful.

The city of Salta is located in north-western Argentina in the province of the same name which can be found on a map at

[HealthMap/ProMED-mail map of Argentina: