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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: 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.
Date: Mon, 1 Jul 2019 11:19:17 +0200

Kabul, July 1, 2019 (AFP) - At least one person was killed and dozens wounded in a Taliban-claimed attack which saw a powerful car bomb rock Kabul early Monday, followed by gunmen who battled special forces in an area housing military and government buildings.   Many children were among the wounded, according to a hospital statement, after the rush-hour explosion sent a plume of smoke into the air above the Puli Mahmood Khan neighbourhood of the Afghan capital and shook buildings up to two kilometres (1.2 miles) away.

AFP reporters could hear gunshots and multiple smaller explosions as fighting between the gunmen and special forces continued more than four hours after the attack began.   "At first, a car bomb took place and then several attackers took over a building. The area is cordoned off by the police special forces and (they) are bringing down the attackers," interior ministry spokesman Nasrat Rahimi said.    He later said that at least one attacker had been killed.   Health ministry spokesman Wahidullah Mayar said that at least one person had been killed and 65 wounded -- including nine children -- and warned that casualties could rise.   "Among the wounded, many children who were going to school," said the Twitter account of the Emergency Hospital in Kabul, where many victims were taken.   Some social media images purportedly taken at the hospital showed wounded, stunned children in school uniforms, still clutching books as they arrived for treatment.

The Taliban claimed the attack, which came just two days after the insurgents began a seventh round of talks with the US in Qatar as Washington eyes a breakthrough before Afghanistan's September presidential election.   Militant spokesman Zabiullah Mujahid released a statement saying the insurgents had targeted a defence ministry building in the area, which was quickly blocked off by Afghan forces and ambulances, with helicopter gunships seen overhead as firing continued.   Authorities have not confirmed the target.    "We were sitting inside the office when the world turned upside down on us," Zaher Usman, an employee at a branch of the culture ministry, which he said stands just 150 metres (yards) from the blast.

- Brief lockdown -
"When I opened my eyes, the office was filled with smoke and dust and everything was broken, my colleagues were screaming," Usman told AFP by telephone.   Shams Amini, a spokesman for the Afghan Football Federation, told AFP that the blast occurred near their HQ gates, and said some colleagues had been injured.   Nearby Shamshad TV station, which was attacked in 2017, aired images of broken glass and damage to its offices. "I was terrified," Shamshad anchor Hashmat Stanikzai told AFP.

The explosion came as the US was set to begin a third day of negotiations with the militants in Doha. There was no immediate confirmation if they would go ahead after the blast.   With the attack still ongoing, the Taliban spokesman in Doha again insisted that the insurgents will not negotiate with Kabul.   "Once the timeline for the withdrawal of foreign forces is set in the presence of international observers, then we will begin the talks to the Afghan sides, but we will not talk to the Kabul administration as a government," Suhail Shaheen tweeted. 

The insurgents have long refused to negotiate with the Western-backed government, whom they deem puppets.   The talks have so far centred on four issues -- counter-terrorism, the foreign troop presence, an intra-Afghan dialogue and a permanent ceasefire.   A potential deal would see the US agree to withdraw its troops after more than 17 years in Afghanistan, igniting deep concerns among Afghans who fear Washington will rush for the exits and allow the militants to return to some semblance of power.   In return, the Taliban would guarantee the country would never again become a safe haven for violent extremism, as happened with Al-Qaeda before the September 11, 2001 attacks.   However, US officials have insisted that "nothing is agreed until everything is agreed", including intra-Afghan talks.
Date 24 Jun 2019
Source: Mena FN [edited]

The number of polio positive cases in Afghanistan has reached 10 so far in 2019, with 4 cases reported from Uruzgan [Oruzgan] province and 1 new case detected in the Mehr Abad area of Tirinkot, the provincial capital.

According to Ministry of Public Health, a 21-month-old girl is permanently paralyzed in Tirinkot, making 10 cases of polio in Afghanistan so far [in 2019].

The Health ministry in a statement said that last week, another polio case was reported from Trinkot, which paralyzed a 30-month-old boy [see Poliomyelitis update (50): Afghanistan (OZ) http://promedmail.org/post/20190619.6528976].

House-to-house polio campaigns have been banned in this area since May 2018. This means children under [5 years of age] living in the area have not been vaccinated and protected from the virus since then, the ministry added.

Only one out of 10 polio cases were reported from Eastern Kunar province, while the rest have been reported from the southern region: 4 cases in Urozgan [Oruzgan], 3 in Helmand and 2 cases in Kandahar.

"Access to health services is the right of every citizen of the country," said Dr. Ferozuddin Feroz, the Minister of Public Health of Afghanistan. "We are deeply concerned about the increasing polio cases and the number of children who still don't have consistent access to vaccination. The virus could spread, and more children will be affected and paralyzed by polio virus in Afghanistan. I ask everyone to work together and protect innocent children against polio, to provide a safe and secure environment for our frontline workers to vaccinate children in every corner of the country."

The polio vaccine is safe, even for sick and new-born children. 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, the statement added.
======================
[In last week's report on the 30-month-old male child from Oruzgan, there was mention that the vaccination teams were unable to enter the zone where the child lived due to security concerns. The media report above mentions there haven't been vaccinations provided through household visits in this zone since May 2018.

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 (<https://www.afghana.com/GetLocal/Afghanistan/Provinces.htm>).

With the addition of this newly confirmed case, there have now been 10 cases of confirmed poliomyelitis reported from Afghanistan since the beginning of 2019. Add these to the 27 cases confirmed in Pakistan, and there are now 37 cases reported this year (2019), 4 more than the total number of cases reported during 2018.

HealthMap/ProMED-mail maps:
Oruzgan Province, Afghanistan: <http://healthmap.org/promed/p/1257>  - ProMED Mod.MPP]
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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 ...

Guinea Bissau

Guinea Bissau - US Consular Information Sheet
July 8, 2008
COUNTRY DESCRIPTION:
The Republic of Guinea-Bissau, a small country in western Africa, is one of the world’s poorest nations.
The capital is Bissau and the official language
is Portuguese.
The country underwent a civil war in 1998-99 that devastated the economy.
Tourist facilities and infrastructure in general are very limited and not up to American standards.
Read the Department of State Background Notes on Guinea-Bissau for additional information.
ENTRY/EXIT REQUIREMENTS:
A valid passport, visa, and proof of onward/return ticket are required.
As of January 2007, the Bissau-Guinean Embassy in Washington, DC is temporarily closed.
The Embassy of Guinea-Bissau does not have a web site.
Due to lack of consular representation in the U.S., it is difficult to obtain the required visa for entry into Guinea-Bissau.
Since most flights destined for Guinea-Bissau must pass through Dakar, Senegal or Lisbon, Portugal, most travelers are able to apply for visas at the Bissau-Guinean embassies in those countries.
Although it is possible to obtain a visa upon arrival in Bissau if arrangements are made in advance, there are no clear instructions for how to make those arrangements.

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.
As of the date of publication of the Country Specific Sheet, the Bissau-Guinean Embassy is closed.
Travelers needing information about customs regulations should contact Bissau-Guinean authorities in Dakar, Senegal or Lisbon, Portugal before traveling.

SAFETY AND SECURITY:
There is no permanent U.S. diplomatic or consular presence in Guinea-Bissau.
The U.S. Embassy in Bissau suspended operations on June 14, 1998.
While officials from the U.S. Embassy in Dakar, Senegal, make periodic visits to Guinea-Bissau, their ability to provide consular services, including emergency assistance, is very limited.
The U.S. maintains a liaison office in Bissau, located at Edifício SITEC, Rua José Carlos Schwarz 245, Bairro d’Ajuda (tel/fax 245-256382, 245-5954647).
This office is staffed by locally employed staff and, while not equipped to provide consular services, may be contacted in the event of an emergency.
The nearest U.S. Embassies are located in Banjul, the Gambia; Conakry, Guinea; and Dakar, Senegal.
Although the civil war that led to the closure of the U.S. Embassy ended in 1999 and elections were held in June and July 2005, travelers should be aware that political tensions persist.
Sporadic politically-motivated violence remains an issue.
Due to the potential for violence, U.S. citizens should avoid political gatherings and street demonstrations, and maintain security awareness at all times.
With legislative elections scheduled for late 2008, the potential for future political unrest remains high.
In December 2004, the Government of Senegal and some factions of the Movement of Democratic Forces of the Casamance (MFDC), a Senegalese separatist movement, instituted an end to hostilities and agreed to negotiate with the goal of achieving a definitive end to the armed conflict in the Casamance.
This conflict has not yet been resolved, however, and its effects reach into Guinea-Bissau.
In the spring of 2006, Bissau-Guinean military forces conducted offensive operations near the town of Sao Domingos to expel elements of the MFDC.
The fighting reportedly resulted in dozens of military and civilian casualties, mostly from landmine explosions.
There are currently instances of fighting in the Casamance region (composed of the Ziguinchor and Kolda regions) involving factions of the Casamance separatist MFDC (Mouvement des Forces Démocratiques de la Casamance) in southern Senegal and the Senegalese military.
Although the recent escalation in hostilities has not spilled over into Guinea-Bissau, the potential for conflict along the border remains.

Unexploded military ordnance and landmines remain scattered throughout the country.
Although the capital city of Bissau was declared “mine-free” in June 2006 by the national de-mining center (CAAMI), occasional findings or unintentional explosions do occur.
There are two non-governmental organizations (NGOs) active in successfully removing mines.
To minimize the risks posed by both bandits and landmines, U.S. citizens are encouraged to limit driving outside of towns to daylight hours only and to remain on well-traveled roads at all times.

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, including the Travel Warning for Uzbekistan 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:
Although there is a fairly low incidence of normal daytime street crime, travelers should observe security precautions in the city, particularly with regard to pickpocket activity in marketplaces.
Travelers should refrain from walking alone at night.
The lack of reliable public electricity means that urban streets are dark at night, even in Bissau.
There have been periodic incidents of bandits accosting travelers in rural areas.
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:
While modern medical facilities are virtually nonexistent in Guinea-Bissau and travelers should not rely on them, limited emergency medical care is available at a new hospital in Bissau operated by the Sant’Egidio Community.
Monday to Saturday there are flights from Bissau to Dakar, Senegal, where more acceptable levels of medical care are available.
Malaria, a serious and sometimes fatal disease, is a risk for travelers to Guinea-Bissau.

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 Guinea-Bissau is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
The public transportation system, urban and rural road conditions, and the availability of roadside assistance are all poor.
There is no consistent public electricity in the capital, and the lack of lighting at night makes careful driving essential.
Since there are minefields left over from the civil war and the war of independence, travelers should not leave designated roads and pathways.
The landmines are scattered in several areas throughout Guinea-Bissau, including Bafata, Oio, Biombo, Quinara and Tombali regions.
While there has been significant progress in locating and removing landmines, an estimated 46,000 landmines remain.
Speak with local authorities first and use caution if leaving a main road or highway to enter a trail network or to make other types of cross-country movement.
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 Guinea- Bissau, the U.S. Federal Aviation Administration (FAA) has not assessed Guinea-Bissau’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES:
Guinea-Bissau's customs authorities may enforce strict regulations concerning the temporary import or export of items such as firearms, antiquities, medications, and business equipment. (See contact information in the section on Entry Requirements.)
International banking and finance is problematic due to a limited formal banking sector.
ATMs are rarely available, credit cards are rarely accepted, currency exchange outside of the black market is almost non-existent, wire transfer possibilities are extremely limited, and repatriation of funds is problematic.

As there is currently no U.S. Embassy in Guinea-Bissau, U.S. consular officials may not be properly notified when an American citizen is arrested or detained in Guinea-Bissau.
Because notification would have to be made to consular officers at U.S. Embassies in neighboring countries, there may be a delay in consular access to such citizens.
U.S. citizens are encouraged to carry a notarized copy of their U.S. passports with them at all times so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available.
Taking photographs of anything that could be perceived as being of military or security interest may result in problems with authorities.
Guinea-Bissau has a cash-only economy, so travelers should not count on using credit cards and ATMs. 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 Bissau-Guinean laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Guinea-Bissau are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Guinea-Bissau are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Guinea-Bissau.
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 Guinea-Bissau remains closed.
U.S. citizens who plan to enter Guinea-Bissau are encouraged to register with the Consular Section of the U.S. Embassy at Avenue Jean XXIII, Dakar, Senegal.
The mailing address is B.P. 49, Dakar, Senegal.
The telephone number is (221) 33 829-2100 and the fax is (221) 33 822-2991.
The e-mail address is consulardakar@state.gov.
The web site is http://dakar.usembassy.gov/.
*
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*
*
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This replaces the Country Specific Information for Guinea-Bissau dated September 12, 2007 to update sections on Country description, Special Circumstances, Safety and Security, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Thu, 18 Oct 2018 12:44:14 +0200

Bissau, Oct 18, 2018 (AFP) - Guinea-Bissau's government on Thursday signed a deal with a federation of truckers, bus owners and taxi drivers to end a strike that had brought the West African state to a standstill, officials said.   The federation launched the strike on Tuesday in protest at the many problems facing transporters, including police bribery.

The protocol agreement was signed on the government's side by the General Directorate for Land Transport (DVGTT), which is in charge of Guinea-Bissau's roads; the National Traffic Police; and the National Guard.   Under the deal, the government pledged to cut the number of checkpoints -- a major source of kickbacks and delays -- within two months.

DVGTT chief Bamba Banjai, speaking to journalists after the signature, hailed the accord.    Bus traffic swiftly began to return to the streets Bissau, the capital, which had been virtually deserted.   Private schools, which depend on minibuses and taxis to drop off and pick up children, had told students to stay at home, and many civil servants did not go to work.

As the strike ran into its second day on wednesday, the head of the transporters' federational, Bubacar Felix Frederico, warned that the protest would only be lifted "with the official undertaking" of Prime Minister Aristides Gomes.   Among the federation's demands were improvement to the country's notoriously poor roads, but the issue is not addressed in the protocol and has been placed to one side.

Guinea-Bissau, a former Portuguese colony, ranks among the poorest countries in the world, according to the UN's development index.   It has just 4,400 kilometres of roads, of which only 10 percent (453 km) are paved. Non-paved roads are notoriously slow and dangerous, and prone to being washed out during the rainy season.
Date: Fri, 3 Aug 2018 13:51:38 +0200

Bissau, Aug 3, 2018 (AFP) - Public-sector workers in the West African state of Guinea-Bissau have called off a strike after securing a pay increase in talks with the government, their main trade union said Friday.   The strike, launched on July 24, ended after the government agreed on Thursday to increase minimum monthly pay from 19,200 CFA francs ($33.91, 29.28 euros) to 50,000 francs from September, Julio Mendonca, head of the UNTG union, told AFP.   However, Prime Minister Aristide Gomes was somewhat more cautious.   In a statement to AFP late Thursday, he said, "all parties have accepted the principle" of a pay rise.   "We are still in negotiations," he said. "We are all going to work at finding a definitive solution to this situation."

The strike, which affected a sector with 13,000 employees, was also followed by state media organisations. Public radio and television went silent and there were strikes at the daily newspaper No-Pintcha and news agency ANG.   Guinea-Bissau, a former Portuguese colony with a population of 1.8 million, is one of the poorest and most unstable countries in the world.   It has experienced years of volatility, marked by coups and soldiers' mutinies.   The country plunged into a power struggle in August 2015, when President Jose Mario Vaz sacked his then prime minister, Domingos Simoes Pereira.   After lawmakers did not meet for nearly two years, an agreement was reached in April at a summit of the Economic Community of West African States (ECOWAS), which led to Gomes's appointment as prime minister.
Date: Tue, 17 Jul 2018 18:32:36 +0200

Bissau, July 17, 2018 (AFP) - Public radio and television in Guinea-Bissau went quiet on Tuesday as state media workers joined an ongoing civil servants' strike.   Daily newspaper No-Pintcha and news agency ANG, both state-funded, also took part in a planned three-day strike over pay and working conditions.   "We have interns who have worked in newsrooms for over three years without pay," union leader Julciano Balde told AFP.   "We work with the little we have, with no means of transport, old computers, while ministers drive brand new cars."   The journalists want better working conditions, including "decent" salaries, the hiring of all interns and means of transportation, according to their representatives.   The minimum wage is 45,000 CFA francs (around 68 euros) at the No Pintcha newspaper, 60,000 CFA francs (90 euros) at the national radio and 120,000 CFA francs (180 euros) at the state television channel.

Civil servants launched regular strikes in June and their largest union UNTG confirmed it will keep asking workers to stay home from Tuesday to Thursday every week.    "We will keep the pressure on and paralyse the administration until we get what we want," UNTG leader Julio Antonio Mendonca told AFP.   Guinea-Bissau, with a population of 1.8 million, has experienced periods of political and military instability marked by coups and mutinies of soldiers for several years.   The former Portuguese colony had been in the grip of a power struggle since August 2015, when President Jose Mario Vaz sacked his then prime minister Domingos Simoes Pereira.   After lawmakers did not meet for nearly two years, an agreement was reached in April at a summit of the Economic Community of West African States (ECOWAS) and a new prime minister, Aristides Gomes, was appointed.
Date: Wed, 11 Jul 2018 17:40:43 +0200

Bissau, July 11, 2018 (AFP) - Hundreds of civil servants took to the streets of Guinea-Bissau on Wednesday to demand a hike in the minimum wage and better living conditions.   The protest was organised by the Union of Guinea-Bissau workers (UNTG), which regroups 8,000 out of the West African country's 13,000 civil servants.  Demonstrators marched from the outskirts of the capital Bissau to its centre, chanting "Down with lawmakers paid to do nothing" and "We demand decent wages and better conditions," an AFP journalist saw.   "It is intolerable for government to raise the wages of ministers and parliamentarians while at the same time other public servants are paid next to nothing," UNTG Secretary General Julio Antonio Mendoca said.

UNTG is calling for the minimum monthly salary to be upped from 19,200 CFA francs (29 euros) to 59,000 CFA francs (90 euros).   "We will carry on until we succeed," Mendoca added.   It is the fifth action organised by UNTG in six weeks, including a three-day strike in June.   "The civil servants' claims are fair but the method used is inappropriate because the government cannot afford to meet the claims," Prime Minister Aristides Gomes told reporters last week.   "The government was formed to organise elections and deal with day-to-day matters."

Parliament last month adopted its first budget after nearly three years of political instability ahead of legislative elections set for November.   The former Portuguese colony was plunged into a power struggle in August 2015, when President Jose Mario Vaz sacked his then prime minister, Domingos Simoes Pereira.   Lawmakers did not meet for nearly two years -- a crisis that was defused in April under an agreement reached at a summit in Togo of the Economic Community of West African States (ECOWAS).   Under it, Gomes was appointed as a consensus prime minister and tasked with steering the country to the November 18 polls.
Date: Tue, 26 Jun 2018 21:40:25 +0200

Bissau, June 26, 2018 (AFP) - Civil servants in Guinea-Bissau went on strike Tuesday, days after the country passed its first budget following a three-year political crisis, their union told AFP.   The workers, who plan to strike for three days, are demanding a higher minimum wage and better working conditions, according to the National Union of Guinea-Bissau Workers (UNTG), the largest civil servants' union.   The small West African country's parliament just unanimously adopted its first budget after nearly three years of political instability ahead of legislative elections set for November.   Guinea-Bissau, with a population of 1.8 million, has experienced periods of political and military instability marked by coups and mutinies of soldiers for several years.

In the capital Bissau, ministries and public offices were closed on Tuesday and hospital services were reduced to a minimum, an AFP journalist said.   UNTG -- which says 90 percent of the country's estimated 13,000 civil servants are striking -- is calling for the minimum monthly salary to be upped from 19,200 CFA francs (29 euros) to 59,000 CFA francs (90 euros).   The government can increase civil servants' salaries as MPs and ministers recently received a raise, UNTG leader Julio Antonio Mendoca told AFP.   The former Portuguese colony had been in the grip of a power struggle since August 2015, when President Jose Mario Vaz sacked his then prime minister Domingos Simoes Pereira.   After lawmakers did not meet for nearly two years, an agreement was reached in April at a summit of the Economic Community of West African States (ECOWAS) and a new prime minister, Aristides Gomes, was appointed.
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World Travel News Headlines

Date: Fri, 8 Nov 2019 12:35:08 +0100 (MET)

Tehran, Nov 8, 2019 (AFP) - An earthquake rocked northwestern Iran before dawn on Friday, killing at least five people and injuring more than 300 in crumbling and collapsed buildings.   The 5.9-magnitude quake struck at 1:17 am (2247 GMT Thursday) about 120 kilometres (75 miles) southeast of the city of Tabriz, in East Azerbaijan province, the Iranian Seismological Centre said.

Described as "moderate", the quake was eight kilometres (five miles) deep and was followed by five aftershocks.    The provincial governor, Mohammad-Reza Pourmohammadi, told Iranian media that rescue operations were underway in 41 villages, but the damage was largely concentrated in two, Varnakesh and Varzaghan.   According to the emergency services, nearly 340 people were admitted to hospital for treatment, but all but 17 were discharged by Friday noon.   Some 40 homes were levelled by the quake and over 200 head of cattle killed.

Around 100 injured residents were pulled out of the rubble of their damaged or flattened homes.   Around noon, emergency teams distributed survival kits, stoves, blankets and tents in 78 villages.   In Varnakesh, an emergency shelter was set up.   State television broadcast images of people who had fled their homes warming themselves around a fire lit on a public highway.   But the damage appeared to be less widespread than initially feared.   The United States Geological Survey (USGS) had issued an alert warning that "significant casualties are likely and the disaster is potentially widespread".

In many areas people had returned to their homes by daybreak after the initial panic subsided and the aftershocks petered out.   The gas supply was restored to all but one of the affected villages.   The quake was felt in the provincial capital Tabriz and as far away as the city of Rasht, near the Black Sea coast 200 kilometres (125 miles) from the epicentre.   Tabriz, which has a population of more than a million, is a historic city which served as Iran's capital several times between the 13th and 16th centuries. Its bazaar is a UNESCO world heritage site.   Iran sits where two major tectonic plates meet and experiences frequent seismic activity.

The country has suffered a number of major disasters in recent decades, including at the ancient city of Bam, which was decimated by a catastrophic earthquake in 2003 that killed at least 31,000 people.     In 1990, a 7.4-magnitude quake in northern Iran killed 40,000 people, injured 300,000 and left half a million homeless, reducing dozens of towns and nearly 2,000 villages to rubble.   Iran has experienced at least two other significant quakes in recent years -- one in 2005 that killed more than 600 people and another in 2012 that left some 300 dead.
Date: Fri, 8 Nov 2019 11:03:11 +0100 (MET)

London, Nov 8, 2019 (AFP) - Royal Mail on Friday made a High Court bid to block a postal strike by workers due next month ahead of Christmas and around the time of Britain's general election.   Members of the Communication Workers Union recently voted to strike amid a dispute with management over pay and other employment conditions.   In a statement, Royal Mail pointed to "potential irregularities in the ballot".   It added: "The company is making this High Court application because the integrity and legal soundness of any electoral process is vital," Royal Mail said in relation to the strike ballot.   "This is particularly the case in relation to potential industrial action around the general election on 12 December 2019.    "Royal Mail is also making this application because of the damage industrial action would do to the company and its customers in the run-up to Christmas," the group added.   It expects the hearing to take place next week.
Date: Thu, 7 Nov 2019 17:15:09 +0100 (MET)

Paris, Nov 7, 2019 (AFP) - Top European medical bodies demanded Thursday that Chinese traditional medicines be subject to the same regulatory oversight as conventional Western methods, despite recent WHO recognition of their use.   "Just because the World Health Organisation includes a chapter on Traditional Chinese Medicine in its new International Classification of Diseases, it is not automatically safe to use without robust evidence," Professor Dan Marhala, President of the Royal Swedish Academy of Sciences, said in a statement issued by top European medical and scientific bodies.   The European Academies' Science Advisory Council (EA SAC) and the Federation of European Academies of Medicine (EAM) said European lawmakers must protect the health of European citizens.

Accordingly, the existing European regulatory framework should be revised to make sure Traditional Chinese Medicine (TC) is held to the same standards of proof and evidence as conventional medicine.   "There have been examples where some Traditional Chinese Medicine has undergone thorough pre-clinical investigation and proven in rigorous clinical trials to contribute significant health benefit -- artemisinin therapy for malaria, for example," Marhala said.   "There may be more leads to diagnosis and therapeutic benefit yet to be discovered but this can in no way mean that other claims can be accepted uncritically."   It was not necessarily the Who's intention to promote the use of TC, but its stamp of approval could lead supporters to promote wider application, the statement cautioned.   As a result, patients could be confused over which diagnosis was appropriate and which therapy was effective.   More serious still, said former EASAC president Jos van der Meer, is that some TCMs "can have serious side effects and interactions with other treatments."   "Moreover, patients may be at risk that severe diseases are treated ineffectively and conventional medical procedures delayed," he added.

The WHO included TCMs in an official classification of diseases coming into effect in January 2022.   In 2015, China's Tu Youyou won the Nobel Prize for medicine for discovering artemisinin, giving a huge boost to the credibility of TCM which many in the west deride as lacking scientific foundation and verging on quackery.   In China, traditional medicine has a long, distinguished history and its practitioners are treated with great respect.   EASAC comprises the national science academies of EU Member states, plus Norway and Switzerland.   FEAM groups medical academies which provide advice to the European authorities.
Date: Thu, 7 Nov 2019 17:11:10 +0100 (MET)

Riga, Nov 7, 2019 (AFP) - Thousands of doctors and nurses rallied Thursday in front of the Latvian parliament in Riga calling for better pay in what was the Baltic state's largest protest in over a decade.   Police said more than 5,000 people, including patients, turned out for the protest, which featured coffins and signs with slogans such as "United for health", "I only want to work one job" and "Patients supporting doctors and nurses".   The LVSADA medical labour union organised the rally to condemn lawmakers for planning to increase their own salaries next year while reneging on a promise to boost wages in the chronically underfunded medical profession.   "We won't allow the healthcare system to be starved again," LVSADA chief Valdis Keris said at the rally, which state hospital employees attended by taking a day of unpaid leave.

Some doctors also participated in the protest by only performing emergency surgery and tending to emergency patients on Thursday while rescheduling everything else.    "The average monthly wage for a doctor at a Latvian public hospital is only between 1,000-3,000 euros ($1,100-$3,300)," protester and doctor Roberts Furmanis said in a statement sent to media.    "I work my daily shift at one hospital, at night I also work overtime driving around in an ambulance, plus sometimes I lecture at medical schools on my rare days off," he added.   "I get less than 3,000 euros a month for those jobs combined. How am I supposed to support my family?"   Last year, lawmakers voted to raise wages for almost all employees of the government-run healthcare system, but now say that they are unable to find the necessary funds in the 2020 state budget.    "I express deep regret for last year's promise, which we cannot carry out," speaker of parliament Inara Murniece told the rally.

Those protesting, however, point out that the 2020 state budget exceeds 10 billion euros for the first time ever in the country of just 1.9 million people -- or 700 million more euros than this year.    Medical workers are upset that while there is no room for better healthcare wages in the new budget, the country's lawmakers and ministers plan to increase their own salaries next year and have also earmarked taxpayer money for their respective political parties.    Thursday's rally was Latvia's largest since some 10,000 people attended a January 2009 protest against government cuts, which grew violent and resulted in dozens of arrests.
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: Thu, 7 Nov 2019 09:57:41 +0100 (MET)

Singapore, Nov 7, 2019 (AFP) - Tourists visiting Singapore can now check in at some hotels using facial recognition technology under a pilot programme that could cut waiting times and help tackle a labour crunch.  The tech-savvy country of 5.7 million people is increasingly turning to automation to speed up services and deal with workforce shortages, with robots deployed for tasks ranging from cleaning to making noodles.

Under the pilot launched Wednesday, visitors will not need to wait to be checked in by hotel staff but can instead use a phone app fitted with facial recognition technology or machines which scan their passports.   The data from the scan is sent to immigration authorities for checks after which the visitor is issued a room key, said the Singapore Tourism Board and Hotel Association, which announced the initiative this week.

The technology, reportedly being trialled at three hotels and is similar to that used in some airports including Singapore's Changi, could reduce check-in times by up to 70 percent, they said.   Singapore welcomed a record high 18.5 million visitors last year, up 6.2 percent from the year before. The city has more than 400 hotels with 67,000 rooms.
Date: Wed, 6 Nov 2019 15:31:58 +0100 (MET)

Amman, Nov 6, 2019 (AFP) - Eight people, including four tourists, were wounded in a knife attack on Wednesday at the famed archeological site of Jerash in northern Jordan, a security spokesman told AFP.   Four tourists -- three Mexicans and a Swiss woman -- were wounded, along with a Jordanian tour guide and a security officer who tried to stop the assailant, public security directorate spokesman Amer Sartawi said.   The attack took place around noon (1000 GMT) at the Roman ruins of Jerash, a popular attraction 50 kilometres (30 miles) from the capital Amman.   The health ministry confirmed that eight people had been wounded, with Sartawi saying earlier that they had "been transported to hospital for treatment".    He said the assailant had been arrested but did not specify his nationality, noting that the motive was as yet unknown.

Jordanian tour guide Zouheir Zreiqat was at the scene and told AFP that the attack happened "just before midday when around 100 foreign tourists" were at the site.    "A bearded man in his twenties wearing black and brandishing a knife started to stab tourists," according to Zreiqat.   He said others started to shout for help and he, along with three other tour guides and three tourists managed to stop the assailant.   "We chased him until we could grab him and get him on the ground," Zreiqat said.    "We took the knife from him. He stayed silent, without saying a word until the police arrived and arrested him."

- Violent attacks -
It was not the first time tourist sites have been targeted by attacks in Jordan.    In December 2016, in Karak, home to one of the region's biggest Crusader castles, 10 people were killed in an attack that also left 30 wounded.    Seven police officers, two Jordanian civilians and a Canadian tourist were killed in the attack.

The attack was claimed by the Islamic State group (IS) and sparked concern over its impact on tourism, a mainstay of the Jordanian economy.    Ten people were convicted of carrying out the attack, with two sentenced to death.   Several violent incidents struck the country the same year, including a suicide attack in June claimed by IS that killed seven Jordanian border guards near the frontier with Syria.    Amman has played a significant role in the United States-led coalition fight against IS in Syria and Iraq, both neighbouring Jordan.

- Economic troubles -
Lacking in natural resources, the country of nearly 10 million depends on tourism and the kingdom has been working to pull the key sector out of a crisis caused by regional unrest in recent years.   Jordan's economy as a whole was hit hard by the combined impact of the international financial crisis, the Arab Spring uprisings that convulsed the Middle East in 2011 and the conflict in Syria.

Tourism accounts for 10 to 12 percent of gross domestic product and the government aims to double this by 2022, former tourism minister Lina Annab told AFP in an interview last year.  The country boasts 21,000 archaeological and historical sites that span millennia, according to the tourism board.   They include the Roman ruins of Jerash, the ancient city of Petra, the Dead Sea and Wadi al-Kharrar, or Bethany Beyond the Jordan, where some believe Jesus was baptised.   Jordan welcomed seven million tourists in 2010, but arrivals plunged to around three million in each of the following two years, tourism board head Abed Al Razzaq Arabiyat said in April.    Numbers have rebounded as spillover from the war in neighbouring Syria has abated, officials have said, with the government working to bring annual tourist arrivals back up to 7 million by 2020.
Date: Tue, 5 Nov 2019 00:54:14 +0100 (MET)

Nuku'alofa, Tonga, Nov 4, 2019 (AFP) - A 6.6 magnitude earthquake struck off the coast of the Pacific island nation of Tonga on Tuesday, but there was no threat of a tsunami, officials said.    The United States Geological Survey (USGS) said the shallow undersea quake hit about 134 kilometres (83 miles) west of Neiafu, the country's second-largest town.    It said the temblor was not expected to have caused significant damage. The quake was not felt in Tonga's capital, Nuku'alofa, according to an AFP reporter.    There was also no threat of a tsunami, the Pacific Tsunami Warning Center said.    A second quake of 5.5 magnitude was recorded a few minutes later, the USGS said.
Date: Mon, 4 Nov 2019 23:47:26 +0100 (MET)

Santiago, Nov 4, 2019 (AFP) - A strong 6.0-magnitude earthquake shook Chile on Monday, rattling buildings in the capital while a big anti-government demonstration was under way.   The quake struck at 6:53 pm (2153 GMT) with its epicentre near the northern town of Illapel, the US Geological Survey said.   A strong and prolonged shaking was felt in the capital.   Chile's National Seismological Center measured the quake at magnitude 6.1, revising down an earlier estimate of 6.3.   There were no immediate reports of damage or casualties.   "There have been no reports of damage to people, disruption of basic services or infrastructure," the National Emergency Office said.   The Army Hydrographic and Oceanographic Service said the quake was unlikely to cause a tsunami on Chile's Pacific coast.

When the quake hit, police in Santiago were dispersing protesters at the start of the third week of anti-austerity protests targeting the conservative government.   Chile is one of the world's most earthquake-prone countries.   The 9.5-magnitude 1960 Valdivia earthquake was the strongest ever recorded on the magnitude scale, according to the USGS.   In 2010 an 8.8-magnitude followed by a tsunami killed more than 500 people.   Chile lies on the Ring of Fire -- an arc of fault lines that circles the Pacific Basin and is prone to frequent earthquakes and volcanic eruptions.
Date: Mon, 4 Nov 2019 20:37:19 +0100 (MET)
By Eugenia LOGIURATTO

Recife, Brazil, Nov 4, 2019 (AFP) - Months after thick oil began turning idyllic beaches in Brazil into "black carpets," workers and volunteers wearing rubber gloves race against time to scrape off the remaining fragments ahead of the country's peak tourism season.   Paiva, Itapuama and Enseada dos Corais in the northeastern state of Pernambuco are among hundreds of beaches fouled by an oil spill that began to appear in early September and has affected more than 2,000 kilometers (1,250 miles) of Atlantic coastline.

As ocean currents brought large globs of crude to shore near the capital Recife in recent weeks, locals rushed to the normally picturesque beaches and used their bare hands to remove the toxic material coating sand, rocks and wildlife.    "I was shocked, there were people entering the water without gloves, without safety equipment, in the middle of the oil," coconut seller Glaucia Dias de Lima, 35, told AFP as she picked up chunks of crude from Itapuama beach.

Thousands of military personnel have been dispatched to help clean up the oil that has killed dozens of animals, including turtles, and reached a humpback whale sanctuary off Bahia state that has some of the country's richest biodiversity.   It is the third major environmental disaster to strike Brazil this year. In recent months fires ravaged the Amazon rainforest and in January a mine dam collapsed in the southeast, spewing millions of tons of toxic waste across the countryside.    Wildfires are still raging across the Pantanal tropical wetlands.

While thousands of tons of crude waste have been recovered so far, the space agency INPE said Friday there might still be oil at sea being pushed by currents. It could reach as far south as Rio de Janeiro state, the agency said.   President Jair Bolsonaro warned Sunday that "the worst is yet to come," saying only a fraction of the spilled crude had been collected so far.    The government on Friday named a Greek-flagged tanker as the prime suspect for being the source of the oil slicks.   The ship Bouboulina took on oil in Venezuela and was headed for Singapore, it said. The tanker's operators have denied the vessel was to blame.

- Fishing paralyzed -
As the southern hemisphere's summer approaches, people dependent on the fishing and tourism industries are nervously waiting for test results to show if the water is safe to swim in and eat from.   Northeastern Brazil is a popular tourist destination all year round, but visitor numbers usually explode in the hotter months. 

Eco-tourism guide Giovana Eulina said the disaster would affect the sector and she called for a campaign to "encourage people to come here."   Fishing in the region also has been largely paralyzed by the oil spill, even in areas where crude has not been detected.   "We still don't have a concrete answer from a scientist who says that (the water) is really contaminated," said Sandra Lima, head of a local fishing association.    Edileuza Nascimento, 63, stands in muddy water near Recife and extracts shellfish that she will sanitize at home, freeze and then sell.   It was already a struggle for fishermen to make a living, she said. But the oil slick has been "too much."    "It has come to finish off the fishing families."