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Anguilla

Anguilla US Consular Information Sheet
March 03, 2009
COUNTRY DESCRIPTION: Anguilla is a British overseas territory in the Caribbean, part of the British West Indies. It is a small but rapidly developing island with particularly well-developed
ourist facilities.

ENTRY/EXIT REQUIREMENTS:
The Intelligence Reform and Terrorism Prevention Act of 2004 requires all travelers to and from the Caribbean, Bermuda, Panama, Mexico and Canada to have a valid passport to enter or re-enter the United States. U.S. citizens must have a valid U.S. passport if traveling by air, including to and from Mexico.
If traveling by sea, U.S. citizens can use a passport or passport card. We strongly encourage all American citizen travelers to apply for a U.S. passport or passport card well in advance of anticipated travel.
American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

In addition to a valid passport, U.S. citizens need onward or return tickets, and sufficient funds for their stay.
A departure tax is charged at the airport or ferry dock when leaving. For further information, travelers may contact the British Embassy, 19 Observatory Circle NW, Washington, DC
20008; telephone (202) 588-7800; or the nearest consulate of the United Kingdom in Atlanta, Boston, Chicago, Dallas, Los Angeles, New York, Denver, Houston, Miami, Orlando, Seattle, or San Francisco. Visit the British Embassy web site for the most current visa information.

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

SAFETY AND SECURITY:
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 A Safe Trip Abroad.

CRIME:
While Anguilla's crime rate is relatively low, both petty and violent crimes
do occur. Travelers should take common-sense precautions to ensure their personal security, such as avoiding carrying large amounts of cash or displaying expensive jewelry. Travelers should not leave valuables unattended in hotel rooms or on the beach. They should use hotel safety deposit facilities to safeguard valuables and travel documents. Similarly, they should keep their lodgings locked at all times, whether they are present or away, and should not leave valuables in their vehicles, even when locked.

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 staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

The local emergency line in Anguilla is 911.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
There is only one hospital, Princess Alexandra Hospital (telephone: 264-497-2551), and a handful of clinics on Anguilla, so medical facilities are limited.
Serious problems requiring extensive care or major surgery may require evacuation to the United States, often at considerable expense.

There are no formal, documented HIV/AIDS entry restrictions for visitors to and foreign residents of Anguilla, but there have been anecdotal reports of exclusion.
Please verify this information with the British Embassy 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 Anguilla is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Unlike the U.S., traffic in Anguilla moves on the left. The few roads on the island are generally poorly paved and narrow. While traffic generally moves at a slow pace, with the increasing number of young drivers in Anguilla, there are occasional severe accidents caused by excessive speed. Although emergency services, including tow truck service, are limited and inconsistent, local residents are often willing to provide roadside assistance. For police, fire, or ambulance service dial 911.

Please refer to our Road Safety page for more information.
Visit the Government of Anguilla web site for further road safety information.

AVIATION SAFETY OVERSIGHT:
Civil aviation operations in Anguilla fall under the jurisdiction of British authorities. The U.S. Federal Aviation Administration (FAA) has assessed the Government of the United Kingdom’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Anguilla’s air carrier operations.
For more information, travelers may visit the FAA web site.

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 Anguilla laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Anguilla 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 Anguilla 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 Anguilla. 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 with consular responsibility over Anguilla is located in Bridgetown, Barbados in the Wildey Business Park in suburban Wildey, southeast of downtown Bridgetown.
The main number for the Consular Section is (246) 431-0225; after hours, the Embassy duty officer can be reached by calling (246) 436-4950.
Visit the U.S. Embassy Bridgetown online for more information.
Hours of operation are 8:30 a.m. – 4:30 p.m. Monday through Friday, except Barbadian and U.S. holidays.
* * *
This replaces the Country Specific Information for Anguilla dated April 2, 2008, to update sections on Country Description, Entry/Exit Requirements, Information for Victims of Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Sat, 9 Sep 2017 19:31:32 +0200

Paris, Sept 9, 2017 (AFP) - France's meteorological agency on Saturday issued its highest warning for the Caribbean islands of St Martin and St Barts as Hurricane Jose bore down, three days after they were hit by Hurricane Irma.   The alert warned of a "dangerous event of exceptional intensity," with winds that could reach 120 kilometres (75 miles) per hour, and strong rains and high waves.

St Barts is a French overseas territory, as is the French part of St Martin, which is divided between France and the Netherlands.   Twelve people were killed on the two islands by Hurricane Irma, thousands of buildings were flattened and the authorities are struggling to control looting.   The French state-owned reinsurer CCR on Saturday estimated the damage at 1.2 billion euros ($1.4 billion).   Irma is now heading for Florida, where a total of 6.3 million people have been ordered to evacuate, according to state authorities.
Date: Tue 29 Apr 2014
Source: National Institute for Public Health and the Environment [edited]

1 Oct 2013-29 Apr 2014 (week 18) St Maarten - Since the last report (week 15 [17?]) 52 new cases have been confirmed among St Maarten residents. Up to 29 Apr 2014, now a total of 343 confirmed cases have been reported. One of these confirmed cases was hospitalized.

The median age of the confirmed patients was 44 years, range 4-92 years. Of those cases for which gender was available, 201 were female and 130 were male.

- On 6 Dec 2013, the 1st indigenous chikungunya [virus infection] case of St Maarten was reported. Retrospectively, the 1st patient with suspected complaints was reported in mid-October 2013 in St Martin.
------------------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
=====================
[The report also has graphs showing case numbers over time.

Maps of St Martin/St Maarten can be accessed at
Date: 5-11 May 2014
Source: Institut de Veille Sanitaire (French Institute for Public Health Surveillance, InVS) [edited]

Cases since the beginning of the outbreak in December 2013:
- St Martin: (susp) 3240 cases; deaths 3; stable.
- St Barthelemy: (susp) 500 cases; stable.
- Martinique: (susp) 24 180; deaths 3; increasing.
- Guadeloupe: (susp) 13 600 cases; deaths 1; increasing.
- French Guiana: (susp) not available; (probable or confirmed) 122 cases with 83 locally acquired; increasing, with a new cluster in Kourou and 2 near Cayenne.
======================
[The 16 May 2014 report from Guyaweb (<http://www.guyaweb.com/actualites/news/sciences-et-environnement/le-chik-revient-kourou-setend-cayenne-desormais-saint-laurent/>) states that there are 2 new cases in Saint-Laurent-du-Maroni, overlooking the Suriname River, of which one is certainly autochthonous, and a new focal point occurred in Kourou with 4 cases.

Maps of the area can be seen at
and <http://healthmap.org/promed/p/35574>. - ProMed Mod.TY]
Date: 7-13 Apr 2014
Source: INVS Point Sanitaire No. 14 [in French, trans. ProMed Mod.TY, edited]

Cases since the beginning of the outbreak in December, 2013:
- St. Martin: (susp.) 2980 cases, (probable and conf.) 793 cases; Deaths 3; Decreasing.
- Saint Barthelemy: (susp.) 460 cases, (probable or confirmed) 135 cases; Decreasing.
- Martinique: (susp.) 16 000, (probable or confirmed) 1473 cases; Deaths 2; Increasing.
- Guadeloupe: (susp.) 4710 cases, (probable or confirmed) 1261 cases; Deaths 1; In epidemic status.
- French Guiana: (susp.) 7 cases with 4 locally acquired, (probable or confirmed) 39 cases with 26 locally acquired) 30 cases; (imported) 16 cases; Moderate to increasing; Half of probable and confirmed cases are located in Kourou; however indigenous cases have also been recorded from the Cayenne Matoury, Remire and Macouria communities.
=================
[Maps showing case distributions on each island can be accessed at the above URL. - ProMed Mod.TY]
Date: Thu 27 Mar 2014
Source: The Daily Herald [edited]

As St. Maarten continues to take measures to combat the spread of the chikungunya virus, the number of cases continues to climb.

Health Minister Cornelius de Weever announced on Wednesday [26 Mar 2014], that the total number of confirmed chikungunya cases thus far stood at 224.

De Weever also announced that government will be signing a Memorandum of Understanding (MOU) with French St. Martin as a means of collectively responding to the mosquito threat that puts the population at risk. He said both sides have been working closely together to address the dengue and chikungunya threats.

The MOU will cover, amongst other things, a regular exchange of epidemiological information on vector-borne diseases and collectively publishing and representing data collected under the agreement.

The need for collective information campaigns and enhancement of the mosquito vector-control programme will also be included in the MOU. The MOU also describes the need for planning execution and evaluation of collective responses to the chikungunya threat.
=========================
[The increase in the number of chikungunya virus infections over the past week in St. Maarten is of concern, rising from 123 cases to 224 cases. This number is confirmed in another report that also indicates that there are an additional 325 suspected cases (<http://www.rivm.nl/dsresource?type=pdf&disposition=inline&objectid=rivmp:239786>).  - ProMed Mod.TY]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/35574>.]
More ...

Tunisia

General Information
************************************
Tunisia is situated in Northern Africa and is a common tourist destination for Irish travellers. It is bordered by Algeria to the west and southwest, Libya to the south east and the Medite
ranean Sea to the east and north. It has a Mediterranean climate with mild rainy winters and hot dry summers. Costal temperatures are less extreme than the inland regions ranging from an average daily low in January of 70C to an average daily high in August of 320C. Rainfall throughout the country varies considerably from about 40" in the northwest down to only 4" in the southwest.
Safety & Security
************************************
Most tourists will not have any significant difficulties in this regard but criminals have targeted tourists and business travellers for thefts, pickpocketing, and scams.
Care should be taken with wallets and other valuables kept in handbags or backpacks that can be easily opened from behind in crowded streets or marketplaces.
Harassment of unaccompanied females occurs rarely in hotels, but more frequently elsewhere.
Health Facilities
************************************
The level of health care facilities in Tunisia will usually be found to be below that normally accepted at home in Ireland. In general the larger hotels will have English speaking doctors in attendance. Unfortunately the hospital/clinic backup for these practitioners is usually very limited.
Food & Water Facilities
************************************
The World Health Organisation statistics suggest that close to 35% of all travellers to these regions will develop significant diarrhoea during their stay. In almost all cases this can be traced back to unwise eating and drinking habits by tourists not taking sufficient care. Most significantly, travellers should stay away from cold foods (especially lettuce) and also all undercooked shell fish (mainly prawns, oysters, mussels and shrimps).
Hotel tap water will frequently not be potable and should not be used for drinking or brushing teeth. Sealed mineral water should be used at all times.
Fruit juice drinks sold by street traders should always be avoided as frequently the drink will have been supplemented with straight tap water.
Malaria in Tunisia
************************************
It is fortunate that this disease is not endemic in Tunisia and so travellers do not require to take prophylactic tablets. Nevertheless there are plenty of mosquitoes and sandflys during the hotter summer months and travellers will need to use insect repellents to protect against these uncomfortable bites. (see Protection against Insect Bites - Tropical Medical Bureau )
Jiggers & Chiggers
************************************
These are uncomfortable parasitic diseases which usually occur on the feet and often present looking like an ingrown toenail. Travellers returning home with unexplained skin rashes should always attend for medical assessment.
Rabies
************************************
This viral disease occurs throughout Africa and is evident in Tunisia. The disease can be transmitted by the bite (or lick or scratch) of any infected warm-blooded animal. Dogs will be the main risk animal but cats and monkeys can also transmit the disease. Any contact must be treated seriously and washed out immediately. An antiseptic should then be applied and further medical attention must always be sought.
Leishmaniasis
************************************
This is a parasitic disease transmitted by the bite of an infected sandfly. The disease occurs in Tunisia mainly during the summer and autumn months. Sandflys are much smaller than mosquitoes and are mainly found hovering around your ankles usually first thing in the morning or during the cooler evening hours. In most cases the bites cause little harm but occasionally deep infection can occur with more serious consequences. Again, travellers should wear sensible clothing and use adequate insect repellent. A bite which is slow to heal needs to be medically checked.
Sunbathing
************************************
One of the common health complaints associated with Tunisia relates to travellers becoming sun burnt while there on holidays. This is particularly the case with smaller children and toddlers. It is essential that travellers use high factor protection creams to lessen the risk of burning and to remember that skin cancer is commonly associated with burnt skin.
Anthrax from Leather Goods
************************************
This bacterial disease has been reported in Tunisia and travellers need to be aware that the disease can be transmitted through unprepared leather goods usually bought in the local market places. Even though this will be rare, any unusual sore should be medically checked after you return home.
Vaccinations for Tunisia
************************************
There are no essential vaccinations for Tunisia but travellers from Ireland are strongly recommended to have vaccination cover against
*
Poliomyelitis (childhood booster)
*
Typhoid (food & water borne disease)
*
Tetanus (childhood booster)
*
Hepatitis A (food & water borne disease)
Those spending longer periods in the country, or trekking, may need to consider vaccination cover
against
Rabies
and
Hepatitis B.
Summary
************************************
Be careful of the intense sun during the summer months. Care with food and water consumption will also be essential at all times.
Further Information
************************************
If you require any further information on staying healthy while overseas please contact either of the help lines at the numbers below.

Travel News Headlines WORLD NEWS

Date: Sun, 1 Dec 2019 17:56:57 +0100 (MET)

Ain Snoussi, Tunisia, Dec 1, 2019 (AFP) - At least 24 Tunisians were killed and 18 more injured Sunday when a bus plunged off a cliff into a ravine in the country's north, officials said.   The bus had set off from Tunis to the picturesque mountain town of Ain Draham, a popular autumn destination for Tunisians near the Algerian border, the tourism ministry said.   Twenty-four people were killed and 18 injured, the victims aged between 20 and 30, said the health ministry, releasing updated information on the tragedy.   Pictures and video footage shared online and posted on the websites of private radio stations showed the mangled remains of the bus with its seats scattered in the bed of a river.

Bodies, some in sports clothes and trainers, and personal belongings were strewn across the ground.   The bus with 43 people on board was travelling through the Ain Snoussi region when it plunged over the cliff, the interior ministry said.   The vehicle had "fallen into a ravine after crashing through an iron barrier," it said on its Facebook page.   The injured were transferred to nearby hospitals, the interior ministry said.   Forensic experts were deployed to investigate the crash, said AFP correspondents at the scene.   It was not immediately clear what caused the accident but Tunisian roads are known to be notoriously dangerous and run-down.

Tourism Minister Rene Trabelsi told a private radio station Mosaique FM that the "unfortunate accident took place in a difficult area" and just after the bus had taken a "sharp bend".  An civil defence official, speaking on state television, said there had previously been deadly accidents at the same spot.   Social network users bemoaned the tragedy, as Tunisian President Kaid Saied and Prime Minister Youssef Chahed arrived at the site of the accident.   "What a heavy toll," one of them said.   Another denounced the "roads of death" in Tunisia and wrote: "24 dead and no one from the government has declared a national catastrophe".

The World Health Organization in 2015 said Tunisia had the second worst traffic death rate per capita in North Africa, behind only war-torn Libya.   Experts blamed run-down roads, reckless driving and poor vehicle maintenance for a rise in accidents the following year.   The authorities recognise the scale of the problem but have said the country's security challenges, including jihadist attacks, have kept them from giving it more attention.
Date: Wed, 27 Nov 2019 20:35:51 +0100 (MET)
By Akim Rezgui

iles Kuriat, Tunisie, Nov 27, 2019 (AFP) - Between plastic chairs on a crowded Tunisian tourist beach, a sign indicates where another species shares the sand: a nest is buried below.   On this paradisaical island off the coast of Monastir -- a resort town south of the capital Tunis -- tourists co-exist with loggerhead turtles thanks to a novel initiative.   Since 2017, the Tunisian government and a local NGO have jointly run a turtle conservation programme under the noses of bathing-suited beach-goers, who are offered an environmental education along with their holiday.

The Kuriat islands are the westernmost permanent loggerhead turtle breeding site on the Mediterranean's south coast, and are in the process of being listed as a protected nature reserve.   But while the islands are an important turtle sanctuary, the white sand beaches and crystal waters of little Kuriat are irresistible to holidaymakers.   During turtle hatching season from July to October, day-trippers arrive daily in their hundreds, transported on pirate-themed boats for barbecues and swimming.   "I thought that this was just an island where I'd go to swim, eat and return," said holidaymaker Souad Khachnaoui.   "I'd never imagined that this site was so important for turtles, birds and other species."

Rather than ban visitors, the authorities work with local volunteers to brief arriving tourists on the local fauna, including the jellyfish-eating turtles, which can live for a century.   "Many people are stunned on arrival, they didn't think that we had these kinds of animals in our country," said Manel Ben Ismail, co-founder of the environmental NGO Notre Grand Bleu, which means "Our great blue (ocean)".   And if they are lucky, tourists can watch as volunteers help defenceless hatchling turtles -- measuring just five centimetres (two inches) across -- on their journey from the nest to the sea.   Loggerheads are classified as vulnerable by the International Union for the Conservation of Nature. They do not become fertile until about 20 years old and breed only every two to three years.    Female loggerheads return to the same beach where they were born to lay their clutch of about 100 eggs. But it is a perilous life cycle and only one in a thousand juveniles lives to reproductive age.

The Kuriat islands -- the largest of which is a military zone and the smaller is not permanently settled -- offer young turtles slightly better survival odds.   Both are far from the light pollution of the mainland, which can disorientate hatchlings.    This year 42 nests were recorded on the islands. Layings have increased since monitoring started in 1997.   If managed correctly, tourism can be a boon for the islands as visitors learn about conservation, the government believes.   "We try to strike a balance between ecological activities and the economic activities of people on this site," said Ahmed Ben Hamida, head of the Kuriat Marine Protected Area for the government agency for coastal protection.
Date: Thu, 27 Jun 2019 14:23:48 +0200

Tunis, June 27, 2019 (AFP) - Two suicide bombers attacked security forces in the Tunisian capital on Thursday, killing a police officer and wounding at least eight people including several civilians, the interior ministry said.   One attack on the main street of Tunis wounded three civilians and two police personnel, the interior ministry initially said.   "Five (are) wounded -- three civilians and two police officers", Interior Ministry spokesman Sofiene Zaag told AFP, before later saying that a police officer had died of his wounds.

Body parts were strewn in the road around a police car on Habib Bourguiba avenue near the old city, according to an AFP correspondent.   "It was a suicide attack, which took place at 10:50 (0950 GMT)," Zaag said.   The second attack targeted a base of the national guard in the capital and wounded four security personnel, the ministry said.   "At 11:00 am (1000 GMT) an individual blew himself up outside the back door" of the base, wounding four security personnel, Zaag said.   Civil protection units and police rapidly deployed to Habib Bourguiba avenue, where the interior ministry is located.    People initially fled in panic, before some crowded around the scene of the attack, expressing anger against the authorities. Shops and offices were closed by police.

Tunisia, the cradle of the Arab Spring uprisings, has been hit by repeated Islamist attacks since the 2011 overthrow of longtime dictator Zine El Abidine Ben Ali.   On October 29, 2018 an unemployed graduate blew herself up near police cars on Habib Bourguiba, killing herself and wounding 26 people, mostly police officers, according to the interior ministry.   The Tunisian authorities said the suicide bomber had sworn allegiance to IS.

The attack was the first to rock the Tunisian capital for over three and a half years.   In March 2015, jihadist gunmen killed 21 tourists and a policeman at the National Bardo Museum in Tunis.   And in June that year, 30 Britons were among 38 foreign holidaymakers killed in a gun and grenade attack on a beach resort near the Tunisian city of Sousse.
Date: Thu, 9 May 2019 17:43:55 +0200
By Caroline Nelly Perrot

Tunis, May 9, 2019 (AFP) - As holidaymakers flock to Tunisia once more following a series of attacks, the country's tourism minister has his sights set on diversifying the industry and taking visitors beyond the beach.   "Practically all the big tour operators here have returned," said Rene Trabelsi, six months into his ministerial post.   He credits "huge efforts" for making the country safe for visitors again, after attacks in 2015 targeting tourists.   Gunmen killed 21 foreign visitors and a Tunisian security guard at the capital's Bardo National Museum, followed by a shooting rampage at a Sousse beach resort which left 38 people dead -- mostly British tourists.

Britain, France and other countries have recently eased their travel warnings, deeming most of Tunisia now safe.   Two million holidaymakers have visited Tunisia so far this year, according to government figures touted by the tourism minister.   That marks a 24 percent jump on the same period last year, and a 7 percent increase compared to the 2010 industry reference point.   But despite tourists returning, revenue has so far failed to reach that of nearly a decade ago.

The indebted industry is heavily reliant upon cheap "all-inclusive" holidays and the government is trying to diversify the tourism sector, which accounts for around 7 percent of GDP.   "During the high season, Tunisia will be packed, but we're interested in the low season, from September to March," said Trabelsi, sitting behind his large desk in the capital Tunis.   The minister wants to attract tourists over the winter months who are also interested in activities away from the beach.   "We're negotiating with the tour operators" to offer charter flights after the summer, said Trabelsi who hopes visitors will sign up for golf, spa treatments and cultural activities.   "This year already, a lot of hotels which closed during winter after the crisis, want to stay open," he said.   An electronic music festival in southern Tunisia is due to take place in September, while a jazz festival is planned in Tabarka near the Algerian border.

- No 'right to fail' -
Whereas half the holidaymakers in 2010 were European, they now make up less than a third of visitors amid an increasing number of tourists from other North African countries and further afield.   The government aims to welcome nine million visitors this year, but Trabelsi said Tunisians still need to tackle "environmental terrorism" to avoid scaring tourists away.   "I'm using that word to shock and alert," said the minister, warning that poor environmental standards can put tourists off "like when there's an attack".

Following Tunisia's 2011 revolution, authorities failed to keep atop of waste management. Municipal councils were elected for the first time a year ago but the clean-up is far from complete.   "We also have a cultural problem," said Trabelsi. "If each person swept outside their front door, that would already be huge."   Trabelsi has for years been co-organiser of an annual Jewish pilgrimage to Djerba, where his father is president of the island's synagogue, and in the 1990s he set up his own travel agency.   But months into his first political post, he said he has no intention of staying in government long-term.   "I want to make a mark, and Tunisians expect a lot from me. I come from the private sector, I have a different religion, so I don't have the right to fail," Trabelsi said.   "But once my mission is accomplished, I'll return to my own affairs."
Date: Sun 16 Feb 2019
Source: Realites Online [in French, trans. ProMED Corr.SB, edited]
<https://www.realites.com.tn/2019/02/tunisie-1318-cas-de-leishmaniose-enregistres-a-gafsa>

As of Sat 15 Feb 209, the Metlaoui Regional Hospital in Gafsa governorate has hosted 1318 patients with leishmaniasis, following the proliferation of mosquitoes [actually leishmania is transmitted by sandflies] near the lakes and wastewater. According to Shems Fm, citing its correspondent in the region, the number of leishmaniasis cases has tripled compared to the year 2017.
============================
[We presume these cases are cutaneous leishmaniasis. Cutaneous leishmaniasis, CL, caused by _Leishmania major_ is a major public health problem in Tunisia. It occurs mainly in central and southwestern Tunisia (semi-arid and arid areas), with thousands of cases. There are foci with a permanent active transmission, so, from time to time, outbreaks occur, related to new agricultural projects or large population movements (introduction to a non-immune population).  In some villages, up to 60 percent of the population is infected.

For a detailed discussion of _Leishmania_ in Tunisia please see Alvar J, Valez ID, Bern C, et al. Leishmaniasis worldwide and global estimates of its incidence.
PLoS One. 2012; 7(5): e35671; <https://doi.org/10.1371/journal.pone.0035671> - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Gafsa, Tunisia:
<http://healthmap.org/promed/p/8782>]
More ...

Liechtenstein

Switzerland and Liechtenstein US Consular Information Sheet
December 01, 2008
COUNTRY DESCRIPTION:
Switzerland is a highly developed democracy.
Liechtenstein is a democratically run constitutional monarchy.
Read the Department of
State Background Notes on Switzerland for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport is required for travel to both Switzerland and Liechtenstein.
A visa is not required for stays up to 90 days in either country.
For more information on entry requirements for both countries, travelers may contact the Embassy of Switzerland at 2900 Cathedral Avenue, NW, Washington, DC 20008, telephone (202) 745-7900, or the nearest Swiss Consulate General in Atlanta, Chicago, Los Angeles, New York, or San Francisco.
Visit the Embassy of Switzerland’s web site at http://www.swissemb.org for the most current visa information.

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

SAFETY AND SECURITY:
Although there have been no recent terrorist attacks in Switzerland, violence by anti-globalization, anti-Semitic, and anti-establishment (anarchist) groups does occur from time to time.
This violence is typically in the form of property damage and clashes between these groups and the police.
The potential for specific threats of violence involving American citizens in Switzerland is remote.
Nevertheless, the Consular Agencies in Zurich and Geneva may close periodically to assess their security situation.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

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

CRIME:
Switzerland has a low rate of violent crime.
However, pick-pocketing and purse snatching do occur in the vicinity of train and bus stations, airports, and some public parks, especially during peak tourist periods (such as summer and Christmas) and when conferences, shows, or exhibits are scheduled in major cities.
Liechtenstein has a low crime rate.
Travelers may wish to exercise caution on trains, especially on overnight trains to neighboring countries.
Thieves, who steal from passengers while they sleep, can enter even locked sleeping compartments.
Thieves have been known to work in pairs to target train passengers; while one member of the pair creates a diversion at a train window or on a platform, the other steals items left briefly unattended.

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.

Switzerland, through its 26 cantons (states), has programs to assist victims of crime and their immediate relatives.
Medical, psychological, social, financial, and legal assistance are available throughout the country.
These programs also protect the rights of the victim during criminal proceedings.
The victim may receive compensation for some damages, if requested during the criminal procedure.
Information is available at the Swiss Department of Justice located on Bundesrain 20, 3003 Bern, telephone: 41-31-322-4750, as well as on the Internet at http://www.bj.admin.ch/bj/en/home.html
The local equivalent to the “911” emergency line in Switzerland is fire 118; police 117; medical 144.
For additional assistance, including possible U.S. compensation, see our information for Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Good medical care is widely available.
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 .

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Switzerland.
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 Switzerland is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Although many roads are mountainous and winding, road safety standards are high.
In some mountain areas, vehicle snow chains are required in winter.
Road travel can be more dangerous during summer, winter holidays, the Easter break, and Whitsunday weekend (late spring) because of increased traffic.
Travel on expressways (indicated by green signs with a white expressway symbol) requires purchase of a sticker or “vignette,” which must be affixed to the car’s windshield.
Vignettes can be purchased at most border crossings points, gas stations and at Swiss post offices.
Drivers using the highway system without a vignette are subject to hefty fines levied on the spot.
Public transportation in Switzerland and Liechtenstein is excellent.

Please refer to our Road Safety page for more information.
Visit the website of Switzerland’s national tourist office at http://www.myswitzerland.com/en.cfm/home.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Switzerland’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Switzerland’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa .

SPECIAL CIRCUMSTANCES:
Travelers who plan to participate in mountain activities (summer and winter) are strongly encouraged to buy mountain search and rescue insurance. Costs of search and rescue operations are the responsibility of the victim. Search and rescue insurance is available inexpensively in Switzerland and may be purchased at many Swiss post offices.
Information can be obtained from the Swiss National Tourist Office, at http://www.myswitzerland.com, at most tourist information offices or with the Swiss Air Rescue Organization at http://www.rega.ch/en/start_en.aspx .
Such insurance has proved useful as uninsured rescues can easily cost $25,000.

Switzerland’s customs authorities encourage the use of an ATA (Admission Temporaire/Admission) Carnet for the temporary admission of professional equipment, commercial samples, and/or goods for exhibitions and fair purposes.
ATA Carnet Headquarters located at the U.S. Council for International Business, 1212 Avenue of the Americas, New York, N.Y. 10036, and issues and guarantees the ATA Carnet in the United States.
For additional information call (212) 354-4480, send an email to atacarnet@uscib.org, or visit http://www.uscib.org for details.
Please see our information on Customs Information.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Switzerland’s laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Switzerland 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 Switzerland are encouraged to register with the U.S. Embassy in Bern, with the Consular Agencies in Geneva or Zurich, or through the State Department’s travel registration web site, and to obtain updated information on travel and security within Switzerland and Liechtenstein.
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, Consulate, or Consular Agent to contact them in case of emergency.
The U.S. Embassy is located at Sulgeneckstrasse 19, 3007 Bern; Tel. (41)(31) 357-7011 (2 p.m. – 5 p.m.); fax (41)(31) 357-7280.
The Embassy’s email address is bernacs@state.gov.
The U.S. Embassy website at http://bern.usembassy.gov answers many questions of interest to Americans visiting and residing in Switzerland.

The U.S. Consular Agency in Zurich is located at the American Center of Zurich, Dufourstrasse 101, 8008 Zurich; Tel: (41)(43) 499-2960 (10 a.m. – 1 p.m.), fax (41)(43) 499-2961.
The U.S. Consular Agency in Geneva is located at rue Versonnex 7, CH-1207 Geneva, Tel: 022-840-51 60 (10 a.m. – 1 p.m.); fax 022-840-51 62.
There is no U.S. Embassy or Consulate in Liechtenstein.
For assistance and information on travel and security in Liechtenstein, U.S. citizens may contact or register at the U.S. Embassy in Bern at the address above.
*
*
*
This replaces the Consular Information Sheet dated March 3, 2008 with changes to the sections on Crime and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Wed, 15 Jan 2014 18:09:10 +0100 (MET)

GENEVA, Jan 15, 2014 (AFP) - Liechtenstein will close its only maternity ward, where some 200 babies are born each year, after all the gynaecologists working there quit at the same time, the government said Wednesday.    "The government regrets the closure of the maternity ward," Health Minister Mauro Pedrazzini said in a statement.

The doctors had decided to leave amid uncertainty over the future of the establishment, the authorities in the tiny landlocked country between Switzerland and Austria explained, saying the ward would close for good during the spring.   The citizens of Liechtenstein in 2011 rejected by popular vote to dish out the cash needed to build a new hospital building and replace the ageing infrastructure.

Since then, the authorities in the country of fewer than 37,000 people, have been struggling to push through a modernisation plan for the maternity ward to bring it up to the standards demanded by the doctors working there.   Each year, some 200 babies are born at the ward, while another some 200 babies are born to Liechtenstein citizens who decide to travel abroad to give birth, mainly to neighbouring Switzerland and Austria.   Once the Liechtenstein ward closes, all young Liechtensteiners will be born abroad.
Date: Tue, 17 Nov 1998 12:14:59 -0500 From: ProMED-mail
14 Mar 2000 VADUZ, Liechtenstein (AP) - Liechtenstein's government Tuesday approved a package of measures to tighten rules against money laundering, insisting that this tiny country has no wish to attract dirty money. The bill, which has been sent to parliament for immediate action, would increase the obligations of financial institutions to report suspicious deposits and expand bribery sanctions to cover payoffs to foreign officials. Banks would have to make more thorough checks on the origin of funds. The government has appointed a special prosecutor to investigate allegations - reported last year in the German news magazine Der Spiegel - that the Alpine principality has become an international money laundering center. See http://www.infobeat.com/stories/cgi/story.cgi?id=2564961602-dc8
More ...

World Travel News Headlines

Date: Thu, 23 Jan 2020 17:57:34 +0100 (MET)
By Eva XIAO

Beijing, Jan 23, 2020 (AFP) - The first fatality of China's new virus would come to represent a common set of traits for those who died to the disease: he was over the age of 60 and in poor health.   Since China reported the emergence of a new coronavirus at the end of December, the SARS-like virus has infected more than 500 and killed 17.   So far, the majority of the victims were elderly individuals with pre-existing health conditions, such as diabetes and liver cirrhosis.   All hailed from central Hubei province, where a local seafood market in the capital city of Wuhan is believed to be the epicentre of the epidemic.   But while older individuals have died from the Wuhan virus, some younger patients -- including a 10-year-old boy -- have since been released from the hospital.   Here's what we know so far about the deaths:

Most victims were over 60
According to details released by China's National Health Commission (NHC) on Thursday, the 17 victims of the virus were between 48 and 89 years old.   Only two were under the age of 60, while the average age of the victims was 73.   Most of them died this week, according to the NHC.   Among those who have been discharged from the hospital were younger patients, including a 35-year-old man from Shenzhen, a bustling tech hub in southern Guangdong province.   He was released from the hospital on Thursday, according to the local health commission, as well as the 10-year-old boy who had visited relatives in Wuhan before falling ill.

Many had pre-existing health conditions
Many of those who died from the virus also had pre-existing health issues before contracting the Wuhan disease, such as diabetes and hypertension.   One man, an 86-year-old who was hospitalised on January 9, had surgery for colon cancer four years prior, on top of suffering from high blood pressure and diabetes.   Another, an 80-year-old woman surnamed Hu, had Parkinson's Disease and more than 20 years of high blood pressure and diabetes in her medical history.

Some were hospitalised for weeks before dying
Several of the 17 victims were hospitalised for weeks before dying -- raising questions on the preparedness of hospitals that may have to treat patients for long periods of time.   The youngest victim of the Wuhan virus, a woman surnamed Yin, was hospitalised for more than a month before succumbing to the virus.   On December 10, the 48-year-old woman reported a fever, coughing, body soreness, and fatigue, and underwent anti-infection treatment for two weeks, according to the NHC.   Later in the end of the month, Yin suffered shortness of breath and chest tightness, and she passed away on January 20.

Not all of them had a fever
Currently, Wuhan authorities are screening passengers for fever at the airport, railway stations, and bus terminals.   At four airports in Thailand, authorities introduced mandatory thermal scans of passengers arriving from high-risk areas of China.   But not all those who died after being infected reported a fever before being hospitalised, according to the NHC.   A 66-year-old man surnamed Luo reported a "mainly dry cough" but no fever on December 22 before suffering from shortness of breath more than a week later.

By mid-January, Luo required a ventilator to help him breathe.   "A major concern is the range of severity of symptoms this virus is causing," said Dr Jeremy Farrar, Director of the Wellcome Trust.   "It is clear some people are being affected and are infectious while experiencing only very mild symptoms or possibly without experiencing symptoms at all," he said in an emailed statement.   "This may be masking the true numbers infected and the extent of person to person transmission," he added.
Date: Thu, 23 Jan 2020 16:05:30 +0100 (MET)

Singapore, Jan 23, 2020 (AFP) - Singapore Thursday confirmed its first case of the new SARS-like virus which has killed 17 people in China and spread to multiple countries including the United States.   The Ministry of Health (MOH) said the patient was a 66-year-old man from Wuhan who arrived in Singapore with his family on Monday.    He was immediately isolated after arriving at a hospital with a fever and cough, and test results later confirmed he was infected with the coronavirus.   One of his travelling companions, a 37-year-old man from Wuhan, has also been admitted to hospital as a suspect case.

Prior to admission, they had stayed at a hotel on the resort island of Sentosa, the ministry said.   It added that Singapore was expecting more cases and alarms "given the high volume of international travel".   Singapore's Changi Airport started screening flights from Wuhan at the beginning of the month, and on Wednesday extended the checks to all flights from China.   The travel hub receives over 430 flights from China every week.   The virus has caused alarm in China and abroad because of its genetic similarities to Severe Acute Respiratory Syndrome (SARS), which killed nearly 650 people across mainland China and Hong Kong in 2002-2003.

Singapore was among the hardest hit by SARS with 33 deaths.   Prime Minister Lee Hsien Loong, who is in Davos for the World Economic Forum, said there was "no need to panic".   Speaking to reporters travelling with him, Lee said Singapore has beefed up its hospital facilities and laid out response measures since the SARS epidemic.   "I think we are much better prepared now," he said in remarks carried by the Straits Times newspaper.
Date: Thu, 23 Jan 2020 14:43:33 +0100 (MET)

Barcelona, Jan 23, 2020 (AFP) - The death toll from a violent storm which has wrought havoc on huge swathes of Spain's eastern and southern coastline rose to nine on Thursday as rescuers pressed the hunt for at least five missing people.    The latest death was that of a man whose body was found in a flooded river near Jorba, some 70 kilometres (45 miles) northwest of Barcelona, the emergency services said.    Rescuers in Catalonia had been searching for a missing person in the same area but said it was too early to confirm if it was him.

Catalan rescuers had late on Wednesday found another body of a man who died after falling into the water in Palamos, a port town about 100 kilometres up the coast from Barcelona.    They are also searching for a man who went missing from a merchant ship in the same area, as well as a person in Cadaques near the French border.   Earlier on Thursday, regional officials confirmed the death of a 75-year-old woman whose house collapsed because of heavy rain in Alcoi, a town in the eastern Alicante region.

Storm Gloria hit the region on Sunday, bringing strong winds, torrential rains and heavy snow, battering Spain's southern and eastern flanks before moving north.   Gale-force winds and huge waves smashed into seafront towns, with dramatic images showing massive flooding that has damaged shops, houses and restaurants.   National weather agency Aemet had on Wednesday said the storm was starting to abate although it kept Catalonia and the Balearic Islands on alert.   As the storm eased, Prime Minister Pedro Sanchez was on Thursday visiting some of the worst-hit areas, overflying parts of Catalonia before heading to the Balearic Islands which on Tuesday were hit by record waves, the port authority said.

Rescuers on the islands are still searching for three people, including a 25-year-old Briton who went missing on a beach in northern Ibiza, and a 27-year-old Spaniard who disappeared in Mallorca while practising canyoning -- a mix of rappelling, climbing and watersliding through deep gorges.   Rescuers had found three other bodies on Wednesday, including that of a 67-year-old man who went missing in his car near the southeastern resort town of Benidom.    They also found two bodies in the southern Andalusia region, one of a 77-year-old man who died when a greenhouse collapsed on him in a hailstorm in Nijar as well as that of a homeless man who died of hypothermia.
Date: Wed 22 Jan 2020 1:04 PM EAT
Source: Uganda Red Cross Twitter [edited]

One confirmed case of Crimean-Congo haemorrhagic fever, 4 others suspected, in Kagadi [western Uganda]

A district Task Force has been formed to manage and coordinate the cases across the district @MinofHealthUG @robert_kwesiga @inakasiita1
========================
[Crimean-Congo haemorrhagic fever (CCHF) can cause serious disease in humans, with a case fatality rate of 10-40%. It can be responsible for severe outbreaks in humans, but it is not pathogenic for ruminants, their amplifying hosts. WHO states that the onset of symptoms in humans is sudden, with fever, myalgia, (muscle ache), dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light). There may be nausea, vomiting, diarrhoea, abdominal pain, and sore throat early on, followed by sharp mood swings and confusion. After 2-4 days, the agitation may be replaced by sleepiness, depression, and lassitude, and the abdominal pain may localize to the upper right quadrant, with detectable hepatomegaly (liver enlargement). Other clinical signs include tachycardia (fast heart rate), lymphadenopathy (enlarged lymph nodes), and a petechial rash (a rash caused by bleeding into the skin) on internal mucosal surfaces, such as in the mouth and throat, and on the skin.

Public education, especially among individuals in contact with livestock or their products, is needed to prevent cases of CCHF infection. A One Health approach is needed for effective surveillance, with effective communication between animal health and human health professionals.

The information in the tweet above indicates that there is one confirmed and at least 4 suspected cases of CCHF in Kagadi district, in the western region of Uganda.  Any updates on the epidemiology of these cases, occupational exposure, and public health response measures to control the transmission will be highly appreciated. - ProMED Mod.UBA]

[Maps of Uganda:
Date: Mon 20 Jan 2020
Source: Global News [edited]

A doctor working with Indigenous Services Canada (ISC) in Saskatchewan is urging caution to residents in and around Onion Lake First Nation following 2 people contracting a rare, deadly bacterial infection. Medical health officer Dr. Ibrahim Khan wrote a letter to the chief of the Onion Lake First Nation that said both patients were admitted to medical facilities shortly after New Years Day with diphtheria. He said one patient is under 18, while the other is an adult and was suffering from skin abrasions [? cutaneous diphtheria], which Khan said is rare for that disease.

In the letter, he said the disease is very uncommon in the province and can lead to "severe complications like breathing problems, heart failure, and paralysis, and without appropriate treatment can result in death." He applauded the medical team in Onion Lake, saying they contained the infection and made sure everyone in the community was aware of the risk and vaccinated.

"Everybody gets that vaccination, and they have that protection. That's why we don't see it. We don't see that many measles cases. We don't see that many prostatitis [pertussis?] cases, and we do not see any tetanus cases, because there is a good immunization for it. A good vaccination for it (and) people are aware of it," he told Global News. He said other local agencies, like pharmacies, made sure those on the front lines were supplied if they came across someone who wasn't vaccinated.

The letter to Chief Henry Louis said vaccination is the best method for preventing diphtheria and that the disease could virtually be eradicated if everyone who could be vaccinated received the shot. He said the target is for 97% of the population to receive the vaccination to prevent further spread in the community and noted the rates in Onion Lake are below that benchmark.  [Byline: Kyle Benning]
=====================
[Although the news report above says that one of the 2 patients with diphtheria was an adult "suffering from skin abrasions, which is rare for that disease," perhaps implying that this patient had cutaneous diphtheria, we are not told specifically the patients' clinical manifestations, i.e., whether they had respiratory diphtheria, cutaneous diphtheria, or both; if the strains of _Corynebacterium diphtheriae_ were toxin-producers; or if the patients were vaccinated against diphtheria.

Diphtheria became nationally notifiable in Canada in 1924, and that year 9057 cases were reported, the highest annual number of cases ever recorded in Canada  (<https://www.canada.ca/en/public-health/services/immunization/vaccine-preventable-diseases/diphtheria/health-professionals.html>).

The diphtheria vaccine was 1st introduced in 1926, and routine immunization in infancy and childhood has been widely practiced since 1930 in Canada. By the mid-1950s, routine immunization had resulted in a remarkable decline in the morbidity and mortality of the disease. Another steep decline in cases occurred in 1980, which has been attributed, in part, to a change in case definition to exclude carriers from reported cases in all provinces and territories. Since 1993, a total of 19 cases have been reported with a range of 0-4 cases annually  (<https://www.canada.ca/en/public-health/services/immunization/vaccine-preventable-diseases/diphtheria/health-professionals.html>).

In the USA, the case definition for reporting to the National Notifiable Diseases Surveillance System includes only respiratory diphtheria
(<https://wwwn.cdc.gov/nndss/conditions/diphtheria/case-definition/2010/>).

Similarly, the WHO case definition for reporting diphtheria only includes clinical respiratory diphtheria. Although no longer reportable, cutaneous diphtheria still occurs in the USA and has been most often associated with homelessness, poor sanitation, poverty, and crowded living conditions  (<https://www.cdc.gov/vaccines/pubs/pinkbook/dip.html>).

However, the Canadian case definition includes both respiratory diphtheria and infection at another site (e.g., wound, cutaneous)
(<https://www.canada.ca/en/public-health/services/immunization/vaccine-preventable-diseases/diphtheria/health-professionals/national-case-definition.html>).

Cutaneous diphtheria is contagious and can be a source of both respiratory and cutaneous infections in contacts. Acquisition of _Corynebacterium diphtheriae_, the cause of diphtheria, can occur even in vaccinated contacts, as vaccine-induced immunity is anti-toxin. - ProMED Mod.ML]

[HealthMap/ProMED-mail map:
Saskatchewan province, Canada: <http://healthmap.org/promed/p/262>]
Date: Wed, 22 Jan 2020 17:37:27 +0100 (MET)
By Helen ROXBURGH

Beijing, Jan 22, 2020 (AFP) - A new SARS-like virus has killed 17 people in China, infected hundreds and reached as far as the United States, with fears mounting about its spread as hundreds of millions travel for Lunar New Year celebrations, which start Friday.   Many countries have stepped up screening of passengers from Wuhan, the Chinese city identified as the epicentre, and the World Health Organization has called an emergency meeting.   Here's what we know so far about the virus:

- It's entirely new -
The pathogen appears to be a never-before-seen strain of coronavirus -- a large family of viruses that can cause diseases ranging from the common cold to Severe Acute Respiratory Syndrome (SARS), which killed 349 people in mainland China and another 299 in Hong Kong between 2002 and 2003.   Arnaud Fontanet, head of the department of epidemiology at the Institut Pasteur in Paris, told AFP the current virus strain was 80 percent genetically identical to SARS.   China has already shared the genome sequencing of this novel coronavirus with the international scientific community.   It has been named "2019-nCoV".

- It's being passed between humans -
The WHO said Monday it believed an animal source was the "primary source" of the outbreak, and Wuhan authorities identified a seafood market as the centre of the epidemic.   But China has since confirmed that there was evidence the virus is now passing from person to person, without any contact with the now-closed market.

The virus has infected more than 400 people across the country, with most cases in Wuhan, according to officials. Li Bin of China's National Health Commission on Wednesday said 1,394 people were still under medical observation.   Doctor Nathalie MacDermott of King's College London said it seems likely that the virus is spread through droplets in the air from sneezing or coughing.   Doctors at the University of Hong Kong published an initial paper on Tuesday modelling the spread of the virus which estimated that there have been some 1,343 cases in Wuhan -- similar to a projection of 1,700 last week by scientists at Imperial College, London.   Both are much higher than official figures.

- It is milder than SARS -
Compared with SARS, the symptoms appear to be less aggressive, and experts say the death toll is still relatively low.   "It's difficult to compare this disease with SARS," said Zhong Nanshan, a renowned scientist at China's National Health Commission at a press conference this week. "It's mild. The condition of the lung is not like SARS."   However, the milder nature of the virus can also cause alarm.

The outbreak comes as China prepares for the Lunar New Year Holiday, with hundreds of millions travelling across the country to see family.   Professor Antoine Flahault, director of the Institute of Global Health at the University of Geneva, told AFP that the fact that the virus seems milder in the majority of people is "paradoxically more worrying" as it allows people to travel further before their symptoms are detected.   "Wuhan is a major hub and with travel being a huge part of the fast approaching Chinese New Year, the concern level must remain high," said Jeremy Farrar, Director of the Wellcome Trust.

- International public health emergency? -
The WHO will hold a meeting on Wednesday to determine whether the outbreak constitutes a "public health emergency of international concern" and if so, what should be done to manage it.   Cases have so far been confirmed in Thailand, Japan, Taiwan, South Korea, Macau and the United States.

The WHO has only used the rare label a handful of times, including during the H1N1 -- or swine flu -- pandemic of 2009 and the Ebola epidemic that devastated parts of West Africa from 2014 to 2016.   The Chinese government announced Tuesday it was classifying the outbreak in the same category as the SARS outbreak, meaning compulsory isolation for those diagnosed with the disease and the potential to implement quarantine measures on travel.   But if the WHO decides to take this step, it would put the Wuhan virus in the same category as a handful of very serious epidemics.

- Global precautions -
As the number of confirmed deaths and infections has risen, so has concern worldwide about the disease spreading to other countries.   In Thailand, authorities have introduced mandatory thermal scans of passengers arriving at airports in Bangkok, Chiang Mai, Phuket and Krabi from high-risk areas in China.

In Hong Kong, where hundreds died during the SARS outbreak of 2002-2003, authorities have said they are on high alert, carrying out scans at the city's airport -- one of the world's busiest -- and at other international land and sea crossing points.

The United States also ordered the screening of passengers arriving on direct or connecting flights from Wuhan, including at airports in New York, San Francisco and Los Angeles.   Taiwan has issued travel advisories, and went to its second-highest alert level for those travelling to or from Wuhan. Vietnam has also ordered more border checks on its border with China.
Date: Wed, 22 Jan 2020 16:53:32 +0100 (MET)
By Beiyi SEOW

Beijing, Jan 22, 2020 (AFP) - The death toll from a new SARS-like virus that has infected hundreds in China rose to 17 on Wednesday, as authorities urged people to steer clear of the city at the centre of the outbreak.   The coronavirus has caused alarm because of its similarity to SARS (Severe Acute Respiratory Syndrome), which killed nearly 650 people across mainland China and Hong Kong in 2002-2003.   With hundreds of millions of people travelling across China this week for the Lunar New Year holiday, the National Health Commission announced measures to contain the disease -- including sterilisation and ventilation at airports and bus stations, as well as inside planes and trains.

In Wuhan, the epicentre of the epidemic, large public events were cancelled and international football matches were moved to a new location. Visitors were urged to stay away, while residents were advised to not to leave the central city, which is home to 11 million people.   "If it's not necessary we suggest that people don't come to Wuhan," Wuhan Mayor Zhou Xianwang told state broadcaster CCTV.    The illness is mainly transmitted via the respiratory tract and there "is the possibility of viral mutation and further spread of the disease", health commission vice minister Li Bin told a news conference in Beijing.   More than 500 cases have now been reported, with the majority in Wuhan, capital of Hubei province.

The virus has now infected at least 444 people in Hubei province alone, said provincial officials at a press conference, adding that the death toll had risen from nine to 17.   Major cities, including Beijing, Shanghai, and Chongqing have also reported cases, as well as provinces in northeastern, central, and southern China.   The World Health Organization started an emergency meeting Wednesday to decide whether or not to declare a rare global public health emergency over the disease, which has now been detected in the United States, Taiwan, Thailand, Japan, South Korea and Macau.

The Chinese government has classified the outbreak in the same category as the SARS epidemic, meaning compulsory isolation for those diagnosed with the illness and the potential to implement quarantine measures.   But they still have not been able to confirm the exact source of the virus.   "We will step up research efforts to identify the source and transmission of the disease," Li said, adding that "the cases are mostly linked to Wuhan".   Countries have intensified efforts to stop the spread of the pathogen -- known by its technical name 2019 Novel Coronavirus (2019-nCoV).   Passengers are facing screening measures at five US airports and a host of transport hubs across Asia. Britain and Italy on Wednesday also announced enhanced monitoring of passengers from Wuhan.

- Virus source -
A prominent expert from China's National Health Commission confirmed this week that the virus can be passed between people.   However, animals are suspected to be the primary source of the outbreak.   A Wuhan market is believed to be the epicentre of the outbreak.

A price list circulating online in China for a business there lists a menagerie of animals or animal-based products including live foxes, crocodiles, wolf puppies and rats. It also offered civets, the animal linked to SARS.   "We already know that the disease originated from a market which conducted illegal transaction of wild animals," said Gao Fu, director of the Chinese centre for disease control and prevention.   He said it was clear "this virus is adapting and mutating".   Hong Kong and British scientists have estimated that between 1,300 and 1,700 people in Wuhan may have been infected.

- Containment -
Health authorities are urging people to wash their hands regularly, avoid crowded places, get plenty of fresh air and wear a mask if they have a cough.   Anyone with a cough or fever was urged to go to hospital.   In Wuhan, city authorities made it mandatory to wear a mask in public places on Wednesday, according to state-run People's Daily.

In response to skyrocketing demand for masks -- which were starting to sell out at pharmacies and on some popular websites -- China's industry and information technology ministry said it would "spare no effort in increasing supply", state media reported.   "These days, I wear masks even in places that are not too crowded, although I wouldn't have done so in the past," said Wang Suping, 50, who works at a Beijing arts school.   At the capital's main international airport, the majority of people were wearing masks.

Hong Kong flag carrier Cathay Pacific said it had agreed to allow staff to wear surgical masks on mainland China flights, and that passengers from Wuhan would be offered masks and antiseptic wipes.   In Wuhan, police were conducting vehicle spot checks for live poultry or wild animals leaving and entering the city, state media said.   Officials also screened people on roads, the airport and the train station for fever.   The local government has cancelled major public activities and banned tour groups from heading out of the city.   Women's Olympics football qualifiers scheduled for February 3-9 in Wuhan have been moved to the eastern city of Nanjing.
Date: Wed, 22 Jan 2020 15:49:25 +0100 (MET)

Montreal, Jan 22, 2020 (AFP) - A Canadian guide died and five French tourists were missing after at least one snowmobile plunged through ice in northern Quebec, police said Tuesday.   The group were riding close to where a river exits the Saint-Jean lake, and were outside the approved area for snowmobiles, police spokesman Hugues Beaulieu told AFP.   Nine people, including the guide, were on the trip on Tuesday evening when the ice broke underneath them.   Police said they were alerted by two of the tourists who had rescued a third tourist from the freezing water.

The 42-year-old guide was pulled out by emergency response teams and taken to hospital, but he died overnight, Beaulieu said, adding "five French tourists are still missing."   The police and army were searching the area on Wednesday, assisted by divers.   "This sector was not part of a marked trail, they were off-piste," said the spokesman.
Date: Wed, 22 Jan 2020 04:55:57 +0100 (MET)

Hong Kong, Jan 22, 2020 (AFP) - Macau on Wednesday reported its first confirmed case of the new SARS-like coronavirus as authorities announced all staff in the city's bustling casinos had been ordered to wear face masks.   The former Portuguese colony is a huge draw for mainland tourists as the only place in China that allows gambling.

With the Lunar New Year approaching this weekend, a huge influx of mainland tourists is expected in the city.   Asian countries have ramped up measures to block the spread of the new virus, which emerged in the Chinese city of Wuhan and has so far killed at least nine people.

On Wednesday, Macau announced its first confirmed case -- a 52-year-old businesswoman from Wuhan who arrived in the city by high-speed rail on Sunday, via the neighbouring city of Zhuhai.    "A series of tests found that she was positive for the coronavirus and had symptoms of pneumonia," Lei Chin-lon, the head of Macau's health bureau, told reporters.    The woman had been staying at the New Orient Landmark Hotel with two friends who were being monitored since her admission to hospital on Tuesday.

Ao Ieong Iu, Macau's Secretary for Social Affairs and Culture, said staff in all casinos would be required to wear masks while anyone arriving at entry ports along the city's border with the mainland would need to fill out health declaration forms.    "We have not banned tourism groups from Wuhan but we are not encouraging them," Ao Ieong said.    "We will stay in close contact with tourism agencies and require them to notify us of all groups going to and coming from Wuhan," she added.
Date: Tue, 21 Jan 2020 22:23:22 +0100 (MET)
By Issam Ahmed with Helen Roxburgh

Washington/Beijing, Jan 21, 2020 (AFP) - The United States on Tuesday announced its first case of a new virus that has claimed six lives in China and sickened hundreds, joining countries around the world in ramping up measures to block its spread.   The man, a US resident in his 30s who lives near Seattle, is in good condition, according to federal and state officials, and approached authorities himself after reading about the SARS-like virus in news reports.   He is "currently hospitalized out of an abundance of precaution, and for short term monitoring, not because there was severe illness," said Chris Spitters, a Washington state health official.  "This is an evolving situation and again, we do expect additional patients in the United States and globally," added Nancy Messonier, a senior official at the Centers for Disease Control and Prevention (CDC), but stressed that the overall risk to Americans remained low.

The man entered the country on January 15 after traveling to Wuhan, two days before the US began deploying health officials at major airports to screen passengers arriving from that central Chinese city which is at the heart of the outbreak. The efforts are to be extended now to a total of five US airports.   It came as countries ramped up measures to block the spread of the virus -- known by its technical name 2019 Novel Coronavirus or 2019-nCoV -- as the number of cases surpassed 300, raising concerns in the middle of a major Chinese holiday travel rush.

Fears of a bigger outbreak rose after a prominent expert from China's National Health Commission confirmed late Monday that the virus can be passed between people.   That conclusion is shared by the CDC, which said "person-to-person spread is occurring, although it's unclear how easily the virus spreads between people," even as the World Health Organization (WHO) adopted a more cautious approach, saying it is still investigating.   The UN agency will hold an emergency meeting Wednesday to determine whether to declare a rare global public health emergency over the disease, which has also been detected in Thailand, Japan and South Korea and Taiwan.

- Holiday rush -
Authorities previously said there was no obvious evidence of person-to-person transmission and animals were suspected to be the source, as a seafood market where live animals were sold in Wuhan was identified as the center of the outbreak.   Hundreds of millions of people are criss-crossing China this week in packed buses, trains and planes to celebrate the Lunar New Year with relatives.

More than 80 new cases have been confirmed, bringing the total number of people hit by the virus in China to 315, with the vast majority in Hubei, the province where Wuhan lies, according to officials.   But cases have also been confirmed around the country, including Beijing and Shanghai.   The first case on the self-ruled island of Taiwan was also confirmed Tuesday, with a woman taken to hospital on arrival at the airport from Wuhan.   Wuhan mayor Zhou Xianwang told state broadcaster CCTV Tuesday that the death toll had risen from four to six.   The coronavirus has caused alarm because of its genetic similarities to Severe Acute Respiratory Syndrome (SARS), which killed nearly 650 people across mainland China and Hong Kong in 2002-2003.

- Fever checks -
At four airports in Thailand, authorities introduced mandatory thermal scans of passengers arriving from high-risk areas of China.   In Hong Kong, authorities said they were on "extreme high alert," with passengers from Wuhan required to fill out health declarations and face possible jail time if they do not declare symptoms.   Enhanced screening measures have also been set up at airports in Australia, Bangladesh, Nepal, Singapore and Russia, Malaysia and Vietnam.   A man showing symptoms of the disease who had travelled to Wuhan has been put in isolation in Australia as health officials await test results, authorities said Tuesday.   In China, the government announced it was classifying the outbreak in the same category as SARS, meaning compulsory isolation for those diagnosed ith the disease and the potential to implement quarantine measures on travel.

In Wuhan, authorities banned tour groups and police were conducting spot checks for animals in vehicles leaving and entering the city, state media said.   It added that city health authorities had scheduled 800 beds to be made available in three hospitals and 1,200 more would soon be ready, and passengers were being screened for fever at the airport, railway stations and bus terminals.   Doctors at the University of Hong Kong released a study on Tuesday estimating that there have been 1,343 cases of the new virus in Wuhan.   The WHO has only called a global public health emergency a handful of times, including during the H1N1 -- or swine flu -- pandemic of 2009 and the Ebola epidemic that devastated parts of West Africa from 2014 to 2016.