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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 ...

Turkey

Geographical Information:
*****************************************
Turkey is officially known as the Republic of Turkey and is bordered on the northwest by Bulgaria and Greece, on the north by the Black Sea and on the south by Syria, Iraq and t
e Mediterranean Sea. The capital is Ankara with a population of about 2.5 million though Istanbul is a much larger city (6.6 million). The population of the country is estimated at 62 million with the majority in the cities and along the costal regions.
Climate:
*****************************************
The Mediterranean and Aegean shores of Turkey have long and hot summers with a milder winter. In Istanbul the average July temperature reaches 230C while in January it can drop to 00C. Throughout the country the annual rainfall is about 29". This is mainly during the months of December and January.

Health Care Facilities:
*****************************************
The level of adequate health facilities vary considerably within the country. Most of the better hotels will have access to English speaking doctors but care may be required if hospital admission is required.
Disease Profile:
*****************************************
Cholera and other water borne diseases are frequently reported from Istanbul. In the southeastern city of Diyarbakir there are regular reports of dysentery, typhoid, meningitis and other contagious diseases.

General Food & Water Hygiene:
*****************************************
There can be little doubt that travellers to Turkey who disregard basic hygiene precautions will run a risk of developing significant illness and a ruined holiday. With simple general care most tourists will remain healthy.

Food Rules:
*****************************************
Always eat in clean restaurants and hotels. Eat freshly cooked hot food. Stay away from cold salads, especially lettuce. Don’t eat any of the bivalve shellfish dishes such as oysters and mussels. Never eat food prepared by street vendors. Always peel your own fruit if at all possible.
Water Rules:
*****************************************
Never use the hotel tap water for drinking or brushing your teeth unless you can easily smell chlorine. Don’t allow ice in your drinks and be wary of the hotel water jug which may be in your room each day. Any of the canned drinks or bottles are usually quite safe. Just check the seal first!
Rabies in Turkey:
*****************************************
This disease is only a particularly risk for travellers who plan to have extended trekking holidays throughout Turkey. Most tourists travelling for a ‘sun’ holiday would be very unfortunate to be exposed but nevertheless care should be taken at all times to ensure that there is no contact with warm blooded animals. This is mainly true for dogs and cats but any infected
warm blooded animal can transmit the disease through its saliva. Any bite, lick or scratch should be treated seriously.
*
Wash out the area
*
Apply an antiseptic
*
Attend for urgent medical attention
Sun Stroke:
*****************************************
The immense strength of the sun in the Middle East can often be underestimated by the Irish traveller. This is especially true for small children and the elderly. Try and stay out of the direct sunlight between 11am to 4pm. Use a wide brimmed hat if possible to protect yourself. Drink plenty of fluid (about 2 or 3 times as much as in Ireland) and remember to increase your salt intake unless this is contraindicated because of high blood pressure or heart disease etc. Any signs of dehydration should be recognised and treated early (dry lips, headache etc.).
Anthrax:
*****************************************
This bacterial disease is sometimes contracted by travellers who purchase untreated leather goods while abroad.
Drug Trafficking:
*****************************************
Remember that Turkey is regarded as a gateway to Europe. Never agree to carry belongings for others unless you are certain of the contents.
Malaria in Turkey:
*****************************************
The risk of malaria in Turkey is very limited and transmission usually only occurs between the months of March to November in the Çukurova / Amikova areas and from mid-March to mid-October in southeast Anatolia. These are mainly away from the standard tourist routes and so prophylaxis will usually not be required. Nevertheless there may be an abundant supply of mosquitoes and other insects around. Travellers should carry insect repellents and wear longer sleeved clothing when at risk.
Vaccinations for Turkey:
*****************************************
There are no compulsory vaccines for entry to Turkey from Ireland. However, travellers are advised to ensure that they are adequately covered against Poliomyelitis, Typhoid, Tetanus and Hepatitis A. Those spending longer in the country or undertaking a trekking holiday may also need to consider vaccination cover against Rabies and Hepatitis B .
Further Information:
*****************************************
Travellers can obtain further health information for overseas travel by contacting either of our offices. Useful web sites for information on Turkey include;

www.WHO.int
www.CDC.gov
www.FCO.gov.uk

Travel News Headlines WORLD NEWS

Date: Wed 6 Nov 2019
Source: FreshPlaza [edited]

Turkish Health Minister Fahrettin Koca urged citizens not to panic amid an increasing number of food poisoning cases due to spinach consumption.

The number of patients poisoned from spinach mixed with toxic herbs has risen to 196, Minister Fahrettin Koca said on [Tue 5 Nov 2019], adding there was no need for panic as none of the cases was life threatening.

Koca said all patients were located in Turkey's north-western provinces, namely Istanbul, Edirne, Tekirdag, and Kocaeli. The minister said only 21 patients remained hospitalized and that all instances were considered food poisoning cases.

"What we actually see is the patients come in with (complaints of) food poisoning but what they all have in common is they have all consumed spinach. The patients were admitted with symptoms of dry mouth, flushed skin, nausea, vomiting, and blurred vision -- common side effects of atropine overdose. The problem seems to be weeds growing around the same area mixing with the produce," Koca said. The minister urged citizens to carefully inspect any produce they buy and thoroughly wash them.

Murak Kapikiran, an official from the Istanbul Chamber of Agriculture Engineers, said a wild plant very similar in appearance to spinach might be the likely culprit. While officials from the Ministry of Agriculture and Forestry on [Mon 4 Nov 2019] said weeds from the Solanaceae plant family were suspected to be the cause for the poisoning, Kapikiran said it was a wild plant called _Atropa belladonna_, also known as deadly nightshade, [which, with other members of the Solanaceae or nightshades family contains] the naturally occurring chemical atropine.

Kapikiran said both spinach and deadly nightshade grew around the same times and were visually similar, which could have easily fooled farmers, causing them to be mixed up.

"The other option is adulteration. Since they look very similar, nightshade might have been intentionally mixed to increase the harvest. And the amount needed to be consumed to show poisoning symptoms is somewhat substantial. We hope this is not the case," he said. Kapikiran urged more inspections for produce, adding that a potential mix-up could happen in the future again with other leafy greens.

A food technology expert urged citizens to wash their spinach with baking soda instead of vinegar, which is a common habit in Turkish kitchens. "Vinegar can make some pesticides and herbicides more potent. Therefore, it is important to use baking soda instead of vinegar. The consumer should first let spinach sit in water with baking soda and then rinse it," Sibel Bolek said.
Date: Tue 5 Nov 2019
Source: Ahval News [edited]

Health officials in Istanbul said on Tuesday (5 Nov 2019) the number of people admitted for care after eating tainted spinach had risen to 108, Turkish news site Diken reported.  The Istanbul Health Directorate said 28 patients had stayed in hospital for observation, and the rest had been discharged.

Health authorities said they suspected foreign plants containing poisonous chemicals had been mixed in with spinach. They said scopolamine and atropine, both chemicals found in many plants in the nightshade family, had caused the poisoning.

The symptoms include blurred vision, dry skin, constipation, a rapid heartbeat, and hypertension, the directorate said.

News of a poisoned spinach outbreak spread quickly over the weekend as dozens of people were admitted to hospitals after eating the leaves.
======================
[The clinical signs associated scopolamine, and atropine, mentioned in the article make me think of a Datura species, specifically Jimsonweed, a _Datura_ sp.

Jimsonweed grows wild and is used as an ornamental plant in much of the United States and other countries. It contains alkaloids such as atropine and scopolamine, which can cause anticholinergic toxicity. The concentration of anticholinergics can vary over time and in different parts of a plant, with the seeds having the highest concentration, containing approximately 0.1 mg of atropine per seed (1). A dosage of 10 mg or more of atropine can be fatal (1).

This article does not provide enough information to estimate how much Jimson weed could have been in the spinach or how much could have been ingested. Cooking does not substantially affect the potency of the leaves, and atropine and scopolamine remain intact during baking (2).

Jimsonweed poisoning causes dry mucous membranes and skin, thirst, flushing, fever, blurred vision, altered mental status, mydriasis, urinary retention, tachycardia, coma, and, in rare cases, death (1,4). Treatment with physostigmine is indicated only in severe cases to reverse anticholinergic toxicity (1). Jimsonweed is sometimes consumed intentionally by persons seeking to experience its hallucinogenic effects (1,4), often in a jimsonweed tea (1). Because previous reports of toxicity have involved adolescents and young adults using jimsonweed to experience its hallucinogenic effects (1,4), health-care providers might be less likely to suspect ingestion of jimsonweed in older adults with signs and symptoms of anticholinergic toxicity.

The diagnosis of jimsonweed poisoning can be difficult because of the wide range of signs and symptoms associated with anticholinergic toxicity and the inability to obtain an accurate history of exposures (1,6,7). No clinical laboratory tests are routinely available to detect anticholinergic toxicity. The diagnosis generally is based on history, physical findings, and symptoms. The signs and symptoms among the patients described in this report varied over time.

Again, this article does not provide us much information regarding the patients. However, patients often report thirst, hallucinations, and dizziness. Clinicians might not suspect jimsonweed poisoning in a lone patient with coma or altered mental status, tachycardia, and mydriasis (6), especially if no specific exposure history is available.

Health-care providers and public health officials should be aware of the signs of anticholinergic toxicity and should consider jimsonweed poisoning as a cause of any compatible food-related outbreak of anticholinergic toxicity. A thorough history of food consumption and drug exposures should be obtained, if possible, for all persons with anticholinergic toxicity. Health departments might have limited experience investigating the types of noninfectious foodborne illnesses, as described in this report. Consultation with horticulturalists, poison control centers, and specialized laboratories can be an important component of such investigations.

Hopefully, the suspect spinach will be taken to the appropriate facility to verify whether it is tainted with Jimsonweed, or whether some other plant has contaminated the spinach.

References:
1. CDC. Jimson weed poisoning---Texas, New York, and California, 1994. MMWR 1995;44:41--3.
2. Friedman M, Levin C. Composition of jimson weed (_Datura stramonium_) seeds. J Agric Food Chem 1989;37:998--1005.
3. US National Library of Medicine. Toxicology data network (TOXNET). Available at <http://toxnet.nlm.nih.gov>. Accessed 28 Jan 2010.
4. Spina SP, Taddei A. Teenagers with Jimson weed (_Datura stramonium_) poisoning. CJEM 2007;9:467--8.
5. Shervette RE, Schydlower M, Lampe RM, Fearnow RG. Jimson "loco" weed abuse in adolescents. Pediatrics 1979;63:520--3.
6. Lazzarini D, Baffoni MT, Cangiotti C, et al. Food poisoning by Datura stramonium: an unusual case report. Intern Emerg Med 2006;1:88--90.
7. Chang SS, Wu ML, Deng JF, Lee CC, Chin TF, Liao SJ. Poisoning by Datura leaves used as edible wild vegetables. Vet Hum Toxicol 1999;41:242--5.

Portions of this comment were extracted from:

[HealthMap/ProMED map available at:
Date: Thu, 26 Sep 2019 15:59:36 +0200 (METDST)

Istanbul, Sept 26, 2019 (AFP) - A 5.7-magnitude earthquake shook Turkey's largest city on Thursday, driving residents to evacuate buildings, AFP journalists witnessed.   Eight people were "lightly injured", President Recep Tayyip Erdogan told a press conference in Istanbul.   "Some buildings have been lightly damaged," he added.

Istanbul's Bogazici University Observatory and Earthquake Research Institute said the quake's centre was in the town of Silivri, around 80 kilometres (50 miles) west of the city.    It said the quake measured magnitude 5.7 and struck at 1:59pm (1059 GMT). Several smaller after-shocks were also recorded.   Turkish broadcasters showed images of a minaret tower that had been snapped in two.    Schools in Istanbul and nearby provinces of Bursa and Yalova were closed for the day, NTV broadcaster reported.

Istanbul lies near a major fault line and experts have forecast that a severe earthquake is due there in the coming years.  On August 17, 1999, a huge earthquake measuring 7.4 magnitude centred on the city of Izmit devastated vast areas in the country's densely-populated north-western zone, notably around Istanbul.    At least 17,400 people were killed including 1,000 within Turkey's economic capital.   A large quake could devastate the city of 15 million, which has allowed widespread building without safety precautions.
Date: Mon 5 Aug 2019 20:42 TRT
Source: Daily Sabah [edited]

A group of Turkish scientists has identified 4 rare viruses in Turkey that cause haemorrhagic fever and lead to death due to renal failure, a scientist said [Mon 5 Aug 2019].

A team from the Biology Department of Bulent Ecevit University, led by Professor Mehmet Ali Oktem of Dokuz Eylul University's Medical Virology Department, conducted research on hantavirus types that develop in rodents and small mammals in Turkey and 4 particular subspecies that can cause human disease.

Oktem said he has been doing fieldwork on the hantavirus since 2000, adding that the presence of the virus in rodents was discovered in Turkey for the 1st time in 2004 in the Black Sea region. Meanwhile, the 1st cases in which the viruses developed in humans were reported in 2004 in the Aegean region, and subsequently in Zonguldak and Bartin provinces in the western Black Sea region in 2009.

The newly-identified rare viruses which can be transmitted to humans from rodents, have been named after the provinces or towns they were found in, namely the "Dobrava Hantavirus Igneada", "Dobrava Hantavirus Giresun", "Puumala Hantavirus Bartin", and "Tuula Hantavirus Palandoken."
=====================
[Cases of hantavirus haemorrhagic fever with renal syndrome have been reported in Turkey previously. In January-March 2009 there were 12 laboratory confirmed cases that were serologically positive for Puumala virus subtype.

Reference
---------
Ertek M, Buzgan T; Refik Saydam National Public Health Agency; Ministry of Health, Ankara, Turkey: An outbreak caused by hantavirus in the Black Sea region of Turkey, January-May 2009. Euro Surveill. 2009; 14(20). pii: 19214;  <https://www.eurosurveillance.org/content/10.2807/ese.14.20.19214-en>

Finding Puumala virus in rodents in Turkey is not surprising, since it has caused human cases there in the past. Dobrava-Belgrade orthohantavirus (DOBV) was first isolated from yellow-necked mice (_Apodemus flavicollis_) found in Dobrava village, Republic of Slovenia. It was subsequently isolated in striped field mice in Russia and other parts of Eastern Europe and this rodent occurs in Turkey. The report above indicates that it harbors DOBV in Turkey. It will be interesting to see a genomic comparison of these viruses from Turkey with sequences of these same viruses from other geographic areas. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Turkey:
Date: Tue 30 Jul 2019
Source: Time Turk [in Turkish, machine trans., edited]
<https://www.timeturk.com/mus-ta-15-kisi-brucella-hastaligina-yakalandi/haber-1150899>

A total of 15 people engaged in animal fattening in the town and highlands of Kirkoy have been infected with brucellosis. A resident of the town said that many small ruminants in the town had suffered a miscarriage during the birth season and that 4 people in one family are now being treated for brucellosis. The patients had been seen at the Elazig Ataturk Research Hospital and "the doctors made the examinations and tests and as a result a brucellosis diagnosis was made. The patients were constantly sluggish and sleepy.

Currently, 15 people are receiving treatment for the same disease, "he said. Mus Provincial Health Director Serdal Turkoglu stated that 119 cases were encountered in Muay in 2019 and that the patients were treated in the hospitals in the province and that they made the necessary studies and tests on the subjects in the field. He reminded that the source of animal products should not be consumed in order to prevent the disease: "cheese, cream, butter, cream, ice cream made from pasteurized or well boiled milk should be preferred. Pickled cheeses should be consumed after waiting for at least 3 months. Frequent abortions and stillbirths should be examined by a veterinarian immediately.

The animals' wastes and the feeds that these wastes come into contact with, should be buried in sealed bags. Animals should be vaccinated against brucella," he said. -- Communicated by: ProMED-mail <promed@promedmail.org> [This infection, a bacterial zoonosis, is classified among the category B biowarfare agents. Natural transmission to humans occurs after occupational exposure or through ingestion of contaminated food products. Although brucellosis has become a rare entity in the United States and many industrialized nations because of animal vaccination programs, this condition remains a significant health problem in many developing countries.

Each species of _Brucella_ has a specific animal reservoir in which chronic disease is present. The bacilli tend to localize in the reproductive organs of the animals, causing sterility and abortions, and are shed in large numbers in the animal's urine, milk, and placental fluid. This localization allows for efficient spread to farmers, veterinarians, slaughterhouse workers, and consumers.

Among the 4 species known to cause disease in humans, _Brucella melitensis_ (from goats, sheep, or camels) may be the most virulent, producing the most severe and acute cases of brucellosis with disabling complications. A prolonged course of illness, which may be associated with suppurative destructive lesions, is associated with _B. suis_ (from feral or commercially raised pigs) infection. _B. abortus_ (from cattle, buffalo, and camels) is associated with mild-to-moderate sporadic disease that is rarely associated with complications. - ProMED Mod.LL]

[HealthMap/ProMED map available at: Turkey:
<http://healthmap.org/promed/p/87>]
More ...

Mali

Mali - US Consular Information Sheet
December 19, 2008
COUNTRY DESCRIPTION:
Mali is a developing country in western Africa with a stable and democratic government.
The official language is French.
The capital is Bamako.
Faci
ities for tourism are limited.
Read the Department of State Background Notes on Mali for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and visa are required.
All travelers must have international vaccination cards with a current yellow fever immunization.
Travelers should obtain the latest visa information and entry requirements from the Republic of Mali Embassy at 2130 R Street NW, Washington, DC
20008, telephone (202) 332-2249.
Inquiries can be made at the nearest Malian embassy or consulate.
Visit the Embassy of Mali web site at http://www.maliembassy.us/ for the most current visa information.
Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY: The U.S. Embassy in Bamako strongly advises American citizens to avoid traveling to the northern regions of Mali.
U.S. Government employees serving in Mali, including those on temporary duty, are required to have approval from the Chief of Mission prior to traveling to areas north of the Niger River, including Timbuktu and areas or north of Timbuktu.
Travelers should exercise caution when traveling in any isolated areas.

In August 2007, Tuareg dissidents attacked and kidnapped civilian and military convoys near the Mali-Niger border.
On January 3, 2008, four Italians were robbed at gunpoint near Araouane, 150 miles north of Timbuktu, by assailants whose affiliation remains unknown.
Tuareg rebels in the Kidal region attacked Malian military units in Tinzawaten and Boughessa in March 2008, in Abeibara in May 2008, and in Tessalit in July 2008.
On October 16, 2008, bandits in the Kidal region of Mali carjacked two vehicles belonging to the International Committee for the Red Cross.

Al-Qaeda in the Land of the Islamic Maghreb (AQIM) has a presence in northern Mali.
AQIM began as a terrorist group seeking the overthrow of the Algerian government, and has been designated as a terrorist organization by both the United States and the European Union.
On October 31, 2008, in northern Mali, AQIM freed two Austrian tourists kidnapped in Tunisia eight months earlier.
The group has declared its intention to attack Algerian and Western targets.

This recent activity and the porous nature of Mali’s northern borders with Mauritania and Algeria, as well as its eastern border with Niger, reinforce long-standing concerns about security for travel in northern Mali.
The Department of State strongly urges citizens to reconsider traveling to northern Mali, including Timbuktu and Essakane.
Northern Mali hosts several annual music festivals in the desert, including one north of Timbuktu at Essakane, one north of Kidal at Essouk, and another near Menaka.
These are official events sanctioned by the Government of Mali.
Americans planning to attend these festivals or otherwise travel to the northern regions of Mali, despite this caution, are urged to notify the U.S. Embassy about their plans by e-mail at consularbamako@state.gov.
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.
Current information on safety and security can also be obtained by calling 1-888-407-4747 toll-free within the U.S. and Canada, or, for callers outside of the U.S. and Canada, on a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Violent crime in Mali is infrequent, but petty crimes, such as pick pocketing and simple theft, are common in urban areas.
Passports and wallets should be closely guarded when in crowded outdoor areas and open-air markets.
Individuals traveling on the Bamako-Dakar railroad are advised to be vigilant for pickpockets, especially at night.
Criminals will not hesitate to use violence if they encounter resistance from their victims.
There are sporadic reports of nighttime robberies occurring on the roads outside of the capital; tourists should not drive outside of Bamako at night.
Travelers should stay alert, remain in groups, and avoid poorly lit areas after dark.

Sporadic banditry and random carjacking have historically plagued Mali's vast desert region and its borders with Mauritania and Niger.
While banditry is not seen as targeting U.S. citizens specifically, such acts of violence cannot be predicted.

On July 1, 2008, six people working as USAID contractors were robbed of their vehicle and all belongings, at gunpoint, by three bandits between the villages of Temera and Bourem, approximately 120 km (75 miles) northeast of Gao along the Niger River.

From May 2008 until July 2008, there were a series of attacks at various Malian government installations.
While most of these have been in eastern Mali, on May 6, bandits attacked a military outpost in Diabali, 175 km (110 miles) north of Segou.
While these actions appear directed exclusively at government security facilities, including military, gendarmerie and national guard bases, bandits have been known to stop cars at gunpoint while making their escape.
Those traveling or living in Mali are strongly encouraged to register with the Embassy to allow e-mail notification should further attacks occur.
Please see the Registration/Embassy Location information at the end of this article.

INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

The local equivalent to the “911” emergency line in Mali is:
1212
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Mali are limited, especially outside of the capital, Bamako.
Psychiatric care is non-existent.
The U.S. Embassy in Bamako maintains a list of physicians and other healthcare professionals who may see U.S. citizen patients.
The Embassy cannot guarantee these services or specifically recommend any physicians.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to, or foreign residents of, Mali.
Many American medicines are unavailable; French medications are more easily found.
Available medications can be obtained at pharmacies throughout Bamako, and are usually less expensive than those in the U.S.
Travelers should carry with them an adequate supply of needed medication and prescription drugs, along with copies of the prescriptions, including the generic names for the drugs.
Caution should be taken to avoid purchasing potentially dangerous counterfeit medications when buying on the local market in Mali.
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 Mali is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
U.S. citizens traveling by road in Mali should exercise caution.
Mali has paved roads leading from Bamako to Segou, Mopti and Sikasso.
During the rainy season from mid-June to mid-September, some unpaved roads may be impassable.
On many roads outside of the capital, deep sand and ditches are common.
Four-wheel drive vehicles with spare tires and emergency equipment are recommended.
The Embassy strongly urges all travelers to avoid traveling after dark on roads outside of urban centers.
The roads from Gao to Kidal and Menaka, and the roads around Timbuktu, are desert tracks with long isolated stretches.
Travelers must be prepared to repair their vehicles should they break down or become stuck in the sand.
Travelers should also carry plenty of food and water.
Drivers drive on the right-hand side of the road in Mali.
Speed limits range from 40-60 km per hour (25-40 miles per hour) within towns, to 100 km per hour (60 miles per hour) between cities.
Road conditions often require lower speeds.
Due to safety concerns, the Embassy recommends against the use of motorbikes, van taxis, and public transportation.
Excessive speeds, poorly maintained vehicles, lack of street lighting and roving livestock pose serious road hazards.
Many vehicles are not maintained well and headlights are either extremely dim or not used.
Driving conditions in the capital of Bamako can be particularly dangerous due to limited street lighting, the absence of sidewalks for pedestrians, and the number of motorcycles, mopeds and bicycles.
Please refer to our Road Safety page for more information.
The Malian authority for road safety is the Compagnie Nationale de Circulation Routiere in Bamako at telephone (223) 20-22-38-83.
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Mali, the U.S. Federal Aviation Administration (FAA) has not assessed Mali’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:
Mali is signatory to the Treaty on Cultural Property, which restricts exportation of Malian archeological objects, in particular those from the Niger River Valley.
Visitors seeking to export any such property are required by Malian law to obtain an export authorization from the National Museum in Bamako.
It is advisable to contact the Embassy of Mali in Washington or the nearest Malian consulate for specific information regarding customs requirements.
U.S. Customs and Border Protection may impose corresponding import restrictions in accordance with the Convention on Cultural Property Implementation Act.
Currency exchange facilities are slow and often involve out-of-date rates.
The U.S. Embassy cannot provide exchange facilities for private Americans.
There are a few ATMs in Bamako that accept American credit cards and debit cards with a Visa logo only.
Maximum withdrawals are generally limited to $400, and local banks charge up to $20 per transaction for use of their ATMs.
There are no ATMs outside of Bamako.
Credit cards are accepted only at major hotels, a few travel agencies, and select restaurants.
Cash advances on credit cards are available from only one bank in Mali, the BMCD Bank in Bamako, and the only card they accept for this is Visa.

The U.S. Embassy does not always receive timely notification by Malian authorities of the arrest of Americans.
U.S. citizens are encouraged to carry a copy of their passport with them at all times, so that proof of identity and citizenship are readily available in the event of questioning by local authorities.
If arrested, U.S. citizens should always politely insist they be allowed to contact the U.S. Embassy (see section on Registration/Embassy Location below).
Photographing military subjects is restricted.
One should also obtain explicit permission from the Malian government before photographing transportation facilities and government buildings.
Taking a photograph without permission in any public area may provoke a response from security personnel or offend the people being photographed.
Taking photos of the U.S. Embassy is also prohibited.
International telephone calls are expensive, and collect calls cannot be made from outside of Bamako.
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 that are available to individuals under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Mali’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Mali 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 Mali are encouraged to register with the U.S. Embassy or through the State Department’s travel registration web site so that they can obtain current information on travel and security within Mali.
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located in ACI 2000 at Rue 243, Porte 297.
The Embassy's mailing address is B.P. 34, Bamako, Mali.
The telephone number is (223) 20-70-2300.
The consular fax number is (223) 20-70-2340.
The Embassy web page is at http://mali.usembassy.gov
* * *
This replaces the Country Specific Information for Mali dated February 7, 2008, to update the sections on Safety and Security, Crime, Information for Victims of Crime, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Thu 26 Dec 2019
Source: WHO Emergencies preparedness, response [edited]

From 3 Nov through 8 Dec 2019, 3 laboratory-confirmed cases of yellow fever including 2 deaths (case fatality rate = 67%) were detected through the national surveillance system in Mali. The 1st case-patient was a 15-year-old girl from a village in Kati district, Koulikoro region, Mali. The 2nd and 3rd cases were in 17- and 25-year-old men, nationals from Cote d'Ivoire, living in the district of Bouguimi, Sikasso region, Mali. All 3 cases tested positive for yellow fever by immunoglobulin M (IgM) and reverse-transcriptase polymerase chain reaction (RT-PCR) on 3 Dec 2019 at Institute Pasteur Dakar (IPD). The 1st case was not vaccinated against yellow fever and had no travel history outside of Kati district. Meanwhile, the vaccination status for the other 2 cases was unknown.

Additionally, there were 9 suspected and 3 probable cases reported from the Bouguimi district, including 3 deaths among the probable cases. The age of the suspected, probable, and confirmed cases ranges between 1 and 33 years, and the male-to-female ratio is 2:1. Among the reported symptoms, fever, jaundice, and vomiting were the most common. There are 8 health areas of Bouguimi health district that have been affected, with Manakoro (4 cases) and Mafele (3 cases) reporting the highest number. One suspected case is pending for confirmation at the Institute Pasteur Dakar laboratory.

On 5 Dec 2019, the government of Mali officially declared a yellow fever outbreak in 2 regions of Sikasso and Koulikoro.

Public health response
- An emergency operations centre (EOC) for public health coordination of the outbreak in the regions of Sikasso, Koulikoro, and the affected districts has been set up. In addition, an EOC has been activated in
Bamako city.
- A multidisciplinary rapid response team was deployed to conduct investigations in the affected districts of Sikasso and Koulikoro regions. A plan to conduct an in-depth entomological survey is underway.
- Enhanced epidemiological surveillance, including active case finding in both the affected districts, has been strengthened.
- A comprehensive response plan is being developed with specific objectives, including the preparation for an international-coordination-group (ICG) request to conduct a yellow fever reactive mass-vaccination campaign.
- Risk communication capacity through involvement of relevant stakeholders [is being provided], as well as public communication and awareness efforts on yellow fever (signs, symptoms, and vaccinations), including prevention measures.
- On 3 Dec 2019, a joint investigation team (WHO Country Office and Ministry of Health) was deployed to characterize the risk and develop an intervention plan. Field investigations indicate vaccination coverage under 80% in Kati and 88% in Manakoro districts.

WHO risk assessment
Although population immunity in the southern regions of Mali has benefited from large-scale preventive mass vaccination campaigns in 2008 (5.8 million people protected) combined with nationwide children routine immunization since 2002, the overall national routine immunization coverage for yellow fever in 2018 was estimated to be 67%, with estimates nearly 80% in the non-desert areas (including the recently affected Koulikoro and Sissako regions). This is below herd immunity thresholds and may indicate the presence of pockets of low immunity in the country. Kati district in Koulikoro region is located proximal to the capital city, Bamako, an urban city with more than 2 million inhabitants, and Bouguimi district in Sikasso region borders with Cote d'Ivoire.

The high population movements within Mali and across borders increases the risk of national and regional spread, and this may have diluted the population immunity. The geographical distribution of the virus, coupled with suboptimal vaccination coverage, and the presence of susceptible populations presents a risk of amplification. Furthermore, the protracted humanitarian crisis and concomitant ongoing outbreaks of epidemic-prone diseases (measles, dengue) may impact the response due to competing limited resources.

Based on available information, WHO assesses the overall risk as high at the national level, moderate at the regional level, and low at the global level.

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

Mali is a high-priority country for the Eliminate Yellow Fever Epidemic (EYE) strategy. Vaccination is the primary intervention for prevention and control of yellow fever. In urban centres, targeted vector control measures are also helpful to interrupt transmission. WHO and partners will continue to support local authorities to implement interventions necessary to control the current outbreak.

WHO recommends vaccination against yellow fever for all international travellers more than 9 months of age going to areas south of the Sahara Desert in Mali. The vaccine is contraindicated in children aged less than 6 months and is not recommended for those aged 6-8 months, except during epidemics when the risk of infection with yellow fever virus may be very high. Other contraindications for yellow fever vaccination are severe hypersensitivity to egg and severe immunodeficiency. Caution is recommended before vaccinating people aged above 60 years against yellow fever.

WHO does not recommend vaccination for travellers whose itineraries are limited to areas within the Sahara Desert. Vaccination is recommended, if indicated, for pregnant or breastfeeding women travelling to endemic areas when such travel cannot be avoided or postponed. Mali requires as a condition of entry a yellow fever vaccination certificate for all travellers aged one year or over.

Yellow fever vaccines recommended by WHO are safe and highly effective and provide life-long protection against infection. In accordance with the IHR (2005) 3rd edition, the validity of the international certificate of vaccination against yellow fever extends to the life of the person vaccinated with a WHO-approved vaccine. For both existing or new certificates, revaccination or a booster dose of yellow fever vaccine cannot be required of international travellers as a condition of entry into a state party, regardless of the date their international certificate of vaccination was initially issued.

On 1 Jul 2019, WHO updated the areas at risk of yellow fever transmission and the corresponding recommendations for vaccination of international travelers. The list of countries at risk and revised recommendations for vaccination against yellow fever are available on the WHO website (International travel and health (ITH),  <https://www.who.int/ith/en/>).

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

WHO does not recommend any restrictions on travel or trade to Mali on the basis of the information available on this outbreak.
=======================
[This updated report includes information about 9 suspected and 3 probable yellow fever (YF) cases that were not mentioned in previous reports, indicating that the outbreak was more extensive than originally stated, with an outbreak declared by government authorities in the 2 regions. These additional cases may have been a result of the additional surveillance that has been undertaken. Since vaccination coverage has been found to be less than 80% and 88% in Kati and Manakoro districts, respectively, presumably the preventive measures mentioned will include vaccination. The entomological survey will be an important factor in risk assessment. The presence of abundant populations of the mosquito vector, _Aedes aegypti_, would be of concern, raising the possibility of urban transmission of YF virus that might get out of hand quickly. - ProMED Mod.TY]

[HealthMap/ProMED-mail maps:
Date: Sun 8 Dec 2019
Source: WHO Weekly Bulletin on Outbreaks and Other Emergencies [edited]

On 3 Dec 2019, WHO was informed through internal communication of 3 yellow fever cases in Mali, including one death. Of these, 2 of the cases are from Wogouna and Keregoura villages, Bougoni district, Sikasso region in the South of Mali and one from Nanakenieba village, Kati district, Koulikoro region in the south west of Mali.

The reported cases are young adults (15-25 years), one female and 2 males, with onset of symptoms in early November 2019.

The cases tested yellow fever IgM and PCR positive at Institute Pasteur Dakar on 3 Dec 2019.

The vaccination status of the cases is being investigated (2 of the cases reported vaccination in the past). The latest vaccination campaign in the country was performed in 2008 including the affected areas where the vaccination coverage was reported to be between 50 and 9% in 2008. The average national vaccination coverage for 2017 has been reported at 65% (data from Imperial College). The YF routine vaccination in the country was introduced in 2002.

A field investigation is ongoing. According to historical data, 10 cases were detected in Mali in 2015.
======================
[This report provides some additional details in that 2 patients were male and one female along with their vaccination status, which were not included in the original post (see Yellow fever - Africa (25): Mali (BA, SK), Cote d'Ivoire http://promedmail.org/post/20191207.6827680). As in the original report, no mention is made of plans to vaccinate in the localities where the cases became infected. Vaccination in those areas is an effective preventive measure especially since, as the report notes, the mosquito vector, _Aedes aegypti_, is abundant enough to transmit dengue viruses. Yellow fever can spread rapidly and quickly get out of hand in susceptible populations with abundant mosquito vectors, as it did in Angola in 2016. - ProMED Mod.TY]

[HealthMap/ProMED-mail maps:
Date: Thu 5 Dec 2019
Source: Ministry of Health and Social Affairs [in French, trans.,
edited]

Communication from the Ministry of Health and Social Affairs on yellow fever cases in Mali
-----------------------------------------------------
The Ministry of Health and Social Affairs declares the occurrence of 3 confirmed cases of yellow fever on Tue 3 Dec 2019.

Of the 3 cases, one resides in Sirakoro-Meguetana in the health district of Kati [Bamako region, Mali], the 2nd in Manankoro in the health district of Bougouni [Sikasso region, Mali], and the 3rd in the village of Keregouana in Cote d'Ivoire [unable to locate this village on a map, but presumably it is near the border of Mali and Cote d'Ivoire. - ProMED CopyEd.TW].

In accordance with International Health Regulations, the outbreak has been reported to the World Health Organization.

The Ministry of Health and Social Affairs immediately analyzed the situation and took the following necessary measures:
- sending investigative teams to the field to better understand the epidemiological situation in order to quickly halt the spread of the epidemic,
- strengthening epidemiological surveillance,
- strengthening the response capacity of health workers, and
- disseminating awareness messages.

The Ministry of Health and Social Affairs invites people to observe the following measures:
- destroy larval breeding sites (old tires or any other abandoned objects containing water),
- protect against mosquito bites,
- sleep under insecticide-impregnated mosquito nets,
- keep households and housing clean, and
- get vaccinated before any trips abroad.

The Minister of Health and Social Affairs calls for calm and vigilance and reassures the population that appropriate measures are underway to control the situation.

Bamako, 4 Dec 2019
P / The Minister / PO
The Secretary General
Dr Mama Coumare
Knight of the National Order
===================
[An outbreak of yellow fever has been recognized in Mali by official sources. The statement from the Ministry of Health specifies the number of cases, the location of the cases detected, the measures taken, the recommendations, and the notification of the outbreak to WHO, as stipulated by International Health Regulations.

Cases of haemorrhagic fevers have recurred in Mali. Last month [November 2019], cases of dengue were diagnosed in Bamako, the capital of Mali.

_Aedes aegypti_, (but also to a lesser extent _Aedes albopictus_) is the vector that transmits these haemorrhagic fevers (dengue, chikungunya, yellow fever, and Zika).

Health authorities must use all channels of communication to raise awareness and get people to seek consultation in case of fever or muscle aches. Caregivers, especially clinicians, should consider haemorrhagic fevers (dengue or yellow fever) in any case of fever with a negative thick smear (or negative RDT) for malaria, or in any case of presumptive malaria that does not respond to appropriate antimalarial treatment. - Mod.BM, from ProMED-FRA archive no. http://promedmail.org/post/20191205.6824988, in French, trans., edited]

[The occurrence of yellow fever (YF) in different locations is a serious concern, and the measures to increase surveillance are prudent. It is curious that no mention is made of vaccination, whether the population of individuals is already vaccinated or whether there are plans to vaccinate in the localities where the cases became infected. Vaccination in those areas is an effective preventive measure especially since, as the report notes, the mosquito vector, _Aedes aegypti_, is abundant enough to transmit dengue viruses. YF can spread rapidly and quickly get out of hand in susceptible populations with abundant mosquito vectors, as it did in Angola in 2016. - ProMED Mod.TY]

[HealthMap/ProMED-mail maps:
Date: Tue, 3 Sep 2019 21:09:12 +0200 (METDST)

Bamako, Sept 3, 2019 (AFP) - Fourteen bus passengers were killed Tuesday by a road mine in central Mali, the bus company said, in an attack bearing the hallmarks of jihadists who plague the region.   The vehicle was en route from the central town of Douentza to the northern town of Gao, Oumar Ould Mamoud of the Sonef bus company told AFP.   "The new toll is 14 dead and eight injured," he said, adding that there had been about 50 people on the bus.

Police earlier had given a toll of eight dead and 13 injured, and said the blast occurred 30 kilometres (18 miles) from Douentza.   Another police official said "terrorists" had set down the mine.   A Malian military unit by coincidence had been travelling on the same road and was able to provide assistance to the passengers, the source said, and Sonef said it had sent a second bus to pick up them up.   The UN stabilization force in Mali, MINUSMA, condemned the attack which it said had caused "many deaths and 30 injuries," adding that some of the injured were helicoptered out.

MINUSMA spokesman Olivier Salgado said on Twitter that two women and two children were among the injured.   Northern Mali fell into the hands of jihadists in 2012 before the militants were forced out by a French-led military intervention.   But much of the region remains chronically unstable and since 2015 violence has spread to the centre of the country, an ethnic mosaic.   Jihadists have carried out dozens of hit-and-run raids and mine attacks, striking troops as well as civilians.   In January 2018, 24 Malian and Burkinabe citizens, including women and children, were killed in a blast in central Mali as they headed to a weekly fair.   The insurgents have also inflamed tensions between rival communities, particularly nomadic Fulani herders and sedentary farmers. Hundreds of lives have been lost in tit-for-tat assaults.
Date: Thu, 16 May 2019 18:37:39 +0200

Bamako, May 16, 2019 (AFP) - Heavy floods claimed 15 lives Thursday in the Malian capital Bamako along with serious property damage, authorities said.   A statement said the flooding claimed a "provisional toll" of 15 dead and two injured.   "Teams are in place to rescue the distressed people," the government said, calling on residents to be "prudent" in the face of the disaster.   Flooding is common in Mali, located in the semi-desert Sahel region.
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.